Fehlings Michael G, Ibrahim Ahmed, Tetreault Lindsay, Albanese Vincenzo, Alvarado Manuel, Arnold Paul, Barbagallo Giuseppe, Bartels Ronald, Bolger Ciaran, Defino Helton, Kale Shashank, Massicotte Eric, Moraes Osmar, Scerrati Massimo, Tan Gamaliel, Tanaka Masato, Toyone Tomoaki, Yukawa Yasutsugu, Zhou Qiang, Zileli Mehmet, Kopjar Branko
*Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada ‡Department of Neurosurgery, University Hospital Catania, Catania, Italy §Hospital San Juan de Dios, Caracas, Venezuela ¶Department Neurosurgery, The University of Kansas, Kansas City ‖Department of Neurosurgery Radboud University, Nijmegen Medical Centre; Nijmegen, the Netherlands **Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland ††Faculty of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil ‡‡Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India §§Department of Neurosurgery, Hospital Santa Marcelina, Santa Marcelina, Brazil ¶¶Department of Neurosurgery, Università Politecnica Delle Marche, Ancona, Italy ‖‖Department of Orthopaedics, Tan Tock Seng Hospital, Singapore, Singapore ***Department of Orthopedic Surgery, Okayama University, Okayama, Japan †††Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan ‡‡‡Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan §§§Department of Orthopedics, Third Military Medical University, Chongqing, China ¶¶¶Department of Neurosurgery, Ege University, Izmir, Turkey; and ‖‖‖Department of Health Services, University of Washington, Seattle.
Spine (Phila Pa 1976). 2015 Sep 1;40(17):1322-8. doi: 10.1097/BRS.0000000000000988.
Prospective, multicenter international cohort.
To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level.
CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM to improve neurological and functional status and quality of life. The outcomes of surgical intervention for CSM have never been evaluated at an international level.
Between October 2007 and January 2011, 479 symptomatic patients with image evidence of CSM were enrolled in the prospective, multicenter AOSpine CSM-International study from 16 global sites. Preoperative and postoperative clinical status, functional impairment, and quality of life were evaluated using the modified Japanese Orthopaedic Assessment Scale, Nurick Scale, Neck Disability Index, and Short-Form-36v2. Preoperative and 12- and 24-month postoperative outcomes were compared using mixed-model analysis of covariance for repeated measurements.
The study cohort consisted of 310 males and 169 females, with a mean age of 56.37 ± 11.91 years. There were significant differences in age, etiology, and surgical approaches between the regions. At 24 months postoperatively, the mean modified Japanese Orthopaedic Assessment Scale score improved from 12.50 (95% confidence interval [CI], 12.24-12.76) to 14.90 (95% CI, 14.64-15.16); the Neck Disability Index improved from 36.38 (95% CI, 34.33-38.43) to 23.20 (95% CI, 21.24-25.15); and the SF36v2 Physical Component Score and Mental Composite Score improved from 34.28 (95% CI, 33.46-35.10) to 40.76 (95% CI, 39.71-41.81) and 39.45 (95% CI, 38.25-40.64) to 46.24 (95% CI, 44.94-47.55), respectively. The rate of neurological complications was 3.13%.
Surgical decompression for CSM is safe and results in improved functional status and quality of life in patients around the world, irrespective of differences in medical systems and sociocultural determinants of health.
前瞻性、多中心国际队列研究。
在全球范围内评估脊髓型颈椎病（CSM）手术减压的效果。
CSM是一种退行性脊柱疾病，是全球脊髓功能障碍最常见的原因。越来越多的人推荐手术作为CSM的首选治疗策略，以改善神经和功能状态以及生活质量。CSM手术干预的效果从未在国际层面进行过评估。
在2007年10月至2011年1月期间，来自16个全球地点的479例有CSM影像证据的有症状患者被纳入前瞻性、多中心AOSpine CSM国际研究。使用改良的日本骨科评估量表、Nurick量表、颈部残疾指数和简短健康调查问卷36项第2版对术前和术后的临床状态、功能损害和生活质量进行评估。使用重复测量的协方差混合模型分析比较术前以及术后12个月和24个月的结果。
研究队列包括310名男性和169名女性，平均年龄为56.37±11.91岁。各地区之间在年龄、病因和手术方式上存在显著差异。术后24个月时，改良的日本骨科评估量表平均评分从12.50（95%置信区间[CI]，12.24 - 12.76）提高到14.90（95%CI，14.64 - 15.16）；颈部残疾指数从36.38（95%CI，34.33 - 38.43）提高到23.20（95%CI，21.24 - 25.15）；简短健康调查问卷36项第2版身体成分评分和精神综合评分分别从34.28（95%CI，33.46 - 35.10）提高到40.76（95%CI，39.71 - 41.81）以及从39.45（95%CI，38.25 - 40.64）提高到46.24（95%CI，44.94 - 47.55）。神经并发症发生率为3.13%。
CSM手术减压是安全的，并且能改善世界各地患者的功能状态和生活质量，无论医疗系统和健康的社会文化决定因素存在何种差异。
3级。
