Nam Tae Wook, Lee Hong Seok, Goh Tae Sik, Lee Jung Sub
*Department of Orthopaedic Surgery, Busan Centum Hospital †Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea.
J Spinal Disord Tech. 2015 Aug;28(7):E405-9. doi: 10.1097/BSD.0b013e31829f5a1f.
Retrospective study.
To identify the significant risk factors for motor weakness caused by cervical disk herniation and for delayed recovery after surgery.
There were a few clinical trials for detecting the significant risk factors for motor weakness after anterior cervical surgery.
We retrospectively examined 72 patients with degenerative disk disease of the cervical spine who were treated with single-level anterior cervical discectomy and fusion. The possible risk factors, including age, sex, symptom duration, operation time, surgery level, preoperative radiologic parameters, and preoperative Neck Disability Index score, were evaluated using multivariate logistic regression analysis.
The patients included 22 women and 50 men; average age, 47.1±7.8 years. Of these 72 patients, 38 (52.8%) patients had motor deficit before surgery. Complete recovery of motor deficit was seen in 33 (86.8%) patients, and the average duration from surgery to complete recovery was 4.2 months. Multivariate logistic regression analysis showed that disk height (P=0.001, odds ratio=0.32), percentage of herniated nucleus pulposus (HNP) in the spinal canal (P=0.0012, odds ratio=1.24), and presence of signal intensity change in the spinal cord (P=0.0015, odds ratio=35.57) were important risk factors for motor weakness. When the cut-off value of disk height was 5.8 mm, the sensitivity and specificity were 39.5% and 94.1%, respectively. When the cut-off value of HNP in the spinal canal was 28.1%, the sensitivity and specificity were 57.9% and 82.4%, respectively. Furthermore, signal intensity change was identified as an important risk factor for delayed recovery.
Decreased disk height, percentage of HNP in the spinal canal, or presence of signal intensity change in the spinal cord seem to be the important risk factors for motor weakness in patients with cervical disk herniation. Moreover, the presence of signal intensity change in the spinal cord seems to be an important risk factor for delayed recovery.
回顾性研究。
确定颈椎间盘突出症所致运动功能减弱及术后恢复延迟的显著危险因素。
针对颈椎前路手术后运动功能减弱的显著危险因素，临床试验较少。
我们回顾性研究了72例接受单节段颈椎间盘切除融合术治疗的颈椎退行性椎间盘疾病患者。使用多因素逻辑回归分析评估可能的危险因素，包括年龄、性别、症状持续时间、手术时间、手术节段、术前影像学参数以及术前颈部功能障碍指数评分。
患者包括22名女性和50名男性；平均年龄47.1±7.8岁。在这72例患者中，38例（52.8%）患者术前存在运动功能障碍。33例（86.8%）患者运动功能障碍完全恢复，从手术到完全恢复的平均时间为4.2个月。多因素逻辑回归分析显示，椎间盘高度（P = 0.001，比值比 = 0.32）、椎管内髓核突出（HNP）百分比（P = 0.0012，比值比 = 1.24）以及脊髓信号强度改变的存在（P = 0.0015，比值比 = 35.57）是运动功能减弱的重要危险因素。当椎间盘高度的截断值为5.8 mm时，敏感性和特异性分别为39.5%和94.1%。当椎管内HNP的截断值为28.1%时，敏感性和特异性分别为57.9%和82.4%。此外，信号强度改变被确定为恢复延迟的重要危险因素。
椎间盘高度降低、椎管内HNP百分比或脊髓信号强度改变的存在似乎是颈椎间盘突出症患者运动功能减弱的重要危险因素。此外，脊髓信号强度改变的存在似乎是恢复延迟的重要危险因素。
