吸烟对颈椎病手术治疗后脊髓愈合的影响。

The Effect of Smoking on Spinal Cord Healing Following Surgical Treatment of Cervical Myelopathy.

作者信息

Kusin David J, Ahn Uri M, Ahn Nicholas U

机构信息

*Case Western Reserve University School of Medicine, Cleveland, OH †New Hampshire Neurospine Institute, Bedford, NH; and ‡Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH.

出版信息

Spine (Phila Pa 1976). 2015 Sep 15;40(18):1391-6. doi: 10.1097/BRS.0000000000001014.

DOI:10.1097/BRS.0000000000001014

PMID:26426709

Abstract

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

The purpose of this study was to compare outcomes of surgical treatment of cervical myelopathy between smokers and nonsmokers as assessed by the Nurick score.

SUMMARY OF BACKGROUND DATA

The harmful effects of smoking on healing have been well established. However, the effect of smoking on postoperative outcomes for cervical myelopathy has not been specifically evaluated.

METHODS

The medical records of 212 patients who underwent surgery for cervical spondylotic myelopathy were reviewed. Inclusion criteria were the diagnosis of cervical spondylotic myelopathy with a Nurick score, surgical intervention, and at least 2 years of follow-up. The patients were categorized into 2 groups according to smoking status and stratified according to pack years and packs per day. Age at presentation, sex, preoperative and postoperative Nurick score, duration of symptoms preoperatively, duration of follow-up, procedure performed, surgical approach, number of levels fused, diabetes status, cocaine use, ethanol use, preoperative magnetic resonance imaging signal change, and whether the patient belonged to the Veterans Administration (VA) were recorded. Analysis was done using simple linear regression and multiple regression.

RESULTS

Univariate analysis demonstrated a postoperative improvement in nonsmokers of 1.53 points on the Nurick scale compared with 0.6 points in smokers (P < 0.001). There is a progressive decrease in improvement as the number of pack years and packs per day increase (P < 0.001). There is a greater improvement in Nurick score with greater (worse) preoperative score but only in patients with fewer than 25 pack years. Smoking status is not associated with preoperative Nurick score.

CONCLUSION

Smoking status is associated with poor improvement in Nurick score after surgical treatment of cervical myelopathy. Smoking may have a directly toxic effect on the intrinsic healing capability of the spinal cord, particularly beyond 25 pack years.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性队列研究。

目的

本研究旨在比较吸烟者和非吸烟者颈椎脊髓病手术治疗的结果，采用Nurick评分进行评估。

背景数据总结

吸烟对愈合的有害影响已得到充分证实。然而，吸烟对颈椎脊髓病术后结果的影响尚未得到具体评估。

方法

回顾了212例因脊髓型颈椎病接受手术治疗患者的病历。纳入标准为脊髓型颈椎病诊断明确且有Nurick评分、手术干预以及至少2年的随访。根据吸烟状况将患者分为两组，并根据吸烟包年数和每日吸烟包数进行分层。记录患者的就诊年龄、性别、术前和术后Nurick评分、术前症状持续时间、随访时间、所行手术、手术入路、融合节段数、糖尿病状况、可卡因使用情况、乙醇使用情况、术前磁共振成像信号变化以及患者是否属于退伍军人管理局（VA）。采用简单线性回归和多元回归进行分析。

结果

单因素分析显示，非吸烟者术后Nurick量表评分改善1.53分，而吸烟者为0.6分（P < 0.001）。随着吸烟包年数和每日吸烟包数的增加，改善程度逐渐降低（P < 0.001）。术前Nurick评分越高（越差），Nurick评分改善越大，但仅在吸烟包年数少于25年的患者中如此。吸烟状况与术前Nurick评分无关。