Sakaura Hironobu, Miwa Toshitada, Kuroda Yusuke, Ohwada Tetsuo
Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
J Neurosurg Spine. 2016 Oct;25(4):444-447. doi: 10.3171/2016.3.SPINE151411. Epub 2016 May 27.
OBJECTIVE The authors recently reported that the presence of chronic kidney disease (CKD) and/or extended abdominal aortic calcification was associated with significantly worse clinical outcomes after posterior lumbar interbody fusion. CKD is one of the highest risk factors for systemic atherosclerosis. Therefore, impaired blood flow due to atherosclerosis could exacerbate degeneration of the cervical spine and neural tissue. However, there has been no report of a study evaluating the deleterious effects of CKD and atherosclerosis on the outcomes after decompression surgery for cervical compression myelopathy. The purpose of this study was thus to examine whether CKD and systemic atherosclerosis affect surgical outcomes after laminoplasty for cervical spondylotic myelopathy (CSM). METHODS The authors analyzed data from 127 consecutive cases involving patients who underwent laminoplasty for CSM and met their inclusion criteria. Stage 3-4 CKD was present as a preoperative comorbidity in 44 cases. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) cervical myelopathy evaluation questionnaire before surgery and 2 years postoperatively. As a marker of systemic atherosclerosis, the presence of aortic arch calcification (AoAC) was assessed on preoperative chest radiographs. RESULTS AoAC was found on preoperative chest radiographs in 40 of 127 patients. Neither CKD nor AoAC had a statistically significant deleterious effect on preoperative JOA score. However, CKD and AoAC were significantly associated with reductions in both the JOA score recovery rate (mean 36.1% in patients with CKD vs 44.7% in those without CKD; 26.0% in patients with AoAC vs 48.9% in those without AoAC) and the change in JOA score at 2 years after surgery (mean 2.3 points in patients with CKD vs 3.1 points in those without CKD; 2.1 points for patients with AoAC vs 3.2 points for those without AoAC). A multivariate regression analysis showed that AoAC was a significant independent predictor of poor outcome with respect to both for the difference between follow-up and preoperative JOA scores and the JOA score recovery rate. CONCLUSIONS CKD and AoAC were associated with increased rates of poor neurological outcomes after laminoplasty for CSM, and AoAC was a significant independent predictive factor for poor outcome.
目的 作者最近报告称，慢性肾脏病（CKD）和/或广泛的腹主动脉钙化与后路腰椎椎间融合术后显著更差的临床结局相关。CKD是全身动脉粥样硬化的最高风险因素之一。因此，动脉粥样硬化导致的血流受损可能会加剧颈椎和神经组织的退变。然而，尚无研究报告评估CKD和动脉粥样硬化对颈椎管狭窄症减压手术后结局的有害影响。因此，本研究的目的是探讨CKD和全身动脉粥样硬化是否会影响脊髓型颈椎病（CSM）椎板成形术后的手术结局。方法 作者分析了127例连续行CSM椎板成形术且符合纳入标准患者的数据。44例患者术前合并3-4期CKD。术前及术后2年使用日本骨科协会（JOA）颈椎病评估问卷评估临床状态。作为全身动脉粥样硬化的标志物，术前胸部X线片评估主动脉弓钙化（AoAC）的存在情况。结果 127例患者中40例术前胸部X线片发现AoAC。CKD和AoAC对术前JOA评分均无统计学意义的有害影响。然而，CKD和AoAC与JOA评分恢复率降低（CKD患者平均为36.1%，无CKD患者为44.7%；AoAC患者为26.0%，无AoAC患者为48.9%）以及术后2年JOA评分变化均显著相关（CKD患者平均为2.3分，无CKD患者为3.1分；AoAC患者为2.1分，无AoAC患者为3.2分）。多因素回归分析显示，就随访与术前JOA评分差值及JOA评分恢复率而言，AoAC是预后不良的显著独立预测因素。结论 CKD和AoAC与CSM椎板成形术后神经功能不良结局发生率增加相关，且AoAC是预后不良的显著独立预测因素。
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