Revanappa Kumbhar Kartik, Moorthy Ranjith K, Alexander Mathew, Rajshekhar Vedantam
a Department of Neurological Sciences , Christian Medical College , Vellore , India.
Br J Neurosurg. 2017 Apr;31(2):199-204. doi: 10.1080/02688697.2016.1206178. Epub 2016 Jul 14.
There are sparse data on the recovery of sympathetic skin response (SSR) following decompressive surgery in patients with cervical spondylotic myelopathy (CSM). We designed a study to assess SSR in patients with moderate and severe (Nurick grades 3, 4 and 5) CSM, and its recovery following central corpectomy (CC).
We conducted a prospective study on 19 patients with moderate and severe CSM who underwent CC from June 2008 to December 2010. Autonomic dysfunction was defined as the presence of 'bladder dysfunction' or 'orthostatic hypotension'. All patients underwent SSR test preoperatively and at follow-up. Functional evaluation was done using Nurick grade and modified Japanese Orthopedic Association (mJOA) score preoperatively and at follow-up.
In the preoperative assessment, 14 of 19 (73.7%) patients had bladder dysfunction and orthostatic hypotension. SSR was absent in 13 (68.4%) patients preoperatively. At a mean follow-up of 14.5 months after CC, SSR was present in 12 of the 14 patients available for follow-up. SSR returned postoperatively in 9 of the 11 patients in whom it was absent preoperatively. Recovery of SSR postoperatively had significant correlation with improvement in Nurick grade (p =0.02), improvement in lower limb component of mJOA score (p =0.001) and Nurick grade recovery rate (p = 0.008).
Dysfunction of the autonomic pathways as determined by the SSR is seen in nearly 70% of patients with moderate and severe CSM but did not correlate with other autonomic functions, suggesting possibly different pathways for different autonomic functions. Following uninstrumented CC, SSR returned in almost 80% of patients in whom it was absent preoperatively and this correlated significantly with improvement in functional grade. Decompressive surgery can reverse autonomic dysfunction in most of these patients.
关于脊髓型颈椎病（CSM）患者减压手术后交感神经皮肤反应（SSR）恢复的数据稀少。我们设计了一项研究来评估中度和重度（Nurick 分级 3、4 和 5 级）CSM 患者的 SSR 及其在椎体次全切除术（CC）后的恢复情况。
我们对 2008 年 6 月至 2010 年 12 月期间接受 CC 的 19 例中度和重度 CSM 患者进行了一项前瞻性研究。自主神经功能障碍定义为存在“膀胱功能障碍”或“体位性低血压”。所有患者在术前和随访时均接受 SSR 测试。术前和随访时使用 Nurick 分级和改良日本骨科学会（mJOA）评分进行功能评估。
在术前评估中，19 例患者中有 14 例（73.7%）存在膀胱功能障碍和体位性低血压。术前 13 例（68.4%）患者 SSR 消失。CC 术后平均随访 14.5 个月时，14 例可进行随访的患者中有 12 例出现 SSR。术前 SSR 消失的 11 例患者中有 9 例术后 SSR 恢复。术后 SSR 的恢复与 Nurick 分级的改善（p = 0.02）、mJOA 评分下肢部分的改善（p = 0.001）以及 Nurick 分级恢复率（p = 0.008）显著相关。
由 SSR 确定的自主神经通路功能障碍在近 70%的中度和重度 CSM 患者中可见，但与其他自主神经功能无关，这表明不同自主神经功能可能存在不同的通路。在未使用内固定的 CC 术后，术前 SSR 消失的患者中近 80%的 SSR 恢复，且这与功能分级的改善显著相关。减压手术可使大多数此类患者的自主神经功能障碍得到逆转。
