Onishi Eijiro, Yasuda Tadashi, Yamamoto Hiroshi, Iwaki Koichi, Ota Satoshi
Department of Orthopedic Surgery, Kurashiki Central Hospital, Okayama Prefecture, Japan.
Department of Orthopedic Surgery, Kobe City Medical Center General Hospital, Hyogo Prefecture, Japan.
Spine (Phila Pa 1976). 2016 Nov 15;41(22):E1356-E1363. doi: 10.1097/BRS.0000000000001622.
STUDY DESIGN: Retrospective study. OBJECTIVE: The aim was to investigate the clinical outcomes in patients with thoracic myelopathy in a single institution and to identify prognostic factors for poor outcomes. SUMMARY OF BACKGROUND DATA: Because of the rarity of thoracic myelopathy, a few studies have analyzed a large number of clinical results for patients with thoracic myelopathy treated in a single institution. METHODS: Seventy-one patients who underwent surgical treatment for thoracic myelopathy between 2000 and 2011 in a single institution were included in this analysis. We investigated the patients' characteristics, surgical outcomes, and prognostic factors for poor outcomes. RESULTS: Of the 73 patients, eight patients had disc herniation (DH) or spinal stenosis (SS), 10 patients had ossification of the posterior longitudinal ligament (OPLL), 40 patients had ossification of the ligamentum flavum (OLF), and 15 patients had OPLL + OLF. The mean patient age at the time of surgery was 61.9 years. Thoracic myelopathy was caused by OPLL and/or OLF in 65 patients (89%). Fifty-eight patients underwent laminectomy, eight patients underwent laminectomy and posterior fusion, four patients underwent OPLL extirpation and posterior fusion, and three patients underwent OPLL extirpation. The mean Japanese Orthopedic Association Scoring System scores before surgery and at the final follow-up examination were 6.0 ± 1.8 and 7.7 ± 2.0 points, respectively, yielding a mean recovery rate of 30% ± 43%. The JOA score improved significantly postoperatively (P < 0.05). Risk factors for poor outcomes were longer preoperative symptom duration, preoperative JOA score < 7, and OPLL and/or OLF. Large blood loss volume was significantly associated with a worse postoperative JOA score. CONCLUSION: A considerable degree of neurological recovery was observed after surgical treatment in patients with thoracic myelopathy. Prognostic factors for poor outcomes were longer preoperative duration of symptoms, worse preoperative symptoms, OPLL and/or OLF, and large volume of intraoperative bleeding. LEVEL OF EVIDENCE: 4.
研究设计：回顾性研究。 目的：旨在调查单机构中胸椎脊髓病患者的临床结局，并确定预后不良的预测因素。 背景数据总结：由于胸椎脊髓病较为罕见，仅有少数研究分析了在单机构接受治疗的胸椎脊髓病患者的大量临床结果。 方法：本分析纳入了2000年至2011年间在单机构接受胸椎脊髓病手术治疗的71例患者。我们调查了患者的特征、手术结局以及预后不良的预测因素。 结果：73例患者中，8例患有椎间盘突出（DH）或椎管狭窄（SS），10例患有后纵韧带骨化（OPLL），40例患有黄韧带骨化（OLF），15例患有OPLL + OLF。手术时患者的平均年龄为61.9岁。65例患者（89%）的胸椎脊髓病由OPLL和/或OLF引起。58例患者接受了椎板切除术，8例患者接受了椎板切除术和后路融合术，4例患者接受了OPLL切除术和后路融合术，3例患者接受了OPLL切除术。术前和末次随访时日本骨科协会评分系统的平均得分分别为6.0±1.8分和7.7±2.0分，平均恢复率为30%±43%。术后JOA评分显著改善（P<0.05）。预后不良的危险因素包括术前症状持续时间较长、术前JOA评分<7分以及OPLL和/或OLF。大量失血与术后较差的JOA评分显著相关。 结论：胸椎脊髓病患者手术治疗后观察到相当程度的神经功能恢复。预后不良的预测因素包括术前症状持续时间较长、术前症状较差、OPLL和/或OLF以及术中大量出血。 证据级别：4级。
Spine (Phila Pa 1976). 2016-11-15
Spine Surg Relat Res. 2024-3-11
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