McClelland Shearwood, Marascalchi Bryan J, Passias Peter G, Protopsaltis Themistocles S, Frempong-Boadu Anthony K, Errico Thomas J
Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, United States.
Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD, United States.
J Clin Neurosci. 2017 May;39:133-136. doi: 10.1016/j.jocn.2016.12.027. Epub 2017 Jan 10.
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in patients older than age 55, with operative management being a widely adopted approach. Previous work has shown that private insurance status, gender and patient race are predictive of the operative approach patients receive (anterior-only, posterior-only, combined anterior-posterior). The Nationwide Inpatient Sample from 2001 to 2010 was used to assess the potential role of multilevel CSM as a contributing factor in determining which operative approach CSM patients receive, as it is rare for an anterior-only approach to be sufficient for CSM patients requiring fusion of four or more involved levels. Multivariate analyses revealed that female sex (OR=3.78; 95% CI=2.08-6.89; p<0.0001), private insurance (OR=5.02; 95% CI=2.26-11.12; p<0.0001), and elective admission type (OR=4.12; 95% CI=1.65-10.32; p=0.0025) were predictive of increased receipt of a 3+ level fusion in CSM. No other variables, including patient age, race, income, or admission source were predictive of either increased or decreased likelihood of receiving fusion of at least three levels for CSM. In conclusion, female sex, private insurance status, and elective admission type are each independent predictors in CSM for receipt of a 3+ level fusion, while patient age, race and income are not. Given the propensity of fusions greater than three levels to require posterior approaches and the association between posterior CSM approaches and increased morbidity/mortality, these findings may prove useful as to which patient demographics are predictive of increased morbidity and mortality in operative treatment of CSM.
脊髓型颈椎病（CSM）是55岁以上患者脊髓功能障碍最常见的原因，手术治疗是一种广泛采用的方法。先前的研究表明，私人保险状况、性别和患者种族可预测患者接受的手术方式（仅前路、仅后路、前后联合）。使用2001年至2010年的全国住院患者样本，评估多节段CSM作为决定CSM患者接受何种手术方式的一个促成因素的潜在作用，因为对于需要融合四个或更多受累节段的CSM患者，仅前路手术很少足够。多变量分析显示，女性（OR = 3.78；95% CI = 2.08 - 6.89；p < 0.0001）、私人保险（OR = 5.02；95% CI = 2.26 - 11.12；p < 0.0001）和择期入院类型（OR = 4.12；95% CI = 1.65 - 10.32；p = 0.0025）可预测CSM患者接受3节段以上融合手术的可能性增加。没有其他变量，包括患者年龄、种族、收入或入院来源，可预测CSM患者接受至少三节段融合手术的可能性增加或减少。总之，女性、私人保险状况和择期入院类型均为CSM患者接受3节段以上融合手术的独立预测因素，而患者年龄、种族和收入则不是。鉴于超过三节段的融合手术倾向于需要后路手术，以及后路CSM手术与发病率/死亡率增加之间的关联，这些发现可能有助于确定哪些患者特征可预测CSM手术治疗中发病率和死亡率的增加。
