Xiao Roy, Miller Jacob A, Lubelski Daniel, Mroz Thomas E, Benzel Edward C, Krishnaney Ajit A, Machado Andre
Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
Neurosurgery. 2017 Aug 1;81(2):350-356. doi: 10.1093/neuros/nyw043.
Distinguishing the causes of weakness and gait instability in patients with Parkinson disease (PD) and cervical spondylotic myelopathy (CSM) is a diagnostic and therapeutic challenge due to symptomatic similarities. No study has reported outcomes following decompression in patients with PD and CSM.
To report outcomes following cervical decompression for patients with coexisting PD and CSM.
A retrospective matched cohort study of all patients with PD and CSM undergoing cervical decompression at a tertiary-care center between January 1996 and December 2014 was conducted. PD patients were matched to patients with CSM alone by age, gender, American Society of Anesthesiologists classification, and operative parameters. Myelopathy was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) scales. The effect of PD on mJOA was modeled using multivariable regression.
Twenty-one matched pairs were included. PD patients experienced poorer improvement in Nurick (0.0 vs -1.0, P < .01) and mJOA (0.9 vs 2.5, P < .01) composite scores. However, no significant changes in absolute improvement in the upper extremity motor, upper extremity sensory, or sphincter mJOA components were observed. Multivariable regression identified PD as a significant predictor of decreased improvement in mJOA (β = -0.89, P < .01) and failure to achieve a minimal clinically important difference in change in mJOA (OR 0.18, P = .03).
This study is the first to characterize outcomes following cervical decompression in patients with PD and CSM. PD patients experienced symptomatic improvement but less overall improvement in myelopathy compared to controls. However, PD patients demonstrated improvement in upper extremity motor, upper extremity sensory, and sphincter symptoms no worse than control patients.
由于症状相似，区分帕金森病（PD）和脊髓型颈椎病（CSM）患者出现虚弱和步态不稳的原因是一项诊断和治疗挑战。尚无研究报道PD和CSM患者减压术后的结果。
报告并存PD和CSM患者颈椎减压术后的结果。
对1996年1月至2014年12月在一家三级医疗中心接受颈椎减压的所有PD和CSM患者进行回顾性匹配队列研究。根据年龄、性别、美国麻醉医师协会分级和手术参数，将PD患者与单纯CSM患者进行匹配。采用Nurick量表和改良日本骨科协会（mJOA）量表评估脊髓病。使用多变量回归模型分析PD对mJOA的影响。
纳入21对匹配病例。PD患者的Nurick综合评分（0.0对-1.0，P<.01）和mJOA综合评分（0.9对2.5，P<.01）改善较差。然而，在上肢运动、上肢感觉或括约肌mJOA分量表的绝对改善方面未观察到显著变化。多变量回归分析确定PD是mJOA改善降低的显著预测因素（β=-0.89，P<.01），且未能在mJOA变化中达到最小临床重要差异（OR=0.18，P=.03）。
本研究首次描述了PD和CSM患者颈椎减压术后的结果。与对照组相比，PD患者症状有改善，但脊髓病总体改善较少。然而，PD患者在上肢运动、上肢感觉和括约肌症状方面的改善并不比对照组差。
