术前Nurick分级及症状持续时间对颈椎病脊髓病和步态障碍患者的预后价值

Prognostic Value of Preoperative Nurick Grade and Time with Symptoms in Patients with Cervical Myelopathy and Gait Impairment.

作者信息

De la Garza-Ramos Rafael, Ramhmdani Seba, Kosztowski Thomas, Xu Risheng, Yassari Reza, Witham Timothy F, Bydon Ali

机构信息

The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.

出版信息

World Neurosurg. 2017 Sep;105:314-320. doi: 10.1016/j.wneu.2017.05.166. Epub 2017 Jun 26.

DOI:10.1016/j.wneu.2017.05.166

PMID:28602883

Abstract

OBJECTIVE

To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy.

METHODS

A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery.

RESULTS

A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A greater preoperative Nurick grade was associated with lower odds of gait improvement (odds ratio 0.74; 95% confidence interval 0.53-0.99, P = 0.048) and gait recovery (odds ratio 0.27; 95% confidence interval 0.17-0.43, P < 0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared with 36.4% for patients with symptoms for over 12 months (P < 0.001). Patients with symptoms for 12 months or less had a 59.6% gait recovery rate, compared to 24.2% in patients with symptoms for over 12 months (P < 0.001). Having symptoms for over 12 months was independently associated with lower odds of improvement and recovery.

CONCLUSIONS

Patients with a greater preoperative Nurick grade and symptoms for more than 12 months may have significantly lower odds of experiencing gait improvement or gait recovery after surgery for cervical myelopathy. This study's conclusion favors early intervention in patients with cervical myelopathy.

摘要

目的

探讨术前Nurick分级及症状持续时间对脊髓型颈椎病继发共济失调患者步态改善及恢复的预后价值。

方法

对1996年至2013年间接受脊髓型颈椎病手术减压的所有成年患者进行回顾性病历审查。仅纳入Nurick分级至少为2级或更差的成年人。观察指标包括步态改善和恢复情况。

结果

共纳入170例患者。分别有57.7%和45.9%的患者出现步态改善和步态恢复。改善时间最早在术后1个月，最晚在24个月。术前Nurick分级越高，步态改善（优势比0.74；95%置信区间0.53 - 0.99，P = 0.048）和步态恢复（优势比0.27；95%置信区间0.17 - 0.43，P < 0.001）的几率越低。症状持续12个月或更短时间的患者中，步态改善的比例为71.2%，而症状持续超过12个月的患者为36.4%（P < 0.001）。症状持续12个月或更短时间的患者步态恢复率为59.6%，而症状持续超过12个月的患者为24.2%（P < 0.001）。症状持续超过12个月与改善和恢复的几率降低独立相关。