轻微创伤后后纵韧带骨化症患者的脊髓症状急性进展的危险因素和预后。
Risk Factors and Prognosis for Acute Progression of Myelopathic Symptoms in Patients Ossification of the Posterior Longitudinal Ligament After Minor Trauma.
机构信息
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2018 Feb 1;43(3):E171-E176. doi: 10.1097/BRS.0000000000002275.
STUDY DESIGN
A retrospective cohort study.
OBJECTIVE
The aim of this study was to identify the risk factors for acute progression of myelopathic symptoms (PMS) associated with ossification of the posterior longitudinal ligament (OPLL) after minor trauma and to compare the prognosis between an acute PMS group and a chronic PMS group.
SUMMARY OF BACKGROUND DATA
Although the prevalence of OPLL among patients with cervical myelopathy is high, few studies have been published regarding the risk factors for acute PMS associated with OPLL after minor trauma.
METHODS
Patients with OPLL who had histories of minor trauma and had undergone surgery were divided according to clinical course into an acute (within 48 hours, n = 38) and a chronic PMS group (n = 32). The type of trauma and the clinical and radiologic characteristics were compared. The clinical outcomes were also compared at admission and at 1 and 2 years postoperatively.
RESULTS
The types of trauma were significantly different between the two groups (P < 0.05). Univariate analysis revealed that older age, a narrower space available for the cord, and a higher rate of stenosis in the spinal canal were associated with acute PMS after minor trauma (P = 0.014, 0.020, and 0.006, respectively). However, the rate of stenosis in the spinal canal was the only risk factor that was identified in a multivariate analysis (P = 0.023; odds ratio, 0.872; 95% confidence interval, 0.774-0.982). The Japanese Orthopedic Association scores at the initial visit and at postoperative years 1 and 2 were significantly lower in the acute PMS group than in the chronic PMS group (P < 0.001, P < 0.001, and P < 0.001, respectively).
CONCLUSION
One risk factor for acute PMS in patients with OPLL after minor trauma is a higher rate of stenosis of the spinal canal. Patients with acute PMS exhibited unfavorable neurologic outcomes. Preventive surgical treatment may be recommended for patients with significant OPLL with mild cervical myelopathy.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究旨在确定与后纵韧带骨化（OPLL）相关的轻微创伤后脊髓病症状（PMS）急性进展的风险因素，并比较急性 PMS 组和慢性 PMS 组之间的预后。
背景资料概要
尽管患有颈椎脊髓病的患者中 OPLL 的患病率较高，但很少有研究报道与轻微创伤后 OPLL 相关的急性 PMS 的风险因素。
方法
将有轻微创伤病史并接受手术的 OPLL 患者根据临床病程分为急性（48 小时内，n=38）和慢性 PMS 组（n=32）。比较两组的创伤类型和临床影像学特征。还比较了入院时和术后 1 年和 2 年的临床结果。
结果
两组的创伤类型存在显著差异（P<0.05）。单因素分析显示，年龄较大、脊髓可用空间较窄以及椎管狭窄率较高与轻微创伤后急性 PMS 相关（P=0.014、0.020 和 0.006）。然而，多因素分析仅确定了椎管狭窄率是一个风险因素（P=0.023；优势比，0.872；95%置信区间，0.774-0.982）。急性 PMS 组在初始就诊时和术后 1 年和 2 年的日本矫形协会评分均明显低于慢性 PMS 组（P<0.001、P<0.001 和 P<0.001）。
结论
轻微创伤后 OPLL 患者急性 PMS 的一个风险因素是椎管狭窄率较高。急性 PMS 患者表现出不利的神经学结果。对于轻度颈椎脊髓病且存在明显 OPLL 的患者，可能推荐预防性手术治疗。
证据水平
3。
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