Department of Neurological Sciences, Christian Medical College, Vellore, India.
Spine (Phila Pa 1976). 2018 Jun 15;43(12):E703-E711. doi: 10.1097/BRS.0000000000002468.
Retrospective study.
To examine predictors of long-term outcome and sustainability of initial functional improvement in patients undergoing corpectomy for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL).
There are limited data on the predictors of outcome and sustainability of initial functional improvement on long-term follow-up after cervical corpectomy.
We studied the functional outcome at more than 1-year follow-up after central corpectomy in 352 patients with CSM or OPLL. Functional status was evaluated with the Nurick grading system. Analysis was directed at identifying factors associated with both improvement in functional status and the achievement of a "cure" (improvement to a follow-up Nurick grade of 0 or 1). A survival analysis was performed to identify factors associated with sustained functional improvement in patients with serial follow-up evaluations.
Nurick grade improved from 3.2 ± 0.1 to 1.9 ± 0.1 over a mean follow-up period of 57.1 months (range 12-228 mo). On multivariate analysis, age ≥50 years (P = 0.008) and symptom duration ≥1 year (P < 0.001) were negatively associated with functional improvement by ≥1 Nurick grade. Independent factors negatively associated with "cure" after surgery included age 50 years or older (P = 0.005), preoperative Nurick grade of 4 or higher (P < 0.001) and symptom duration of 1 or more years (P < 0.001). Early improvement in functional status was maintained in 90.5% and 76.3% of patients at 5 and 10 years follow-up, respectively. On survival analysis, patients with shorter preoperative symptom duration (<1 yr) were more likely to demonstrate sustained improvement in functional status after surgery (P = 0.022).
Initial gains in functional status after central corpectomy for CSM and OPLL are maintained in more than 75% of patients at 10 years after surgery. Overall, the most favorable long-term outcomes are achieved in younger patients who present early and with good preoperative functional status.
回顾性研究。
研究颈椎脊髓病（CSM）或后纵韧带骨化（OPLL）患者接受颈椎前路椎体次全切除术后长期预后和初始功能改善的可持续性的预测因素。
颈椎前路椎体次全切除术后长期随访时，关于功能改善结果和初始功能改善可持续性的预测因素的数据有限。
我们研究了 352 例 CSM 或 OPLL 患者行颈椎前路中央椎体次全切除术后 1 年以上的功能预后。采用 Nurick 分级系统评估功能状态。分析旨在确定与功能状态改善和“治愈”（随访 Nurick 分级改善至 0 或 1）相关的因素。进行生存分析以确定在具有连续随访评估的患者中与持续功能改善相关的因素。
Nurick 分级从手术前的 3.2±0.1 改善至平均随访 57.1 个月（12-228 个月）后的 1.9±0.1。多变量分析显示，年龄≥50 岁（P=0.008）和症状持续时间≥1 年（P<0.001）与≥1 级 Nurick 分级的功能改善呈负相关。与术后“治愈”相关的独立负相关因素包括年龄 50 岁或以上（P=0.005）、术前 Nurick 分级 4 级或更高（P<0.001）和症状持续时间 1 年或更长（P<0.001）。在 5 年和 10 年随访时，分别有 90.5%和 76.3%的患者早期功能状态改善得到维持。生存分析显示，术前症状持续时间较短（<1 年）的患者术后功能状态持续改善的可能性更大（P=0.022）。
CSM 和 OPLL 患者行颈椎前路椎体次全切除术后，初始功能状态改善在术后 10 年仍保持在 75%以上。总体而言，在发病早且术前功能状态良好的年轻患者中，可获得最佳的长期预后。
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