非常严重的退行性颈椎病患者的手术减压治疗结果。
Outcomes of Surgical Decompression in Patients With Very Severe Degenerative Cervical Myelopathy.
机构信息
Department of Health Services, University of Washington, Seattle, WA.
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS.
出版信息
Spine (Phila Pa 1976). 2018 Aug;43(16):1102-1109. doi: 10.1097/BRS.0000000000002602.
STUDY DESIGN
A prospective observational international study.
OBJECTIVE
The aim of this study was to evaluate outcomes of decompressive surgery in patients with very severe degenerative cervical myelopathy (DCM).
SUMMARY OF BACKGROUND DATA
Although decompressive surgery has been evidenced as a safe and effective approach for patients with myelopathic deficiencies, studies have suggested residual disability following treatment in patients with more severe disease presentation.
METHODS
Postoperative outcomes of 60 patients with very severe DCM (modified Japanese Orthopaedic Association [mJOA] score ≤8) were compared to outcomes of 188 patients with severe DCM (mJOA 9-11). Postimputation follow-up rate was 93.1%. Unadjusted and adjusted analyses were performed using two-way repeated measures of covariance.
RESULTS
The two cohorts were similar in demographics, length of duration of myelopathy symptoms, source of stenosis, and surgical approaches used to decompress the spine. The very severe and severe cohorts differed in preoperative Nurick grades (4.97 vs. 3.91, respectively, P < 0.0001) and Neck Disability Index scores (45.20 vs. 56.21, respectively, P = 0.0006). There were no differences in Short Form 36 (SF-36v2) physical (PCS) and mental (MCS) component summary scores. Both cohorts improved in mJOA, Nurick, Neck Disability Index, and SF-36v2 PCS and MCS scores. Despite the substantial postoperative improvements, patients in both cohorts had considerable residual symptoms. Two-thirds of the patients in the very severe cohort had severe (mJOA ≤11) or moderate (mJOA ≤ 14) myelopathy symptoms at 24 months follow-up. Longer duration of disease was associated with poorer treatment response.
CONCLUSION
Decompressive surgery is effective in patients with very severe DCM; however, patients have significant residual symptoms and disability. The very severe subgroup (mJOA ≤8) of patients with DCM represents a distinct group of patients and their different clinical trajectory is important for clinicians and patients to recognize. Duration of symptoms negatively affects chances for recovery. Whenever possible, patients with DCM should be treated before developing very severe symptomatology.
LEVEL OF EVIDENCE
研究设计
一项前瞻性观察性国际研究。
目的
本研究旨在评估减压手术对非常严重的退行性颈椎脊髓病（DCM）患者的疗效。
背景资料概要
尽管减压手术已被证明是治疗脊髓病缺陷患者的一种安全有效的方法，但研究表明，对于病情较重的患者，治疗后仍存在残留残疾。
方法
比较了 60 例非常严重的 DCM 患者（改良日本骨科协会[mJOA]评分≤8）和 188 例严重 DCM 患者（mJOA 9-11）的术后结果。事后随访率为 93.1%。采用双向重复测量协方差进行未调整和调整分析。
结果
两组在人口统计学特征、脊髓病症状持续时间、狭窄来源和用于减压的脊柱手术入路方面相似。非常严重和严重两组在术前 Nurick 分级（分别为 4.97 与 3.91，P<0.0001）和颈痛残疾指数（分别为 45.20 与 56.21，P=0.0006）方面存在差异。SF-36v2 生理（PCS）和心理（MCS）分量表总分无差异。两组 mJOA、Nurick、颈痛残疾指数和 SF-36v2 PCS 和 MCS 评分均有改善。尽管术后有明显改善，但两组患者仍有明显的残留症状。非常严重组中有三分之二的患者在 24 个月随访时仍有严重（mJOA≤11）或中度（mJOA≤14）脊髓病症状。疾病持续时间较长与治疗反应较差相关。
结论
减压手术对非常严重的 DCM 患者有效；然而，患者仍有明显的残留症状和残疾。DCM 的非常严重亚组（mJOA≤8）是一组独特的患者，他们不同的临床轨迹对临床医生和患者来说是重要的，需要认识到。症状持续时间会影响恢复的机会。只要可能，应在患者出现非常严重的症状之前对 DCM 患者进行治疗。
证据等级
2。
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