Diebo Bassel G, Tishelman Jared C, Horn Samantha, Poorman Gregory W, Jalai Cyrus, Segreto Frank A, Bortz Cole A, Gerling Michael C, Lafage Virginie, White Andrew P, Mok James M, Cha Thomas D, Eastlack Robert K, Radcliff Kris E, Paulino Carl B, Passias Peter G
Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
J Clin Neurosci. 2018 Aug;54:102-108. doi: 10.1016/j.jocn.2018.06.014. Epub 2018 Jun 12.
Optimizing functional outcomes and disability status are essential for effective surgical treatment of cervical spine disorders. Mental impairment is common among patients with cervical spine complaints; yet little is known about the impact of baseline mental status with respect to overall patient-reported outcomes. This was a retrospective analysis of patients with cervical spondylosis with myelopathy(CM) or radiculopathy(CR: cervical disc herniation, stenosis, or spondylosis without myelopathy) at 2-year follow-ups. Patients were assessed for several health-related quality of life HRQOL) measures at baseline and 24-months post-operatively: Neck Disability Index (NDI), Visual Analog Scale(VAS), Short Form-36(SF) Physical(PCS) and Mental(MCS) Components. Patients were dichotomized by MCS score: LOW-MCS(SF-MCS < 40th percentile) vs. HIGH-MCS(SF-MCS > 60th percentile). Independent and paired t-tests compared improvement in each group for HIGH-MCS and LOW-MCS cohorts. 375 patients were analyzed(65.4yrs, 67.6%F). LOW-MCS radiculopathy patients showed significant improvement in NDI, VAS Neck and Arm Pain(p < 0.05). HIGH-MCS radiculopathy patients showed greater improvement in NDI score, VAS Neck and Arm Pain, and improvement in PCS(all p < 0.05). Comparing baseline and 2-year follow-up, LOW-MCS CM patients showed significant improvement in PCS, NDI, VAS Neck and Arm Pain(p < 0.05). HIGH-MCS myelopathy patients group showed marked improvement in NDI scores, VAS Neck and Arm Pain(p < 0.05). LOW-MCS CR patients were more likely to be less satisfied 2-years post-op(p < 0.001). Postoperative CR patients with lower baseline mental status saw less improvement and significantly worse outcomes than patients with higher baseline mental status. Improving baseline mental health may improve post-operative recovery. Implementing additional screening and care can optimize functional outcomes and disability status for patients with CR.
优化功能预后和残疾状况对于颈椎疾病的有效手术治疗至关重要。精神障碍在颈椎疾病患者中很常见；然而，关于基线精神状态对患者总体报告结局的影响却知之甚少。这是一项对脊髓型颈椎病（CM）或神经根型颈椎病（CR：颈椎间盘突出症、狭窄或无脊髓病的颈椎病）患者进行2年随访的回顾性分析。在基线和术后24个月对患者进行了多项与健康相关的生活质量（HRQOL）测量：颈部残疾指数（NDI）、视觉模拟量表（VAS）、简短36项健康调查（SF-36）身体（PCS）和精神（MCS）分量表。根据MCS评分将患者分为两组：低MCS组（SF-MCS＜第40百分位数）与高MCS组（SF-MCS＞第60百分位数）。采用独立样本t检验和配对t检验比较高MCS组和低MCS组各指标的改善情况。共分析了375例患者（年龄65.4岁，女性占67.6%）。低MCS神经根型颈椎病患者的NDI、VAS颈部和手臂疼痛评分有显著改善（p＜0.05）。高MCS神经根型颈椎病患者的NDI评分、VAS颈部和手臂疼痛评分改善更明显，且PCS也有改善（均p＜0.05）。比较基线和2年随访情况，低MCS脊髓型颈椎病患者的PCS、NDI、VAS颈部和手臂疼痛评分有显著改善（p＜0.05）。高MCS脊髓型颈椎病患者组的NDI评分、VAS颈部和手臂疼痛评分有明显改善（p＜0.05）。低MCS神经根型颈椎病患者术后2年更可能满意度较低（p＜0.001）。与基线精神状态较高的患者相比，基线精神状态较低的术后神经根型颈椎病患者改善较少，结局明显较差。改善基线心理健康可能会改善术后恢复情况。对神经根型颈椎病患者实施额外筛查和护理可优化其功能预后和残疾状况。
