症状术前持续时间较长会对颈椎神经根病手术后的健康相关生活质量产生负面影响。
Longer Preoperative Duration of Symptoms Negatively Affects Health-related Quality of Life After Surgery for Cervical Radiculopathy.
机构信息
Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
出版信息
Spine (Phila Pa 1976). 2019 May 15;44(10):685-690. doi: 10.1097/BRS.0000000000002924.
STUDY DESIGN
Retrospective cohort.
OBJECTIVE
Determine the effect of duration of symptoms (DOS) on health-related quality of life (HRQOL) outcomes for patients with cervical radiculopathy.
SUMMARY OF BACKGROUND DATA
The effect of DOS has not been extensively evaluated for cervical radiculopathy.
METHODS
A retrospective analysis of patients who underwent an anterior cervical decompression and fusion for radiculopathy was performed. Patients were grouped based on DOS of less than 6 months, 6 months to 2 years, and more than 2 years and HRQOL outcomes were evaluated.
RESULTS
A total of 216 patients were included with a mean follow-up of 16.0 months. There were 86, 61, and 69 patients with symptoms for less than 6 months, 6 months to 2 years, and more than 2 years, respectively. No difference in the absolute postoperative score of the patient reported outcomes was identified between the cohorts. However, in the multivariate analysis, radiculopathy for more than 2 years predicted lower postoperative Short Form-12 Physical Component Score (P = 0.037) and Short Form-12 Mental Component Score (P = 0.029), and higher postoperative Neck Disability Index (P = 0.003), neck pain (P = 0.001), and arm pain (P = 0.004) than radiculopathy for less than 6 months. Furthermore, the recovery ratios for patients with symptoms for less than 6 months demonstrated a greater improvement in NDI, neck pain, and arm pain than for 6 months to 2 years (P = 0.041; 0.005; 0.044) and more than 2 years (P = 0.016; 0.014; 0.002), respectively.
CONCLUSION
Patients benefit from spine surgery for cervical radiculopathy at all time points, and the absolute postoperative score for the patient reported outcomes did not vary based on the duration of symptoms; however, the regression analysis clearly identified symptoms for more than 2 years as a predictor of worse outcomes, and the recovery ratio was statistically significantly improved in patients who underwent surgery within 6 months of the onset of symptoms.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
确定颈椎神经根病患者症状持续时间（DOS）对健康相关生活质量（HRQOL）结局的影响。
背景资料概要
DOS 对颈椎神经根病的影响尚未得到广泛评估。
方法
对接受前路颈椎减压融合术治疗神经根病的患者进行回顾性分析。根据 DOS 少于 6 个月、6 个月至 2 年和超过 2 年将患者分组，并评估 HRQOL 结果。
结果
共纳入 216 例患者，平均随访 16.0 个月。症状少于 6 个月、6 个月至 2 年和超过 2 年的患者分别为 86、61 和 69 例。在各队列间，患者报告结局的术后绝对评分无差异。然而，在多变量分析中，DOS 超过 2 年预示着术后 SF-12 物理成分评分（P=0.037）和 SF-12 心理成分评分（P=0.029）较低，术后 Neck Disability Index（P=0.003）、颈部疼痛（P=0.001）和手臂疼痛（P=0.004）较高，与 DOS 少于 6 个月相比。此外，DOS 少于 6 个月的患者的恢复比例在 NDI、颈部疼痛和手臂疼痛方面较 6 个月至 2 年（P=0.041；0.005；0.044）和超过 2 年（P=0.016；0.014；0.002）的患者有更大的改善。
结论
颈椎神经根病患者在所有时间点均从脊柱手术中获益，且患者报告结局的绝对术后评分与症状持续时间无关；然而，回归分析清楚地表明，DOS 超过 2 年是不良结局的预测因素，而症状出现后 6 个月内接受手术的患者的恢复比例有统计学意义上的显著改善。
证据等级
3。
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