Spurgas Morgan P, Abbas Syed F, Szewczyk Benjamin S, Yim Benjamin, Ata Ashar, German John W
Medical School, Albany Medical College, Albany, NY, United States; PGY-1 Neurosurgery Resident, Albany Medical Center, 518-956-4526, United States.
Medical School, Albany Medical College, Albany, NY, United States.
J Clin Neurosci. 2019 Apr;62:88-93. doi: 10.1016/j.jocn.2018.12.013. Epub 2019 Jan 16.
Patient-reported outcome measures are increasingly used to access pain, disability, physical function, and mental status to quantify effectiveness of surgical intervention in cervical myelopathy, yet each score has little meaning without established thresholds linked to clinical benefit. We set out to develop thresholds for substantial clinical benefit (SCB) in patients undergoing surgery for cervical myelopathy and to evaluate the effect of length of follow-up on SCB thresholds. Thirty-five patients undergoing spinal surgery for progressive cervical myelopathy were tracked from 2005 to 2015. Observations were categorized into three groups: short-term, intermediate, and long-term, corresponding to average follow-up intervals of 3.8, 9.2, and 29.0 months. SCB thresholds were calculated for neck visual analog score (VAS), Neck Disability Index (NDI), Short Form-12 physical (PCS), SF-12 mental component scores (MCS), and modified Japanese Orthopedic Association score (mJOA) using receiver operating curve analysis with a 5-level patient satisfaction index as the anchor. SCB thresholds for each outcome measure were obtained with a range of areas under the curve indicating varying degrees of discriminatory ability, reported with increasing length of follow-up. NDI and PCS were most discriminatory of SCB at any time period. Stratification of thresholds by length of time revealed a significant effect of follow-up time with NDI but not PCS. NDI and PCS thresholds have significantly strong discriminatory value in identifying patients receiving substantial clinical benefit with regard to cervical myelopathy. When NDI is used to predict outcome, choosing thresholds calibrated for follow-up time is recommended to maximize predictive power.
患者报告的结局指标越来越多地用于评估疼痛、残疾、身体功能和精神状态，以量化手术干预对脊髓型颈椎病的有效性。然而，如果没有与临床益处相关的既定阈值，每个评分都没有什么意义。我们着手为接受脊髓型颈椎病手术的患者制定显著临床益处（SCB）的阈值，并评估随访时间长度对SCB阈值的影响。从2005年到2015年对35例因进行性脊髓型颈椎病接受脊柱手术的患者进行了跟踪。观察结果分为三组：短期、中期和长期，分别对应平均随访间隔3.8个月、9.2个月和29.0个月。使用以5级患者满意度指数为锚点的受试者工作特征曲线分析，计算颈部视觉模拟评分（VAS）、颈部残疾指数（NDI）、简明健康状况调查量表-12身体维度（PCS）、SF-12精神维度评分（MCS）和改良日本骨科协会评分（mJOA）的SCB阈值。随着随访时间延长，每个结局指标的SCB阈值通过一系列曲线下面积获得，这些面积表明了不同程度的区分能力。在任何时间段，NDI和PCS对SCB的区分能力最强。按时间长度对阈值进行分层显示，随访时间对NDI有显著影响，但对PCS没有影响。NDI和PCS阈值在识别脊髓型颈椎病患者是否获得显著临床益处方面具有显著的强区分价值。当使用NDI预测结局时，建议选择根据随访时间校准的阈值以最大化预测能力。
