Division of Neurosurgery, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
Department of Clinical Neurological Sciences, London Health Science Centre, London, Ontario, Canada.
World Neurosurg. 2019 Dec;132:e885-e890. doi: 10.1016/j.wneu.2019.07.195. Epub 2019 Aug 2.
In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM.
A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes.
The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01).
Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.
在患有神经疾病的患者中，患者对治疗结果的感知与客观神经检查结果之间可能存在差异。退行性颈椎脊髓病（DCM）是一种常见的疾病，其特征是颈椎脊髓逐渐受压，可导致衰弱症状和严重的神经学发现。本研究旨在确定美国脊柱损伤协会（ASIA）总结评分记录的医生得出的神经检查结果是否与 DCM 的患者得出的结果测量指标相关。
共有 78 例 DCM 患者接受了手术治疗，并完成了术前和 6 个月的随访评估。手术治疗包括前路或后路颈椎减压。所有患者均接受了神经评估，包括手术前和手术后 6 个月的 ASIA 评估，并在术前和术后完成了改良日本骨科协会（mJOA）、颈部残疾指数（NDI）和简明 36 项健康调查量表（SF-36）评分，以衡量疾病特异性和一般感知结果。
客观的医生得出的神经检查结果（ASIA）与患者得出的量表（mJOA、NDI 和 SF-36）在术前或术后均无相关性。患者在术后 6 个月时报告四肢功能（mJOA）、颈部疼痛（NDI）、整体身体健康（SF-36）以及客观力量和感觉功能（ASIA）均有显著改善（P<0.001）。所有患者感知的结果测量指标在术前和术后均相互关联（P<0.01）。
术后神经功能的客观评分与 DCM 患者手术前后的患者感知结果不相关。作为神经评估一部分的运动和感觉功能的传统测试可能不足以评估 DCM 患者经历的神经变化范围。
