Zileli Mehmet, Maheshwari Shradha, Kale Shashank Sharad, Garg Kanwaljeet, Menon Sajesh K, Parthiban Jutty
Department of Neurosurgery, Ege University, Izmir, Turkey.
Department of Neurosurgery, LTMG Hospital & LTM Medical College, Mumbai, India.
Neurospine. 2019 Sep;16(3):435-447. doi: 10.14245/ns.1938196.098. Epub 2019 Sep 30.
This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.
本研究旨在系统回顾文献，以确定最可靠的疗效指标，以及影响脊髓型颈椎病患者预后的重要临床和影像学变量。对过去10年发表的文章进行了文献检索。作为功能疗效指标，我们建议使用改良日本骨科学会量表、努里克分级和脊髓病残疾指数。影响预后的三个临床变量是年龄、症状持续时间和脊髓病严重程度。检查结果需要更详细的研究来验证其对预后的影响。影响预后的预测变量是手部萎缩、腿部痉挛、阵挛和巴宾斯基征。在影像学变量中，颈椎曲度是最重要的预后预测指标。不稳定的患者手术预后可能较差。脊髓压迫率是预后的关键因素。T2加权磁共振图像上的高信号强度是预后的负性预测指标。预后的最重要预测指标是术前严重程度和症状持续时间。T2高信号和脊髓压迫率也可以预测预后。未来新的影像学检查可能会给出有前景的结果。
