Tsukamoto Manabu, Nakamura Eiichiro, Narusawa Kenichiro, Shimizu Kenji, Otomo Hajime, Yamane Hirotoshi, Muramoto Teppei, Yamada Shinji, Sakai Akinori
Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Orthopaedic Surgery, Nakashibetsu Town Hospital, Nakashibetsu, Japan.
Spine (Phila Pa 1976). 2020 Jul 1;45(13):E792-E798. doi: 10.1097/BRS.0000000000003411.
Case-control study.
We aimed to identify predictors for latent myelopathy and to develop a diagnostic protocol based on these factors.
There is no diagnostic protocol for latent myelopathy to avoid misdiagnosis in patients complaining only of lower extremity symptoms.
This case-control study identified 791 patients discussed at conferences from April 2006 to August 2012. Overall, 460 patients complaining only of lower extremity symptoms and who underwent spine surgery were included as participants; 54 underwent surgery involving the cervical and thoracic vertebrae and were assigned to the cervical-thoracic group (C-T group); 406 underwent lumbar surgery and were assigned to the lumbar group (L group).
By univariate analysis, age ≥67 years, patellar tendon (PT) hyperreflexia, Achilles tendon (AT) hyperreflexia, spastic gait, and gait inability were more common in the C-T group than in the L group. By multivariate analysis, age ≥67 years (OR, 8; P = 0.001), AT hyperreflexia (OR, 20.5; P < 0.001), spastic gait (OR, 225; P < 0.001), and gait inability (OR, 64; P < 0.001) were significant predictive factors. In patients with age ≥67 years, PT hyperreflexia, and/or AT hyperreflexia, the sensitivity for myelopathy diagnosis was 98%. In patients with spastic gait or gait inability, the specificity of myelopathy diagnosis was 96%.
We analyzed factors that predict latent myelopathy in patients complaining only of lower extremity symptoms. We believe a diagnostic protocol based on the predictors shown in this study would contribute to the accurate diagnosis of latent myelopathy.
病例对照研究。
我们旨在确定潜在脊髓病的预测因素，并基于这些因素制定诊断方案。
目前尚无针对潜在脊髓病的诊断方案，以避免仅主诉下肢症状的患者被误诊。
这项病例对照研究纳入了2006年4月至2012年8月在会议上讨论的791例患者。总体而言，460例仅主诉下肢症状且接受脊柱手术的患者被纳入研究；54例接受了涉及颈椎和胸椎的手术，被分配到颈胸组（C-T组）；406例接受了腰椎手术，被分配到腰椎组（L组）。
单因素分析显示，年龄≥67岁、髌腱（PT）反射亢进、跟腱（AT）反射亢进、痉挛步态和步态障碍在C-T组中比在L组中更常见。多因素分析显示，年龄≥67岁（OR，8；P = 0.001）、AT反射亢进（OR，20.5；P < 0.001）、痉挛步态（OR，225；P < 0.001）和步态障碍（OR，64；P < 0.001）是显著的预测因素。在年龄≥67岁、PT反射亢进和/或AT反射亢进的患者中，脊髓病诊断的敏感性为98%。在有痉挛步态或步态障碍的患者中，脊髓病诊断的特异性为96%。
我们分析了仅主诉下肢症状患者潜在脊髓病的预测因素。我们认为基于本研究中所示预测因素的诊断方案将有助于准确诊断潜在脊髓病。
4级。
