Nouri Aria, Badhiwala Jetan H, Kato So, Reihani-Kermani Hamed, Patel Kishan, Wilson Jefferson R, Janssen Insa, Cheng Joseph S, Schaller Karl, Tessitore Enrico, Fehlings Michael G
Department of Neurosurgery, University of Geneva, 1205 Geneva, Switzerland.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0515, USA.
J Clin Med. 2020 Feb 26;9(3):624. doi: 10.3390/jcm9030624.
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 ± 1.10 vs. 3.28 ± 1.16, = 0.044) but not based on mJOA (12.74 ± 2.62 vs. 12.48 ± 2.76, = 0.33). They also had a worse physical health score (32.80 ± 8.79 vs. 34.65 ± 9.38 = 0.049), worse neck disability (46.31 ± 20.04 vs. 38.23 ± 20.44, < 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, = 0.037; Babinski's sign 24.8% vs. 37.3%, = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, < 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, < 0.001; T1 hypointensity, 9.7% vs. 21.1%, = 0.036), and had a lower number of T2 hyperintensity levels (0.82 ± 0.98 vs. 1.3 ± 1.11, = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have less clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in DCM, and it is therefore plausible that nutritional factors may contribute to this unique observation.
退行性颈椎脊髓病（DCM）是成人脊髓损伤最常见的原因，最常出现在50岁及以上的患者中。胃肠道合并症（GICs）在该群体中普遍存在；然而，它们与DCM的关系尚未得到充分研究。本研究的目的是调查接受DCM手术治疗的有或无GICs患者之间的差异。对来自北美脊柱外科学会（AOSpine North America）和国际脊柱外科学会（AOSpine International）关于DCM研究的757例有临床数据的患者和458例有磁共振成像（MRI）数据的患者进行了评估。GICs在就诊时确定，包括胃、肠、肝和胰腺疾病。患者被分为两组：有GICs的患者和无GICs的患者。比较了临床和MRI表现以及基线神经和功能状态。还比较了2年随访时的神经和功能结果。121例患者（16%）存在GICs。这些患者男性较少见（48.76%对65.4%，P = 0.001），根据Nurick分级神经损伤略轻（3.05±1.10对3.28±1.16，P = 0.044），但根据改良日本骨科学会（mJOA）评分无差异（12.74±2.62对12.48±2.76，P = 0.33）。他们的身体健康评分也较差（32.80±8.79对34.65±9.38，P = 0.049），颈部残疾更严重（46.31±20.04对38.23±20.44，P < 0.001），上运动神经元体征的患病率较低（腱反射亢进，70.2%对78.9%，P = 0.037；巴宾斯基征，24.8%对37.3%，P = 0.008），精神合并症的发生率较高（31.4%对10.4%，P < 0.0001）。在MRI上，有GICs的患者信号强度改变较少见（T2高信号，49.2%对75.6%，P < 0.001；T1低信号，9.7%对21.1%，P = 0.036），T2高信号水平较低（0.82±0.98对1.3±1.11，P = 0.001）。两组手术结果无差异。患有GICs的DCM患者更可能为女性，且有明显更多的全身健康损害和颈部残疾。然而，这些患者具有典型的更严重神经损伤的临床和MRI特征较少。这种症状组合与DCM中通常观察到的症状有很大不同，因此营养因素可能导致这种独特表现似乎是合理的。
