Department of Orthopedic Surgery, Osaka Medical College, Takastuki, Japan.
Clin Spine Surg. 2020 Dec;33(10):E466-E471. doi: 10.1097/BSD.0000000000000972.
This is a retrospective study.
The objective of this study was to investigate the surgical outcomes of postural instability and its predictors in patients with cervical myelopathy (CM).
Although several studies have shown impaired postural stability in CM patients, there remains a paucity of literature examining its surgical outcome.
Postural stability was assessed using a stabilometer preoperatively, at the early phase (3-6 months postoperatively), and 1-year postoperatively, employing 2 stabilometric parameters: sway area [SwA (cm): the amount of sway of gravity center assessed by the outer peripheral area of the stabilogram] and sway density [SwD (/cm): the indicator of proprioceptive reflexes calculated by the locus length of the stabilogram per SwA]. Twenty-seven healthy age-matched, sex-matched, and body mass index-matched subjects were recruited as controls. To investigate the predictors of postoperative postural instability, univariate, and multivariate analyses were performed, including demographic data, preoperative neurological symptom severity, radiographic findings, and preoperative stabilometric parameters as independent variables.
Altogether, 54 CM patients were included in the present study. SwA was 7.89±0.84, 4.78±0.68, and 4.85±0.49, and SwD was 14.63±0.85, 20.41±1.23, and 19.36±1.40 preoperatively, at the early phase, and 1-year postoperatively, respectively, and significant improvement was found in both parameters postoperatively. However, at all timepoints, these parameters were significantly worse in CM patients than in the healthy subjects (SwA: 2.68±0.24, SwD: 24.91±1.83). Multivariate analyses showed that worse preoperative stabilometric parameters were significantly related to worse postoperative stabilometric parameters.
Surgery significantly improved postural stability in CM patients; however, it did not reach the level observed in healthy controls, even postoperatively. A predictor of greater residual postoperative postural instability was a greater level of preoperative postural instability. In CM patients, to achieve better surgical outcome of postural stability, surgical intervention is recommended before the symptoms related to bodily imbalance deteriorate.
Level III.
这是一项回顾性研究。
本研究的目的是探讨颈椎脊髓病（CM）患者姿势不稳定及其预测因素的手术结果。
尽管几项研究表明 CM 患者存在姿势稳定性受损，但仍缺乏关于其手术结果的文献。
使用平衡仪在术前、术后早期（3-6 个月）和术后 1 年评估姿势稳定性，采用 2 个平衡仪参数：摆动面积[SwA（cm）：通过稳定图外周区域评估的重心摆动量]和摆动密度[SwD（/cm）：通过稳定图的轨迹长度除以 SwA 计算的本体感受反射指标]。招募了 27 名年龄、性别和体重指数匹配的健康对照者作为对照组。为了探讨术后姿势不稳定的预测因素，进行了单变量和多变量分析，包括人口统计学数据、术前神经症状严重程度、影像学发现以及术前平衡仪参数作为独立变量。
本研究共纳入 54 例 CM 患者。SwA 分别为术前 7.89±0.84、术后早期 4.78±0.68 和术后 1 年 4.85±0.49，SwD 分别为术前 14.63±0.85、术后早期 20.41±1.23 和术后 1 年 19.36±1.40，术后均显著改善。然而，在所有时间点，CM 患者的这些参数均明显差于健康受试者（SwA：2.68±0.24，SwD：24.91±1.83）。多变量分析显示，术前平衡仪参数较差与术后平衡仪参数较差显著相关。
手术显著改善了 CM 患者的姿势稳定性；然而，即使在术后，也未达到健康对照组的水平。术后残余姿势不稳定程度较大的预测因素是术前姿势不稳定程度较高。在 CM 患者中，为了获得更好的术后姿势稳定性手术结果，建议在与身体失衡相关的症状恶化之前进行手术干预。
III 级。
