退行性颈椎脊髓病:手术结果预测因素及多模式治疗方法需求综述
Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach.
作者信息
Jannelli Gianpaolo, Nouri Aria, Molliqaj Granit, Grasso Giovanni, Tessitore Enrico
机构信息
Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
出版信息
World Neurosurg. 2020 Aug;140:541-547. doi: 10.1016/j.wneu.2020.04.233. Epub 2020 May 8.
Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. Clinically, the baseline neurological impairment appears to be strongly related to the outcome, and the magnetic resonance imaging findings of T1-weighted hypointensity and the length of T2-weighted hyperintensity appear to be the most prognostic. In this context, electrophysiology findings (both motor and sensory evoked potentials) have shown some predictive capacity. However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.
在发达国家,退行性颈椎脊髓病是老年人群脊髓损伤的最常见原因,它显著影响患者及其照料者的生活质量。手术仍然是能够阻止疾病进展并为大多数患者提供神经功能恢复的唯一治疗选择。尽管准确预测哪些患者术后会有所改善一直具有挑战性,但越来越多的研究表明,临床、影像学和电生理因素能够以相对较高的准确性预测哪些患者更可能从中受益。临床上,基线神经功能损害似乎与预后密切相关,T1加权像低信号和T2加权像高信号的磁共振成像表现似乎最具预后价值。在此背景下,电生理检查结果(运动和感觉诱发电位)已显示出一定的预测能力。然而,缺乏大型研究。尽管已经使用临床和磁共振成像数据建立了多变量模型,但尚无包含临床、影像学和电生理数据预测能力的多模式预测模型。在本综述中,我们探讨了临床、影像学和电生理检查在临床实践中的应用原理,并讨论了一种用于退行性颈椎脊髓病管理的多模式评估模型。