Nouri Aria, Kato So, Badhiwala Jetan H, Robinson Michael, Mejia Munne Juan, Yang George, Jeong William, Nasser Rani, Gimbel David A, Cheng Joseph S, Fehlings Michael G
University of Cincinnati College of Medicine, Cincinnati, OH, USA.
University of Tokyo, Tokyo, Japan.
Global Spine J. 2020 Jun;10(4):448-455. doi: 10.1177/2192568219860827. Epub 2019 Jul 9.
Ambispective study with propensity matching.
To assess the impact of cervical spondylolisthesis (CS) on clinical presentation and surgical outcome in patients with degenerative cervical myelopathy (DCM).
A total of 458 magnetic resonance images (MRIs) from the AOSpine CSM-NA and CSM-I studies were reviewed and CS was identified. Patients with DCM were divided into 2 cohorts, those with CS and those without, and propensity matching was performed. Patient demographics, neurological and functional status at baseline and 2-year follow-up were compared.
Compared with nonspondylolisthesis (n = 404), CS patients (n = 54) were 8.8 years older ( < .0001), presented with worse baseline neurological and functional status (mJOA [modified Japanese Orthopaedic Association Assessment Scale], = .008; Nurick, = .008; SF-36-PCS [Short Form-36 Physical Component Score], = .01), more commonly presented with ligamentum flavum enlargement (81.5% vs 53.5%, < .0001), and were less commonly from Asia ( = .0002). Surgical approach varied between cohorts ( = .0002), with posterior approaches favored in CS (61.1% vs 37.4%). CS patients had more operated levels (4.3 ± 1.4 vs 3.6 ± 1.2, = .0002) and tended to undergo longer operations (196.6 ± 89.2 vs 177.2 ± 75.6 minutes, = .087). Neurological functional recovery was lower with CS (mJOA [1.5 ± 3.6 vs 2.8 ± 2.7, = .003]; Nurick [-0.8 ± 1.4 vs -1.5 ± 1.5, = .002]), and CS was an independent predictor of worse mJOA recovery ratio at 2 years (B = -0.190, < .0001). After propensity matching, improvement of neurological function was still lower in CS patients (mJOA [1.5 ± 3.6 vs 3.2 ± 2.8, < .01]; Nurick [-0.8 ± 1.4 vs -1.4 ± 1.6, = .02]).
CS patients are older, present with worse neurological/functional impairment, and receive surgery on more levels and more commonly from the posterior. CS may indicate a more advanced state of DCM pathology and is more likely to result in a suboptimal surgical outcome.
倾向匹配的双向性研究。
评估颈椎滑脱（CS）对退行性颈椎脊髓病（DCM）患者临床表现及手术结果的影响。
回顾了AOSpine CSM-NA和CSM-I研究中的458份磁共振成像（MRI）并确定了颈椎滑脱情况。将DCM患者分为两组，有颈椎滑脱组和无颈椎滑脱组，并进行倾向匹配。比较了患者的人口统计学特征、基线及2年随访时的神经和功能状态。
与无滑脱（n = 404）患者相比，颈椎滑脱患者（n = 54）年龄大8.8岁（P <.0001），基线神经和功能状态更差（改良日本骨科协会评估量表[mJOA]，P =.008；Nurick量表，P =.008；简短健康调查问卷-36身体成分得分[SF-36-PCS]，P =.01），更常出现黄韧带增厚（81.5%对53.5%，P <.0001），且较少来自亚洲（P =.0002）。两组手术方式不同（P =.0002），颈椎滑脱患者更倾向于后路手术（61.1%对37.4%）。颈椎滑脱患者手术节段更多（4.3±1.4对3.6±1.2，P =.0002），手术时间往往更长（196.6±89.2对177.2±75.6分钟，P =.087）。颈椎滑脱患者神经功能恢复较差（mJOA[1.5±3.6对2.8±2.7，P =.003]；Nurick量表[-0.8±1.4对-1.5±1.5，P =.002]），且颈椎滑脱是2年时mJOA恢复率较差的独立预测因素（B = -0.190，P <.0001）。倾向匹配后，颈椎滑脱患者神经功能改善情况仍较差（mJOA[1.5±3.6对3.2±2.8，P <.01]；Nurick量表[-0.8±1.4对-1.4±1.6，P =.02]）。
颈椎滑脱患者年龄更大，神经/功能损害更严重，手术节段更多且更常采用后路手术。颈椎滑脱可能提示DCM病理处于更晚期状态，更可能导致手术效果欠佳。
