Rothman Orthopedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th floor, Philadelphia, PA, 19107 USA.
Rothman Orthopedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th floor, Philadelphia, PA, 19107 USA.
Spine J. 2020 Nov;20(11):1744-1751. doi: 10.1016/j.spinee.2020.06.016. Epub 2020 Jun 27.
The majority of patients with preoperative upper extremity weakness show improvements in motor function after anterior cervical discectomy and fusion (ACDF). Although numerous studies have examined both the extent and time course to which motor function can be expected to improve, few have shown that these improvements in motor function translate to improved health related quality of life (HRQOL) outcomes.
The purpose of this study was to examine the effect of preoperative weakness and duration of symptoms on HRQOL outcomes in patients who underwent ACDF.
Retrospective cohort study.
Adult patients who underwent an ACDF procedure at an academic hospital from January 2015 to December 2016 by a fellowship-trained spine surgeon.
The primary outcomes of interest were HRQOL outcomes: Short Form-12 Physical/Mental Component Scores (SF-12 PCS/MCS), Neck Disability Index (NDI), and Visual Analog Scale Arm/Neck scores (VAS Arm/Neck).
Patient demographics, surgical case characteristics, and motor strength exams were collected in patients who underwent ACDF over a 2-year period. Preoperative weakness was defined by a strength grade ≤3 (on a scale from 0 to 5) in at least one upper extremity muscle group. Multivariate linear regression analysis was performed to determine the effect of the preoperative weakness on HRQOL outcomes.
Of the 276 patients identified, 45 (16.3%) showed evidence of preoperative weakness, 44 (97.8%) of which showed subsequent postoperative motor improvements after ACDF. All patients reported significant improvements in all HRQOL outcome measures. Patients with preoperative weakness reported significantly worse preoperative VAS Arm (6.9 vs. 5.2; p=.01) and VAS Neck (6.1 vs. 4.8; p=.02) pain scores. Compared with patients without preoperative weakness, those with preoperative weakness reported significantly more improvement in NDI (β: -10.9; p=.001). Patients with symptoms greater than or equal to 12 months and preoperative weakness showed significantly less improvement in NDI (β: 14.8; p=.03).
Patients with preoperative weakness generally exhibited worse pain and HRQOL measures preoperatively, and showed greater potential for improvement after ACDF. Patients with a shorter duration of preoperative weakness had greater potential for improvement in HRQOL measures after ACDF compared with those with longer duration of symptoms. ACDF is an effective procedure to improve strength and HRQOL measures across all patient groups under appropriate indications.
大多数术前上肢无力的患者在接受前路颈椎间盘切除融合术（ACDF）后，上肢运动功能均有改善。尽管有许多研究探讨了运动功能的改善程度和时间进程，但很少有研究表明这些运动功能的改善与健康相关生活质量（HRQOL）结果的改善相关。
本研究旨在探讨术前无力和症状持续时间对接受 ACDF 治疗的患者 HRQOL 结果的影响。
回顾性队列研究。
2015 年 1 月至 2016 年 12 月在一家学术医院接受 ACDF 手术的成年患者，由一名脊柱外科 fellowship培训医师施行。
主要结局指标为 HRQOL 结果：简明健康状况调查问卷 12 项（SF-12）生理/心理成分评分（SF-12 PCS/MCS）、颈部残疾指数（NDI）和视觉模拟量表上肢/颈部评分（VAS 上肢/颈部）。
在 2 年期间收集接受 ACDF 手术的患者的患者人口统计学、手术病例特征和运动力量检查。术前无力定义为至少一个上肢肌群的肌力等级≤3（0 至 5 级）。采用多元线性回归分析确定术前无力对 HRQOL 结果的影响。
在确定的 276 例患者中，45 例（16.3%）存在术前无力，其中 44 例（97.8%）在接受 ACDF 后上肢运动功能均有改善。所有患者报告的所有 HRQOL 结局指标均有显著改善。术前无力患者的术前 VAS 上肢（6.9 比 5.2；p=.01）和 VAS 颈部（6.1 比 4.8；p=.02）疼痛评分显著更高。与术前无无力的患者相比，术前无力患者的 NDI 评分改善更明显（β：-10.9；p=.001）。术前无力且症状持续时间大于或等于 12 个月的患者，其 NDI 评分改善程度显著较低（β：14.8；p=.03）。
术前无力的患者一般术前疼痛和 HRQOL 测量值较差，并且在 ACDF 后有更大的改善潜力。与术前无力持续时间较长的患者相比，术前无力持续时间较短的患者在 ACDF 后有更大的改善 HRQOL 测量值的潜力。在适当的适应证下，ACDF 是一种有效改善所有患者群体的力量和 HRQOL 测量值的手术。
