Gondar Renato, Nouri Aria, Jannelli Gianpaolo, Schaller Karl, Tessitore Enrico
27230University of Geneva, Switzerland.
Global Spine J. 2021 Sep;11(7):1134-1141. doi: 10.1177/2192568220960452. Epub 2020 Oct 16.
This was a systematic review and meta-analysis.
Degenerative cervical myelopathy (DCM) with spondylolisthesis remains not well defined, poorly studied, and underreported and plays a minor role in the therapeutic decision-making. Spondylolisthesis, however, is not uncommon and may result in dynamic injury to the spinal cord. We aim to describe the impact of spondylolisthesis in DCM severity and postoperative outcomes.
Two independent reviewers conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2015)-based review between 1970 and May 2020 for articles reporting outcome of DCM in patients with degenerative cervical spondylolisthesis. Patient clinical and radiological data was recorded at baseline and during postoperative follow-up (FU). A meta-analysis comparing surgical outcome between DCM patients with and without spondylolisthesis assessed by the regular/modified Japanese Orthopaedic Association Assessment Scale (mJOA) recovery ratio was completed.
A total of 3 studies were included (1 ambispective and 2 retrospective cohorts); 607 patients with DCM were identified, 102 (16.8%) of whom also had spondylolisthesis. DCM patients with spondylolisthesis were significantly older ( < .05), presented with worse baseline mJOA and Nurick grades ( < .05 in 2 studies), and were more commonly operated via posterior approaches ( < .05). All groups experienced a (m)JOA and/or Neck Disability Index score improvement during FU. In the pooled meta-analysis, spondylolisthesis patients showed a significantly lower functional recovery ratio at 2 years compared with other DCM patients ( = .05).
Spondylolisthesis is frequent in older DCM patients and may be a predictor of a more advanced degeneration and subsequent worse baseline conditions and postoperative outcome.
这是一项系统评价和荟萃分析。
伴有椎体滑脱的退行性颈椎病（DCM）仍未得到明确界定，研究较少且报道不足，在治疗决策中作用较小。然而，椎体滑脱并不罕见，可能导致脊髓的动态损伤。我们旨在描述椎体滑脱对DCM严重程度和术后结果的影响。
两名独立的评审员在1970年至2020年5月期间，基于系统评价和荟萃分析的首选报告项目（PRISMA 2015）对报道退行性颈椎椎体滑脱患者DCM结局的文章进行了综述。在基线和术后随访（FU）期间记录患者的临床和放射学数据。通过常规/改良日本骨科学会评估量表（mJOA）恢复率对有和无椎体滑脱的DCM患者的手术结果进行了荟萃分析。
共纳入3项研究（1项前瞻性队列研究和2项回顾性队列研究）；确定了607例DCM患者，其中102例（16.8%）也有椎体滑脱。伴有椎体滑脱的DCM患者年龄显著更大（P<0.05），基线mJOA和Nurick分级更差（2项研究中P<0.05），且更常通过后路手术（P<0.05）。所有组在随访期间mJOA和/或颈部残疾指数评分均有所改善。在汇总的荟萃分析中，椎体滑脱患者在2年时的功能恢复率显著低于其他DCM患者（P = 0.05）。
椎体滑脱在老年DCM患者中很常见，可能是更严重退变以及随后更差的基线状况和术后结果的一个预测指标。
