Loe Michael Lumintang, Vivas-Buitrago Tito, Domingo Ricardo A, Heemskerk Johan, Tripathi Shashwat, Bendok Bernard R, Bydon Mohamad, Quinones-Hinojosa Alfredo, Abode-Iyamah Kingsley
1Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara/H. Adam Malik General Hospital, Medan, Indonesia.
2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.
J Neurosurg Spine. 2020 Oct 16;34(2):171-177. doi: 10.3171/2020.6.SPINE20544. Print 2021 Feb 1.
The authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1-C2 facet malalignment, in terms of surgical outcomes after foramen magnum decompression of adult Chiari malformation type I.
The electronic medical records of 273 symptomatic patients with Chiari malformation type I who were treated with foramen magnum decompression, C1 laminectomy, and duraplasty at Mayo Clinic were retrospectively reviewed. Preoperative and postoperative Neurological Scoring System scores were compared using the Friedman test. Bivariate analysis was conducted to identify the preoperative variables that correlated with the patient Chicago Chiari Outcome Scale (CCOS) scores. Multiple linear regression analysis was subsequently performed using the variables with p < 0.05 on the bivariate analysis to check for independent associations with the outcome measures. Statistical software SPSS version 25.0 was used for the data analysis. Significance was defined as p < 0.05 for all analyses.
Fifty-two adult patients with preoperative clinical and radiological data and a minimum follow-up of 12 months were included. Motor deficits, syrinx, and C1-C2 facet malalignment were found to have significant negative associations with the CCOS score at the 1- to 3-month follow-up (p < 0.05), while at the 9- to 12-month follow-up only swallowing function and C1-C2 facet malalignment were significantly associated with the CCOS score (p < 0.05). Multivariate analysis showed that syrinx presence and C1-C2 facet malalignment were independently associated with the CCOS score at the 1- to 3-month follow-up. Swallowing function and C1-C2 facet malalignment were found to be independently associated with the CCOS score at the 9- to 12-month follow-up.
The observed results in this pilot study suggest a significant negative correlation between C1-C2 facet malalignment and clinical outcomes evaluated by the CCOS score at 1-3 months and 9-12 months postoperatively. Prospective studies are needed to further validate the prognostic value of C1-C2 facet malalignment and the potential role of atlantoaxial fixation as part of the treatment.
作者评估了包括C1-C2关节面排列不齐在内的各种临床和影像学特征对成人I型Chiari畸形枕骨大孔减压术后手术结果的预后意义。
回顾性分析梅奥诊所273例接受枕骨大孔减压、C1椎板切除术和硬脑膜成形术治疗的有症状I型Chiari畸形患者的电子病历。使用Friedman检验比较术前和术后神经评分系统得分。进行双变量分析以确定与患者芝加哥Chiari结局量表（CCOS）得分相关的术前变量。随后使用双变量分析中p<0.05的变量进行多元线性回归分析，以检查与结局指标的独立关联。使用统计软件SPSS 25.0进行数据分析。所有分析的显著性定义为p<0.05。
纳入52例有术前临床和放射学数据且至少随访12个月的成年患者。发现运动功能障碍、脊髓空洞症和C1-C2关节面排列不齐在1至3个月随访时与CCOS得分有显著负相关（p<0.05），而在9至12个月随访时，仅吞咽功能和C1-C2关节面排列不齐与CCOS得分显著相关（p<0.05）。多变量分析显示，在1至3个月随访时，脊髓空洞症的存在和C1-C2关节面排列不齐与CCOS得分独立相关。在9至12个月随访时，发现吞咽功能和C1-C2关节面排列不齐与CCOS得分独立相关。
这项初步研究的观察结果表明，C1-C2关节面排列不齐与术后1-3个月和9-12个月通过CCOS评分评估的临床结果之间存在显著负相关。需要进行前瞻性研究以进一步验证C1-C2关节面排列不齐的预后价值以及寰枢椎固定作为治疗一部分的潜在作用。
