Davies Benjamin M, Nourallah Basil, Venkatesh Ashwin, Ali Ahmad M S, Guilfoyle Mathew, Francis Jibin, Kotter Mark R N, Laing Rodney J C
Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK.
WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.
Br J Neurosurg. 2023 Oct;37(5):1018-1022. doi: 10.1080/02688697.2020.1839741. Epub 2020 Nov 10.
Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compression and consequent injury of the cervical spinal cord. Stratification of CSM severity has been useful to inform clinical practice and research analysis. In the UK the Myelopathy Disability Index (MDI) is a popular assessment tool and has been adopted by the British Spinal Registry. However, no categories of severity exist. Therefore, the aim of this study was to define categories of mild, moderate and severe.
An anchor-based analysis was carried out on previously collected data from a prospective observational cohort ( = 404) of patients with CSM scheduled for surgery and assessed pre-operatively and at 3, 12, 24 and 60 months post-operatively. Outcomes collected included the SF-36 version-1 quality of life measure, visual analogue scales for neck/arm/hand pain, MDI and Neck Disability Index (NDI). A Receiver Operating Curve (ROC) analysis, using the NDI for an anchor-based approach, was performed to identify MDI thresholds.
Complete data was available for 404 patients (219 Men, 185 Women). The majority of patients underwent anterior surgery (284, 70.3%). ROC curves plotted to identify the thresholds from mild to moderate to severe disease, selected optimal thresholds of 4-5 (AUC 0.83) and 8-9 (AUC 0.87). These MDI categories were validated against domains of the SF36 and VAS scores with expected positive linear correlations.
Categories of mild, moderate and severe CSM according to the MDI of 4-5 and 8-9 were established based on the NDI.
脊髓型颈椎病（CSM）是一种因颈椎关节炎性压迫及随后脊髓损伤导致的致残性疾病。对CSM严重程度进行分层有助于指导临床实践和研究分析。在英国，脊髓病残疾指数（MDI）是一种常用的评估工具，并已被英国脊柱注册中心采用。然而，目前尚无严重程度分类。因此，本研究的目的是定义轻度、中度和重度的类别。
对先前从一个前瞻性观察队列（n = 404）收集的数据进行基于锚定的分析，该队列中的CSM患者计划接受手术，并在术前以及术后3、12、24和60个月进行评估。收集的结果包括SF-36第1版生活质量测量、颈部/手臂/手部疼痛视觉模拟量表、MDI和颈部残疾指数（NDI）。使用NDI进行基于锚定方法的受试者工作特征曲线（ROC）分析，以确定MDI阈值。
404例患者（219例男性，185例女性）有完整数据。大多数患者接受了前路手术（284例，70.3%）。绘制ROC曲线以确定从轻度到中度再到重度疾病的阈值，选择的最佳阈值为4 - 5（AUC 0.83）和8 - 9（AUC 0.87）。这些MDI类别通过SF36各领域和VAS评分进行验证，具有预期的正线性相关性。
基于NDI建立了根据MDI分为4 - 5和8 - 9的轻度、中度和重度CSM类别。
