Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
World Neurosurg. 2021 Jun;150:e279-e286. doi: 10.1016/j.wneu.2021.02.130. Epub 2021 Mar 6.
To study pattern and rate of neurological functional recovery after surgery for cervical spondylotic myelopathy (CSM).
This prospective study comprised 25 patients with CSM who underwent surgical decompression at our institution. Upper limb, lower limb, and sphincter functions were assessed using the modified Japanese Orthopaedic Association score (mJOA). Assessment was done before the operation and at 1 month, 3 months, and 1 year after surgery.
The mJOA score did not significantly increase at 1 month after surgery (P = 0.051); however, increase in mJOA score was statistically significant at 3 and 1 year after surgery (P < 0.001 and P < 0.001, respectively). Upper limb motor dysfunction improved in 65% of patients, lower limb motor dysfunction improved in 52% of patients, upper limb sensory dysfunction improved in 48% of patients, and sphincter dysfunction improved in 14.2% of patients. There was a significant positive correlation between preoperative and postoperative mJOA score at 1 month, 3 months, and 1 year after surgery.
Minimal improvement occurred in the first month after CSM surgery to reach a peak at 3 months after surgery and steady improvement up to 1 year after surgery. Upper limbs recovered better and earlier than lower limbs and sphincter function. Preoperative severity of CSM is one of the main predictors of postoperative neurological outcome.
研究颈椎脊髓病(CSM)手术后神经功能恢复的模式和速度。
本前瞻性研究纳入了在我院接受手术减压的 25 例 CSM 患者。采用改良日本矫形协会评分(mJOA)评估上肢、下肢和括约肌功能。在术前以及术后 1 个月、3 个月和 1 年进行评估。
术后 1 个月时 mJOA 评分无显著增加(P=0.051);但术后 3 个月和 1 年 mJOA 评分增加具有统计学意义(P<0.001 和 P<0.001)。65%的患者上肢运动功能障碍改善,52%的患者下肢运动功能障碍改善,48%的患者上肢感觉功能障碍改善,14.2%的患者括约肌功能障碍改善。术后 1 个月、3 个月和 1 年时,术前和术后 mJOA 评分之间呈显著正相关。
CSM 手术后第一个月改善较小,在术后 3 个月达到峰值,术后 1 年持续改善。上肢比下肢和括约肌功能恢复得更好、更早。CSM 的术前严重程度是术后神经功能预后的主要预测因素之一。