Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada.
University of Calgary Combined Spine Program, Departments of Neuroscience, Neurosurgery and Radiology, Hotchkiss Brain Institute,, Calgary, Canada.
Neurosurgery. 2021 Oct 13;89(5):844-851. doi: 10.1093/neuros/nyab295.
BACKGROUND: Conflicting evidence exists regarding the effectiveness of surgery for degenerative cervical myelopathy (DCM), particularly in mild DCM. OBJECTIVE: To prospectively evaluate the impact of surgery on patient-reported outcomes in patients with mild (modified Japanese Orthopaedic Association [mJOA] ≥ 15), moderate (mJOA 12-14), and severe (mJOA < 12) DCM. METHODS: Prospective, multicenter cohort study of patients with DCM who underwent surgery between 2015 and 2019 and completed 1-yr follow-up. Outcome measures (mJOA, Neck Disability Index [NDI], EuroQol-5D [EQ-5D], Short Form [SF-12] Physical Component Score [PCS]/Mental Component Score [MCS], numeric rating scale [NRS] neck, and arm pain) were assessed at 3 and 12 mo postoperatively and compared to baseline, stratified by DCM severity. Changes in outcome measures that were statistically significant (P < .05) and met their respective minimum clinically important differences (MCIDs) were deemed clinically meaningful. Responder analysis was performed to compare the proportion of patients between DCM severity groups who met the MCID for each outcome measure. RESULTS: The cohort comprised 391 patients: 110 mild, 163 moderate, and 118 severe. At 12 mo after surgery, severe DCM patients experienced significant improvements in all outcome measures; moderate DCM patients improved in mJOA, NDI, EQ-5D, and PCS; mild DCM patients improved in EQ-5D and PCS. There was no significant difference between severity groups in the proportion of patients reaching MCID at 12 mo after surgery for any outcome measure, except NDI. CONCLUSION: At 12 mo after surgery, patients with mild, moderate, and severe DCM all demonstrated improved outcomes. Severe DCM patients experienced the greatest breadth of improvement, but the proportion of patients in each severity group achieving clinically meaningful changes did not differ significantly across most outcome measures.
背景:关于手术治疗退行性颈椎脊髓病(DCM)的疗效存在相互矛盾的证据,特别是在轻度 DCM 中。
目的:前瞻性评估手术对轻度(改良日本骨科协会[mJOA]≥15)、中度(mJOA 12-14)和重度(mJOA<12)DCM 患者的报告结局的影响。
方法:这是一项在 2015 年至 2019 年间接受手术并完成 1 年随访的 DCM 患者的前瞻性、多中心队列研究。在术后 3 个月和 12 个月时评估 mJOA、颈部残疾指数(NDI)、欧洲五维健康量表(EQ-5D)、SF-12 生理成分评分(PCS)/心理成分评分(MCS)、数字评分量表(NRS)颈部和手臂疼痛等结局指标,并与基线进行比较,按 DCM 严重程度进行分层。统计学上有显著差异(P<0.05)且达到各自最小临床重要差异(MCID)的结局指标的变化被认为具有临床意义。进行应答者分析以比较每个结局指标的 DCM 严重程度组之间达到 MCID 的患者比例。
结果:该队列纳入 391 例患者:110 例轻度、163 例中度和 118 例重度。术后 12 个月,重度 DCM 患者在所有结局指标上均有显著改善;中度 DCM 患者在 mJOA、NDI、EQ-5D 和 PCS 上有改善;轻度 DCM 患者在 EQ-5D 和 PCS 上有改善。除 NDI 外,在术后 12 个月时,各严重程度组患者达到 MCID 的比例在任何结局指标上均无显著差异。
结论:术后 12 个月,轻度、中度和重度 DCM 患者的结局均有改善。重度 DCM 患者的改善幅度最大,但在大多数结局指标上,每个严重程度组中达到临床显著改善的患者比例并无显著差异。
Spine (Phila Pa 1976). 2018-8
Spine (Phila Pa 1976). 2018-8