接受严重小儿脊柱畸形手术的脊髓病患者在术后1年时神经功能可改善至非脊髓病患者的水平。
Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative.
作者信息
Cerpa Meghan, Zuckerman Scott L, Lenke Lawrence G, Kelly Michael P, Yaszay Burt, Newton Peter, Sponseller Paul, Erickson Mark, Garg Sumeet, Pahys Joshua, Samdani Amer, Cahill Patrick, McCarthy Richard, Bumpass David, Sucato Daniel, Boachie-Adjei Oheneba, Shah Suken, Gupta Munish
机构信息
Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
Department of Orthopaedics, Washington University, St. Louis, MO, USA.
出版信息
Global Spine J. 2023 Jun;13(5):1384-1393. doi: 10.1177/21925682211034837. Epub 2021 Aug 19.
STUDY DESIGN
Multi-center, prospective, observational cohort.
OBJECTIVE
To compare myelopathic vs. non-myelopathic ambulatory patients in short- and long-term neurologic function, operative treatment, and patient-reported outcomes.
METHODS
Pediatric deformity patients from 16 centers were enrolled with the following inclusion criteria: aged 10-21 years-old, a Cobb angle ≥100° in either the coronal or sagittal plane or any sized deformity with a planned 3-column osteotomy, and community ambulators. Patients were dichotomized into 2 groups: myelopathic (abnormal preoperative neurologic exam with signs/symptoms of myelopathy) and non-myelopathic (no clinical signs/symptoms of myelopathy).
RESULTS
Of 311 patients with an average age of 14.7 ± 2.8 years, 29 (9.3%) were myelopathic and 282 (90.7%) were non-myelopathic. There was no difference in age ( = 0.18), gender ( = 0.09), and Risser Stage ( = 0.06), while more patients in the non-myelopathic group had previous surgery (16.1% vs. 3.9%; = 0.03). Mean lower extremity motor score (LEMS) in myelopathic patients increased significantly compared to baseline at every postoperative visit: Baseline: 40.7 ± 9.9; Immediate postop: 46.0 ± 7.1, = 0.02; 1-year: 48.2 ± 3.7, < 0.001; 2-year: 48.2 ± 7.7, < 0.001). The non-myelopathic group had significantly higher LEMS immediately postoperative ( = 0.0007), but by 1-year postoperative, there was no difference in LEMS between groups (non-myelopathic: 49.3 ± 3.6, myelopathic: 48.2 ± 3.7, = 0.10) and was maintained at 2-years postoperative (non-myelopathic: 49.2 ± 3.3, myelopathic: 48.2 ± 5.7, = 0.09). Both groups improved significantly in all SRS domains compared to preoperative, with no difference in scores in the domains for pain ( = 0.12), self-image ( = 0.08), and satisfaction ( = 0.83) at latest follow-up.
CONCLUSION
In severe spinal deformity pediatric patients presenting with preoperative myelopathy undergoing spinal reconstructive surgery, myelopathic patients can expect significant improvement in neurologic function postoperatively. At 1-year and 2-year postoperative, neurologic function was no different between groups. While non-myelopathic patients had significantly higher postoperative outcomes in SRS mental-health, function, and total-score, both groups had significantly improved outcomes in every SRS domain compared to preoperative.
研究设计
多中心、前瞻性、观察性队列研究。
目的
比较脊髓病性与非脊髓病性门诊患者的短期和长期神经功能、手术治疗及患者报告的结局。
方法
来自16个中心的小儿脊柱畸形患者符合以下纳入标准：年龄10 - 21岁，冠状面或矢状面Cobb角≥100°，或任何大小的畸形且计划行三柱截骨术，以及社区行走者。患者被分为两组：脊髓病性（术前神经检查异常且有脊髓病体征/症状）和非脊髓病性（无脊髓病临床体征/症状）。
结果
311例患者平均年龄为14.7±2.8岁，其中29例（9.3%）为脊髓病性，282例（90.7%）为非脊髓病性。两组在年龄（P = 0.18）、性别（P = 0.09）和Risser分期（P = 0.06）方面无差异，而非脊髓病性组既往有手术史的患者更多（16.1%对3.9%；P = 0.03）。脊髓病性患者术后每次随访时的平均下肢运动评分（LEMS）与基线相比均显著增加：基线时：40.7±9.9；术后即刻：46.0±7.1，P = 0.02；1年时：48.2±3.7，P < 0.001；2年时：48.2±7.7，P < 0.001）。非脊髓病性组术后即刻的LEMS显著更高（P = 0.0007），但术后1年时，两组间的LEMS无差异（非脊髓病性组：49.3±3.6，脊髓病性组：48.2±3.7，P = 0.10），且在术后2年时保持无差异（非脊髓病性组：49.2±3.3，脊髓病性组：48.2±5.7，P = 0.09）。与术前相比，两组在所有SRS领域均有显著改善，在最新随访时疼痛（P = 0.12）、自我形象（P = 0.08）和满意度（P = 0.83）领域的评分无差异。
结论
在患有术前脊髓病的严重脊柱畸形小儿患者接受脊柱重建手术时，脊髓病性患者术后神经功能有望显著改善。术后1年和2年时，两组间神经功能无差异。虽然非脊髓病性患者在SRS心理健康、功能和总分方面的术后结局显著更高，但与术前相比，两组在每个SRS领域的结局均有显著改善。
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