Moradi Farid, Bagheri Seyed Reza, Saeidiborojeni Hamidreza, Eden Sonia V, Naderi Mobin, Hamid Shafi, Amirian Sepideh, Amiri Akram, Alimohammadi Ehsan
Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Wayne State University School of Medicine, Detroit, USA.
Musculoskelet Surg. 2023 Mar;107(1):77-83. doi: 10.1007/s12306-021-00731-w. Epub 2021 Sep 26.
Cervical spondylotic myelopathy (CSM) is a common degenerative disease that arises from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is one of the most common approaches used to treat patients with CSM. The present study aimed to evaluate predictors of poor clinical outcome in patients with CSM undergoing LPSF.
We retrospectively evaluated 157 patients with CSM who underwent LPSF at our center between April 2014 and June 2019. The neurological outcome was assessed using the modified Japanese Orthopaedic Association (mJOA) scale before the surgery and at the last follow-up visit. Based on the clinical outcomes, all patients were divided into two groups [the good group (recovery rates ≥ 75%) and the poor group (recovery rates < 75%)]. The following suggested variables as potential predictors for the poor clinical outcome were compared between the two groups:age, gender, body mass index (BMI), smoking, diabetes, number of laminectomy levels, presence of signal changes in Magnetic Resonance Imaging (MRI), duration of symptoms, preoperative JOA scale, preoperative Pavlov ratio, preoperative cervical curvature, and preoperative cervical range of motion (ROM).
There were 86 males (54.8%) and 71 females (45.2%) with the mean follow-up time of 24.96 ± 1.67 months. Overall, 114 patients (72.6%) had a good clinical outcome. However, 43 subjects (27.4%) failed to achieve a good outcome. According to the binary logistic regression analysis, age (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.87-2.63; P = 0.014) and preoperative JOA scale (OR, 3.73; 95% CI 2.96-4.87; p < 0.001) were independent predictors of poor clinical outcome.
The results of the present study showed that age and preoperative JOA scale were predictors of poor clinical outcome in patients with CSM undergoing LPSF. These findings will be of great value in preoperative counseling and management of postoperative expectations.
脊髓型颈椎病（CSM）是一种常见的退行性疾病，由脊髓受压和损伤引起。椎板切除术加后路脊柱融合术（LPSF）是治疗CSM患者最常用的方法之一。本研究旨在评估接受LPSF的CSM患者临床预后不良的预测因素。
我们回顾性评估了2014年4月至2019年6月期间在本中心接受LPSF的157例CSM患者。在手术前和最后一次随访时，使用改良日本骨科协会（mJOA）量表评估神经功能结果。根据临床结果，将所有患者分为两组[良好组（恢复率≥75%）和不良组（恢复率<75%）]。比较两组之间以下作为临床预后不良潜在预测因素的建议变量：年龄、性别、体重指数（BMI）、吸烟、糖尿病、椎板切除节段数、磁共振成像（MRI）信号改变情况、症状持续时间、术前JOA量表、术前帕夫洛夫比值、术前颈椎曲度和术前颈椎活动范围（ROM）。
共有86例男性（54.8%）和71例女性（45.2%），平均随访时间为24.96±1.67个月。总体而言，114例患者（72.6%）临床预后良好。然而，43例患者（27.4%）未取得良好预后。根据二元逻辑回归分析，年龄（比值比[OR]，2.14；95%置信区间[95%CI]，1.87 - 2.63；P = 0.014）和术前JOA量表（OR，3.73；95%CI 2.96 - 4.87；p < 0.001）是临床预后不良的独立预测因素。
本研究结果表明，年龄和术前JOA量表是接受LPSF的CSM患者临床预后不良的预测因素。这些发现对于术前咨询和术后预期管理具有重要价值。
