颈椎脊髓病延迟手术治疗≥ 12 个月与术后转归恶化相关：质量结果数据库的多中心分析。

Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database.

机构信息

1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.

2Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.

出版信息

J Neurosurg Spine. 2021 Nov 5;36(4):568-574. doi: 10.3171/2021.7.SPINE21590. Print 2022 Apr 1.

DOI:10.3171/2021.7.SPINE21590

PMID:34740180

Abstract

OBJECTIVE

Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes.

METHODS

Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes.

RESULTS

In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05).

CONCLUSIONS

Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.

摘要

目的

退行性颈椎病（DCM）会导致严重的发病率。手术干预前症状的持续时间可能与术后手术结果和功能恢复有关。作者的目的是研究 DCM 的延迟手术治疗是否与术后结果恶化有关。

方法

对来自 14 个手术中心的 1036 例患者的质量结果数据库中的数据进行了分析。评估了基线人口统计学特征和术前及术后症状评估的结果，包括症状持续时间。术后功能结果使用颈部残疾指数（NDI）和改良日本矫形协会（mJOA）量表进行测量。将症状持续时间分为<12 个月和≥12 个月。使用单变量和多变量回归来评估症状持续时间与术后结果之间的关系。

结果

在这项研究中，513 例患者（49.5%）的症状持续时间<12 个月，523 例（50.5%）的症状持续时间为 12 个月或更长。症状持续时间较长的患者 BMI 更高，焦虑症和糖尿病的患病率更高（均 p <0.05）。症状持续时间≥12 个月与较高的平均基线 NDI 评分相关（41 与 36，p <0.01）。然而，在 3 个月（p = 0.77）或 12 个月（p = 0.51）时，两组的 NDI 评分从基线的改善无显著差异。同样，作者发现两组之间从基线到 3 个月或 12 个月 mJOA 评分的变化无显著差异（均 p >0.05）。