Özkan Neriman, Chihi Mehdi, Schoemberg Tobias, Dinger Thiemo Florin, Helsper Moritz, Parlak Ahmet, Jabbarli Ramazan, Ahmadipour Yahya, Sure Ulrich, El Hindy Nicolai, Gembruch Oliver
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
Spine-Center Werne, Katholisches Klinikum Lünen/Werne GmbH St. Christophorus-Krankenhaus, Am See 1, Werne, Germany.
Eur Spine J. 2022 Feb;31(2):327-333. doi: 10.1007/s00586-021-07060-3. Epub 2021 Nov 25.
Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery.
A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome.
In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score.
Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.
退行性颈椎脊髓病（DCM）是脊髓功能障碍最常见的非创伤性病因。预测手术后的神经功能结局很重要。本研究的目的是分析DCM的首发症状与手术后神经功能结局之间的关系。
进行了为期10年的回顾性分析。评估了诸如颈臂神经痛、感觉和运动障碍以及步态障碍等首发症状与术后神经功能结局的关系。采用改良日本骨科协会评分（mJOA评分）评估神经功能结局。
共纳入411例患者（263例男性，占64%），中位年龄为62.6±12.1岁。首发症状中，40.2%为颈臂神经痛，31.6%为步态障碍，19%为感觉障碍，9.2%为运动障碍。颈臂神经痛患者明显比步态障碍患者年轻（中位年龄58岁，p = 0.0005）（步态障碍患者中位年龄68岁，p = 0.0005）。首发症状为步态障碍和运动障碍的患者mJOA评分显著低于其他患者（p = 0.0005）。此外，根据mJOA评分，运动障碍和步态障碍是术后结局的负性预测因素。
运动障碍和步态障碍作为DCM的首发症状是术后神经功能结局的负性预测因素。然而，尽管术前mJOA评分较差，但有运动障碍和步态障碍的患者仍能从手术治疗中显著获益。
