Dijkman Mark D, van Bilsen Martine W T, Fehlings Michael G, Bartels Ronald H M A
1Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
2Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; and.
J Neurosurg Spine. 2021 Nov 26;36(5):830-840. doi: 10.3171/2021.8.SPINE21651. Print 2022 May 1.
Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM.
A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0-18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models.
Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10-12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients.
Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.
退行性颈椎脊髓病（DCM）是导致全球脊髓功能障碍的主要原因。手术治疗被认为是改善功能预后的一种安全有效的方法，尽管随着寿命延长，关于长期功能预后的信息仍然匮乏。本研究的目的是描述DCM手术后10年的功能预后。
在一所大学附属神经外科进行了一项前瞻性观察队列研究。纳入了2008年至2010年间作为多中心国际颈椎病性脊髓病试验一部分而接受DCM手术的所有患者。在术后10年对参与者进行额外的虚拟评估。根据改良日本骨科协会（mJOA；评分0 - 18）在基线、术后1年、2年和10年时的评分评估功能预后。轻度、中度和重度脊髓病的最小临床重要差异分别定义为改善1分、2分或3分。如果2年后的稳定或改善在10年时得以维持，则认为预后是持久的。使用4分量表评估患者对手术效果的自我评估。使用描述性统计比较病情恶化与改善或保持稳定的组之间的人口统计学、临床和手术数据。使用线性混合模型比较随访期间不同时间点的功能预后。
最初纳入的42例患者中，37例参与了随访（随访失访率11.9%，应答率100%）。患者平均年龄为56.1岁，42.9%为女性。手术方式为前路（76.2%）、后路（21.4%）或后路融合（2.4%）。平均随访时间为10.8年（范围10 - 12年）。mJOA平均评分从基线时的13.1（标准差2.3）显著提高到10年时的14.2（标准差3.3）（p = .01）。54.1%的患者实现了最小临床重要差异，长期来看75.0%的患者功能状态保持稳定。病情恶化的患者年龄更大（中位数63岁对52岁，p < .01）且合并症更多（70.0%对25.9%，p < .01）。78.3%的患者自我报告手术有有益效果。
DCM的手术治疗导致功能预后得到令人满意的改善，且在10年随访时得以维持。
