Soufi Khadija H, Perez Tess M, Umoye Alexis O, Yang Jamie, Burgos Maria, Martin Allan R
Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA.
J Clin Med. 2022 Mar 5;11(5):1441. doi: 10.3390/jcm11051441.
Degenerative cervical myelopathy (DCM) is a prevalent condition in which spinal degeneration causes cord compression and neurological dysfunction. The spinal cord is anatomically complex and operates in conjunction with the brain, the musculoskeletal system, and numerous organs to control numerous functions, including simple and coordinated movement, sensation, and autonomic functions. As a result, accurate and comprehensive measurement of spinal cord function in patients with DCM and other spinal pathologies is challenging. This project aimed to summarize the neurological, functional, and quality of life (QoL) outcome measures currently in use to quantify impairment in DCM. A systematic review of the literature was performed to identify prospective studies with at least 100 DCM subjects that utilized one or more quantitative neurological, functional, or QoL outcome measures. A total of 148 studies were identified. The most commonly used instruments were subjective functional scales including the Japanese Orthopedic Association (JOA) (71 studies), modified JOA (mJOA) (66 studies), Neck Disability Index (NDI) (54 studies), and Nurick (39 studies), in addition to the QoL measure Short-Form-36 (SF-36, 52 studies). A total of 92% (320/349) of all outcome measures were questionnaires, whereas objective physical testing of neurological function (strength, gait, balance, dexterity, or sensation) made up 8% (29/349). Studies utilized an average of 2.36 outcomes measures, while 58 studies (39%) utilized only a single outcome measure. No studies were identified that specifically assessed the dorsal column sensory pathway or respiratory, bowel, or sexual function. In the past five years, there were no significant differences in the number of total, functional, or QoL outcome measures used, but physical testing of neurological function has increased ( = 0.005). Prior to 2017, cervical spondylotic myelopathy (CSM) was the most frequently used term to describe the study population, whereas in the last five years, DCM has become the preferred terminology. In conclusion, clinical studies of DCM typically utilize limited data to characterize impairment, often relying on subjective, simplistic, and non-specific measures that do not reflect the complexity of the spinal cord. Although accurate measurement of impairment in DCM is challenging, it is necessary for early diagnosis, monitoring for deterioration, and quantifying recovery after therapeutic interventions. Clinical decision-making and future clinical studies in DCM should employ a combination of subjective and objective assessments to capture the multitude of spinal cord functions to improve clinical management and inform practice guidelines.
退行性颈椎脊髓病（DCM）是一种常见病症，其中脊髓退变导致脊髓受压和神经功能障碍。脊髓在解剖学上很复杂，与大脑、肌肉骨骼系统以及众多器官协同运作，以控制多种功能，包括简单和协调的运动、感觉及自主功能。因此，准确全面地测量DCM及其他脊柱疾病患者的脊髓功能具有挑战性。本项目旨在总结目前用于量化DCM损伤的神经学、功能和生活质量（QoL）结局指标。对文献进行了系统回顾，以确定至少有100名DCM受试者的前瞻性研究，这些研究使用了一种或多种定量神经学、功能或QoL结局指标。共识别出148项研究。最常用的工具是主观功能量表，包括日本骨科协会（JOA）（71项研究）、改良JOA（mJOA）（66项研究）、颈部残疾指数（NDI）（54项研究）和努里克量表（39项研究），此外还有生活质量测量工具简明健康调查问卷（SF - 36，52项研究）。所有结局指标中，共有92%（320/349）是问卷，而神经功能的客观体格检查（力量、步态、平衡、灵活性或感觉）占8%（29/349）。研究平均使用2.36种结局指标，而58项研究（39%）仅使用单一结局指标。未发现专门评估脊髓后索感觉通路或呼吸、肠道或性功能的研究。在过去五年中，使用的总结局指标、功能结局指标或QoL结局指标数量没有显著差异，但神经功能的体格检查有所增加（ = 0.005）。2017年之前，脊髓型颈椎病（CSM）是描述研究人群最常用的术语，而在过去五年中，DCM已成为首选术语。总之，DCM的临床研究通常利用有限的数据来描述损伤情况，常常依赖主观、简单和非特异性的指标，这些指标无法反映脊髓的复杂性。尽管准确测量DCM损伤具有挑战性，但对于早期诊断、监测病情恶化以及量化治疗干预后的恢复情况是必要的。DCM的临床决策和未来临床研究应采用主观和客观评估相结合的方法，以涵盖多种脊髓功能，改善临床管理并为实践指南提供依据。
