Toci Gregory R, Canseco Jose A, Karamian Brian A, Chang Michael, Grasso Giovanni, Nicholson Kristen, Pflug Emily M, Russo Glenn S, Tarazona Daniel, Kaye I David, Kurd Mark F, Hilibrand Alan S, Woods Barrett I, Rihn Jeffrey A, Anderson D Greg, Radcliff Kris E, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Spine Service, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy.
J Craniovertebr Junction Spine. 2022 Jan-Mar;13(1):94-100. doi: 10.4103/jcvjs.jcvjs_165_21. Epub 2022 Mar 9.
The study design is a retrospective cohort study.
To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM).
Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements.
A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association (mJOA) scale as either mild (≥15) or moderate-to-severe (<15). Other outcomes included neck disability index (NDI), 12-item short-form survey (SF-12), and visual analog scale (VAS) for arm and neck pain. Differences in outcomes were tested by linear mixed-effects models followed by pairwise comparisons using least square means. Multiple linear regression determined whether any baseline outcomes or demographics predicted postoperative mJOA.
There were 67 patients with mild and 50 patients with moderate-to-severe myelopathy. Preoperatively, patients with moderate-to-severe myelopathy reported significantly worse outcomes compared to the mild group for NDI, Physical Component Score (PCS-12), and VAS arm ( = 0.031). While both groups experienced improvements in NDI, PCS-12, VAS Arm and Neck after surgery, only the moderate-to-severe patients achieved improved mJOA (+3.1 points, < 0.001). However, mJOA was significantly worse in the moderate-to-severe when compared to the mild group postoperatively (-1.2 points, = 0.017). Both younger age ( = 0.017, -coefficient = -0.05) and higher preoperative mJOA ( < 0.001, -coefficient = 0.37) predicted higher postoperative mJOA.
Although patients with moderate-to-severe myelopathy improved for all outcomes, they did not achieve normal absolute neurological function, indicating potential irreversible spinal cord changes. Early surgical intervention should be considered in patients with mild myelopathy if they seek to prevent progressive neurological decline over time.
本研究设计为一项回顾性队列研究。
比较脊髓型颈椎病（CSM）手术后轻度与中度至重度脊髓病患者的患者报告结局。
近期研究表明，通过患者报告结局衡量，CSM减压可改善生活质量。然而，术前脊髓病分类是否能预测术后更好的改善尚不清楚。
对2014年至2015年在单一机构接受CSM手术治疗的患者进行回顾性分析。术前脊髓病严重程度根据改良日本骨科协会（mJOA）量表分为轻度（≥15）或中度至重度（<15）。其他结局包括颈部残疾指数（NDI）、12项简短健康调查（SF - 12）以及手臂和颈部疼痛的视觉模拟量表（VAS）。通过线性混合效应模型检验结局差异，随后使用最小二乘均值进行两两比较。多元线性回归确定任何基线结局或人口统计学因素是否可预测术后mJOA。
有67例轻度脊髓病患者和50例中度至重度脊髓病患者。术前，中度至重度脊髓病患者在NDI、身体成分评分（PCS - 12）和VAS手臂评分方面的结局明显比轻度组差（P = 0.031）。虽然两组术后NDI、PCS - 12、VAS手臂和颈部评分均有改善，但只有中度至重度患者的mJOA得到改善（提高3.1分，P < 0.001）。然而，术后中度至重度患者的mJOA与轻度组相比明显更差（低1.2分，P = 0.017）。年龄较小（P = 0.017，β系数 = - 0.05）和术前mJOA较高（P < 0.001，β系数 = 0.37）均预测术后mJOA较高。
尽管中度至重度脊髓病患者在所有结局方面均有改善，但他们未达到正常的绝对神经功能，表明脊髓可能发生了不可逆变化。如果轻度脊髓病患者希望预防随着时间推移出现的进行性神经功能衰退，应考虑早期手术干预。
