Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Spine (Phila Pa 1976). 2023 Feb 15;48(4):247-252. doi: 10.1097/BRS.0000000000004508. Epub 2022 Oct 13.
Retrospective multicenter study with propensity score matching.
To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy.
In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown.
The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores.
Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate ( P =0.029) and lower postoperative arm numbness NRS score ( P =0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected.
In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.
回顾性多中心倾向评分匹配研究。
比较单节段和多节段颈椎退行性神经根病减压的临床疗效。
在患有神经根型颈椎病的患者中，体格检查结果有时与影像学数据不一致。对于多个椎间孔狭窄，可能需要进行多节段减压。额外的减压更具侵袭性，但预计可全面减压所有可疑神经根受压区域。然而，与单节段减压相比，这种方法的手术效果尚不清楚。
收集接受单纯颈椎神经根病脊柱手术的患者数据。将患者分为 C3/C4/C5/C6/C7/T1 单节段（SLDG）或多节段（MLDG）减压组。收集人口统计学数据和患者报告的结果评分，包括颈椎障碍指数（NDI）和颈部、上背部和手臂疼痛和麻木的数字评定量表（NRS）评分。术后一年进行患者报告的结果评估，分析 NDI 改善率和 NRS 评分的变化。通过倾向评分匹配，调整基线特征（包括术前 NDI 和 NRS 评分）后，比较两组。
在这项研究的 357 名患者中，SLDG 和 MLDG 分别有 231 名和 126 名患者。通过倾向评分匹配创建了两组（每组 112 名）。与 MLDG 相比，SLDG 术后 NDI 改善率更高（P=0.029），手臂麻木 NRS 评分更低（P=0.037）。其他结果在 SLDG 中似乎优于 MLDG，但未检测到统计学意义。
在患有神经根型颈椎病的患者中，SLDG 的手术效果在临床结果改善方面优于 MLDG。接受多节段减压的患者在远端（手臂）而不是中央（颈部和上背部）区域仍存在麻木。
