一种治疗多节段退行性颈椎病的算法后路手术方法：一项多中心前瞻性研究。
An Algorithmic Posterior Approach to the Treatment of Multilevel Degenerative Cervical Spine Disease: A Multicenter Prospective Study.
作者信息
Byvaltsev Vadim A, Kalinin Andrei A, Belykh Eugenii G, Aliyev Marat A, Shepelev Valerii V, Biryuchkov Mikhail Y, Yusupov Bobur R, Aglakov Bakhyt M, Daniel Riew K
机构信息
Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
出版信息
Int J Spine Surg. 2022 Aug;16(5):890-898. doi: 10.14444/8341. Epub 2022 Aug 31.
BACKGROUND
The choice of surgical method for the treatment of multilevel degenerative cervical spine disease is based on the assessment of neurological symptoms and anatomical source of compression. However, such decision-making process remains complex and poorly defined.
PURPOSE
To analyze the effectiveness of an algorithmic posterior approach to the surgical treatment of patients with multilevel degenerative disease of the cervical spine based on the preoperative clinical and imaging parameters.
STUDY DESIGN
Prospective nonrandomized multicenter cohort study.
METHODS
The study included 338 patients with multilevel degenerative disease of the cervical spine. Two groups of patients were evaluated at 3 neurosurgical centers between 2015 and 2019. The prospective group (Group I, = 214) consisted of patients who were treated using an algorithm to decide whether they should be treated with an instrumented arthrodesis or a nonfusion procedure. The control group (Group II, = 124) consisted of patients who underwent posterior decompression with or without stabilization between 2007 and 2014. A total of 192 patients in Group I and 112 in Group II had more than 2 years of follow-up. Visual analog scale (VAS) neck pain, Neck Disability Index (NDI), MacNab and Nurick Scales were collected. Perioperative complications were identified.
RESULTS
At 2-year follow-up, Group I had significantly better clinical outcomes based on VAS neck pain score ( = 0.02), NDI score ( = 0.01), satisfaction with surgery on the MacNab Scale ( < 0.001), and outcome of surgery based on the Nurick Scale ( < 0.001). Complication rate was lower in Group I, 5.7% compared with 34.8% in Group II, = 0.004.
CONCLUSIONS
The algorithmic posterior approach to the surgical treatment of patients with multilevel degenerative disease of the cervical spine resulted in significant improvement of functional outcomes and a decrease in complications at a minimum 2 years of follow-up.
背景
治疗多节段退变性颈椎疾病的手术方法选择基于对神经症状和压迫解剖来源的评估。然而，这种决策过程仍然复杂且定义不明确。
目的
基于术前临床和影像学参数，分析一种算法化后路手术方法治疗多节段退变性颈椎疾病患者的有效性。
研究设计
前瞻性非随机多中心队列研究。
方法
该研究纳入了338例多节段退变性颈椎疾病患者。2015年至2019年期间，在3个神经外科中心对两组患者进行了评估。前瞻性组（第一组，n = 214）由使用一种算法来决定是接受器械辅助融合术还是非融合手术治疗的患者组成。对照组（第二组，n = 124）由2007年至2014年期间接受后路减压并伴有或不伴有稳定手术的患者组成。第一组共有192例患者和第二组112例患者进行了超过2年的随访。收集了视觉模拟量表（VAS）颈部疼痛评分、颈部功能障碍指数（NDI）、MacNab和Nurick量表。确定围手术期并发症。
结果
在2年随访时，基于VAS颈部疼痛评分（P = 0.02）、NDI评分（P = 0.01）、MacNab量表对手术的满意度（P < 0.001）以及基于Nurick量表的手术结果（P < 0.001），第一组的临床结果明显更好。第一组的并发症发生率较低，为5.7%，而第二组为34.8%，P = 0.004。
结论
算法化后路手术方法治疗多节段退变性颈椎疾病患者，在至少2年的随访中，功能结果有显著改善，并发症减少。
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