退行性颈椎脊髓病手术后的神经功能留存情况：一项针对195例患者的纵向研究

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients.

作者信息

Yick Victor Hin Ting, Zhang Changmeng, Wong Janus Siu Him, Ng Samuel Yan Lik, Wong Nicholas San Tung, Wang Hongfei, Koljonen Paul Aarne, Shea Graham Ka Hon

机构信息

Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.

出版信息

J Bone Joint Surg Am. 2023 Feb 1;105(3):181-190. doi: 10.2106/JBJS.22.00218. Epub 2022 Dec 2.

DOI:10.2106/JBJS.22.00218

PMID:36723463

Abstract

BACKGROUND

Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration.

METHODS

A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis.

RESULTS

The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019).

CONCLUSIONS

Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

关于退行性颈椎脊髓病（DCM）患者接受减压手术后神经功能长期存活情况的数据有限。本研究的目的是评估DCM初次减压手术后的神经功能存活情况，并确定术后病情恶化的预测因素。

方法

收集了195例在1999年至2020年间接受DCM手术患者的纵向临床数据集，包括手术细节、合并症和影像学特征，平均观察期为75.9个月。绘制了Kaplan-Meier曲线，并对与神经功能衰竭相关的因素进行单因素分析的对数秩检验。套索回归有助于在Cox比例风险模型中进行多因素分析的变量选择。

结果

5年时总体神经功能存活率为89.3%，10年时为77.3%。套索回归后的Cox多因素分析确定，缝线成形术（风险比[HR]，4.76；p < 0.001）、肾衰竭（HR，4.43；p = 0.013）、T2高信号（HR，3.34；p = 0.05）和后纵韧带骨化（OPLL）（HR，2.32；p = 0.032）的风险比升高。OPLL患者的亚组分析表明，未进行融合的患者神经功能衰竭率显著更高（77.8%比26.3%；p = 0.019）。