Evaniew Nathan, Burger Lukas D, Dea Nicolas, Cadotte David W, Bailey Christopher S, Christie Sean D, Fisher Charles G, Rampersaud Y Raja, Paquet Jérôme, Singh Supriya, Weber Michael H, Attabib Najmedden, Johnson Michael G, Manson Neil, Phan Philippe, Nataraj Andrew, Wilson Jefferson R, Hall Hamilton, McIntosh Greg, Jacobs W Bradley
University of Calgary Spine Program, University of Calgary, Calgary, AB, Canada.
McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
Spine (Phila Pa 1976). 2023 Mar 1;48(5):310-320. doi: 10.1097/BRS.0000000000004552. Epub 2022 Dec 1.
A Prospective cohort study.
To investigate the incidence, etiology, and outcomes of patients who experience neurological deterioration after surgery for Degenerative Cervical Myelopathy (DCM).
Postoperative neurological deterioration is one of the most undesirable complications that can occur after surgery for DCM.
We analyzed data from the Canadian Spine Outcomes and Research Network DCM prospective cohort study. We defined postoperative neurological deterioration as any decrease in modified Japanese Orthopaedic Association (mJOA) score by at least one point from baseline to three months after surgery. Adverse events were collected using the Spinal Adverse Events Severity protocol. Secondary outcomes included patient-reported pain, disability, and health-related quality of life.
Among a study cohort of 428 patients, 50 (12%) deteriorated by at least one mJOA point after surgery for DCM (21 by one point, 15 by two points, and 14 by three points or more). Significant risk factors included older age, female sex, and milder disease. Among those who deteriorated, 13 experienced contributing intraoperative or postoperative adverse events, six had alternative non-DCM diagnoses, and 31 did not have an identifiable reason for deterioration. Patients who deteriorated had significantly lower mJOA scores at one year after surgery [13.5 (SD 2.7) vs. 15.2 (SD 2.2), P <0.01 and those with larger deteriorations were less likely to recover their mJOA to at least their preoperative baseline, but most secondary measures of pain, disability, and health-related quality of life were unaffected.
The incidence of deterioration of mJOA scores after surgery for DCM was approximately one in 10, but some deteriorations were unrelated to actual spinal cord impairment and most secondary outcomes were unaffected. These findings can inform patient and surgeon expectations during shared decision-making, and they demonstrate that the interpretation of mJOA scores without clinical context can sometimes be misleading.
一项前瞻性队列研究。
调查退行性颈椎病（DCM）手术后出现神经功能恶化的患者的发病率、病因及预后。
术后神经功能恶化是DCM手术后可能发生的最不良并发症之一。
我们分析了加拿大脊柱结局与研究网络DCM前瞻性队列研究的数据。我们将术后神经功能恶化定义为从基线到术后三个月改良日本骨科协会（mJOA）评分至少降低1分。使用脊柱不良事件严重程度协议收集不良事件。次要结局包括患者报告的疼痛、残疾及健康相关生活质量。
在428例研究队列患者中，50例（12%）在DCM手术后mJOA评分至少降低1分（21例降低1分，15例降低2分，14例降低3分或更多）。显著危险因素包括年龄较大、女性及病情较轻。在病情恶化的患者中，13例经历了术中或术后导致病情恶化的不良事件，6例有其他非DCM诊断，31例没有可明确的恶化原因。病情恶化的患者术后一年mJOA评分显著更低[13.5（标准差2.7）对15.2（标准差2.2），P<0.01]，且恶化程度较大的患者mJOA评分恢复到至少术前基线的可能性较小，但疼痛、残疾及健康相关生活质量的大多数次要指标未受影响。
DCM手术后mJOA评分恶化的发生率约为十分之一，但有些恶化与实际脊髓损伤无关，且大多数次要结局未受影响。这些发现可为患者和外科医生在共同决策过程中的期望提供参考，并且表明在缺乏临床背景的情况下对mJOA评分的解读有时可能会产生误导。
