Lambrechts Mark J, Toci Gregory R, Karamian Brian A, Siniakowicz Claudia, Canseco Jose A, Woods Barrett I, Hilibrand Alan S, Schroeder Gregory D, Vaccaro Alexander R, Kepler Christopher K
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Spine (Phila Pa 1976). 2023 Mar 1;48(5):321-329. doi: 10.1097/BRS.0000000000004518. Epub 2022 Nov 4.
Retrospective cohort study.
To determine if myelopathy severity predicted the magnitude of improvement in health-related quality of life metrics following anterior cervical discectomy and fusion (ACDF).
Surgery for myelopathy is primarily performed to halt disease progression. However, it is still controversial if these patients can expect significant health-related quality-of life improvements following ACDF. We explore the relationship between modified Japanese Orthopaedic Association (mJOA) improvements and its effect on other health-related quality-of life metrics.
Patients undergoing ACDF for myelopathy were grouped based on preoperative mJOA scores into mild (15-17), moderate (12-14), and severe (<12) groups. Patients were subsequently categorized based on if they attained the minimum clinically detectable improvement (MCID) threshold for mJOA. Multivariate linear regression was performed to determine the magnitude of improvement in ∆patient-reported outcome measures.
A total of 374 patients were identified for inclusion. Of those, 169 (45.2%) had mild myelopathy, 125 (33.4%) had moderate, and 80 (21.4%) had severe myelopathy. Only the moderate and severe groups had significant improvements in mJOA following surgery (mild: P =0.073, moderate: P <0.001, severe: P <0.001). There were no significant differences in the magnitude of improvement for any patient-reported outcome measure based on myelopathy severity, except for mJOA (mild: 0.27, moderate: 1.88, severe: 3.91; P <0.001). Patients meeting the MCID for mJOA had better ∆Short-Form 12 Mental Component Score (3.29 vs. -0.21, P =0.007), ∆Short-Form 12 Physical Component Score (6.82 vs. 1.96, P <0.001), ∆Visual Analog Scale Neck (-3.11 vs. -2.17, P =0.001), ∆Visual Analog Scale Arm (-2.92 vs. -1.48, P <0.001), ∆Neck Disability Index (-18.35 vs. -7.86, P <0.001), and ∆mJOA (3.38 vs. -0.56, P <0.001) compared with patients who did not.
Worse baseline myelopathy severity predicts worse postoperative outcomes. However, baseline myelopathy severity is not predictive of the magnitude of postoperative improvement with the exception of mJOA. Patients who attain MCID improvement in mJOA had greater postoperative improvement for other health-related quality of life metrics.
回顾性队列研究。
确定脊髓病严重程度是否能预测颈椎前路椎间盘切除融合术（ACDF）后健康相关生活质量指标的改善程度。
脊髓病手术主要是为了阻止疾病进展。然而，这些患者在ACDF术后能否期望健康相关生活质量得到显著改善仍存在争议。我们探讨了改良日本骨科协会（mJOA）评分改善情况及其对其他健康相关生活质量指标的影响。
因脊髓病接受ACDF手术的患者根据术前mJOA评分分为轻度（15 - 17分）、中度（12 - 14分）和重度（<12分）组。随后根据患者是否达到mJOA的最小临床可检测改善（MCID）阈值进行分类。进行多变量线性回归以确定患者报告结局指标的改善程度。
共纳入374例患者。其中，169例（45.2%）患有轻度脊髓病，125例（33.4%）患有中度脊髓病，80例（21.4%）患有重度脊髓病。仅中度和重度组术后mJOA评分有显著改善（轻度：P = 0.073，中度：P < 0.001，重度：P < 0.001）。除mJOA外，基于脊髓病严重程度的任何患者报告结局指标的改善程度均无显著差异（轻度：0.27，中度：1.88，重度：3.91；P < 0.001）。达到mJOA的MCID的患者在简明健康调查12项量表精神健康分量表（3.29对 - 0.21，P = 0.007）、简明健康调查12项量表生理健康分量表（6.82对1.96，P < 0.001）、视觉模拟评分法颈部评分（ - 3.11对 - 2.17，P = 0.001）、视觉模拟评分法手臂评分（ - 2.92对 - 1.48，P < 0.001）、颈部残疾指数（ - 18.35对 - 7.86，P < 0.001）和mJOA评分（3.38对 - 0.56，P < 0.001）方面的改善程度优于未达到的患者。
基线脊髓病严重程度越差，术后结局越差。然而，除mJOA外，基线脊髓病严重程度不能预测术后改善程度。达到mJOA MCID改善的患者在其他健康相关生活质量指标方面术后改善更大。
