Jaja Blessing N R, Witiw Christopher D, Harrington Erin M, He Yingshi, Moghaddamjou Ali, Fehlings Michael G, Wilson Jefferson R
1Neuroscience Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto.
2Department of Surgery, Division of Neurosurgery, University of Toronto.
J Neurosurg Spine. 2023 Mar 17:1-9. doi: 10.3171/2023.1.SPINE221053.
There is a need to better understand and predict postsurgical outcomes for degenerative cervical myelopathy (DCM) patients, particularly to support treatment decisions for patients with mild DCM. The goal of this study was to identify and predict outcome trajectories for DCM patients up to 2 years postsurgery.
The authors analyzed two North American multicenter prospective DCM studies (n = 757). Functional recovery and physical health component quality of life were assessed in DCM patients at baseline, 6 months, and 1 and 2 years postoperatively using the modified Japanese Orthopaedic Association (mJOA) score and Physical Component Summary (PCS) of the SF-36, respectively. Group-based trajectory modeling was used to identify recovery trajectories for mild, moderate, and severe DCM. Prediction models for recovery trajectories were developed and validated in bootstrap resamples.
Two recovery trajectories were identified for the functional and physical components of quality of life: good recovery and marginal recovery. Depending on outcome and myelopathy severity, one-half to three-fourths of the study patients followed the good recovery trajectory characterized by improvement in mJOA and PCS scores over time. The remaining one-half to one-fourth of patients followed the marginal recovery trajectory, experiencing little improvement and, in certain cases, worsening postoperatively. The prediction model for mild DCM had an area under the curve of 0.72 (95% CI 0.65-0.80), with preoperative neck pain, smoking, and posterior surgical approach noted as dominant predictors of marginal recovery.
Surgically treated DCM patients follow distinct recovery trajectories in the first 2 years postoperatively. While most patients experience substantial improvement, a significant minority experience little improvement or worsening. The ability to predict DCM patient recovery trajectories in the preoperative setting facilitates the formulation of individualized treatment recommendations for patients with mild symptoms.
有必要更好地理解和预测退行性颈椎脊髓病（DCM）患者的术后结局，特别是为轻度DCM患者的治疗决策提供支持。本研究的目的是识别和预测DCM患者术后2年内的结局轨迹。
作者分析了两项北美多中心前瞻性DCM研究（n = 757）。分别使用改良日本骨科协会（mJOA）评分和SF-36的身体成分总结（PCS），在基线、术后6个月、1年和2年时对DCM患者的功能恢复和身体健康成分生活质量进行评估。基于组的轨迹建模用于识别轻度、中度和重度DCM的恢复轨迹。在自举重采样中开发并验证了恢复轨迹的预测模型。
确定了生活质量的功能和身体成分的两种恢复轨迹：良好恢复和边缘恢复。根据结局和脊髓病严重程度，一半至四分之三的研究患者遵循良好恢复轨迹，其特征是mJOA和PCS评分随时间改善。其余四分之一至二分之一的患者遵循边缘恢复轨迹，改善很少，在某些情况下术后病情恶化。轻度DCM的预测模型曲线下面积为0.72（95%CI 0.65-0.80），术前颈部疼痛、吸烟和后路手术方式被认为是边缘恢复的主要预测因素。
手术治疗后的DCM患者在术后2年内遵循不同的恢复轨迹。虽然大多数患者有显著改善，但有相当一部分患者改善很少或病情恶化。术前预测DCM患者恢复轨迹的能力有助于为症状轻微的患者制定个性化的治疗建议。
