脊柱旁肌减少症与退行性颈椎脊髓病患者行椎板成形术后的患者报告结局恶化相关。
Paraspinal Sarcopenia is Associated With Worse Patient-Reported Outcomes Following Laminoplasty for Degenerative Cervical Myelopathy.
机构信息
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
出版信息
Spine (Phila Pa 1976). 2023 Jun 1;48(11):772-781. doi: 10.1097/BRS.0000000000004650. Epub 2023 Mar 27.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following cervical laminoplasty.
BACKGROUND
While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following laminoplasty has not been investigated.
METHODS
We performed a retrospective review of patients undergoing laminoplasty from C4-6 at a single institution between 2010 and 2021. Two independent reviewers utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral transversospinales muscle group at the C5-6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups.
RESULTS
We identified 114 patients for inclusion in this study, including 35 patients with mild sarcopenia, 49 patients with moderate sarcopenia, and 30 patients with severe sarcopenia. There were no differences in preoperative PROMs between subgroups. Mean postoperative neck disability index scores were lower in the mild and moderate sarcopenia subgroups (6.2 and 9.1, respectively) than in the severe sarcopenia subgroup (12.9, P =0.01). Patients with mild sarcopenia were nearly twice as likely to achieve minimal clinically important difference (88.6 vs. 53.5%; P <0.001) and six times as likely to achieve SCB (82.9 vs. 13.3%; P =0.006) compared with patients with severe sarcopenia. A higher percentage of patients with severe sarcopenia reported postoperative worsening of their neck disability index (13 patients, 43.3%; P =0.002) and Visual Analog Scale Arm scores (10 patients, 33.3%; P =0.03).
CONCLUSION
Patients with severe paraspinal sarcopenia demonstrate less improvement in neck disability and pain postoperatively and are more likely to report worsening PROMs following laminoplasty.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究首次评估了颈椎板成形术后脊柱旁肌肉减少症对患者报告的结果测量（PROM）的影响。
背景
虽然肌肉减少症对腰椎手术后 PROM 的影响已得到充分证实，但脊柱旁肌肉减少症对板成形术后 PROM 的影响尚未得到研究。
方法
我们对 2010 年至 2021 年期间在一家机构接受 C4-6 颈椎板成形术的患者进行了回顾性审查。两位独立的审查员利用 T2 加权磁共振成像序列的轴向切片来评估双侧横突间肌群在 C5-6 水平的脂肪浸润，并根据 Fuchs 改良的 Goutalier 分级系统对患者进行分类。然后比较亚组之间的 PROM。
结果
我们共纳入了 114 名患者，其中 35 名患者有轻度肌肉减少症，49 名患者有中度肌肉减少症，30 名患者有重度肌肉减少症。各组间术前 PROM 无差异。轻度和中度肌肉减少症亚组的平均术后颈部残疾指数评分（分别为 6.2 和 9.1）低于重度肌肉减少症亚组（12.9，P=0.01）。轻度肌肉减少症患者实现最小临床重要差异的可能性几乎是重度肌肉减少症患者的两倍（88.6%比 53.5%；P<0.001），达到 SCB 的可能性是重度肌肉减少症患者的六倍（82.9%比 13.3%；P=0.006）。重度肌肉减少症患者中有 13 名（43.3%）报告术后颈部残疾指数和视觉模拟量表手臂评分恶化（P=0.002），高于轻度肌肉减少症患者。
结论
严重脊柱旁肌肉减少症患者术后颈部残疾和疼痛改善较少，更有可能报告板成形术后 PROM 恶化。
证据等级
3。
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