Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Orthopedic Surgery, Shimada Hospital, Habikino, Japan.
Spine (Phila Pa 1976). 2023 Oct 1;48(19):1365-1372. doi: 10.1097/BRS.0000000000004764. Epub 2023 Jun 28.
Prospective cohort study.
To identify the effects of multidisciplinary approaches (MAs) to improve social functioning (SF) on 1-year surgical outcomes in patients with cervical myelopathy.
Despite significant improvement in cervical myelopathy, a patient's quality of life (QOL) sometimes does not improve postoperatively. A previous study revealed that SF, rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy.
This study compared two prospective cohorts in Japan. Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the MA cohort. Patients in the control cohort were treated with a standard care protocol, and those in the MA cohort were treated with a multidisciplinary protocol that focused on SF improvement. The changes in the total Japanese Orthopedic Association (JOA) score and in the domains of the JOA scores (upper limb function, lower limb function, upper limb sensory, and lower limb sensory) from preoperatively to 1 year postoperatively were compared between the control and MA cohorts using a mixed-effect model.
The control and MA cohorts comprised 140 and 31 patients, respectively. The improvement in the JOA score was significantly better in the MA cohort than in the control cohort ( P = 0.040). In analyses of each JOA score domain, the improvement of upper limb function was significantly better in the MA cohort than in the control cohort ( P = 0.033). Similarly, the MA cohort demonstrated significantly higher patient-reported outcomes for upper extremity function than the control cohort ( P < 0.001). In addition, the self-care domain of QOL score at 1 year postoperatively was significantly higher in the MA cohort than in the control cohort ( P = 0.047).
MAs to improve/rebuild a patient's SF were effective in improving cervical myelopathy and the self-care domain of QOL. This study is the first to demonstrate the effectiveness of postoperative MAs in patients with cervical myelopathy.
Level 3.
前瞻性队列研究。
确定多学科方法（MA）对改善颈椎脊髓病患者社会功能（SF）对 1 年手术结果的影响。
尽管颈椎脊髓病有显著改善，但患者的生活质量（QOL）有时术后不会提高。先前的研究表明，SF 而不是脊髓病的严重程度与颈椎脊髓病减压手术后 QOL 的改善相关。
本研究在日本比较了两个前瞻性队列。2018 年至 2020 年因颈椎脊髓病接受颈椎板切除术的患者被纳入对照组。2020 年至 2021 年期间因相同适应症接受相同手术的患者被纳入 MA 队列。对照组患者接受标准护理方案，MA 队列患者接受注重 SF 改善的多学科方案治疗。使用混合效应模型比较对照组和 MA 队列从术前到术后 1 年的总日本矫形协会（JOA）评分和 JOA 评分（上肢功能、下肢功能、上肢感觉和下肢感觉）各领域的变化。
对照组和 MA 队列分别包括 140 例和 31 例患者。MA 队列的 JOA 评分改善明显优于对照组（P=0.040）。在每个 JOA 评分领域的分析中，MA 队列上肢功能的改善明显优于对照组（P=0.033）。同样，MA 队列患者上肢功能的报告结果明显优于对照组（P<0.001）。此外，MA 队列术后 1 年的生活质量自我护理领域评分明显高于对照组（P=0.047）。
改善/重建患者 SF 的 MA 方法对改善颈椎脊髓病和生活质量的自我护理领域有效。本研究首次证明了颈椎脊髓病患者术后 MA 的有效性。
3 级。
