Zuckerman Scott L, Goldberg Jacob L, Cerpa Meghan, Vulapalli Meghana, Delgardo Mychael W, Flowers Xena E, Leskinen Sandra, Kerolus Mena G, Buchanan Ian A, Ha Alex S, Riew K Daniel
Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Global Spine J. 2025 Jan;15(1):76-83. doi: 10.1177/21925682231208083. Epub 2023 Oct 21.
Retrospective, cohort study.
Hand function can be difficult to objectively assess perioperatively. In patients undergoing cervical spine surgery by a single-surgeon, we sought to: (1) use a hand dynamometer to report pre/postoperative grip strength, (2) distinguish grip strength changes in patients with radiculopathy-only vs myelopathy, and (3) assess predictors of grip strength improvement.
Demographic and operative data were collected for patients who underwent surgery 2015-2018. Hand dynamometer readings were pre/postoperatively at three follow-up time periods (0-3 m, 3-6 m, 6-12 m).
262 patients (mean age of 59 ± 14 years; 37% female) underwent the following operations: ACDF (80%), corpectomy (25%), laminoplasty (19%), and posterior cervical fusion (7%), with 81 (31%) patients undergoing multiple operations in a single anesthetic setting. Radiculopathy-only was seen in 128 (49%) patients, and myelopathy was seen 134 (51%) patients. 110 (42%) had improved grip strength by ≥10-lbs, including 69/128 (54%) in the radiculopathy-only group, and 41/134 (31%) in the myelopathy group. Those most likely to improve grip strength were patients undergoing ACDF (OR 2.53, = .005). Patients less likely to improve grip strength were older (OR = .97, = .003) and underwent laminoplasty (OR = .44, 95% CI .23, .85, = .014). Patients undergoing surgery at the C2/3-C5/6 levels and C6/7-T1/2 levels both experienced improvement during the 0-3-month time range (C2-5: = .035, C6-T2: = .015), but only lower cervical patients experienced improvement in the 3-6-month interval ( = .030).
Grip strength significantly improved in 42% of patients. Patients with radiculopathy were more likely to improve than those with myelopathy. Patients undergoing surgery from the C2/3-C5/6 levels and the C6/7-T1/2 levels both significantly improved grip strength at 3-month postoperatively.
回顾性队列研究。
围手术期手部功能难以进行客观评估。对于由单一外科医生实施颈椎手术的患者，我们试图：（1）使用握力计报告术前/术后握力；（2）区分仅患有神经根病与脊髓病患者的握力变化；（3）评估握力改善的预测因素。
收集2015 - 2018年接受手术患者的人口统计学和手术数据。在三个随访时间段（0 - 3个月、3 - 6个月、6 - 12个月）进行术前/术后握力计读数测量。
262例患者（平均年龄59±14岁；37%为女性）接受了以下手术：前路颈椎间盘切除融合术（ACDF，80%）、椎体次全切除术（25%）、椎板成形术（19%）和后路颈椎融合术（7%），81例（31%）患者在单次麻醉下接受了多次手术。仅患有神经根病的患者有128例（49%），患有脊髓病的患者有134例（51%）。110例（42%）患者握力改善≥10磅，其中仅患有神经根病组69/128例（54%），脊髓病组41/134例（31%）。最有可能改善握力的是接受ACDF手术的患者（比值比2.53，P = .005）。握力改善可能性较小的患者年龄较大（比值比 = .97，P = .003）且接受了椎板成形术（比值比 = .44，95%置信区间.23，.85，P = .014）。在C2/3 - C5/6节段和C6/7 - T1/2节段进行手术的患者在0 - 3个月时间段内握力均有改善（C2 - 5：P = .035，C6 - T2：P = .015），但只有下颈椎节段的患者在3 - 6个月时间段内握力有改善（P = .030）。
42%的患者握力显著改善。神经根病患者比脊髓病患者更有可能改善握力。在C2/3 - C5/6节段和C6/7 - T1/2节段进行手术的患者术后3个月时握力均显著改善。
