Iwamae Masayoshi, Tamai Koji, Suzuki Akinobu, Terai Hidetomi, Hoshino Masatoshi, Kato Minori, Toyoda Hiromitsu, Takahashi Shinji, Yabu Akito, Sawada Yuta, Nakamura Hiroaki
Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine.
Department of Orthopedic Surgery, Osaka City General Hospital, Osaka.
Clin Spine Surg. 2024 Oct 1;37(8):E364-E370. doi: 10.1097/BSD.0000000000001585. Epub 2024 Feb 16.
A retrospective cohort study.
The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles.
The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous.
Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis.
In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age ( R =-0.358, P =0.002), preoperative JOA score ( R =0.286, P =0.021), preoperative PCS ( R =0.603, P <0.001), C2-C7 lordotic angle ( R =-0.284, P =0.017), stenosis severity ( R =-0.271, P =0.019), and Goutallier classification at the C7 level ( R =-0.268, P =0.021). In multiple linear regression analysis, sex (β=-0.334, P =0.002), age (β=-0.299, P =0.013), preoperative PCS (β=0.356, P =0.009), and Goutallier classification at the C7 level (β=-0.280, P =0.018) were significantly related to 2-year postoperative PCS.
Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty.
Level III.
一项回顾性队列研究。
本研究旨在调查退行性颈椎脊髓病（DCM）行颈椎椎板成形术后2年影响身体活动相关生活质量（QOL）的相关因素，重点关注术前颈多裂肌退变程度。
脊柱手术后椎旁肌退变与临床结局之间的关联正在研究中。颈椎椎板成形术患者术前颈多裂肌退变的影响尚不明确。
回顾性分析行DCM椎板成形术并随访超过2年的患者。为评估身体生活质量，术后2年记录36项简明健康调查问卷（SF - 36）的身体成分总结（PCS）得分。根据Goutallier分级系统对轴向T2加权磁共振成像（MRI）上C4和C7水平多裂肌的术前退变程度进行分类。分析术后2年PCS与各术前临床结局、影像学参数及MRI表现（包括Goutallier分级）之间的相关性。单因素分析中P值<0.10的变量纳入多元线性回归分析。
共纳入106例连续患者。术后2年PCS与年龄（R = - 0.358，P = 0.002）、术前JOA评分（R = 0.286，P = 0.021）、术前PCS（R = 0.603，P < 0.001）、C2 - C7前凸角（R = - 0.284，P = 0.017）、狭窄严重程度（R = - 0.271，P = 0.019）及C7水平的Goutallier分级（R = - 0.268，P = 0.021）显著相关。多元线性回归分析中，性别（β = - 0.334，P = 0.002）、年龄（β = - 0.299，P = 0.013）术前PCS（β = 0.356，P = 0.009）及C7水平的Goutallier分级（β = - 0.280，P = 0.018）与术后2年PCS显著相关。
C7水平多裂肌退变加重对术后身体活动相关生活质量产生负面影响。这些结果可为脊柱外科医生预测DCM患者椎板成形术后身体活动相关生活质量提供指导。
III级。
