Partha Sarathi Celine Iswarya, Sinha Amil, Rafati Fard Amir, Bhatti Faheem, Rujeedawa Tanzil, Ahmed Shahzaib, Akhbari Melika, Bhatti Aniqah, Nouri Aria, Kotter Mark R, Davies Benjamin M, Mowforth Oliver D
Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Front Neurol. 2024 Feb 5;15:1301003. doi: 10.3389/fneur.2024.1301003. eCollection 2024.
Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury. The objective was therefore to synthesise current evidence on the effect of metabolism on DCM susceptibility, severity, and surgical outcomes.
A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English, with a focus on DCM and metabolism, including diabetes, cardiovascular disease, anaemia, and lipid profile, were eligible for inclusion. Risk of methodological bias was assessed using the Joanna Briggs Institute (JBI) critical assessment tools. Quality assessments were performed using the GRADE assessment tool. Patient demographics, metabolic factors and the relationships between metabolism and spinal cord disease, spinal column disease and post-operative outcomes were assessed.
In total, 8,523 papers were identified, of which 57 met criteria for inclusion in the final analysis. A total of 91% (52/57) of included papers assessed the effects of diabetes in relation to DCM, of which 85% (44/52) reported an association with poor surgical outcomes; 42% of papers (24/57) discussed the association between cardiovascular health and DCM, of which 88% (21/24) reported a significant association. Overall, DCM patients with diabetes or cardiovascular disease experienced greater perioperative morbidity and poorer neurological recovery. They were also more likely to have comorbidities such as obesity and hyperlipidaemia.
Metabolic factors appear to be associated with surgical outcomes in DCM. However, evidence for a more specific role in DCM susceptibility and severity is uncertain. The pathophysiology and natural history of DCM are critical research priorities; the role of metabolism is therefore a key area for future research focus.
https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268814.
退行性颈椎脊髓病（DCM）是一种慢性脊髓损伤形式，其自然病程具有随时间进展的可能性。虽然它由退行性和先天性病理改变对脊髓造成的机械应力驱动，但DCM的神经表型可能会受到多种全身因素的影响。因此，代谢因素的作用备受关注，特别是考虑到缺血被认为是脊髓损伤的关键病理机制。因此，本研究的目的是综合当前关于代谢对DCM易感性、严重程度和手术结果影响的证据。
按照PRISMA指南在MEDLINE和Embase数据库中进行系统综述。纳入以英文撰写的全文论文，重点关注DCM和代谢，包括糖尿病、心血管疾病、贫血和血脂谱。使用乔安娜·布里格斯研究所（JBI）的批判性评估工具评估方法学偏倚风险。使用GRADE评估工具进行质量评估。评估患者人口统计学、代谢因素以及代谢与脊髓疾病、脊柱疾病和术后结果之间的关系。
共识别出8523篇论文，其中57篇符合纳入最终分析的标准。纳入论文中共有91%（52/57）评估了糖尿病与DCM的关系，其中85%（44/52）报告糖尿病与手术结果不佳有关；42%的论文（24/57）讨论了心血管健康与DCM之间的关联，其中88%（21/24）报告存在显著关联。总体而言，患有糖尿病或心血管疾病的DCM患者围手术期发病率更高，神经恢复更差。他们也更有可能患有肥胖和高脂血症等合并症。
代谢因素似乎与DCM的手术结果相关。然而，关于其在DCM易感性和严重程度中更具体作用的证据尚不确定。DCM的病理生理学和自然病程是关键的研究重点；因此，代谢的作用是未来研究重点的关键领域。
