Yee Andy Hon Fai, Zhang Changmeng, Koljonen Paul Aarne, Shea Graham Ka Hon
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
J Spine Surg. 2024 Mar 20;10(1):89-97. doi: 10.21037/jss-23-116. Epub 2024 Mar 14.
Delayed neurological decline may be experienced following successful decompression surgery for cervical myelopathy. Our objective was to analyze neurological recovery upon revision surgery with relation to the index procedure and a matched control.
Fourteen patients underwent both primary and revision decompression at a single academic center. Peri-operative clinical, radiological, and surgical details were retrieved. Neurological outcomes [change in modified Japanese Orthopedic Association (mJOA), recovery ratio] following the second surgery were compared to (I) the primary operation and (II) a control subject receiving primary decompression matched for gender, age, mJOA score, and surgical approach. The minimum clinically important difference (MCID) in mJOA score was set at 2.5.
Revision decompressions were performed 6.8±4.2 years following the index surgery, when patients were 61.4±11.0 years of age. An increase in mJOA score of 2.7±2.0 following revision surgery was similar to that achieved after the primary operation (2.2±2.1, P=0.616). A recovery ratio of 38.1%±25.4% upon revision compared favorably to that following the primary operation (35.0%±37.4%, P=0.867). Non-inferiority testing between revision surgery and the first operation (P=0.02) demonstrated a similar capacity to achieve the MCID as did comparison with matched subjects (P<0.01).
Patients were able to make up for lost neurological gains following revision surgery. Careful selection of cases for revision likely facilitated recovery. Recovery trajectories should be consolidated upon larger sample sizes allowing for identification of prognostic factors.
颈椎脊髓病减压手术成功后可能会出现延迟性神经功能衰退。我们的目的是分析翻修手术时的神经功能恢复情况，并与初次手术及匹配的对照组进行比较。
14例患者在单一学术中心接受了初次减压和翻修减压手术。收集围手术期的临床、影像学和手术细节。将第二次手术后的神经功能结果[改良日本骨科学会（mJOA）评分变化、恢复率]与（I）初次手术及（II）性别、年龄、mJOA评分和手术方式相匹配的接受初次减压的对照对象进行比较。mJOA评分的最小临床重要差异（MCID）设定为2.5。
翻修减压手术在初次手术后6.8±4.2年进行，此时患者年龄为61.4±11.0岁。翻修手术后mJOA评分增加2.7±2.0，与初次手术后的增加幅度相似（2.2±2.1，P=0.616）。翻修后的恢复率为38.1%±25.4%，与初次手术后的恢复率（35.0%±37.4%，P=0.867）相比更有利。翻修手术与初次手术之间的非劣效性检验（P=0.02）表明，与达到MCID的能力相似，与匹配对象的比较也是如此（P<0.01）。
患者在翻修手术后能够弥补失去的神经功能改善。仔细选择翻修病例可能有助于恢复。应在更大样本量的基础上巩固恢复轨迹，以便识别预后因素。
