Department of Spine, Hospital for Special Surgery, New York, NY.
Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2024 Sep 15;49(18):1251-1258. doi: 10.1097/BRS.0000000000005020. Epub 2024 Apr 29.
STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To determine the impact of preoperative symptom duration on postoperative functional outcomes after cervical disc replacement (CDR) for radiculopathy. SUMMARY OF BACKGROUND DATA: CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes after CDR is not well established. METHODS: Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included neck disability index (NDI), visual analog scale (VAS) neck and arm. Changes in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo-2 y) postoperative periods. RESULTS: A total of 201 patients (43.6±8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared with the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P =0.001), VAS-Neck (87.0% vs. 56.0%, P <0.001), and VAS-Arm (90.5% vs. 70.7%, P =0.002). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P =0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P <0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P <0.001). CONCLUSIONS: Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability. LEVEL OF EVIDENCE: Level III.
研究设计：前瞻性数据回顾。 目的：确定颈椎间盘置换术（CDR）治疗神经根病的术前症状持续时间对术后功能结果的影响。 背景资料概要：CDR 已成为治疗退行性颈椎病变的可靠有效治疗选择。术前症状持续时间与 CDR 后结果之间的关系尚未得到很好的确定。 方法：纳入了患有神经根病但无脊髓病且接受初次 1 或 2 级 CDR 的患者，并根据术前症状持续时间分为较短（<6 个月）和较长（≥6 个月）队列。患者报告的结果测量（PROM）包括颈部残疾指数（NDI）、视觉模拟量表（VAS）颈部和手臂。计算 PROM 评分的变化和最小临床重要差异（MCID）率。在早期（术后 3 个月内）和晚期（6 个月-2 年）进行分析。 结果：共纳入 201 例患者（43.6±8.7 岁，33.3%为女性）。在早期和晚期术后期间，与较长术前症状持续时间队列相比，较短术前症状持续时间队列的 NDI、VAS 颈部和 VAS 手臂的术前 PROM 评分变化显著更大。较短症状持续时间队列在早期术后达到 MCID 的比例显著更高，NDI（78.9%对 54.9%，P=0.001）、VAS 颈部（87.0%对 56.0%，P<0.001）和 VAS 手臂（90.5%对 70.7%，P=0.002）。术前症状持续时间较长（≥6 个月）被确定为 NDI（OR：2.9，95%CI：1.2-6.9，P=0.016）、VAS 颈部（OR：9.8，95%CI：3.7-26.0，P<0.001）和 VAS 手臂（OR：7.5，95%CI：2.5-22.5，P<0.001）的最晚时间点未达到 MCID 的独立危险因素。 结论：我们的研究表明，对于接受 CDR 治疗神经根病的患者，术前症状持续时间较短的患者报告的结果有所改善，这表明延迟手术干预可能导致结果较差和术后残疾增加。 证据水平：III 级。
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