Takeda Hiroki, Michikawa Takehiro, Nagai Sota, Kawabata Soya, Ito Kei, Ikeda Daiki, Fujita Nobuyuki, Kaneko Shinjiro
Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
Spine Surg Relat Res. 2023 Dec 27;8(3):287-296. doi: 10.22603/ssrr.2023-0191. eCollection 2024 May 27.
Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.
We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.
We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.
This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.
据报道，退行性肌肉骨骼疾病引起的机车综合征通过手术治疗可得到改善。然而，手术治疗对退行性颈椎脊髓病（DCM）患者发生的机车综合征是否有效尚不清楚。因此，本研究主要旨在使用25项老年机车功能量表（GLFS-25）纵向评估DCM患者颈椎手术后机车综合征阶段的变化。次要目标是确定与机车综合征阶段术后改善相关的因素。
我们回顾性分析了2020年4月至2022年5月在我院接受颈椎手术患者的临床资料，这些患者在术前、术后6个月和1年回答了日本骨科协会颈椎脊髓病评估问卷、视觉模拟量表和GLFS-25。我们收集了人口统计学数据、病史、术前影像学参数、后纵韧带骨化的有无以及手术数据。
本研究共纳入115例患者（78例男性和37例女性）。术前，使用GLFS-25，73.9%的患者为3期，10.4%为2期，9.6%为1期，6.1%无机车综合征。术后6个月和1年，机车综合征的阶段分布有显著改善。多变量泊松回归分析显示，术前更好的下肢功能（相对风险：3.0；95%置信区间：1.01-8.8）与机车综合征阶段的术后改善显著相关。
这是第一项使用GLFS-25纵向评估DCM患者机车综合征阶段的研究。我们的结果表明，DCM患者颈椎手术后机车综合征阶段有显著改善。特别是，术前下肢功能对机车综合征阶段的术后改善具有重要意义。
