Bak Alex B, Alvi Mohammed Ali, Moghaddamjou Ali, Fehlings Michael G
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2025 Aug 15;50(16):1102-1109. doi: 10.1097/BRS.0000000000005394. Epub 2025 May 19.
Retrospective cohort study using prospectively accrued data.
To describe the functional recovery trajectories after surgery for mild degenerative cervical myelopathy (DCM) and identify trajectory-associated preoperative factors.
Indications for surgical intervention for mild DCM remain a topic of discussion and uncertainty. We sought to address the hypothesis that optimal surgical candidates with mild DCM could be identified based on their predicted postoperative functional recovery after surgery.
We identified patients who underwent surgical decompression for mild DCM (modified Japanese Orthopedic Association score 15-17) enrolled in the prospective, multicenter AO Spine CSM-NA and CSM-I trials. Patients were classified using trajectory modelling into distinct recovery trajectories for their mJOA and Short Form 36, version 2 Physical Component Summary (SF36-PCS) scores over a 2-year follow-up. Predictors of recovery trajectories were identified using multivariate logistic regression.
Of 198 patients with mild DCM, two distinct functional recovery trajectories for mJOA and two trajectories for SF36-PCS were identified. The good recovery trajectory for mJOA included 138 patients (69.7%) that achieved clinically important improvements in their function through 2-year follow up while 60 patients (30.3%) followed a marginal recovery trajectory, whereas the SF36-PCS good recovery trajectory group captured 166 patients (59.5%), and 79 patients (40.5%) in the marginal recovery group. Achieving good recovery in both mJOA and SF36-PCS was associated with higher self-reported baseline physical functioning. Patients who were older or current or former tobacco smokers were less likely to have a good postoperative recovery.
Most mild DCM patients achieve clinically important recoveries of their function and self-reported physical function after surgery. However, a heterogeneous group of patients does not improve after surgical management. Further prospective studies are needed to evaluate clinically relevant factors associated with varying postoperative trajectories.
Level 3.
使用前瞻性收集的数据进行回顾性队列研究。
描述轻度退行性颈椎病（DCM）手术后的功能恢复轨迹，并确定与轨迹相关的术前因素。
轻度DCM手术干预的适应症仍是一个讨论和存在不确定性的话题。我们试图验证这样一个假设，即轻度DCM的最佳手术候选者可以根据其术后预测的功能恢复情况来确定。
我们确定了参与前瞻性多中心AO脊柱CSM-NA和CSM-I试验的因轻度DCM接受手术减压的患者（改良日本骨科协会评分15-17）。在2年的随访期间，使用轨迹模型将患者的改良日本骨科协会（mJOA）评分和简明健康状况调查简表第2版身体成分总结（SF36-PCS）评分分为不同的恢复轨迹。使用多变量逻辑回归确定恢复轨迹的预测因素。
在198例轻度DCM患者中，确定了mJOA的两种不同功能恢复轨迹和SF36-PCS的两种轨迹。mJOA的良好恢复轨迹包括138例患者（69.7%），这些患者在2年随访期间功能实现了具有临床意义的改善，而60例患者（30.3%）遵循边缘恢复轨迹，而SF36-PCS良好恢复轨迹组有166例患者（59.5%），边缘恢复组有79例患者（40.5%）。mJOA和SF36-PCS均实现良好恢复与自我报告的较高基线身体功能相关。年龄较大或目前或曾经吸烟的患者术后恢复良好的可能性较小。
大多数轻度DCM患者术后功能和自我报告的身体功能实现了具有临床意义的恢复。然而，一组异质性患者在手术治疗后没有改善。需要进一步的前瞻性研究来评估与不同术后轨迹相关的临床相关因素。
3级。
