Ozaki Masahiro, Nagoshi Narihito, Yamane Junichi, Iga Takahito, Okubo Toshiki, Takeda Kazuki, Suzuki Satoshi, Yasuda Akimasa, Takahashi Yohei, Kono Hitoshi, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Keio Spine Research Group (KSRG), Tokyo, Japan.
Spine (Phila Pa 1976). 2025 Jun 9. doi: 10.1097/BRS.0000000000005423.
A retrospective multicenter study.
To analyze symptom-specific surgical outcomes in patients with mild degenerative cervical myelopathy (DCM) and identify predictors of postoperative residual symptoms.
DCM is the most common cause of spinal cord impairment in adults. While surgical intervention is recommended for moderate to severe DCM, optimal treatment strategies for mild DCM remain unclear. Previous studies have focused on total Japanese Orthopaedic Association (JOA)/modified JOA (mJOA) score without detailed symptom-specific analyses.
We reviewed 679 consecutive patients who underwent surgical decompression with or without fusion for DCM across three institutions in Japan. Among them, 104 patients with mild DCM (JOA score 14.5-16.5) were included. We assessed demographic data, radiographic factors, magnetic resonance imaging parameters, and clinical scores. Symptom-specific analyses were conducted using preoperative and 2-year postoperative JOA scores, and the predictors of persistent symptoms were analyzed using multivariable logistic regression.
The mean maximum canal compromise was 49.7%, and maximum spinal cord compression was 37.2%. The most common factors leading to surgery was symptom deterioration (94.2%). In symptom-specific analysis, 60.9% of patients exhibited persistent upper extremity sensory impairment, significantly higher than other domains. Multivariable analysis identified angular-edged deformity of the spinal cord on axial MRI as an independent predictor of persistent upper extremity sensory impairment (Odds Ratio: 4.264, 95% confidence interval: 1.312-13.854, P=0.016).
The majority of mild DCM patients who underwent surgery had severe spinal cord compression, with symptom progression serving as the trigger for surgical intervention. While surgical intervention improves overall function, upper extremity sensory impairments frequently persisted postoperatively, even in mild cases. Angular-edged deformity was a significant predictor for postoperative upper extremity sensory deficits, emphasizing the need for careful preoperative evaluation of spinal cord morphology to better inform prognosis and guide treatment decisions in patients with mild DCM.
一项回顾性多中心研究。
分析轻度退行性颈椎脊髓病（DCM）患者特定症状的手术疗效，并确定术后残留症状的预测因素。
DCM是成人脊髓损伤最常见的原因。虽然推荐对中度至重度DCM进行手术干预，但轻度DCM的最佳治疗策略仍不明确。既往研究集中于日本骨科协会（JOA）总分/改良JOA（mJOA）评分，未进行详细的特定症状分析。
我们回顾了日本三家机构连续679例接受DCM减压术（伴或不伴融合术）的患者。其中，纳入104例轻度DCM患者（JOA评分14.5 - 16.5）。我们评估了人口统计学数据、影像学因素、磁共振成像参数和临床评分。使用术前和术后2年的JOA评分进行特定症状分析，并采用多变量逻辑回归分析持续症状的预测因素。
平均最大椎管狭窄率为49.7%，最大脊髓压迫率为37.2%。导致手术的最常见因素是症状恶化（94.2%）。在特定症状分析中，60.9%的患者存在持续的上肢感觉障碍，显著高于其他领域。多变量分析确定轴向MRI上脊髓的角缘畸形是持续上肢感觉障碍的独立预测因素（比值比：4.264，95%置信区间：1.312 - 13.854，P = 0.016）。
大多数接受手术的轻度DCM患者存在严重脊髓压迫，症状进展是手术干预的触发因素。虽然手术干预可改善整体功能，但即使在轻度病例中，上肢感觉障碍术后也常持续存在。角缘畸形是术后上肢感觉障碍的重要预测因素，强调术前需仔细评估脊髓形态，以更好地了解预后并指导轻度DCM患者的治疗决策。
4级
