Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy Results of the AOSpine North America Prospective Multi-Center Study
Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy Results of the AOSpine North America Prospective Multi-Center Study
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DOI：
10.2106/jbjs.l.00589
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发表时间：
2013-09-18
影响因子：
5.3
通讯作者：
Gokaslan, Ziya L.
中科院分区：
文献类型：
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作者：
Fehlings, Michael G.;Wilson, Jefferson R.;Gokaslan, Ziya L.
背景：脊髓型颈椎病是世界范围内脊髓功能障碍的主要原因。本研究的目的是评估手术减压对功能，生活质量和残疾的影响，在一个大型队列的患者在手术后一年的结果，这种condition.Methods：成年患者有症状的脊髓型颈椎病和脊髓压迫的磁共振成像证据，从2005年至2007年在北美12个中心。在入组时，脊髓病被分为轻度（改良日本骨科协会[mJOA]评分>= 15）、中度（mJOA = 12 - 14）或重度（mJOA < 12）。患者前瞻性随访1年，此时关注的结局包括mJOA评分、Nurick分级、颈部残疾指数（NDI）和简明健康调查表-36第2版（SF-36 v2）。使用单变量配对统计将1年时的所有结局与术前值进行比较。还使用单向方差分析比较了严重程度类别之间的结果。最后，进行了多变量分析，调整了严重程度组之间的基线差异。结果：278例患者中，术前轻度脊髓型颈椎病85例（30.6%），中度脊髓型颈椎病110例（39.6%），重度脊髓型颈椎病83例（29.9%）。260例患者中有222例（85.4%）的1年随访数据可用。从基线到术后1年，mJOA评分、Nurick分级、NDI评分和除一般健康外的所有SF-36 v2健康维度（包括心理和身体健康复合评分）均显著改善（p < 0.05）。除mJOA的变化外，改善程度不取决于术前症状的严重程度。在多变量分析中调整相关混杂因素后，这些结果保持不变。52例患者出现并发症（患病率，18.7%），与严重groups.Conclusions之间没有显着差异：脊髓型颈椎病的治疗手术减压与改善功能，残疾相关的，和生活质量的结果在一年的后续所有疾病的严重程度类别。此外，研究中观察到的并发症发生率与先前报道的脊髓型颈椎病系列中的并发症发生率相当。
Background: Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction worldwide. The objective of this study was to evaluate the impact of surgical decompression on functional, quality-of-life, and disability outcomes at one year after surgery in a large cohort of patients with this condition.Methods: Adult patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression were enrolled at twelve North American centers from 2005 to 2007. At enrollment, the myelopathy was categorized as mild (modified Japanese Orthopaedic Association [mJOA] score >= 15), moderate (mJOA = 12 to 14), or severe (mJOA < 12). Patients were followed prospectively for one year, at which point the outcomes of interest included the mJOA score, Nurick grade, Neck Disability Index (NDI), and Short Form-36 version 2 (SF-36v2). All outcomes at one year were compared with the preoperative values with use of univariate paired statistics. Outcomes were also compared among the severity classes with use of one-way analysis of variance. Finally, a multivariate analysis that adjusted for baseline differences among the severity groups was performed. Treatment-related complication data were collected and the overall complication rate was calculated.Results: Eighty-five (30.6%) of the 278 enrolled patients had mild cervical spondylotic myelopathy, 110 (39.6%) had moderate disease, and 83 (29.9%) had severe disease preoperatively. One-year follow-up data were available for 222 (85.4%) of 260 patients. There was a significant improvement from baseline to one year postoperatively (p < 0.05) in the mJOA score, Nurick grade, NDI score, and all SF-36v2 health dimensions (including the mental and physical health composite scores) except general health. With the exception of the change in the mJOA, the degree of improvement did not depend on the severity of the preoperative symptoms. These results remained unchanged after adjusting for relevant confounders in the multivariate analysis. Fifty-two patients experienced complications (prevalence, 18.7%), with no significant differences among the severity groups.Conclusions: Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories. Furthermore, complication rates observed in the study were commensurate with those in previously reported cervical spondylotic myelopathy series.