Outcome of patients treated for cervical myelopathy - A prospective, multicenter study with independent clinical review
Outcome of patients treated for cervical myelopathy - A prospective, multicenter study with independent clinical review
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DOI：
10.1097/00007632-200003150-00004
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发表时间：
2000-03-15
期刊：
影响因子：
3
通讯作者：
Ducker, TB
中科院分区：
文献类型：
--
作者：
Sampath, P;Bendebba, M;Ducker, TB
研究设计.本颈椎研究协会（CSRS）研究是一项针对颈椎病和椎间盘疾病患者的前瞻性、多中心、非随机研究。在本分析中，仅考虑以脊髓型颈椎病为主要综合征的患者。确定症状性脊髓病患者的人口统计学资料、外科医生的治疗实践和结局。背景资料摘要。目前尚不存在关于患者人口统计学和外科医生治疗实践的数据。目前还没有发表的前瞻性研究，其中神经，功能，疼痛和日常生活活动的结果进行了系统的量化。患者由参与的CSRS外科医生招募。人口统计信息、患者症状和患者功能数据是根据初步检查时完成的患者和医生调查编制的，结果是根据治疗后完成的患者调查评估的。数据由盲法第三方进行汇总和统计分析。41名CSRS外科医生招募的503名患者中有62名（12%）患有脊髓病。患者（48.4%男性;平均年龄48.7 ± 12.03岁）的平均症状持续时间为29.8个月（范围8周至180个月）。这些患者中有31例（50%）建议手术。43名患者（69%）返回接受随访，并充分完成了问卷调查以进行分析。在有随访数据的43名患者中，有20名（46%）接受了手术，23名（54%）接受了药物治疗。手术治疗的患者在功能状态和总体疼痛方面有显著改善，神经系统症状也有改善。非手术治疗的患者日常生活能力显著下降，神经功能障碍加重。当比较药物和手术治疗时，手术治疗的患者似乎有更好的结果，尽管在治疗前表现出更多的神经和非神经症状，并且有更大的功能障碍。如果可行，应进行随机研究，以进一步解决脊髓型颈椎病的结局。
Study Design. This Cervical Spine Research Society (CSRS) Study is a prospective, multicenter, nonrandomized investigation of patients with cervical spondylosis and disc disease. In this analysis, only patients with cervical myelopathy as the predominant syndrome were considered.Objectives. To determine demographics, surgeon treatment practices, and outcomes in patients with symptomatic myelopathy.Summary of Background Data. Current data on patient demographics and treatment practices of surgeons do not exist. There are no published prospective studies in which neurologic, functional, pain, and activities of daily living outcomes are systematically quantified.Methods. Patients were recruited by participating CSRS surgeons. Demographic information, patients' symptoms, and patients' functional data were compiled from patient and physician surveys completed at the time of initial examination, and outcomes were assessed from patient surveys completed after treatment. Data were compiled and statistically analyzed by a blinded third party.Results. Sixty-two (12%) of the 503 patients enrolled by 41 CSRS surgeons had myelopathy. Patients (48.4% male; mean age, 48.7 +/- 12.03 years) had a mean duration of symptoms of 29.8 months (range, 8 weeks to 180 months). Surgery was recommended for 31 (50%) of these patients. Forty-three patients (69%) returned for follow-up and completed the questionnaire adequately for analysis. Twenty (46%) of the 43 patients on whom follow-up data are available underwent surgery, and 23 (54%) received medical treatment. Surgically treated patients had a significant improvement in functional status and overall pain, with improvement also observed in neurologic symptoms. Patients treated nonsurgically had a significant worsening of their ability to perform activities of daily living, with worsening of neurologic symptoms.Conclusions. When medical and surgical treatments are compared, surgically treated patients appear to have better outcomes, despite exhibiting a greater number of neurologic and nonneurologic symptoms and having greater functional disability before treatment. Randomized studies, if feasible, should be performed to address outcome in cervical myelopathy further.