Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study
Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study
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DOI：
10.1097/brs.0000000000004359
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发表时间：
2022-08-01
期刊：
影响因子：
3
通讯作者：
Okawa，Atsushi
中科院分区：
文献类型：
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作者：
Nagoshi，Narihito;Yoshii，Toshitaka;Okawa，Atsushi
研究设计：前瞻性多中心研究。目的：本研究旨在使用日本骨科学会颈椎脊髓病评估问卷(JOACMEQ)评估患者报告的结果，并阐明影响颈椎后纵韧带骨化症(OPLL)患者疗效的临床因素。背景资料概述。虽然先前的研究确定了影响手术结果的因素，但它们的评估主要基于日本骨科学会评分，该评分仅包括神经功能。从多种功能和生活质量(QOL)来研究这一病理，对于了解颈椎OPLL的全面临床表现及其治疗结果至关重要。材料和方法。本研究由日本脊柱韧带骨化多中心研究组织进行。对2014年至2017年28家机构478例颈椎OPLL所致脊髓病患者进行前瞻性登记，并随访2年。在这些患者中，168人接受了椎板成形术并完成了完整的问卷调查。收集人口统计学信息、影像表现和临床结果。患者根据JOACMEQ定义的有效或无效的手术结果进行分组，采用Logistic回归分析。结果：椎板成形术使40%的患者颈椎和上肢功能改善，而生活质量只有21.4%(P<；0.01)。多变量分析显示，较年轻的年龄和术后手臂或手疼痛的减轻与上肢功能的显著改善相关。肢体疼痛的减轻有利于术后肢体功能的恢复。术后上肢疼痛的减轻促进了生活质量的恢复。结论：外科医生应该认识到椎板成形术后手术结果的多样性，并认识到即使在手术后也有必要对疼痛进行管理，以提高颈椎OPLL患者的身体功能和生活质量。
Study Design.A prospective multicenter study.Objective.This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data.Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes.Materials and Methods.This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses.Results.Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4%(P< 0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery.Conclusions.Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.