Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale.
Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale.
复制标题
退行性脊髓型颈椎病：使用 NIH 工具箱评估量表建立老化脊柱神经运动功能障碍的严重阈值。
DOI：
10.1007/s11357-023-00983-3
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发表时间：
2024
期刊：
影响因子：
5.6
通讯作者：
Smith,ZacharyA
中科院分区：
文献类型：
--
作者：
Muhammad,Fauziyya;Hameed,Sanaa;Haynes,Grace;Mohammadi,Esmaeil;Khan,AliF;Shakir,Hakeem;Smith,ZacharyA
退行性脊髓型颈椎病 (DCM) 是颈椎慢性退变导致的与年龄相关的非创伤性脊髓疾病的主要原因。虽然传统的临床评估依赖于患者报告的测量结果，但本研究使用 NIH Toolbox Motor Battery (NIHTBm) 作为客观、定量的测量方法来确定 DCM 的严重程度。目的是定义 NIHTBm 截止值，以准确分类 DCM 神经运动功能障碍的严重程度。对 DCM 患者和年龄匹配对照进行的病例对照试点研究。重点是使用 NIHTBm 进行深入的定量运动评估，以了解退行性脊柱疾病导致的神经运动缺陷的严重程度。对 45 名 DCM 患者和 37 名年龄匹配的健康受试者 (HC) 进行了运动评估、灵活性、握力、平衡和步态速度。受试者工作曲线（ROC）分析确定了轻度和中度至重度脊髓病的临界值，通过比较运动评估分数与残疾分数来验证该临界值。 ROC曲线确定了轻度灵活性障碍（T分数范围38.4 − 33.5，AUC 0.77）、中度至重度灵活性障碍（< 33.5，AUC 0.70）、轻度握力障碍（47.4 − 32.0，AUC 0.80）、中度至重度握力障碍的阈值（< 32.0，AUC 0.75）、轻度平衡障碍（36.4 − 33.0，AUC 0.61）和中度至重度平衡障碍（< 33.0，AUC 0.78）。轻度步态速度障碍定义为 0.78–0.6 m/sec (AUC 0.65)，中度至重度步态速度障碍定义为 < 0.6 m/sec (AUC 0.65)。 NIHTB 运动评分截止点与 DCM 颈部残疾指数 (NDI) 呈负相关，并显示平衡和敏捷性测量是 DCM 功能障碍的独立指标。 NIHTB 的使用可以通过建立与轻度和中度至重度脊髓病相对应的截止值来精确描述 DCM 的严重程度。在 DCM 中使用 NIHTB 可以提高临床精度，使临床医生能够更好地查明 DCM 中的特定运动缺陷以及其他具有运动缺陷的神经系统疾病，包括中风和创伤性脑损伤 (TBI)。此外，客观评估 NIHTB 的实用性使我们能够更好地了解 DCM 的异质性，这将增强治疗策略。这项研究为未来的研究奠定了基础，以促进发现 DCM 和其他神经系统疾病的创新治疗策略。
Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 − 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 − 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 − 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78–0.6 m/sec (AUC 0.65),while moderate-to-severe gait speed impairment was < 0.6 m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.