Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy
Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy
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DOI：
10.1097/brs.0000000000001064
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发表时间：
2015-10-15
期刊：
影响因子：
3
通讯作者：
Lind, Bengt
中科院分区：
文献类型：
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作者：
Engquist, Markus;Lofgren, Hakan;Lind, Bengt
研究设计.前瞻性随机对照试验。分析可能影响颈椎前路减压融合术（ACDF）后物理治疗与单纯物理治疗治疗颈椎神经根病患者结局的因素。背景资料总结。了解影响ACDF结果的患者相关因素对术前患者选择非常重要。以前没有前瞻性的，随机研究的治疗效果修饰符有关的结果ACDF相比，物理治疗已经进行。60例颈神经根病患者随机接受ACDF，随后接受物理治疗或单纯物理治疗。收集1年时治疗结局的可能修饰因素数据，如性别、年龄、疼痛持续时间、疼痛强度、残疾（颈部残疾指数，NDI）、患者治疗预期、颈部/手臂疼痛引起的焦虑、痛苦（痛苦和风险评估方法）、自我效能（自我效能量表）、健康状况（EQ-5D）和磁共振成像结果。进行多变量分析，以寻找影响手臂/颈部疼痛强度和NDI结果的治疗效果修饰因子。显著改变治疗组之间治疗效果的因素有利于手术：颈部疼痛持续时间少于12个月（P = 0.007），手臂疼痛持续时间小于12个月（P = 0.01）和女性（P = 0.007）（结局：手臂疼痛），低EQ-5D指数（结果：颈部疼痛，P = 0.02），由于颈部/手臂疼痛导致的高水平焦虑（结果：颈部疼痛，P = 0.02，NDI，P = 0.02），低自我效能量表评分（P = 0.05），高痛苦和风险评估方法评分（P = 0.04）（结果：NDI）。没有发现与单独物理治疗的更好结果相关的因素。在这项前瞻性随机研究中，颈椎神经根病患者疼痛持续时间短，女性，健康质量低，因颈部/手臂疼痛引起的焦虑水平高，自我效能低，治疗前痛苦程度高与手术结局较好相关。没有发现任何因素与单独物理治疗的更好结果相关。
Study Design. Prospective randomized controlled trial.Objective. To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy.Summary of Background Data. An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out.Methods. 60 patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at 1 year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress and Risk Assessment Method), self-efficacy (Self-Efficacy Scale) health status (EQ-5D), and magnetic resonance imaging findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/neck pain intensity and NDI.Results. Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain less than 12 months (P = 0.007), duration of arm pain less than 12 months (P = 0.01) and female sex (P = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, P = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, P = 0.02 and NDI, P = 0.02), low Self-Efficacy Scale score (P = 0.05), and high Distress and Risk Assessment Method score (P = 0.04) (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone.Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.