Effect of Modified Japanese Orthopedic Association Severity Classifications on Satisfaction With Outcomes 12 Months After Elective Surgery for Cervical Spine Myelopathy
Effect of Modified Japanese Orthopedic Association Severity Classifications on Satisfaction With Outcomes 12 Months After Elective Surgery for Cervical Spine Myelopathy
复制标题
改良日本骨科协会严重程度分类对脊髓型颈椎病择期手术后 12 个月结果满意度的影响
作者：
A. Asher;C. Devin;Benjamin M. Weisenthal;J. Pennings;Inamullah Khan;Kristin R. Archer;A. Sivaganesan;Silky Chotai;M. Bydon;H. Nian;F. Harrell;M. McGirt;P. Mummaneni;E. Bisson;C. Shaffrey;K. Foley
研究设计.本研究回顾性分析了前瞻性收集的数据。Objective.在此，我们旨在确定术前和12个月改良日本骨科协会（mJOA）对满意度的影响，并了解退行性颈椎病（DCM）手术治疗后mJOA严重程度分类的变化。背景数据总结。扩张型心肌病是一种由颈髓压迫引起的进行性退行性脊柱疾病。DCM的自然进展是可变的;一些患者经历稳定期，而另一些患者在疾病发作后迅速恶化。mJOA通常用于脊髓病症状的分级和分类，但其与术后满意度的关系尚未进行过研究。方法.查询质量和结局数据库（QOD）中接受DCM择期手术的患者。根据mJOA评分将患者分为轻度（≥14）、中度（9 - 13）或重度（<9）类别。使用McNemar-Bowker检验评估术前和术后12个月之间是否有显著比例的患者改变了mJOA类别。多变量比例优势有序逻辑回归模型与12个月的满意度作为关注的结果进行拟合。结果我们确定了1963例因DCM接受择期手术并完成12个月随访的患者。比较术前和12个月时的mJOA严重度水平显示，55%保持在同一类别，37%改善，7%变为更差类别。在调整基线和手术特异性变量后，12个月mJOA类别对患者满意度的影响最大（P <0.001）。 结论患者满意度是衡量脊柱手术后护理质量的不可或缺的工具。在该样本中，12个月mJOA类别（不考虑术前mJOA）与满意度显著相关。鉴于这些结果，重要的是告知患者手术将改变其mJOA严重度分类的可能性以及实现术后满意度所需的变化。证据等级：3
Study Design. This study retrospectively analyzes prospectively collected data. Objective. Here, we aim to determine the influence of preoperative and 12-month modified Japanese Orthopedic Association (mJOA) on satisfaction and understand the change in mJOA severity classification after surgical management of degenerative cervical myelopathy (DCM). Summary of Background Data. DCM is a progressive degenerative spine disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The mJOA is commonly used to grade and categorize myelopathy symptoms, but its association with postoperative satisfaction has not been previously explored. Methods. The quality and outcomes database (QOD) was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9 to 13), or severe (<9) categories on the mJOA scores. A McNemar–Bowker test was used to assess whether a significant proportion of patients changed mJOA category between preoperative and 12 months postoperative. A multivariable proportional odds ordinal logistic regression model was fitted with 12-month satisfaction as the outcome of interest. Results. We identified 1963 patients who underwent elective surgery for DCM and completed 12-months follow-ups. Comparing mJOA severity level preoperatively and at 12 months revealed that 55% remained in the same category, 37% improved, and 7% moved to a worse category. After adjusting for baseline and surgery-specific variables, the 12-month mJOA category had the highest impact on patient satisfaction (P < 0.001). Conclusion. Patient satisfaction is an indispensable tool for measuring quality of care after spine surgery. In this sample, 12-month mJOA category, regardless of preop mJOA, was significantly correlated with satisfaction. Given these findings, it is important to advise patients of the probability that surgery will change their mJOA severity classification and the changes required to achieve postoperative satisfaction. Level of Evidence: 3
影响因子：
22.4
作者：
Robles, Theodore F.;Slatcher, Richard B.;Trombello, Joseph M.;McGinn, Meghan M.
通讯作者：
McGinn, Meghan M.