A Global Perspective on the Outcomes of Surgical Decompression in Patients With Cervical Spondylotic Myelopathy

被引：242

作者：

Fehlings, Michael G. ^{[1
]}

Ibrahim, Ahmed ^{[2
]}

Tetreault, Lindsay ^{[2
]}

Albanese, Vincenzo ^{[3
]}

Alvarado, Manuel ^{[4
]}

Arnold, Paul ^{[5
]}

Barbagallo, Giuseppe ^{[3
]}

Bartels, Ronald ^{[6
]}

Bolger, Ciaran ^{[7
]}

Defino, Helton ^{[8
]}

Kale, Shashank ^{[9
]}

Massicotte, Eric ^{[2
]}

Moraes, Osmar ^{[10
]}

Scerrati, Massimo ^{[11
]}

Tan, Gamaliel ^{[12
]}

Tanaka, Masato ^{[13
]}

Toyone, Tomoaki ^{[14
]}

Yukawa, Yasutsugu ^{[15
]}

Zhou, Qiang ^{[16
]}

Zileli, Mehmet ^{[17
]}

Kopjar, Branko ^{[18
]}

机构：

[1] Univ Toronto, Dept Surg, Toronto, ON, Canada

[2] Toronto Western Hosp, Dept Surg, Toronto, ON M5T 2S8, Canada

[3] Univ Hosp Catania, Dept Neurosurg, Catania, Italy

[4] Hosp San Juan Dios, Caracas, Venezuela

[5] Univ Kansas, Dept Neurosurg, Kansas City, KS USA

[6] Radboud Univ Nijmegen, Med Ctr, Dept Neurosurg, NL-6525 ED Nijmegen, Netherlands

[7] Beaumont Hosp, Dept Neurosurg, Dublin 9, Ireland

[8] Univ Sao Paulo, Fac Med, BR-14049 Ribeirao Preto, Brazil

[9] All India Inst Med Sci, Dept Neurosurg, New Delhi, India

[10] Hosp Santa Marcelina, Dept Neurosurg, Santa Marcelina, Brazil

[11] Univ Politecn Marche, Dept Neurosurg, Ancona, Italy

[12] Tan Tock Seng Hosp, Dept Orthopaed, Singapore, Singapore

[13] Okayama Univ, Dept Orthoped Surg, Okayama 7008530, Japan

[14] Teikyo Univ, Sch Med, Dept Orthopaed Surg, Tokyo 173, Japan

[15] Chubu Rosai Hosp, Dept Orthopaed Surg, Nagoya, Aichi, Japan

[16] Third Mil Med Univ, Dept Orthoped, Chongqing, Peoples R China

[17] Ege Univ, Dept Neurosurg, Izmir, Turkey

[18] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA

来源：

SPINE | 2015年 / 40卷 / 17期

关键词：

cervical spondylotic myelopathy; surgery; international; outcomes; safety; modified Japanese Orthopaedic Association Scale; Nurick score; Neck Disability Index; 30-m walking test; Short-Form-36; complications; prospective cohort; multicenter; POSTERIOR LONGITUDINAL LIGAMENT; NECK DISABILITY INDEX; NATURAL-HISTORY; OSSIFICATION; SPINE; RECOVERY;

D O I：

10.1097/BRS.0000000000000988

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. Prospective, multicenter international cohort. Objective. To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level. Summary of Background Data. CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM to improve neurological and functional status and quality of life. The outcomes of surgical intervention for CSM have never been evaluated at an international level. Methods. Between October 2007 and January 2011, 479 symptomatic patients with image evidence of CSM were enrolled in the prospective, multicenter AOSpine CSM-International study from 16 global sites. Preoperative and postoperative clinical status, functional impairment, and quality of life were evaluated using the modified Japanese Orthopaedic Assessment Scale, Nurick Scale, Neck Disability Index, and Short-Form-36v2. Preoperative and 12- and 24-month postoperative outcomes were compared using mixed-model analysis of covariance for repeated measurements. Results. The study cohort consisted of 310 males and 169 females, with a mean age of 56.37 11.91 years. There were significant differences in age, etiology, and surgical approaches between the regions. At 24 months postoperatively, the mean modified Japanese Orthopaedic Assessment Scale score improved from 12.50 (95% confidence interval [CI], 12.24-12.76) to 14.90 (95% CI, 14.64-15.16); the Neck Disability Index improved from 36.38 (95% CI, 34.33-38.43) to 23.20 (95% CI, 21.24-25.15); and the SF36v2 Physical Component Score and Mental Composite Score improved from 34.28 (95% CI, 33.46-35.10) to 40.76 (95% CI, 39.71-41.81) and 39.45 (95% CI, 38.25-40.64) to 46.24 (95% CI, 44.94-47.55), respectively. The rate of neurological complications was 3.13%. Conclusion. Surgical decompression for CSM is safe and results in improved functional status and quality of life in patients around the world, irrespective of differences in medical systems and sociocultural determinants of health. Level of Evidence: 3

引用

页码：1322 / 1328

页数：7

共 46 条

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