Comparative analysis of patient-reported outcomes in myelopathy and myeloradiculopathy: a Quality Outcomes Database study.

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of neurosurgery. Spine Pub Date : 2024-09-06 Print Date: 2024-12-01 DOI:10.3171/2024.5.SPINE24170
Ken Porche, Erica F Bisson, Brandon Sherrod, Alexander Dru, Andrew K Chan, Christopher I Shaffrey, Oren N Gottfried, Mohamad Bydon, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, John J Knightly, Scott Meyer, Cheerag D Upadhyaya, Mark E Shaffrey, Juan S Uribe, Luis M Tumialán, Jay D Turner, Dean Chou, Regis W Haid, Praveen V Mummaneni, Paul Park
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引用次数: 0

Abstract

Objective: Myelopathy in the cervical spine can present with diverse symptoms, many of which can be debilitating for patients. Patients with radiculopathy symptoms demonstrate added complexity because of the overlapping symptoms and treatment considerations. The authors sought to assess outcomes in patients with myelopathy presenting with or without concurrent radiculopathy.

Methods: The Quality Outcomes Database, a prospectively collected multi-institutional database, was used to analyze demographic, clinical, and surgical variables of patients presenting with myelopathy or myeloradiculopathy as a result of degenerative pathology. Outcome measures included arm (VAS-arm) and neck (VAS-neck) visual analog scale (VAS) scores, modified Japanese Orthopaedic Association (mJOA) scale score, EuroQol VAS (EQ-VAS) score, and Neck Disability Index (NDI) at 3, 12, and 24 months compared with baseline.

Results: A total of 1015 patients were included in the study: 289 patients with myelopathy alone (M0), 239 with myeloradiculopathy but no arm pain (MRAP-), and 487 patients with myeloradiculopathy and arm pain (MRAP+). M0 patients were older than the myeloradiculopathy cohorts combined (M0 64.2 vs MRAP- + MRAP+ 59.5 years, p < 0.001), whereas MRAP+ patients had higher BMI and a greater incidence of current smoking compared with the other cohorts. There were more anterior approaches used in in MRAP+ patients and more posterior approaches used in M0 patients. In severely myelopathic patients (mJOA scale score ≤ 10), posterior approaches were used more often for M0 (p < 0.0001) and MRAP+ (p < 0.0001) patients. Patients with myelopathy and myeloradiculopathy both exhibited significant improvement at 1 and 2 years across all outcome domains. The amount of improvement did not vary based on surgical approach. In comparing cohort outcomes, postoperative outcome differences were associated with patient-reported scores at baseline.

Conclusions: Patients with myelopathy and those with myeloradiculopathy demonstrated significant and similar improvement in arm and neck pain scores, myelopathy, disability, and quality of life at 3 months that was sustained at 1- and 2-year follow-up intervals. More radicular symptoms and arm pain increased the likelihood of a surgeon choosing an anterior approach, whereas more severe myelopathy increased the likelihood of approaching posteriorly. Surgical approach itself was not an independent predictor of outcome.

脊髓病和脊髓脊髓病患者报告结果的比较分析:质量结果数据库研究。
目的:颈椎脊髓病会表现出多种症状,其中许多症状会使患者感到虚弱无力。由于症状和治疗注意事项的重叠,伴有神经根病症状的患者病情更为复杂。作者试图评估伴有或不伴有根病变的脊髓病患者的治疗效果:质量结果数据库是一个前瞻性收集的多机构数据库,用于分析因退行性病变而出现脊髓病或脊髓根病变的患者的人口统计学、临床和手术变量。结果测量包括手臂(VAS-手臂)和颈部(VAS-颈部)视觉模拟量表(VAS)评分、改良日本骨科协会(mJOA)量表评分、EuroQol VAS(EQ-VAS)评分以及颈部残疾指数(NDI)在3、12和24个月时与基线的比较:研究共纳入了 1015 名患者:289 名患者仅患有脊髓病(M0),239 名患者患有脊髓脊膜病但无手臂疼痛(MRAP-),487 名患者患有脊髓脊膜病并伴有手臂疼痛(MRAP+)。M0患者的年龄比骨髓腔疾病患者的年龄总和要大(M0 64.2岁 vs MRAP- + MRAP+ 59.5岁,P <0.001),而MRAP+患者的体重指数(BMI)比其他患者高,目前吸烟的比例也更高。MRAP+患者使用的前路方法较多,而M0患者使用的后路方法较多。在严重脊髓病变患者中(mJOA评分≤10分),M0(p < 0.0001)和MRAP+(p < 0.0001)患者更多采用后路入路。脊髓病和脊髓脊膜病患者在1年和2年后的所有结果领域均有显著改善。手术方法不同,改善程度也不同。在比较队列结果时,术后结果差异与基线时患者报告的评分有关:结论:在3个月时,脊髓病患者和脊髓脊膜病患者在手臂和颈部疼痛评分、脊髓病、残疾和生活质量方面都有了显著且相似的改善,这种改善在1年和2年的随访中得以持续。更多的根性症状和手臂疼痛增加了外科医生选择前路手术的可能性,而更严重的脊髓病则增加了后路手术的可能性。手术方法本身并不是预测结果的独立因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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