36. Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2023-09-01 DOI:10.1016/j.spinee.2023.06.088

Nathan Evaniew MD, PhD, FRCSC , Philippe Phan MD , Charles Fisher MD, FRCSC, MHS , Jerome Paquet MD, FRCSC , Christopher Bailey MD, FRCSC , Lukas Burger MD , Sean Christie MD , Nicolas Dea MD, MSc, FRCSC

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引用次数: 0

Abstract

BACKGROUND CONTEXT

Postoperative neurological deterioration is one of the most undesirable complications that can occur after surgery for degenerative cervical myelopathy (DCM).

PURPOSE

To investigate the incidence, etiology, and outcomes of patients who experience neurological deterioration after surgery for DCM.

STUDY DESIGN/SETTING

We analyzed data from the Canadian Spine Outcomes and Research Network (CSORN) DCM prospective cohort study.

PATIENT SAMPLE

We identified 428 patients with DCM who underwent surgery.

OUTCOME MEASURES

mJOA, adverse events, NPRS, NDI, SF12, EQ5D.

METHODS

We defined postoperative neurological deterioration as any decrease in modified Japanese Orthopaedic Association (mJOA) score by at least one point from baseline to 3 months after surgery. Adverse events were collected using the Spinal Adverse Events Severity (SAVES) protocol. Secondary outcomes included patient-reported pain, disability, and health-related quality of life.

RESULTS

Among a study cohort of 428 patients, 50 (12%) deteriorated by at least one mJOA point after surgery for DCM (21 by 1 point, 15 by 2 points, and 14 by three points or more). Significant risk factors included older age, female sex, and milder disease. Among those who deteriorated, 13 experienced contributing intra- or postoperative adverse events, 6 had alternative non-DCM diagnoses, and 31 did not have an identifiable reason for deterioration. Patients who deteriorated had significantly lower mJOA scores at one year after surgery (13.5 (SD 2.7) vs 15.2 (SD 2.2), p<0.01) and those with larger deteriorations were less likely to recover their mJOA to at least their preoperative baseline, but most secondary measures of pain, disability, and health-related quality of life were unaffected.

CONCLUSIONS

The incidence of deterioration of mJOA scores after surgery for DCM was approximately one in ten, but some deteriorations were unrelated to actual spinal cord impairment and most secondary outcomes were unaffected. These findings can inform patient and surgeon expectations during shared decision-making, and they demonstrate that interpretation of mJOA scores without clinical context can sometimes be misleading.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

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36. 退行性颈椎病术后恶化:来自加拿大脊柱结局和研究网络的一项观察性研究

背景:术后神经功能恶化是退行性颈椎病(DCM)术后最不希望发生的并发症之一。目的探讨DCM术后神经功能恶化的发生率、病因及预后。研究设计/设置我们分析了来自加拿大脊柱结局与研究网络(CSORN) DCM前瞻性队列研究的数据。患者样本:我们确定了428例接受手术的DCM患者。结果测量:joa、不良事件、NPRS、NDI、SF12、EQ5D。方法我们将术后神经功能恶化定义为术后3个月改良日本骨科协会(mJOA)评分从基线下降至少1分。不良事件收集采用脊柱不良事件严重程度(saved)方案。次要结局包括患者报告的疼痛、残疾和与健康相关的生活质量。结果在428例患者中，50例(12%)患者在DCM手术后mJOA至少恶化1个点(21例恶化1个点，15例恶化2个点，14例恶化3个点或更多)。重要的危险因素包括年龄较大、女性和较轻的疾病。在恶化的患者中，13例经历了严重的内部或术后不良事件，6例有其他非dcm诊断，31例没有可识别的恶化原因。术后1年病情恶化的患者mJOA评分显著降低(13.5 (SD 2.7) vs 15.2 (SD 2.2)， p<0.01)，病情恶化的患者mJOA恢复到至少术前基线的可能性较小，但大多数疼痛、残疾和健康相关生活质量的次要指标未受影响。结论DCM术后mJOA评分恶化的发生率约为十分之一，但一些恶化与实际脊髓损伤无关，大多数次要结局不受影响。这些发现可以告知患者和外科医生在共同决策时的期望，并且它们表明，在没有临床背景的情况下解释mJOA评分有时会产生误导。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.