6.OPLL 手术后膀胱功能恢复的预测因素：综合分析

Q3 Medicine

North American Spine Society Journal Pub Date : 2024-07-01 DOI:10.1016/j.xnsj.2024.100344

Yusuke Setojima MD , Kengo Fujii MD, PhD , Toru Funayama MD, PhD , Masashi Yamazaki MD, PhD , Masao Koda MD, PhD

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However, no valid prediction rule is currently available for bladder outcomes.</p></div><div><h3>PURPOSE</h3><p>This study aims to discover the independent factors for predicting the recovery of bowel function one year after surgery for OPLL patients.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>A total of 477 patients treated surgically for OPLL at various departments between 2014 and 2018 were reviewed. The treatment modalities included anterior and posterior surgical approaches and combined both, involving procedures such as corpectomy, discectomy, laminoplasty, laminectomy, and fusion. Exclusion criteria for the study were: (i) patients with a preoperative JOA score of 3 points in bladder function and (ii) patients with less than one year of follow-up after surgery. Among the remaining 192 patients analyzed, consisting of 145 men and 47 women with a mean age of 68 (standard deviation [SD]: 11.0), 2 groups were formed: the improved group (n=125) with a postoperative JOA score increase of 3 points in bladder function, and the unimproved group (n=67) with a postoperative JOA score under 2 points. JOA score consists of 6 domains: motor function in the upper extremities (MU), motor function in the lower extremities (ML), sensory function in the upper extremities (SU), sensory function in the trunk (ST), sensory function in the lower extremities (SL), and bladder function, with a minimum total score of 0 and maximum of 17. Univariable and multivariable analyses were executed using the Cox proportional hazards regression model. This study investigates factors at the initial visit, including age, sex, BMI, comorbidities, preoperative JOA score, OPLL occupation ratio, and K-line.</p></div><div><h3>RESULTS</h3><p>The improved group comprised 94 men and 31 women, with a mean age of 65 (standard deviation: 10.8) years. The unimproved group included 51 men and 16 women, with a mean age of 70 (standard deviation [SD]: 10.4) years. Among the improved group, 106 patients (84%) had comorbidities, and 42 patients (34%) had diabetes. The mean OPLL occupation ratio was 44.7 (SD: 16), and the mean preoperative JOA MU score was 2.41 (SD: 0.81), ML 2.05 (SD: 0.4), SU 1 (SD: 0.92), ST 1.66 (SD: 0.53), SL 1.34 (SD: 0.58), and total score of 9.98 (SD: 2.27). In the unimproved group, 56 patients (83%) had comorbidities and 23 patients (34%) had diabetes. The mean OPLL occupation ratio was 45.7 (15.7), and the mean preoperative JOA MU score was 1.93 (SD: 1.13), ML 1.3 (SD: 0.92), SU 0.88 (SD: 0.48), ST 1.35 (SD: 0.70), SL 1.12 (SD: 0.59), and total score of 7.65 (SD: 3.24). In the multivariable analyses, it was found that age (P = 0.003), preoperative JOA ML (P < 0.001), and preoperative JOA ST significantly influenced postoperative bladder function recovery. Using the receiver operating characteristic curve, a preoperative JOA ML cut-off value of 1.5 points (P < 0.001) was identified as a threshold for full bladder function recovery. The sensitivity was 0.582, and the specificity was 0.776. Conversely, a preoperative JOA SL cut-off value of 1.5 points (P < 0.001) was determined to achieve full bladder function recovery. 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引用次数: 0

摘要

背景背景神经源性膀胱功能障碍是后纵韧带骨化症（OPLL）患者面临的一项重大挑战，会影响膀胱储尿和排尿功能。预测 OPLL 患者手术后的膀胱功能结果对于咨询、康复计划和出院至关重要。本研究旨在发现预测 OPLL 患者术后一年肠道功能恢复的独立因素。研究设计/设定N/受试者样本/结局测量N/方法回顾了 2014 年至 2018 年期间在不同科室接受手术治疗的 OPLL 患者，共计 477 例。治疗方式包括前路和后路手术方式以及两者的结合，涉及的手术包括椎间盘切除术、椎间盘切除术、椎板成形术、椎板切除术和融合术。研究的排除标准是(i) 术前膀胱功能 JOA 评分为 3 分的患者；(ii) 术后随访不足一年的患者。在分析的其余 192 名患者中，男性 145 人，女性 47 人，平均年龄 68 岁（标准差 [SD]：11.0），分为两组：术后膀胱功能 JOA 评分提高 3 分的改善组（125 人）和术后 JOA 评分低于 2 分的未改善组（67 人）。JOA 评分包括 6 个方面：上肢运动功能（MU）、下肢运动功能（ML）、上肢感觉功能（SU）、躯干感觉功能（ST）、下肢感觉功能（SL）和膀胱功能，总分最低为 0 分，最高为 17 分。采用 Cox 比例危险回归模型进行单变量和多变量分析。本研究调查了初诊时的因素，包括年龄、性别、体重指数、合并症、术前 JOA 评分、OPLL 占位比和 K 线。结果改善组包括 94 名男性和 31 名女性，平均年龄 65 岁（标准差：10.8）。未改善组包括 51 名男性和 16 名女性，平均年龄为 70 岁（标准差 [SD]：10.4）。在病情好转组中，106 名患者（84%）患有合并症，42 名患者（34%）患有糖尿病。平均 OPLL 占用率为 44.7（标准差：16），术前 JOA MU 平均得分为 2.41（标准差：0.81），ML 2.05（标准差：0.4），SU 1（标准差：0.92），ST 1.66（标准差：0.53），SL 1.34（标准差：0.58），总分 9.98（标准差：2.27）。在未改善组中，56 名患者（83%）患有合并症，23 名患者（34%）患有糖尿病。平均 OPLL 占用率为 45.7 (15.7)，术前 JOA MU 平均得分为 1.93 (SD: 1.13)，ML 1.3 (SD: 0.92)，SU 0.88 (SD: 0.48)，ST 1.35 (SD: 0.70)，SL 1.12 (SD: 0.59)，总得分为 7.65 (SD: 3.24)。多变量分析发现，年龄（P = 0.003）、术前 JOA ML（P < 0.001）和术前 JOA ST 对术后膀胱功能恢复有显著影响。利用接收器操作特征曲线，确定术前 JOA ML 临界值为 1.5 点（P < 0.001），作为膀胱功能完全恢复的阈值。灵敏度为 0.582，特异度为 0.776。相反，术前 JOA SL 临界值为 1.5 点 (P < 0.001) 时，膀胱功能完全恢复。结论利用接收器操作特征曲线，确定术前 JOA ML 和 SL 临界值为 1.5 点（P < 0.001）时，膀胱功能可完全恢复。年龄、术前 JOA ML 和术前 JOA ST 被确定为预测术后膀胱功能的相关因素。这些发现为临床医生优化患者护理和提高预后精确性提供了宝贵的见解，有助于管理患有神经源性膀胱功能障碍的 OPLL 患者。

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6. Predictive factors for bladder function recovery following OPLL surgery: a comprehensive analysis

BACKGROUND CONTEXT

Neurogenic bladder dysfunction poses a significant challenge in patients with ossification of posterior longitudinal ligaments (OPLL), affecting both bladder storage and voiding function. Predicting postsurgery bladder function outcomes in OPLL patients is essential for counselling, rehabilitation planning, and discharge. However, no valid prediction rule is currently available for bladder outcomes.

PURPOSE

This study aims to discover the independent factors for predicting the recovery of bowel function one year after surgery for OPLL patients.

STUDY DESIGN/SETTING

N/A

PATIENT SAMPLE

N/A

OUTCOME MEASURES

N/A

METHODS

A total of 477 patients treated surgically for OPLL at various departments between 2014 and 2018 were reviewed. The treatment modalities included anterior and posterior surgical approaches and combined both, involving procedures such as corpectomy, discectomy, laminoplasty, laminectomy, and fusion. Exclusion criteria for the study were: (i) patients with a preoperative JOA score of 3 points in bladder function and (ii) patients with less than one year of follow-up after surgery. Among the remaining 192 patients analyzed, consisting of 145 men and 47 women with a mean age of 68 (standard deviation [SD]: 11.0), 2 groups were formed: the improved group (n=125) with a postoperative JOA score increase of 3 points in bladder function, and the unimproved group (n=67) with a postoperative JOA score under 2 points. JOA score consists of 6 domains: motor function in the upper extremities (MU), motor function in the lower extremities (ML), sensory function in the upper extremities (SU), sensory function in the trunk (ST), sensory function in the lower extremities (SL), and bladder function, with a minimum total score of 0 and maximum of 17. Univariable and multivariable analyses were executed using the Cox proportional hazards regression model. This study investigates factors at the initial visit, including age, sex, BMI, comorbidities, preoperative JOA score, OPLL occupation ratio, and K-line.

RESULTS

The improved group comprised 94 men and 31 women, with a mean age of 65 (standard deviation: 10.8) years. The unimproved group included 51 men and 16 women, with a mean age of 70 (standard deviation [SD]: 10.4) years. Among the improved group, 106 patients (84%) had comorbidities, and 42 patients (34%) had diabetes. The mean OPLL occupation ratio was 44.7 (SD: 16), and the mean preoperative JOA MU score was 2.41 (SD: 0.81), ML 2.05 (SD: 0.4), SU 1 (SD: 0.92), ST 1.66 (SD: 0.53), SL 1.34 (SD: 0.58), and total score of 9.98 (SD: 2.27). In the unimproved group, 56 patients (83%) had comorbidities and 23 patients (34%) had diabetes. The mean OPLL occupation ratio was 45.7 (15.7), and the mean preoperative JOA MU score was 1.93 (SD: 1.13), ML 1.3 (SD: 0.92), SU 0.88 (SD: 0.48), ST 1.35 (SD: 0.70), SL 1.12 (SD: 0.59), and total score of 7.65 (SD: 3.24). In the multivariable analyses, it was found that age (P = 0.003), preoperative JOA ML (P < 0.001), and preoperative JOA ST significantly influenced postoperative bladder function recovery. Using the receiver operating characteristic curve, a preoperative JOA ML cut-off value of 1.5 points (P < 0.001) was identified as a threshold for full bladder function recovery. The sensitivity was 0.582, and the specificity was 0.776. Conversely, a preoperative JOA SL cut-off value of 1.5 points (P < 0.001) was determined to achieve full bladder function recovery. The sensitivity was 0.478, and the specificity was 0.736.

CONCLUSIONS

Utilizing the receiver operating characteristic curve, a preoperative JOA ML and SL cut-off value of 1.5 points (P < 0.001) were determined for achieving full recovery of bladder function.

Age, preoperative JOA ML, and preoperative JOA ST are identified as relevant factors for predicting postoperative bladder function. These findings offer valuable insights for clinicians in optimizing patient care and enhancing prognostic precision in managing OPLL patients with neurogenic bladder dysfunction.