年龄对脊髓型颈椎病手术干预后24个月颈部残疾指数改善影响的比较研究:一项质量结局数据库研究

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Ken Porche, Brandon A Sherrod, Spencer Rosero, 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, Erica F Bisson
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引用次数: 0

摘要

目的:脊髓型颈椎病(Cervical spondylotic myelopathy, CSM)常伴有颈部疼痛,颈部疼痛与运动、感觉改变等神经功能障碍共同影响患者的生活质量。作者研究了年龄是否会影响颈性残疾的改善以及颈性脊髓型颈椎病术后相关的生活质量指标。采用颈部残疾指数(NDI)作为主要结局,他们比较了≥65岁、≥75岁和< 65岁患者24个月时的长期结局,探讨手术干预对老年人疼痛相关残疾和功能恢复的影响。方法:使用质量结局数据库,作者对≥65岁和≥75岁的队列与< 65岁的队列进行了详细的倾向评分匹配分析,同时控制基线NDI评分、其他人口统计学变量、健康状况、潜在病理、水平数、手术指征、手术入路和手术类型。术后24个月NDI总分和子域评分的差异是改善的主要指标。评估NDI差异的年龄相关变异性。EQ-5D和计算的SF-6D为次要测量。结果:在该队列的1141例患者中(2016年1月至2018年12月),687例患者< 65岁,325例65至< 75岁,129例≥75岁。倾向评分匹配后,≥65岁(平均71.4岁)和< 65岁(平均55.3岁)队列中各有197例患者匹配良好;同样,在≥75岁(平均78.3岁)和< 65岁(平均55.8岁)的队列中各匹配了57例患者。在所有队列中,术后3、12和24个月NDI评分和子域评分、EQ-5D和计算的SF-6D的改善是一致的。24个月时,≥65岁患者的NDI评分改善(-14.7±22.3)与< 65岁患者(-13.0±21.3,p = 0.454)相似,≥75岁患者的NDI评分改善(-15.0±19.7)与< 65岁患者(-17.6±20.4,p = 0.499)相似。线性关系的敏感性分析发现,老年患者的NDI改善在统计学上更大(每30年7.5分,p < 0.0001),但这一差异低于最低临床重要差异。其他临床结果在队列之间相似。结论:在不同年龄组(包括65岁和75岁以上的人群)中,CSM的手术干预在NDI评分和其他指标上取得了实质性的和类似的改善。这些结果强调了手术在广泛患者人群中的有效性,强调了其在治疗CSM方面的价值,而与年龄无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A comparative study on the effect of age on Neck Disability Index improvement at 24 months after surgical intervention for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Objective: Cervical spondylotic myelopathy (CSM) is often accompanied by neck pain, which, along with more recognized neurological deficits like motor and sensory changes, significantly impacts patients' quality of life. The authors examined whether age influences improvements in neck disability and related quality-of-life measures after surgery for CSM. Using the Neck Disability Index (NDI) as the primary outcome, they compared long-term outcomes at 24 months among patients aged ≥ 65, ≥75, and < 65 years, exploring the effects of surgical intervention on both pain-related disability and functional recovery in older adults.

Methods: Using the Quality Outcomes Database, the authors conducted a detailed propensity score-matched analysis on cohorts aged ≥ 65 and ≥ 75 years compared with a < 65-year-old cohort while controlling for baseline NDI scores, other demographic variables, health status, underlying pathology, number of levels, indication for surgery, surgical approach, and type of surgery. Differences in NDI total and subdomain scores at 24 months postoperatively were the primary measures of improvement. Age-related variability in NDI differential was assessed. EQ-5D and calculated SF-6D were secondary measures.

Results: Of the 1141 patients in the cohort (January 2016 to December 2018), 687 patients were < 65 years, 325 were 65 to < 75 years, and 129 were ≥ 75 years of age. After propensity score matching, 197 patients each were well matched in the ≥ 65-year (mean 71.4 years) and < 65-year (mean 55.3 years) cohorts; similarly, 57 patients each were matched in the ≥ 75-year (mean 78.3 years) and < 65-year (mean 55.8 years) cohorts. Improvements in NDI scores and subdomain scores, EQ-5D, and calculated SF-6D were consistent at 3, 12, and 24 months postoperatively across all cohorts. At 24 months, patients ≥ 65 years showed NDI score improvements (-14.7 ± 22.3) similar to those < 65 years (-13.0 ± 21.3, p = 0.454), and patients ≥ 75 years demonstrated NDI improvements (-15.0 ± 19.7) comparable to those < 65 years (-17.6 ± 20.4, p = 0.499). A sensitivity analysis for linear relationship found that NDI improvement was statistically greater in older patients (7.5 points every 30 years, p < 0.0001), but this difference was below the minimal clinically important difference. Other clinical outcomes were similar between cohorts.

Conclusions: Surgical intervention for CSM yields substantial and similar improvements in NDI scores and other metrics among various age groups, including those aged at least 65 and 75 years. These results highlight the effectiveness of surgery across a broad patient demographic, underscoring its value in treating CSM irrespective of age.

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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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