12. 社会功能的多学科方法可能改善颈椎病患者的手术结果：两个前瞻性队列的比较

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100706

Koji Tamai MD , Hiroshi Taniwaki MD , Akinobu Suzuki MD, PhD , Shinji Takahashi MD, PhD , Hiromitsu Toyoda MD, PhD , Minori Kato MD , Hidetomi Terai MD, PhD

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引用次数: 0

摘要

背景：适当时机的手术减压是退行性颈椎病（DCM）患者的标准治疗策略。然而，脊柱外科医生和主治医生有时会遇到，尽管颈脊髓病的疾病结局有了显著改善，但患者对手术不满意，并且/或者手术后他们的生活质量（QOL）没有改善。先前的一项研究表明，与颈椎病减压手术后生活质量改善相关的是患者的社会功能（SF），而不是脊髓病的严重程度。目的：本研究旨在确定多学科方法改善脊髓型颈椎病患者SF对1年手术结果的影响。研究设计/背景：本研究比较了日本的两个前瞻性队列。2018年至2020年因颈椎病接受颈椎椎板成形术的患者被纳入对照队列。在2020年至2021年期间接受相同适应症的相同手术的患者被纳入SF队列。比较两组患者1年的临床结果（JOA评分、JOACMEQ、EQ-5D-5L、颈部疼痛、手臂疼痛VAS评分和手术满意度）和影像学结果（C7斜率、C2-7角度和C2-C7 SVA）。方法对照组患者采用标准治疗，SF组患者采用多学科治疗方案，重点关注SF的改善。该方案的关键是：1)临床心理学家在手术前通过多次访谈确定患者的SF；2) SF信息由医生、治疗师、护士和医务秘书共享；3)脊柱外科医生、治疗师和临床心理学家根据病人的SF信息制定了以病人为导向的康复计划。结果对照组和SF组共140例患者(平均年龄73.5±7.0岁；62例女性)，31例患者(平均年龄72.2±6.9岁；15只雌性)。虽然背景资料无显著差异，但SF组在日本骨科协会（JOA）评分改善方面明显优于对照组（p=0.040，混合效应模型）。详细分析各JOA评分域，SF组上肢功能改善明显优于对照组（p=0.033，混合效应模型）。同样，SF组患者报告的上肢功能结果明显高于对照组(p<；0.001, Mann-Whitney U检验)。SF组在生活质量总分中自我照顾域得分显著高于对照组（p=0.047， Mann-Whitney U检验），而SF组在生活质量总分中自我照顾域得分显著高于对照组。结论多学科方法在DCM患者治疗中的有效性尚不明确。目前的研究发现，多学科的方法来改善/重建患者的SF是有效的改善脊髓型颈椎病和生活质量的自我保健领域。这项研究首次证明了DCM患者术后多学科方法的有效性。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。

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12. A multidisciplinary approach to social functioning might improve the surgical outcomes of patients with cervical myelopathy: comparisons of two prospective cohorts

BACKGROUND CONTEXT

Surgical decompression with adequate timing is the standard treatment strategy for patients with degenerative cervical myelopathy (DCM). However, spine surgeons and attending physicians sometimes experience that despite significant improvement in the disease outcomes of cervical myelopathy, patients are not satisfied with surgery and/or their quality-of-life (QOL) does not improve after surgery. A previous study revealed that patients’ social functioning (SF), rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy.

PURPOSE

This study aimed to identify the effects of a multidisciplinary approach for improving SF on 1-year surgical outcomes in cervical myelopathy patients.

STUDY DESIGN/SETTING

This study compared two prospective cohorts in Japan.

PATIENT SAMPLE

Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the SF cohort.

OUTCOME MEASURES

Clinical outcomes (JOA score, JOACMEQ, EQ-5D-5L, VAS of neck pain, arm pain and surgical satisfaction) and radiographical outcomes (C7 slope, C2-7 angle, and C2-C7 SVA) at 1-year were compared between the groups.

METHODS

Patients in the control cohort were treated with standard care, and those in the SF cohort were treated with a multidisciplinary protocol that focused on SF improvement. The key to the protocol was as follows: 1) clinical psychologists identified the patient’s SF before surgery through several interviews; 2) information on SF was shared by physicians, therapists, nurses, and medical secretaries; and 3) spine surgeons, therapists, and clinical psychologists developed patient-oriented rehabilitation programs with information on the patient’s SF.

RESULTS

The control and SF cohorts comprised 140 patients (mean age, 73.5 ± 7.0 years; 62 females) and 31 patients (mean age, 72.2 ± 6.9 years; 15 females), respectively. Although there were no significant differences in the background data, the improvement in the Japanese Orthopaedic Association (JOA) score was significantly better in the SF cohort than in the control cohort (p=0.040, mixed effect model). In a detailed analysis of each JOA score domain, the improvement of upper limb function was significantly better in the SF cohort than in the control cohort (p=0.033, mixed effect model). Similarly, the SF cohort demonstrated significantly higher patient-reported outcome for upper extremity function than those in the control cohort (p< 0.001, Mann-Whitney U test). Although there was no significant difference in the total QOL score, the self-care domain in the QOL score was significantly higher in the SF group than in the control group (p=0.047, Mann-Whitney U test).

CONCLUSIONS

The evidence for the effectiveness of a multidisciplinary approach in the care of patients with DCM is not well established. The current study identified that a multidisciplinary approach to improving/rebuilding a patient’s SF was effective in improving cervical myelopathy and self-care domain of QOL. This study is the first to demonstrate the effectiveness of a postoperative multidisciplinary approach in patients with DCM.