Predictors of surgical outcome in patients with cervical spondilotic myelopathy

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Uvod/Cilj: Cervikalna spondilotična mijelopatija (CSM) predstavlja najčešći oblik disfunkcije kičmene moždine i najčešći oblik oštećenja kičmene moždine kod osoba starijih od 55 godina. Pored sve većeg broja podataka koji ukazuju da se pacijenti oporavljaju nakon operacije, ključni klinički i radiografski parametri koji utiču na konačan ishod operacije i dalje su nedovoljno definisani. Metod: Pedeset devet pacijenata sa simptomatskom CSM je uključeno u ovu prospektivnu studiju, po završetku perioda praćenja od 12 meseci, analizirano je 50 pacijenata. Svi pacijenti su operisani, rađena je dekompresija prednjim ili zadnjim hirurškim pristupom. Ishod je praćen preoperativno i postoperativno nakon 12 meseci pomoću skala za merenje ishoda: modifikovana skala Japanskog Udruženja Ortopeda (mJOA), Nurikov skor i Neck Disability Index (NDI). Funkcionalni oporavak je računat nakon operacije, korišćenjem Hirabajašijeve formule. Rezultati: Prema rezultatima naše studije, značajan oporavak je registrovan prema svim skalama za praćenje ishoda (mJOA skor, Nurik skor i NDI). Pored toga, zabeleženo je statistički značajno poboljšanje u sve tri grupe pacijenata u odnosu na preoperativni mJOA (blaga, umerena i teška). Funkcionalni oporavak je bio zadovoljavajući kod 23 pacijenta (46%), dok je 27 (54%) pacijenata imalo nezadovoljavajući funkcionalni oporavak. Upotrebom multivarijantne analize, preoperativni mJOA skor (p=0,05), broj zahvaćenih segmenata (p=0,03) i uzrast bolesnika (p=0,02) su parametri koji statistički značajno utiču na ishod operativnog lečenja. Zaključak: Hirurško lečenje CSM je veoma uspešna metoda i dovodi do značajnog poboljšanja prema svim skala za merenje ishoda u periodu praćenja od godinu dana.

Background/Aim. Cervical spondylotic myelopathy (CSM) is the most common form of spinal cord dysfunction in patients and the commonest cause of spinal cord injury in individuals older than 55 years. Although there is emerging evidence that most patients improve after surgery, the key clinical and imaging factors that predict the final outcome remain uncertain. Methods. Fifty nine patients with symptomatic CSM were enrolled in this prospective study, at the end of follow-up period of 12 months, 50 patients were analyzed. All patients were operated, surgical decompression was performed by anterior or posterior surgical approach. Outcome evaluations were obtained preoperatively and 12 months postoperatively by using outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick grade and the Neck Disability Index (NDI). Functional recovery ratio was calculated postoperatively by using the formula of Hirabayashi. Results. According to our results, significant improvements were detected in all outcomes variables (mJOA score, Nurick grade and NDI). Also, statistically significant improvement was observed in all three category of patients according to preoperative mJOA score (mild, moderate, severe). Twenty three (46%) patients had satisfied functional recovery, while twenty seven (54%) had unsatisfied functional recovery rate. Using multivariate analysis, the functional outcomes after surgery were best predicted by baseline mJOA score (p=0,05), number of involved segments (p=0,03) and age of patients (p=0,02). Conclusion. Surgical treatment of CSM is a very effective and resulted in a significant improvement in all outcomes measures for 1 year follow-up period.

Vratna kičma, cervikalna spondilotična mijelopatija, degenerativna cervikalna mijelopatija, ishod operativnog lečenja, hirurški pristupi

Cervical spine, cervical spondilotic myelopathy, degenerative cervical myelopathy, surgical outcomes, surgical approaches

616.711-008.64-089(043.3)

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