Purpose

To investigate improvement rates, adverse events and predictors of clinical outcome after laminectomy alone (LAM) or laminectomy with instrumented fusion (LAM + F) for degenerative cervical myelopathy (DCM).

Methods

This is a post hoc analysis of a previously published DCM cohort. Improvement rates for European myelopathy score (EMS) and Neck Disability Index (NDI) at 2- and 5-year follow-ups and adverse events are presented descriptively for available cases. Predictor endpoints were EMS and NDI scores at follow-ups, surgeon- and patient-reported complications, and reoperation-free interval. For predictors, univariate and multivariable models were fitted to imputed data.

Results

Mean age of patients (LAM n = 412; LAM + F n = 305) was 68 years, and 37.4% were women. LAM + F patients had more severe spondylolisthesis and less severe kyphosis at baseline, more surgeon-reported complications, more patient-reported complications, and more reoperations (p ≤ 0.05). After imputation, the overall EMS improvement rate was 43.8% at 2 years and 36.3% at 5 years. At follow-ups, worse EMS scores were independent predictors of worse EMS outcomes and older age and worse NDI scores were independent predictors of worse NDI outcomes. LAM + F was associated with more surgeon-reported complications (ratio 1.81; 95% CI 1.17–2.80; p = 0.008). More operated levels were associated with more patient-reported complications (ratio 1.12; 95% CI 1.02–1.22; p = 0.012) and a shorter reoperation-free interval (hazard ratio 1.30; 95% CI 1.08–1.58; p = 0.046).

Conclusions

These findings suggest that surgical intervention at an earlier myelopathy stage might be beneficial and that less invasive procedures are preferable in this patient population.

中文翻译：

---

退行性脊髓型颈椎病手术后的改善率、不良事件和临床结果预测因子

目的

调查单独椎板切除术 (LAM) 或椎板切除联合器械融合 (LAM + F) 治疗退行性脊髓型颈椎病 (DCM) 后的改善率、不良事件和临床结果的预测因子。

方法

这是对先前发布的 DCM 队列的事后分析。欧洲脊髓病评分 (EMS) 和颈部残疾指数 (NDI) 在 2 年和 5 年随访时的改善率以及不良事件均针对现有病例进行了描述性介绍。预测终点是随访时的 EMS 和 NDI 评分、外科医生和患者报告的并发症以及无再手术间隔。对于预测变量，单变量和多变量模型适用于估算数据。

结果

患者（LAM n  = 412；LAM + F n  = 305）的平均年龄为 68 岁，37.4% 为女性。LAM + F 患者在基线时有更严重的脊椎滑脱和更不严重的脊柱后凸、更多的外科医生报告的并发症、更多的患者报告的并发症和更多的再次手术 ( p  ≤ 0.05)。插补后，总体 EMS 改善率在 2 年时为 43.8%，在 5 年时为 36.3%。在随访中，较差的 EMS 评分是较差的 EMS 结果的独立预测因子，年龄较大和较差的 NDI 评分是较差的 NDI 结果的独立预测因子。LAM + F 与更多外科医生报告的并发症相关（比率 1.81；95% CI 1.17–2.80；p = 0.008）。更多的手术水平与更多的患者报告的并发症（比率 1.12；95% CI 1.02–1.22；p  = 0.012）和更短的无再手术间隔（风险比 1.30；95% CI 1.08–1.58；p  = 0.046）相关。

结论

这些研究结果表明，在早期脊髓病阶段进行手术干预可能是有益的，并且在该患者群体中更可取侵入性较小的手术。