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Different Approaches for Treating Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 153 Cases from a Single Spinal Center
Li, Xiumao1; Jiang, Liang1; Liu, Zhongjun1; Liu, Xiaoguang1; Zhang, Hua2; Zhou, Hua1; Wei, Feng1; Yu, Miao1; Wu, Fengliang1
刊名PLOS ONE
2015-10-13
DOI10.1371/journal.pone.0140031
10期:10
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Multidisciplinary Sciences
研究领域[WOS]Science & Technology - Other Topics
关键词[WOS]POSTERIOR LONGITUDINAL LIGAMENT ; SURGICAL-TREATMENT ; ANTERIOR ; DECOMPRESSION ; LAMINOPLASTY ; COMPRESSION ; OUTCOMES ; FUSION ; RATIO ; CORD
英文摘要

Objective

The optimal surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) remains controversial. This study compared the outcomes of three surgical approaches for MSCM treatment, focusing on the efficacy and safety of a combined approach.

Methods

This retrospective study included 153 consecutive MCSM patients (100 men, 53 women; mean age +/- standard deviation, 55.7 +/- 9.4 years) undergoing operations involving >= 3 intervertebral segments. The patients were divided into three groups according to surgical approach: anterior (n = 19), posterior (n = 76), and combined (n = 58). We assessed demographic variables, perioperative parameters, and clinical outcomes >= 12 months after surgery (20.5 +/- 7.6 months), including Japanese Orthopaedic Association (JOA) score, improvement, recovery rate, and complications.

Results

The anterior group had the most favorable preoperative conditions, including the highest preoperative JOA score (12.95 +/- 1.86, rho = 0.046). In contrast, the combined group had the highest occupancy ratio (48.0% +/- 11.6%, rho = 0.002). All groups showed significant neurological improvement at final follow-ups, with JOA recovery rates of 59.7%, 54.6%, and 68.9% in the anterior, posterior, and combined groups, respectively (rho = 0.163). After multi-variable adjustments, the groups did not have significantly different clinical outcomes (postoperative JOA score, rho = 0.424; improvement, rho = 0.424; recovery rate, rho = 0.080). Further, subgroup analyses of patients with occupancy ratios >= 50% showed similar functional outcomes following the posterior and combined approaches. Overall complication rates did not differ significantly among the three approaches (rho = 0.600). Occupancy ratios did not have a significant negative influence on postoperative recovery following the posterior approach.

Conclusions

If applied appropriately, all three approaches are effective for treating MCSM. All three approaches had equivalent neurological outcomes, even in subgroups with high occupancy ratios. Further investigations of surgical approaches to MCSM are needed, particularly prospective multicenter studies with long-term follow-up.

语种英语
WOS记录号WOS:000362962300049
项目编号AOSCN (R) 2013-07
资助机构AOSpine China Research Grant Project
引用统计
被引频次:5[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/51201
专题北京大学第三临床医学院_骨科
作者单位1.Peking Univ, Hosp 3, Dept Orthopaed, Beijing 100191, Peoples R China
2.Peking Univ, Hosp 3, Res Ctr Clin Epidemiol, Beijing 100191, Peoples R China
推荐引用方式
GB/T 7714
Li, Xiumao,Jiang, Liang,Liu, Zhongjun,et al. Different Approaches for Treating Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 153 Cases from a Single Spinal Center[J]. PLOS ONE,2015,10(10).
APA Li, Xiumao.,Jiang, Liang.,Liu, Zhongjun.,Liu, Xiaoguang.,Zhang, Hua.,...&Wu, Fengliang.(2015).Different Approaches for Treating Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 153 Cases from a Single Spinal Center.PLOS ONE,10(10).
MLA Li, Xiumao,et al."Different Approaches for Treating Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 153 Cases from a Single Spinal Center".PLOS ONE 10.10(2015).
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