Efikasnost hirurškog lečenja bolesnika sa cervikalnom spondilotičnom mijelopatijom
Sažetak
Uvod/Cilj. Izbor tretmana u lečenju cervikalne spondilotične mijelopatije (CSM) predstavlja temu za diskusiju zbog nedostatka kontrolisanih randomizovanih prospektivnih studija. Prirodan tok CSM nije moguće predvideti, a sa druge strane efikasnost hirurške dekompresije je i dalje diskutabilna. Cilj ove prospektivne studije bio je prikazivanje rezultata hirurškog lečenja bolesnika sa CSM u jednoj hirurškoj ustanovi. Metode. U studiju je uključeno 59 bolesnika sa simptomatskom CSM u jednom centru, na kraju perioda praćenja od 12 meseci, analizirano je 50 bolesnika. Svi bolesnici u studiji su operisani, a dekompresija je urađena 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), Nurick-ov skor i Neck Disability Index (NDI – indeks ograničenja sposobnosti zbog bola u vratu). Funkcionalni oporavak računat je nakon operacije, korišćenjem Hirabayashijeve formule. Rezultati. Prema našim rezultatima, značajno poboljšanje je registrovano prema svim skalama za merenje ishoda (mJOA, Nurick-ov skor, NDI). Pored toga, zabeleženo je statistički značajno poboljšanje u sve tri grupe bolesnika u odnosu na preoperativni mJOA (blaga, umerena i teška mijelopatija). Funkcionalni oporavak bio je zadovoljavajući kod 23 bolesnika (46%), dok je 27 bolesnika (54%) imalo nezadovoljavajući oporavak. Zaključak. Hirurško lečenje CSM veoma je efikasna metoda lečenja, ono dovodi do značajnog poboljšanja prema svim skalama za merenje ishoda u periodu praćenja od jedne godine. Takođe, mogu se predložiti nova istarživanja radi boljeg praćenja toka bolesti, definisanja optimalne hirurške strategije i boljeg definisanja faktora koji utiču na ishod operativnog lečenja CSM.
Reference
Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the current patho-biology of an incrisingly prevalent and devastating disorder. Neuroscientist 2013; 19(4): 409‒21.
Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. De-generative Cervical Myelopathy: epidemiology, genetics, and pathogenesis. Spine 2015; 40(12): E675‒93.
Tretault L, Tan G, Kopjar B, Côté P, Arnold P, Nugaeva N, et al. Clinical and surgical predictors of complications following surgery for the treatment of cervical spondylotic myelopathy: results from the multicenter, prospective AOSpine interna-tional study of 479 patients. Neurosurgery 2016; 79(1): 33‒44.
Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual inci-dence and course of neck pain in the general population: a population-based cohort study. Pain 2004; 112(3): 267‒73.
Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. The pathophysiology and natural history of cervical spondylot-ic myelopathy. Spine (Phila Pa) 2013; 38(22 Suppl 1): S21‒36.
Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Mas-sicotte EM, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America multi-centre study. J Bone Joint Surg Am 2013; 95(18): 1651‒8.
Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminec-tomy and dentate ligamnent section for cervical spondylotic myelopathy. J Spinal Disord 1991; 4(3): 286‒95.
Nurick S. The natural history and the results of surgical treat-ment of the spinal cord disorder associated with cervical spondylosis. Brain 1972; 95(1): 101‒8.
Vernon H, Mior S. The Neck Disability Index: a study of relia-bility and validity. J Manipulative Physiol Ther 1991; 14(7): 409‒15.
Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitu-dinal ligaments. Spine (Phila Pa 1976) 1981; 6(4): 354‒64.
Henderson FC, Geddes JF, Vaccaro AR, Woodard E, Berry KJ, Benzel EC. Strech-associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery 2005; 56(5): 1101‒13; discussion 1101‒13.
Rowland LP. Surgical treatment of cervical spondylotic mye-lopathy: time for a controlled trial. Neurology 1992; 42(1): 5‒13.
Tetreault L, Willson JR, Kotter MLN, Côté P, Nouri A, Kopjar B, et al. Is preoperative duration of symptoms a significant pre-dictors of functional outcomes in patients undergoing surgery for the treatment of degenerative cervical myelopathy? Neuro-surgery 2018; https://doi.org/10.1093/neuros/nyy474 (In Press)
Fehlings MG, Tetreault L, Kurpad S, Brodke DS, Wilson JR, Smith JS, et al. Change in functional impairment, disability, and quality of life following operative treatment for degenera-tive cervical myelopathy: a systematic review and meta-analysis. Global Spine J 2017; 7(3 Suppl): 53S‒69S.
Fehlings MG, Ahuja CS, Mroz T, Hsu W, Harrop J. Future ad-vances in spine surgery: The AOSpine North America perspec-tive. Neurosurgery 2017; 80(3 Suppl): S1‒S8.
Kadanka Z, Bednarík J, Vohánka S, Vlach O, Stejskal L, Chaloupka R, et al. Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study. Eur Spine J 2000; 9(6): 538‒44.
Kadanka Z, Mares M, Bednaník J, Smrcka V, Krbec M, Stejskal L, et al. Approaches to sponylotic cervical myelopathy: con-servative versus surgical results in a 3-year follow-up study. Spine (Phila Pa 1976) 2002; 27(20): 2205‒10; discussion 2210‒1.
Kadaňka Z, Bednařík J, Novotný O, Urbánek I, Dušek L. Cervical spondylotic myelopathy: conservative versus surgical treat-ment after 10 years. Eur Spine J 2011; 20(9): 1533‒8.
Ghogawala Z, Benzel EC, Riew KD, Bisson EF, Heary RF. Sur-gery vs conservative care for cervical spondylotic myelopathy: surgery is appropriate for progressive myelopathy. Neurosur-gery 2015; 62(Suppl 1): 56‒61.
Badhiwala JH, Witiw CD, Nassiri F, Akbar MA, Mansouri A, Wilson JR, et al. Efficacy and safety of surgery for mild degen-erative cervical myelopathy: results of the AOSpine North America and International prospective multicenter study. Neurosurgery 2019; 84(4): 890‒7.