建议采用新的评分系统(颈椎手术评分)来治疗退行性颈椎病。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Journal of neurosurgical sciences Pub Date : 2024-03-19 DOI:10.23736/S0390-5616.23.06165-9
Francesco Costa, Francesco Restelli, Elio Mazzapicchi, Emanuele Rubiu, Giulio Bonomo, Marco Schiariti, Niccolò Innocenti, Carla D Anania, Andrea Cardia, Maurizio Fornari
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引用次数: 0

摘要

背景:迄今为止,尚无旨在指导复杂颈椎退行性脊髓病(DCM)病例手术策略的通用算法。我们的目的是提出颈椎手术评分(CSS),帮助识别复杂的 DCM 病例,提出手术策略建议:我们在多学科讨论和文献研究的基础上,根据颈椎病变和脊髓病变的层数、压迫类型和主要程度以及临床脊髓病变的等级等八个参数创建了 CSS。我们在 15 个月的时间里对接受手术的 DCM 患者进行了前瞻性登记,并收集了临床和放射学数据。在门诊期间,我们为 DCM 患者提供了特定的手术指征。为了验证评分结果,每个门诊手术指征都与多学科 CSS 评分结果进行了事后比较,重点关注前后路均适合的患者:在 2021 年 12 月至 2023 年 2 月期间,我院共对 100 名接受 DCM 手术的患者进行了前瞻性研究。53%的患者存在两级以上的病变。根据 CSS 计算,14% 的患者属于 "灰色区域",即前后入路均可行。其中,42.8%的病例的CSS允许对原计划的手术进行修改。结果显示,62%的患者 m-JOA 评分有所改善:这项初步研究显示了 CSS 在检测复杂 DCM 病例方面的可靠性和实用性,需要脊柱外科医生专家进行进一步分析,并提出手术策略建议。
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Proposal of a new score system (Cervical Surgical Score) for management of degenerative cervical myelopathy.

Background: To date, no shared algorithms with the aim of guiding surgical strategy in complex cases of degenerative cervical myelopathy (DCM) exist. Our purpose is to present the Cervical Surgical Score (CSS) which could help in identifying complex DCM cases, suggesting a surgical strategy.

Methods: We created the CSS based on multidisciplinary and literature-focused discussions, based on eight parameters including number of levels of cervical pathology and myelopathy, type and predominance of compression and grade of clinical myelopathy. We prospectively enrolled surgical DCM patients in a 15-months period, collecting clinical and radiological data. During outpatient clinic a specific surgical indication was offered to DCM patients. To validate the score, each outpatient clinic surgical indication was compared a posteriori to the one that resulted from multidisciplinary CSS scoring, focusing on patients for which both an anterior and posterior approach were considered suitable.

Results: A total of 100 patients operated on for DCM at our Institution between December 2021 and February 2023 were prospectively enrolled. In 53% of patients the pathology was present at more than two levels. According to CSS calculation, 14% of patients resulted in the "grey zone", where both an anterior and posterior approach were deemed feasible. Among them, in 42.8% of cases the CSS allowed a modification of the originally planned surgery. Looking at outcome, an improvement of m-JOA score in 62% of patients was disclosed.

Conclusions: This preliminary study showed the reliability and usefulness of CSS in detecting complex DCM cases, requiring further analysis by expert spine surgeons, suggesting a surgical strategy.

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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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