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具有异位骨化且术前后凸对齐的多节段脊髓型颈椎病患者前路手术后预后不良的多因素分析
Authors Li S, Zhang B, Shen Y, Wu Z
Received 16 March 2019
Accepted for publication 27 July 2019
Published 27 August 2019 Volume 2019:15 Pages 1053—1060
DOI https://doi.org/10.2147/TCRM.S208991
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Garry Walsh
Objective: The aim of this study was to evaluate the risk factors for poor outcome in patients who underwent multi-segmental anterior surgery, and analyze postoperative complications.
Methods: We retrospectively reviewed 158 patients after anterior surgery due to multilevel cervical spondylotic myelopathy (m-CSM) between June 2008 and June 2016. Adjusted ORs and 95% CIs were determined by multivariate logistic regression analysis. Cutoff values and the area under the curve for continuous risk factors were calculated through receiver operating characteristic curve analysis. The chi-squared test was performed for the comparison of complications among the three surgical groups.
Results: By analyzing 105 patients with good outcome and 53 patients with poor outcome, we established that the risk factors for poor outcome were advanced age (OR =1.12, P =0.003), longer duration of symptoms (OR =1.07, P =0.028), and bigger kyphotic angle at final follow-up (OR =1.29, P < 0.001). The optimal cutoff values for age, duration of symptoms, and kyphotic angle at final follow-up were 63.1 years, 15.5 months, and 5.3 angle. Postoperative complications occurred in 21 patients (13.3%). The incidence of dysphagia and cerebrospinal fluid leakage were higher in multilevel anterior cervical discectomy and fusion (m-ACDF) group than in other groups (P < 0.05).
Conclusion: Advanced age, longer duration of symptoms, and bigger kyphotic angle at final follow-up were the risk factors for poor postoperative outcome in patients with m-CSM. The complications after hybrid approach and m-ACDF approach were less than after anterior cervical corpectomy and fusion approach.
Keywords: multilevel cervical spondylotic myelopathy, kyphotic, heterotopic ossification, hybrid approach, complication