The Prognosis of Patients With Cervical Spondylotic Myelopathy

我們研究過去六年來（民國七十七年一八十二年）於高雄醫學院附設醫院經完整神經學檢查，影像學檢查或電氣生理檢查，56位診斷符合頸椎退化性脊髓病變的患者，目的在於了解可能影響預後因子及比較保守療法及手術療法的成效，本研究藉經由復健科醫師訪診及完成功能狀況評估的病人共有31人，其中有17位病人接受保守療法（男性11人，女性6人）平均年齡52 歲（28~70）歲；另有14位病人接受手術治療（男性11人，女性3人）平均年齡50 (29-65）歲。接受保守療法病人的平均追蹤期間為54個月。接受手術療法病人症狀發生到接受開刀平均期間為23個月。以日本骨科協會評估表（The Japanese Orthopaedic Associa-tion Scale）及恢復量表(Recovery Rate Scale)追縱評估功能變化情形並對有關預後因子加以分析。發現病人年齡大於50歲及Pavlov ratio小於0.7對預後並無影響，於症狀發生後18個月內接受開刀治療的病人顯示有較佳的恢復(P= 0 . 03 )。接受保守療法的病人有35％獲得改善，而手術治療的病人有43％獲得改善。顯示經由適當選擇的手術療法其改善情形優於保守療法，所以病人在接受保守療法時，定期的追蹤評估，以早期發現進行性壓迫性脊髓病變的症狀是相當重要的。

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並列摘要

We studied 56 patients who received complete neurological examinations, image studies, or eiectrophysiological studies, and for these cervical spondylotic myelopathy was diagnosed at the Kaohsiung Medical College Hospital during the period 1988 to 1993. For the purposes of identifying possible prognosis factors and comparing the results of patients with conservative treatment versus operative treatment, we designed this study. Informed consent and a completed functional evaluation were obtained from 31 patients via physiatrist’s visits. 17 patients (male = 11, female = 6) mean age 52 years old received conservative treatment and 14 patients (male = 11, female = 3) mean age 50 years old received operative treatment. For the conservative group, the average follow-up was 54 months and for the operative group, the average duration (from symptom and sign onset until operation) was 23 months. According to “The Japanese Orthopaedic Association Scale” and “The Recovery Rate Scale”, we have evaluated the functional change of patients during the follow-up period and different possible prognosis factors have been analyzed. There is no significant difference in recovery rate whether patient’s age is over 50 years old or whether the individual Pavlov ratio is smaller than 0.7. Interestingly, patients who received operation (anterior or posterior approach) within 18 months since symptom and sign onset were found to have a better recovery rate (p = 0.03). In our study, conservative management leads to 35% improvement and the operative management leads to 43% improvement. The results of proper cases selection and operation are superior to conservative treatment. If a patient has received a conservative treatment, routine re-evaluation is then very important for the early detection of progressive compression myelopathy signs.

並列關鍵字

cervical spondylotic myelopathy ； conservative or operative treatment ； prognosis

國際替代計量

The Prognosis of Patients With Cervical Spondylotic Myelopathy

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