Background: 

Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration.

Methods: 

A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis.

Results: 

The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019).

Conclusions: 

Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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退行性脊髓型颈椎病手术后的神经系统存活率：对 195 名患者的纵向研究

背景： 

接受减压手术的退行性脊髓型颈椎病 (DCM) 患者术后神经系统存活率的长期数据有限。本研究的目的是评估 DCM 初次减压手术后的神经系统存活率，并确定术后恶化的预测因子。

方法： 

为 1999 年至 2020 年间接受 DCM 外科手术的 195 名患者收集了一个纵向临床数据集，其中包含手术细节、医学合并症和影像学特征，平均观察期为 75.9 个月。绘制了 Kaplan-Meier 曲线，并进行了对数秩检验以对与神经功能衰竭相关的因素进行单变量分析。套索回归促进了用于多变量分析的 Cox 比例风险模型中的变量选择。

结果： 

总体神经系统生存率在 5 年时为 89.3%，在 10 年时为 77.3%。套索回归后的 Cox 多变量分析确定缝合椎板成形术（HR，4.76；p < 0.001）、肾功能衰竭（HR，4.43；p = 0.013）、T2 高信号（HR，3.34；p = 0.05）、和后纵韧带骨化 (OPLL)（HR，2.32；p = 0.032）。OPLL 受试者的亚组分析表明，在没有融合的情况下，神经系统失败率显着更高（77.8% 与 26.3% 相比；p = 0.019）。

结论： 

总体而言，接受 DCM 外科手术的患者表现出神经功能改善的时间延长。在 OPLL 中表明颈椎融合以减少神经功能衰竭。随着全球颈椎手术和再手术量的增加，我们关于早期恶化预测因素的研究结果有助于病例选择、预测和咨询。

证据等级： 

预后三级。有关证据等级的完整描述，请参阅作者须知。