Yu.A. Shulev, V.V. Remenets, V.L. Rychkov, V.N. Bukmullin, A.V. Vorobyev, A.A. Ivanov
Municipal Multi-Field Hospital N 2,
Medical Academy of Postgraduate Education, Saint Petersburg, Russia
A systemic approach to estimating remote results of surgical treatment, watched in patients with neurologic manifestations of a degenerative process in the cervical spine, is the basis of further progress in surgery of this zone. Common views on estimation criteria permit to elaborate optimum algorithms of treatment. Use of a common scale for assessment of outcomes will make it possible to objectify results of introduction of new surgical technologies. Besides, such a system will rise efficacy of multicenter studies.
Our estimation of surgical outcomes in patients with compression syndromes, caused by degenerative changed at a cervical level, was based on the system, whose criteria included evaluation of dynamics of a dominating clinical syndrome and functional adaptation of a patient.
There were 87 cases, operated by us in 1997-2002. The dominating clinical syndrome was as follows: myelopathy - 11 cases, radiculopathy - 26 cases, myeloradiculopathy - 50 cases. The dominating pain syndrome in a group of patients with radiculopathy was estimated according to Denis scale. We used the CSRS scale and Barthel's index for assessment of functional adaptation. It allowed to carry out comparative analysis of everyday activity in the above groups.
The leading symptom-complex in a group of patients with meylopathy was represented by conduction disorders, estimated according to the European Myelopathy Scale (EMS). Functional adaptation was assessed on the basis of the JOA scale.
As for cases with myeloradiculopathy, a degree of impairment of functional adaptation was conditioned first of all by conduction disorders. We estimated them with the help of the EMS and JOA scales. Evaluation of radiculopathy was carried out on the basis of Denis scale.
Dynamics was assessed during a year and patients were tested before operation and 3, 6 and 12 months after it.
Pain syndrome, estimated in a radiculopathy group (Denis scale), had a score of 3.96±0.21; there was regression of pain in 12 months and this index was equal to 1.0. The patients felt better, which was confirmed by reliable reduction of a total score (the CSRS scale) from 2.42±0.98 up to 1.07±0.27; a neurologic outcome score, equal to 0.15±0.54; improvement of a functional status with a score increase from 2.5±0.76 up to 3.92±0.27; better dynamics of everyday activity, manifesting itself in reliable reduction of this index from 3.34±1.01 up to 0.42±0.5. Barthel's index grew from 81.92±2.46 up to 99.0±0.48.
A level of conduction disorders in a group with meylopathy (the EMS scale) was characterized by a value of 13.90±2.70. There was regression of its manifestations 12 months after intervention. It was proved by a reliable increase of the EMS index up to 16.27±2.72; an index of functional adaptation (the JOA scale) grew from 10.81±0.79 up to 15.81±0.51; Barthel's index changed from 64.54±6.0 up to 90.0±4.26.
Pain syndrome in a group with meyloradiculopathy (Denis scale) had a score of 2.18±0.21 before operation; its value 12 months after it was 1.0. Improvement of patients' states was confirmed by reliable decrease of the CSRS index from 2.18±0.21 up to 1.12±0.32; a neurologic outcome index was 0.28±0.67; an index of everyday activity changed from 3.7±1.07 (before operation) up to 1.1±0.3 (after it). A level of conduction disorders became reliably smaller in 12 months, which was proved by increase of the EMS index from 13.72±2.03 up to 17.68±0.86. Reliable improvement of patients' states (the JOA scale) was demonstrated by change of a score from 11.2±0.39 up to 16.36±0.15 and increase of Barthel's index from 70.2±2.24 up to 95.2±0.84.
Thus, our study showed, that a digital equivalent of the dominating clinical syndrome and functional adaptation allows to estimate an applied method of treatment, to prognosticate an outcome in each individual patient and to adapt "qualitative characteristics", used earlier, to a unified and common system of analyzing treatment results.