경미한 외상이 경추 척수병증 환자의 수술 결과에 미치는 영향 = The Relationship of Minor Trauma with the Surgical Outcome in Patients with Cervical Myelopathy

국문 초록 (Abstract)

연구 계획: 후향적 연구.
목적: 경추 척수병증으로 수술을 시행한 환자의 신경학적 회복에 외상의 영향을 알아보고자 하였다.
선행문헌의 요약: 경추 후종인대 골화증 및 경추 척수강 협착증이 있는 환자에서 외상에 의해 악화된 환자는 외상이 없었던 환자에 비하여 수술 이후 결과가 나쁜 것으로 보고된다.
대상 및 방법: 2004년 1월부터 2013년 12월까지 경추 척수병증으로 수술을 시행 받고 최소 1년 이상 추시가 가능하였던 70명의 환자를 대상으로 하였으며, 외상의 유무에 따라 두 그룹으로 나누어 단순 방사선, CT, MRI로 방사선학적, JOA score와 상지 근력으로 임상적 결과를 비교하였다.
결과: 총 70명의 환자 중 외상성 그룹은 18명, 비외상성 그룹은 52명이었으며, 외상에 의한 경우 모든 예에서 경미한 외상 병력을 가지고 있었다(차내교통 사고 11예, 미끄러짐 손상 4예, 경미한 보행자 교통 사고 2예, 낙상 1예). 방사선학적으로 경추 척수강이 좁은 것은 두 그룹간 유의한 차이를 보였으며(p=0.042), 임상적으로 술전, 술후 JOA 점수와 회복률은 두 그룹간 유의한 차이를 보이지 않았으나, 상지의 근력 회복 정도는 외상성 그룹의 술후 1 주내에서 의미있게 큰 것으로 나타났다(p=0.040).
결론: 경추 척수병증은 경미한 외상 자체만으로 임상 경과에 악영향을 미칠 수 있다.

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective study.
Objectives: To determine the influence of trauma on the neurologic course in patients who have undergone surgery for cervical myelopathy.
Summary of Literature Review: The postsurgical outcomes were worse from trauma in patients who had a cervical ossification of the posterior longitudinal ligament (OPLL) or cervical canal stenosis, in comparison with patients who did not.
Materials and Methods: The study was conducted on 70 patients who had undergone surgery due to cervical myelopathy from January 2004 to December 2013 and had at least 1 year of follow-up. Depending on trauma history, the patients were divided into two groups, and their radiological (simple radiographic, computed tomographic, and magnetic resonance imaging) and clinical (Japanese Orthopaedic Association [JOA] score, motor power of upper extremities) results were compared retrospectively.
Results: Among 70 patients in total, 18 patients were in the trauma group and 52 were in the non-trauma group, and all cases in the trauma group had a history of minor trauma (11 cases of drivers traffic accidents, 4 cases of slipping and falling, 2 cases of minor pedestrian accidents, and 1 case of falling). Radiologically narrower diameter of the spinal canal showed statistically significant difference between two groups (p=0.042). The JOA scores before and after surgery and the recovery rate did not have a clinically meaningful difference with trauma. However, the degree of motor improvement was significantly higher for the trauma group within 1 week after surgery (p=0.040).
Conclusions: Minor trauma itself may adversely affect the patients’ clinical courses.

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