肌萎缩侧索硬化患者19例发病后行颈椎手术的随访观察

The follow-up study of spinal decompression surgery after the onset of symptom of 19 patients with amyotrophic lateral sclerosis

目的探讨颈椎手术对肌萎缩侧索硬化（amyotrophic lateral sclerosis，AkS）的病情进展和预后的影响。方法收集确诊和拟诊的AkS患者329例，记录病史、流行病学，颈椎核磁检查结果及手术史等相关资料。部分患者每3个月进行随访，直至死亡或行气管切开术。结果329例AkS患者中，有颈椎异常者156例（47．4％），其中行颈椎手术者19例（5.8％）。手术组与未手术组诊断时发病年龄、性别构成、神经功能评分差异均无统计学意义，但从发病到确诊的时间，手术组[（23．0±6．5）个月]较未手术组[（13．7±7．9）个月]明显延长（t=4．800，P=0．000）。通过随访，两组诊断后1年的病情进展速度和生存时间差异无统计学意义。结论颈椎手术后患者确诊时间延长，病情继续进展，虽然未造成明显的病情进展加快和生存时间缩短，仍应尽量避免，对ALS和脊髓型颈椎病共病的患者施行手术应慎重。

Objective To investigate the progression rate and prognosis of spinal decompression surgery after the onset of symptoms of amyotrophic lateral sclerosis （ALS）, Methods A total of 329 consecutive patients with definite or probable ALS were enrolled in the study. The patients were recorded with clinical features, history of spinal surgery, etc. Some of the patients were monitored every 3 months from visit to death or tracheostomy. Results Of 329 typical sporadic ALS, we found cervical spondylosis in 156 （47.4%） patients, among whom 19 （5.8%） underwent decompressive spinal surgery. No differences were noted regarding age at symptom onset, sex and ALSFRS-R at time of diagnosis between ALS patients who underwent spinal surgery and other ALS patients. But the time from symptom onset to diagnosis was significantly longer in patients with spinal surgery （ （ 23.0 ± 6. 5 ） months vs （ 13.7 ±7.9 ） months, t = 4. 800 ,P =0. 000）. In the follow-up study, there were no differences in the rate of disease progression and survival between 2 groups. Conclusions All patients have inevitably progressed after spinal surgery. Although the surgery does not obviously fasten disease progression rate and shorten survival, it prolongs the time from disease onset to diagnosis, therefore should be handled with caution in patients with concurrent ALS and cervical spondylotic myelopathy.