Shoda E, Sumi M, Kataoka O, Mukai H, Kurosaka M
Department of Orthopaedic Surgery, Kobe National Hospital, Japan.
Spine (Phila Pa 1976). 1999 Jul 15;24(14):1421-4. doi: 10.1097/00007632-199907150-00006.
The correlation between preoperative and postoperative lateral functional radiograms and clinical results was analyzed in 74 cases of myelopathy treated by anterior cervical fusion.
To clarify the correlation between clinical results and radiologic findings (developmental and dynamic stenosis).
Although radiologic changes have been reported at the disc level adjacent to anterior cervical fusion, the question of whether these radiologic findings affect the clinical results of anterior fusion has not been resolved.
The "deteriorated" results group (28 cases) was composed of cases with deterioration of 2 points or more in the Japan Orthopedic Association score at follow-up compared with the postoperative best score. The "good" results group (46 cases) exhibited a recovery rate of > or = 50%. The two groups were compared in lateral functional roentgenograms on which the sagittal canal diameter in each vertebra and the diameter between the inferoposterior lip of the vertebral body and the anterior margin of the lamina of the distal vertebra in the extended neck were measured. A diameter of less than 12 mm was defined as developmental canal stenosis or dynamic canal stenosis.
Fifty-four percent of the cases in the deteriorated results group had developmental canal stenosis, whereas the same findings were identified in only 2% of the cases in the good results group (P < 0.01). Preoperative dynamic canal stenosis at the disc level adjacent to the fusion was found in 64% of the patients in the deteriorated results group and in only 4% of the patients in the good results group (P < 0.01).
Patients in the deteriorated results group showed a higher incidence of preoperative developmental and/or dynamic canal stenosis at the adjacent disc level than those in the the good results group. These results indicate that patients with preoperative developmental canal stenosis are not suitable candidates for anterior cervical fusion. When dynamic canal stenosis is found below or above the level of fusion, simultaneous fusion is recommended to avoid deterioration of the myelopathy.
分析了74例行颈椎前路融合术治疗的脊髓病患者术前和术后的侧位功能X线片与临床结果之间的相关性。
阐明临床结果与放射学表现（发育性和动态性狭窄）之间的相关性。
尽管已有报道称颈椎前路融合术相邻椎间盘水平存在放射学改变，但这些放射学表现是否影响前路融合的临床结果这一问题尚未得到解决。
“结果恶化”组（28例）由随访时日本骨科协会评分较术后最佳评分下降2分或更多的病例组成。“结果良好”组（46例）的恢复率≥50%。对两组患者的侧位功能X线片进行比较，测量每个椎体的矢状管直径以及伸展位颈部时椎体下后缘与远侧椎体椎板前缘之间的直径。直径小于12mm被定义为发育性管狭窄或动态性管狭窄。
“结果恶化”组中54%的病例存在发育性管狭窄，而在“结果良好”组中只有2%的病例有相同表现（P<0.01）。“结果恶化”组中64%的患者在融合相邻椎间盘水平存在术前动态性管狭窄，而“结果良好”组中只有4%的患者有此表现（P<0.01）。
“结果恶化”组患者在相邻椎间盘水平术前发育性和/或动态性管狭窄的发生率高于“结果良好”组患者即术前发育性管狭窄患者不适合行颈椎前路融合术。当在融合水平以下或以上发现动态性管狭窄时，建议同时进行融合以避免脊髓病恶化。
