Masaki Yutaka, Yamazaki Masashi, Okawa Akihiko, Aramomi Masaaki, Hashimoto Mitsuhiro, Koda Masao, Mochizuki Makondo, Moriya Hideshige
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
J Spinal Disord Tech. 2007 Feb;20(1):7-13. doi: 10.1097/01.bsd.0000211260.28497.35.
We compared the surgical outcome of anterior decompression with spinal fusion (ASF) with the surgical outcome of laminoplasty for patients with cervical myelopathy due to ossification of the posterior longitudinal ligament.
The study group comprised 19 ASF patients (A-group) and 40 laminoplasty patients (P-group) treated from 1993 to 2002 with 1 year or longer follow-up. The Japanese Orthopedic Association scoring system was used to evaluate cervical myelopathy, and the recovery rate calculated 1 year after surgery.
The mean recovery rate was 68.4% in the A-group and 52.5% in the P-group (P<0.05). Fifteen patients had a recovery rate less than 40%: 2 in the A-group and 13 in the P-group. One P-group patient and none of the A-group patients developed postoperative aggravation of their neurologic status. The P-group was divided into 2 subgroups: a good outcome group comprising patients whose recovery rate was 40% or higher (n=27) and a poor outcome group comprising patients whose recovery rate was less than 40% (n=13). The mean age at surgery was 59.9 years in the good outcome group and 68.0 years in the poor outcome group (P<0.05). The mean range of intervertebral mobility at maximum cord compression level before surgery was 6.9 degrees in the good outcome group and 10 degrees in the poor outcome group (P<0.05).
These results demonstrated that the surgical outcome of ASF was superior to the surgical outcome of laminoplasty. Elderly patients treated with laminoplasty showed an especially poor surgical outcome. We suggest that hypermobility of vertebrae at the cord compression level is a risk factor for poor surgical outcome after laminoplasty. Based on these results, we recommend that ASF should be the first choice of treatment for patients with significant ossification of the posterior longitudinal ligament and a hypermobile cervical spine. When laminoplasty is used for such cases, the addition of posterior instrumented fusion would be desirable for stabilizing the spine and decreasing damage to the spinal cord.
我们比较了因后纵韧带骨化导致的颈椎脊髓病患者行前路减压融合术（ASF）与椎板成形术的手术效果。
研究组包括1993年至2002年接受治疗且随访1年或更长时间的19例行ASF患者（A组）和40例行椎板成形术患者（P组）。采用日本骨科协会评分系统评估颈椎脊髓病，并计算术后1年的恢复率。
A组平均恢复率为68.4%，P组为52.5%（P<0.05）。15例患者恢复率低于40%：A组2例，P组13例。P组1例患者出现术后神经功能加重，A组无患者出现。P组分为2个亚组：恢复率40%或更高的患者组成的良好结局组（n = 27）和恢复率低于40%的患者组成的不良结局组（n = 13）。良好结局组手术时的平均年龄为59.9岁，不良结局组为68.0岁（P<0.05）。术前最大脊髓压迫水平处的椎间活动度平均范围在良好结局组为6.9度，在不良结局组为10度（P<0.05）。
这些结果表明，ASF的手术效果优于椎板成形术。接受椎板成形术治疗的老年患者手术效果尤其差。我们认为脊髓压迫水平处椎体活动度过高是椎板成形术后手术效果不佳的一个危险因素。基于这些结果，我们建议对于后纵韧带明显骨化且颈椎活动度过高的患者，ASF应作为首选治疗方法。当对这类病例采用椎板成形术时，增加后路器械融合术以稳定脊柱并减少对脊髓的损伤是可取的。
