Aizawa Toshimi, Sato Tetsuro, Sasaki Hirotoshi, Matsumoto Fujio, Morozumi Naoki, Kusakabe Takashi, Itoi Eiji, Kokubun Shoichi
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Nishitaga National Hospital, Sendai, Japan.
J Neurosurg Spine. 2007 Jul;7(1):13-20. doi: 10.3171/SPI-07/07/013.
Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement.
Between 1988 and 2002, 132 patients with thoracic myelopathy underwent surgery and a minimum 2-year observation period. Clinical data were collected from medical and operative records, and sagittal alignment of the spine was measured on radiographs. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors affecting the preoperative severity of myelopathy and postoperative improvement were also examined.
The population consisted of 97 men (mean age at surgery was 58 years) and 35 women (mean age at surgery 62 years). Myelopathy was caused by ossification of the ligamentum flavum (OLF) in 73 patients, ossification of the posterior longitudinal ligament (OPLL) in 21, combined OLF-OPLL in 10, intervertebral disc herniation (IDH) in 15, posterior bone spur in 11, and OLF with IDH or posterior bone spur in one patient each. The surgical outcome was relatively good: a mean preoperative JOA score of 5.3 improved to a mean score of 7.8 at the last follow-up, 50 months on average after surgery. Thoracic myelopathy caused by OPLL, however, was associated with lower postoperative scores and recovery rates. In more than half of the patients the authors documented an increase of kyphosis of less than 2 degrees.
Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the surgical treatment for OPLL still involves many problems.
与颈椎病性脊髓病相比，胸段脊髓病并不常见。在本研究中，对因脊柱退变过程导致胸段脊髓病患者所获得的数据进行回顾性分析，以阐明手术效果并研究影响术后改善的各种因素。
1988年至2002年间，132例胸段脊髓病患者接受了手术，并进行了至少2年的观察期。从医疗和手术记录中收集临床数据，并在X线片上测量脊柱矢状位排列。使用改良的日本骨科协会（JOA）量表（最高分11分）对患者进行术前和术后评估。还研究了影响脊髓病术前严重程度和术后改善的各种因素之间的关系。
研究人群包括97名男性（手术时平均年龄58岁）和35名女性（手术时平均年龄62岁）。脊髓病由黄韧带骨化（OLF）引起的有73例，后纵韧带骨化（OPLL）引起的有21例，OLF合并OPLL的有10例，椎间盘突出（IDH）引起的有15例，后骨赘引起的有11例，OLF合并IDH或后骨赘各1例。手术效果相对较好：术前JOA平均评分为5.3分，末次随访时平均评分为7.8分，平均在术后50个月。然而，由OPLL引起的胸段脊髓病术后评分和恢复率较低。在超过一半的患者中，作者记录到后凸增加小于2度。
术前症状持续时间较短且脊髓病较轻的患者术后神经状况明显较好，这表明那些出现较早且残疾较少的患者应及时建议手术，尽管OPLL的手术治疗仍存在许多问题。
