Hosono Noboru, Sakaura Hironobu, Mukai Yoshihiro, Yoshikawa Hideki
Department of Orthopedic Surgery, Osaka Kosei-nenkin Hospital, Osaka, Japan.
Spine (Phila Pa 1976). 2007 Dec 15;32(26):2985-8. doi: 10.1097/BRS.0b013e31815cda83.
Prospective study to investigate the incidence of axial pain in the 3 different procedures of laminoplasty.
To inquire which is more important in the development of axial pain after laminoplasty: C7 or deep extensor muscles.
The etiology of axial pain remains largely unknown. Some surgeons have attempted to preserve the paravertebral muscles with innovative procedures of laminoplasty and thereby reduce the incidence of axial pain. Meanwhile, we have reported that axial pain can be prevented by avoiding inclusion of C7 in laminoplasty.
There were 91 patients with myelopathy who underwent our original laminoplasty, in which the deep extensor muscles were completely preserved exclusively on the hinged side. Until 2001, all candidates for laminoplasty underwent this procedure from C3-C7 (left-opened C3-C7 group, n = 37). From 2002, the same procedure was performed from C3-C6 (left-opened C3-C6 group, n = 31). From 2004, the opened side was changed from left to right (right-opened C3-C6 group, n = 23). Axial neck pain was graded as severe, moderate, or mild. Early pain during the first month after surgery and late pain during the first year after surgery were investigated. The laterality of early pain in the C3-C6 groups was recorded.
Significant early pain graded severe or moderate was observed in 49% in the left-opened C3-C7 group, but 15% in the left- or right-opened C3-C6 groups (P = 0.0008). Significant late pain was noted in 30% in the left-opened C3-C7 group and in 5.6% in the C3-C6 groups (P = 0.0036). Early axial pain, which usually was mild, was predominantly observed on the opened side in the C3-C6 groups.
To prevent axial pain, C7 should not be included in cervical laminoplasty, while detachment of the deep extensor muscles does not result in significant axial pain.
一项前瞻性研究，旨在调查三种不同椎板成形术式中轴性疼痛的发生率。
探究在椎板成形术后轴性疼痛的发生过程中，C7或深层伸肌哪一个更为重要。
轴性疼痛的病因在很大程度上仍然未知。一些外科医生尝试通过创新的椎板成形术式保留椎旁肌肉，从而降低轴性疼痛的发生率。同时，我们曾报道通过避免在椎板成形术中纳入C7可预防轴性疼痛。
91例脊髓病患者接受了我们最初的椎板成形术，其中仅在铰链侧完全保留深层伸肌。到2001年，所有椎板成形术候选患者均接受从C3至C7的此术式（左开C3-C7组，n = 37）。从2002年起，相同术式从C3至C6进行（左开C3-C6组，n = 31）。从2004年起，开口侧从左侧改为右侧（右开C3-C6组，n = 23）。颈部轴性疼痛分为重度、中度或轻度。对术后第一个月的早期疼痛和术后第一年的晚期疼痛进行调查。记录C3-C6组早期疼痛的部位。
左开C3-C7组中49%观察到重度或中度的显著早期疼痛，而左开或右开C3-C6组中为15%（P = 0.0008）。左开C3-C7组中30%注意到显著晚期疼痛，C3-C6组中为5.6%（P = 0.0036）。早期轴性疼痛通常为轻度，主要在C3-C6组的开口侧观察到。
为预防轴性疼痛，颈椎椎板成形术不应纳入C7，而深层伸肌的分离不会导致显著的轴性疼痛。
