后纵韧带骨化症患者椎板切除术后驼背：是否会导致神经功能恶化？
Post-laminectomy kyphosis in patients with cervical ossification of the posterior longitudinal ligament : does it cause neurological deterioration?
作者信息
Cho Won-Sang, Chung Chun Kee, Jahng Tae-Ahn, Kim Hyun Jib
机构信息
Department of Neurosurgery , Seoul National University, College of Medicine, Seoul, Korea.
出版信息
J Korean Neurosurg Soc. 2008 Jun;43(6):259-64. doi: 10.3340/jkns.2008.43.6.259. Epub 2008 Jun 20.
OBJECTIVE
Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status.
METHODS
We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated.
RESULTS
The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0.002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae.
CONCLUSION
Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.
目的
全椎板切除术（TL）是治疗多节段颈椎后纵韧带骨化症（OPLL）的一种有效手术技术。然而，椎板切除术后常出现后凸畸形和可能的神经功能恶化。我们分析了TL术后颈椎曲度的变化以及随后神经功能状态的变化。
方法
我们回顾性分析了1998年1月至2003年12月期间接受TL治疗颈椎OPLL的14例患者的记录。根据先前确定的标准选择TL。在术前和最后一次随访检查时，通过颈椎侧位X线片观察颈椎曲度，并使用石原曲率指数（CI）进行测量。在评估图像的同时，使用改良日本骨科协会评分和改善率（IR）评估围手术期神经功能状态。
结果
患者的平均年龄为57岁，男女比例为10:4，平均随访期为41个月。OPLL的平均节段数为4.9，手术节段的平均数也为4.9。TL术后CI降低（p = 0.002），这表明存在后凸畸形改变。然而，这种后凸畸形改变与随访期长短、手术节段数和术前CI均无相关性。最后一次随访时的神经学检查显示所有患者的神经功能状态均有改善（p = 0.001）。随访期间无一例出现神经功能恶化。此外，IR与后凸畸形改变程度之间无相关性。术后并发症，如C5神经根病和硬膜外出血，均自发缓解，无神经后遗症。
结论
除1例接受TL治疗颈椎OPLL的患者外，其余患者均出现了后凸畸形改变。然而，我们未发现导致后凸畸形的任何因素或术后神经功能恶化的证据。
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