Hyun Seung-Jae, Rhim Seung-Chul, Roh Sung-Woo, Kang Suk-Hyung, Riew K Daniel
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Spine (Phila Pa 1976). 2009 May 15;34(11):1134-9. doi: 10.1097/BRS.0b013e31819c389b.
A prospective study.
To identify the time-dependent change in range of motion (ROM) after cervical laminoplasty.
Although numerous studies have reported on the loss of flexion/extension ROM associated with laminoplasty, few have reported on the time course of this loss of motion.
Twenty-three patients who received unilateral open-door laminoplasties, including miniplate fixation over 2 levels, were serially evaluated at regular set intervals after surgery. The mean follow-up period was 26.78 months (range: 24-41 months). Twelve patients had OPLL and 11 patients had cervical spondylotic myelopathy. Enrolled patients were divided into 2 groups (ossification of posterior longitudinal ligament [OPLL] and cervical spondylotic myelopathy) to compare the ROM between the OPLL and the spondylosis patients. We evaluated the time-dependent neck ROM changes by taking neutral, flexion, and extension radiographs before surgery and at 1, 3, 6, 9, 12, 18, and 24 months after surgery. Postoperative neck and arm pain was evaluated using a numerical rating scale.
The preoperative, and 1-, 3-, 6-, 9-, 12-, 18-, and 24-month postoperative ROM figures were 37.8 degrees +/- 14.6 degrees, 34.1 degrees +/- 12.9 degrees, 35.0 degrees +/- 12.3 degrees, 30.3 degrees +/- 13.0 degrees, 28.6 degrees +/- 15.1 degrees, 27.3 degrees +/- 12.4 degrees, 26.1 degrees +/- 14.8 degrees, and 25.9 degrees +/- 13.2 degrees, respectively, and at the most recent follow-up, ROM was 25.8 +/- 15.2 degrees. Thus, the mean ROM decreased by 10.1 degrees +/- 9.5 degrees (31.66%) after surgery (P = 0.002). In OPLL group, we observed a more limited cervical ROM than in cervical spondylotic myelopathy group (35.3% vs. 29.2%). However, the rate of ROM reduction slowed with time in both groups (P = 0.000). Postoperative axial pain did not correlate with the degree of serial cervical ROM.
The results suggest that the loss of cervical ROM is time-dependent and plateaus by 18 months after surgery, with no further decreases thereafter.
前瞻性研究。
确定颈椎椎板成形术后活动范围（ROM）随时间的变化。
尽管众多研究报告了与椎板成形术相关的屈伸ROM丧失情况，但很少有研究报告这种活动丧失的时间进程。
对23例行单侧开门椎板成形术（包括2节段微型钢板固定）的患者在术后定期进行系列评估。平均随访期为26.78个月（范围：24 - 41个月）。12例患者患有后纵韧带骨化症（OPLL），11例患者患有脊髓型颈椎病。将纳入的患者分为2组（后纵韧带骨化症[OPLL]组和脊髓型颈椎病组）以比较OPLL组和颈椎病患者之间的ROM。我们通过在术前以及术后1、3、6、9、12、18和24个月拍摄中立位、屈曲位和伸展位X线片来评估随时间变化的颈部ROM改变。使用数字评分量表评估术后颈部和手臂疼痛。
术前以及术后1、3、6、9、12、18和24个月的ROM数值分别为37.8°±14.6°、34.1°±12.9°、35.0°±12.3°、30.3°±13.0°、28.6°±15.1°、27.3°±12.4°、26.1°±14.8°和25.9°±13.2°，在最近一次随访时，ROM为25.8±15.2°。因此，术后平均ROM下降了10.1°±9.5°（31.66%）（P = 0.002）。在OPLL组中，我们观察到颈椎ROM比脊髓型颈椎病组更受限（35.3%对29.2%）。然而，两组中ROM降低的速率均随时间减慢（P = 0.000）。术后轴性疼痛与系列颈椎ROM程度无关。
结果表明颈椎ROM的丧失是时间依赖性的，术后18个月达到平台期，此后不再进一步下降。
