Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Clin Orthop Relat Res. 2011 Mar;469(3):688-95. doi: 10.1007/s11999-010-1653-5.
Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous.
QUESTIONS/PURPOSES: We therefore compared the pain, function and alignment of patients who underwent laminectomy with fusion to those with laminoplasty for the treatment of multilevel cervical spondylotic myelopathy.
We performed a retrospective matched cohort analysis on all 121 patients from 2002 to 2007 who underwent laminectomy with fusion (82) or laminoplasty (39) for multilevel cervical spondylotic myelopathy. We determined change in preoperative and postoperative sagittal alignment using Cobb measurement, development of junctional stenosis, and subjective improvements in pain and gait. Complications were recorded for both cohorts.
The majority of patients in both cohorts reported improvements in pain and gait postoperatively. There were seven complications in the laminectomy and fusion cohort (9%) with two patients requiring formal revision surgery (2%). There were five complications in the laminoplasty cohort (13%) with two formal revision procedures (5%).
Patients in both the laminectomy with fusion and laminoplasty cohorts reported similar functional improvements after treatment for cervical spondylotic myelopathy. Prospective randomized control trials are needed to determine whether one procedure is truly superior.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
颈椎脊髓病在老年人中越来越普遍，是该人群脊髓功能障碍的主要原因。颈椎后路单开门椎管扩大成形术和颈椎后路单开门椎管扩大成形术融合术可阻止脊髓病的进展，但这两种手术都有明确记载的并发症和相关发病率，目前尚不清楚哪种手术更有利。
问题/目的：因此，我们比较了接受颈椎后路单开门椎管扩大成形术融合术与颈椎后路单开门椎管扩大成形术治疗多节段颈椎脊髓病的患者的疼痛、功能和排列。
我们对 2002 年至 2007 年间接受颈椎后路单开门椎管扩大成形术融合术（82 例）或颈椎后路单开门椎管扩大成形术（39 例）治疗多节段颈椎脊髓病的 121 例患者进行了回顾性匹配队列分析。我们使用 Cobb 测量法确定术前和术后矢状位排列的变化、交界性狭窄的发展以及疼痛和步态的主观改善。记录了两个队列的并发症。
两个队列的大多数患者术后疼痛和步态均有改善。颈椎后路单开门椎管扩大成形术融合组有 7 例并发症（9%），其中 2 例需要正式修正手术（2%）。颈椎后路单开门椎管扩大成形术组有 5 例并发症（13%），其中 2 例行正式修正手术（5%）。
颈椎后路单开门椎管扩大成形术融合术和颈椎后路单开门椎管扩大成形术组的患者在治疗颈椎脊髓病后报告了类似的功能改善。需要前瞻性随机对照试验来确定哪种手术方法确实更优。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
