Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
Spine (Phila Pa 1976). 2011 Nov 1;36(23):1940-7. doi: 10.1097/BRS.0b013e3181feeeb2.
A clinical prospective study.
To assess whether clinical and radiologic outcomes differ between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of cervical spondylotic myelopathy (CSM).
No reports to date have accurately and prospectively compared middle-term clinical outcomes after anterior and posterior decompression for CSM.
We prospectively performed LAMP (n = 50) in 1996, 1998, 2000, and 2002, and ADF (n = 45) in 1997, 1999, 2001, and 2003. The Japanese Orthopedic Association (JOA) score, recovery rate, and each item of the JOA score were evaluated. For radiographic evaluation, the lordotic angle and range of motion (ROM) at C2-C7 and residual anterior compression to the spinal cord (ACS) after LAMP on magnetic resonance imaging were investigated.
Eighty-six patients (ADF n = 39; LAMP n = 47) could be followed for more than 5 years (follow-up rate 91.5%). Demographics were similar between the two groups. The mean JOA score and recovery rate in the ADF group were superior to those in the LAMP group from 2-year data collected after surgery. However, LAMP was safer and less invasive than ADF with respect to physical status and complications in the perioperative period. For individual items of the JOA score, the ADF group showed significantly more improvement of upper extremity motor function than the LAMP group (P < 0.05). There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group despite no difference in ROM.The LAMP group was divided into two subgroups: (1) LAMP(+) (n = 16) comprising patients who had ACS at 2 years after surgery, and (2) LAMP(-) (n = 31) comprising patients without ACS. Recovery rate differed significantly between the LAMP(+) and LAMP(-) groups despite there being no difference between the LAMP(-) and ADF groups.
The recovery rate of the JOA score in the ADF group was better than that in the LAMP group. The clinical outcomes after LAMP could be influenced by ACS.
一项临床前瞻性研究。
评估颈椎脊髓病（CSM）的前路减压融合（ADF）与椎板成形术（LAMP）在临床和影像学结果上的差异。
目前尚无报告准确、前瞻性地比较CSM 前后减压的中期临床结果。
我们前瞻性地分别于 1996 年、1998 年、2000 年和 2002 年进行 LAMP（n = 50），于 1997 年、1999 年、2001 年和 2003 年进行 ADF（n = 45）。评估日本骨科协会（JOA）评分、恢复率以及 JOA 评分的各个项目。影像学评估包括 LAMP 后磁共振成像上颈椎 2-7 节段的后凸角和活动度（ROM）以及脊髓前缘残余压迫（ACS）。
86 例患者（ADF n = 39；LAMP n = 47）可随访 5 年以上（随访率 91.5%）。两组患者的人口统计学特征相似。从手术后 2 年收集的数据来看，ADF 组的平均 JOA 评分和恢复率优于 LAMP 组。然而，在围手术期的身体状况和并发症方面，LAMP 比 ADF 更安全、创伤更小。对于 JOA 评分的各个项目，ADF 组上肢运动功能的改善明显优于 LAMP 组（P < 0.05）。尽管 ADF 组的 ROM 无差异，但 ADF 组在后凸角的维持方面明显优于 LAMP 组。LAMP 组分为两个亚组：（1）LAMP(+)（n = 16），包括术后 2 年有 ACS 的患者；（2）LAMP(-)（n = 31），包括无 ACS 的患者。尽管 LAMP(-)组与 ADF 组之间没有差异，但 LAMP(+)和 LAMP(-)组之间的恢复率差异显著。
ADF 组的 JOA 评分恢复率优于 LAMP 组。LAMP 后的临床结果可能受到 ACS 的影响。
