Department of Neurological Surgery, University of California-San Francisco, CA, USA.
Neurosurg Focus. 2011 Mar;30(3):E9. doi: 10.3171/2011.1.FOCUS10279.
Two common causes of cervical myelopathy include degenerative stenosis and ossification of the posterior longitudinal ligament (OPLL). It has been postulated that patients with OPLL have more complications and worse outcomes than those with degenerative stenosis. The authors sought to compare the surgical results of laminoplasty in the treatment of cervical stenosis with myelopathy due to either degenerative changes or segmental OPLL.
The authors conducted a retrospective review of 40 instrumented laminoplasty cases performed at a single institution over a 4-year period to treat cervical myelopathy without kyphosis. Twelve of these patients had degenerative cervical stenotic myelopathy ([CSM]; degenerative group), and the remaining 28 had segmental OPLL (OPLL group). The 2 groups had statistically similar demographic characteristics and number of treated levels (mean 3.9 surgically treated levels; p > 0.05). The authors collected perioperative and follow-up data, including radiographic results.
The overall clinical follow-up rate was 88%, and the mean clinical follow-up duration was 16.4 months. The mean radiographic follow-up rate was 83%, and the mean length of radiographic follow-up was 9.3 months. There were no significant differences in the estimated blood loss (EBL) or length of hospital stay (LOS) between the groups (p > 0.05). The mean EBL and LOS for the degenerative group were 206 ml and 3.7 days, respectively. The mean EBL and LOS for the OPLL group were 155 ml and 4 days, respectively. There was a statistically significant improvement of more than one grade in the Nurick score for both groups following surgery (p < 0.05). The Nurick score improvement was not statistically different between the groups (p > 0.05). The visual analog scale (VAS) neck pain scores were similar between groups pre- and postoperatively (p > 0.05). The complication rates were not statistically different between groups either (p > 0.05). Radiographically, both groups lost extension range of motion (ROM) following laminoplasty, but this change was not statistically significant (p > 0.05).
Patients with CSM due to either degenerative disease or segmental OPLL have similar perioperative results and neurological outcomes with laminoplasty. The VAS neck pain scores did not improve significantly with laminoplasty for either group. Laminoplasty may limit extension ROM.
颈椎脊髓病的两个常见病因包括退行性狭窄和后纵韧带骨化（OPLL）。据推测，OPLL 患者比退行性狭窄患者并发症更多，预后更差。作者旨在比较因退行性改变或节段性 OPLL 导致的颈椎狭窄合并脊髓病患者行椎板成形术的手术结果。
作者对 4 年内于单机构行颈椎后路单开门椎管扩大成形术治疗无后凸的颈椎脊髓病的 40 例患者进行回顾性研究。其中 12 例患者为退行性颈椎狭窄性脊髓病（CSM；退行性组），其余 28 例患者为节段性 OPLL（OPLL 组）。2 组患者的人口统计学特征和治疗节段数量具有统计学相似性（平均 3.9 个手术治疗节段；p＞0.05）。作者收集了围手术期和随访数据，包括影像学结果。
总的临床随访率为 88%，平均临床随访时间为 16.4 个月。平均影像学随访率为 83%，平均影像学随访时间为 9.3 个月。2 组间术中估计失血量（EBL）或住院时间（LOS）无显著差异（p＞0.05）。退行性组的 EBL 和 LOS 分别为 206ml 和 3.7 天，OPLL 组的 EBL 和 LOS 分别为 155ml 和 4 天。2 组患者术后 Nurick 评分均有 1 个等级以上的显著改善（p＜0.05）。但 2 组间 Nurick 评分改善无统计学差异（p＞0.05）。2 组患者术前和术后的视觉模拟量表（VAS）颈部疼痛评分相似（p＞0.05）。并发症发生率在 2 组间也无统计学差异（p＞0.05）。影像学方面，2 组患者行椎板成形术后均丧失了颈椎伸展活动度（ROM），但变化无统计学意义（p＞0.05）。
退行性疾病或节段性 OPLL 引起的 CSM 患者行椎板成形术的围手术期结果和神经学结果相似。VAS 颈部疼痛评分在 2 组患者中均未因椎板成形术而显著改善。椎板成形术可能会限制颈椎伸展 ROM。
