Tsutsumimoto T, Shimogata M, Yui M, Ohta H, Misawa H
Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano 386-0603, Japan.
J Bone Joint Surg Br. 2012 Mar;94(3):378-84. doi: 10.1302/0301-620X.94B3.27867.
We retrospectively examined the prevalence and natural history of asymptomatic lumbar canal stenosis in patients treated surgically for cervical compressive myelopathy in order to assess the influence of latent lumbar canal stenosis on the recovery after surgery. Of 214 patients who had undergone cervical laminoplasty for cervical myelopathy, we identified 69 (32%) with myelographically documented lumbar canal stenosis. Of these, 28 (13%) patients with symptomatic lumbar canal stenosis underwent simultaneous cervical and lumbar decompression. Of the remaining 41 (19%) patients with asymptomatic lumbar canal stenosis who underwent only cervical surgery, 39 were followed up for ≥ 1 year (mean 4.9 years (1 to 12)) and were included in the analysis (study group). Patients without myelographic evidence of lumbar canal stenosis, who had been followed up for ≥ 1 year after the cervical surgery, served as controls (135 patients; mean follow-up period 6.5 years (1 to 17)). Among the 39 patients with asymptomatic lumbar canal stenosis, seven had lumbar-related leg symptoms after the cervical surgery. Kaplan-Meier analysis showed that 89.6% (95% confidence interval (CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients with asymptomatic lumbar canal stenosis were free from leg symptoms for three and five years, respectively. There were no significant differences between the study and control groups in the recovery rate measured by the Japanese Orthopaedic Association score or improvement in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does not influence recovery following surgery for cervical myelopathy; moreover, prophylactic lumbar decompression does not appear to be warranted as a routine procedure for coexistent asymptomatic lumbar canal stenosis in patients with cervical myelopathy, when planning cervical surgery.
我们回顾性研究了因颈椎压迫性脊髓病接受手术治疗的患者中无症状腰椎管狭窄的患病率及自然病史，以评估潜在腰椎管狭窄对术后恢复的影响。在214例行颈椎椎板成形术治疗颈椎脊髓病的患者中，我们确定69例（32%）存在脊髓造影证实的腰椎管狭窄。其中，28例（13%）有症状的腰椎管狭窄患者同时接受了颈椎和腰椎减压术。其余41例（19%）无症状腰椎管狭窄患者仅接受了颈椎手术，其中39例随访≥1年（平均4.9年（1至12年））并纳入分析（研究组）。颈椎手术后随访≥1年且无脊髓造影证据显示腰椎管狭窄的患者作为对照组（135例；平均随访期6.5年（1至17年））。在39例无症状腰椎管狭窄患者中，7例在颈椎手术后出现了与腰椎相关的腿部症状。Kaplan-Meier分析显示，无症状腰椎管狭窄患者在术后3年和5年时分别有89.6%（95%置信区间（CI）75.3至96.0）和76.7%（95%CI 53.7至90.3）无腿部症状。在术后1年或末次随访时，研究组和对照组在日本骨科协会评分测量的恢复率或Nurick评分改善方面无显著差异。这些结果表明，潜在腰椎管狭窄不影响颈椎脊髓病手术后的恢复；此外，在计划颈椎手术时，对于合并无症状腰椎管狭窄的颈椎脊髓病患者，预防性腰椎减压似乎没有必要作为常规手术。
