Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Korea.
Spine J. 2013 Apr;13(4):384-90. doi: 10.1016/j.spinee.2012.10.037. Epub 2012 Dec 6.
Although numerous studies have reported on the loss of flexion-extension range of motion (ROM) associated with laminoplasty, few have reported on the time course of this loss of motion for a long-term follow-up period.
We previously reported our early data on postlaminoplasty cervical ROM. In this article, we describe our minimum 5-year follow-up data to identify the time-dependent change in ROM after cervical laminoplasty.
A prospective cohort study.
The procedure was performed in 23 patients. Eighteen patients with a minimum 5-year follow-up were included in the study.
The time-dependent neck ROM changes observed in the neutral, flexion, and extension radiographs were used to measure the radiological outcome. The Japanese Orthopaedic Association classification and a numerical rating scale of axial neck pain and arm pain were used to evaluate clinical outcome.
Twenty-three patients who received unilateral open-door laminoplasties, including miniplate fixation over three levels, were serially evaluated at regular set intervals postoperatively. Eighteen patients with a minimum 5-year follow-up were included in the study. The mean follow-up period was 68.1 months (range, 60-78 months). Nine patients had ossification of posterior longitudinal ligament (OPLL) and nine patients had cervical spondylotic myelopathy (CSM). Enrolled patients were divided into subgroups (OPLL vs. CSM; autofusion vs. nonautofusion) to compare the ROM between the groups. We evaluated the time-dependent neck ROM changes by taking neutral, flexion, and extension radiographs preoperatively and at 1, 3, 6, 9, 12, 18, and 24 months postoperatively. Follow-up radiographs were taken annually after a 2-year follow-up.
The preoperative and 1-, 3-, 6-, 12-, 24-, 36-, 48-, and 60-month postoperative ROM figures were 39.9 ± 11.2°, 35.0 ± 9.2°, 33.0 ± 11.0°, 30.1 ± 10.4°, 25.8 ± 13.1°, 24.7 ± 10.0°, 23.8 ± 6.5°, 24.6 ± 8.3°, and 23.6 ± 9.4°, respectively, and at the most recent follow-up, ROM was 24.5 ± 10.1°. Thus, the mean ROM decreased by 15.4 ± 8.4° (38.5%) by the last follow-up (p<.0001). In the OPLL group, we observed a more limited cervical ROM than in the CSM group (47.2% vs. 72.7%). As expected, in the laminar autofusion group, the ROM decreased significantly (55.6% decrease), whereas in the nonautofusion group, the ROM decreased less significantly (13.4% decrease) at the last follow-up. Postoperative axial pain did not correlate with the cervical ROM.
These results suggest that the loss of cervical ROM after laminoplasty is time-dependent, and patients with OPLL and laminar autofusion had less ROM. Postlaminoplasty ROM reduction can recover after several years, unless laminar autofusion occurs.
虽然有许多研究报告了与椎板成形术相关的屈伸范围（ROM）丧失，但很少有研究报告长期随访期间这种运动丧失的时间过程。
我们之前报告了椎板成形术后颈椎 ROM 的早期数据。在本文中，我们描述了我们至少 5 年的随访数据，以确定椎板成形术后 ROM 的时间依赖性变化。
前瞻性队列研究。
该手术在 23 名患者中进行。18 名至少随访 5 年的患者纳入研究。
使用中立位、前屈和伸展位 X 线片观察到的颈部 ROM 随时间的变化来测量放射学结果。日本矫形协会分类和轴向颈部疼痛和手臂疼痛的数字评分量表用于评估临床结果。
23 名接受单侧开门椎板成形术的患者，包括在三个水平以上进行微型板固定，术后在固定间隔时间内进行连续评估。18 名至少随访 5 年的患者纳入研究。平均随访时间为 68.1 个月（范围 60-78 个月）。9 名患者有后纵韧带骨化（OPLL），9 名患者有颈椎脊髓病（CSM）。纳入的患者分为亚组（OPLL 与 CSM；自动融合与非自动融合），以比较组间的 ROM。我们通过在术前和术后 1、3、6、9、12、18 和 24 个月拍摄中立位、前屈位和伸展位 X 线片来评估颈部 ROM 随时间的变化。2 年随访后，每年进行一次随访 X 线片。
术前和术后 1、3、6、12、24、36、48 和 60 个月的 ROM 分别为 39.9±11.2°、35.0±9.2°、33.0±11.0°、30.1±10.4°、25.8±13.1°、24.7±10.0°、23.8±6.5°、24.6±8.3°和 23.6±9.4°，而在最近一次随访时，ROM 为 24.5±10.1°。因此，最后随访时平均 ROM 减少了 15.4±8.4°（38.5%）（p<.0001）。在 OPLL 组中，我们观察到比 CSM 组更有限的颈椎 ROM（47.2%比 72.7%）。正如预期的那样，在层板自动融合组中，ROM 明显下降（下降 55.6%），而在非自动融合组中，ROM 下降幅度较小（下降 13.4%）。术后轴向疼痛与颈椎 ROM 无关。
这些结果表明，椎板成形术后颈椎 ROM 的丧失是时间依赖性的，OPLL 患者和层板自动融合患者的 ROM 较小。除非发生层板自动融合，否则椎板成形术后 ROM 的减少可以在几年后恢复。
