Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore 632 004, Tamil Nadu, India.
Eur Spine J. 2013 Jul;22(7):1509-16. doi: 10.1007/s00586-013-2724-6. Epub 2013 Mar 1.
To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial follow-up.
We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan's system graded anterior osteophyte formation. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores.
The majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). 17% of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77% of the whole spine ROM and 62% of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2° and 10.9°, respectively (p ≤ 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan's grade showed increase in osteophytosis in more than two-thirds of the patients (p ≤ 0.01). The whole spine range of movement at follow-up significantly correlated with Nathan's grade.
Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.
通过连续随访，确定颈椎侧块切除术（OCC）治疗颈椎病性脊髓病（CSM）后是否能保持运动保留。
我们纳入了 28 例接受 OCC 治疗 CSM 的患者，这些患者术前及至少有 2 次连续随访的中立位和动力位颈椎 X 线片。排除有骨化后纵韧带（OPLL）的患者。测量矢状曲度、节段和全脊柱活动范围（ROM）的变化。Nathan 系统对前骨赘形成进行分级。通过 Nurick 分级和改良日本矫形协会（JOA）评分评估神经功能。
大多数患者（23 例）行单或 2 个节段的椎体切除术。平均随访时间为 45 个月。术后 Nurick 分级和 JOA 评分均有统计学显著改善（p<0.001）。术前脊柱前凸的 17%患者在末次随访时丢失了前凸，但无临床恶化。末次随访时，全脊柱和节段 ROM 分别保留了 77%和 62%。全脊柱和节段 ROM 分别减少了 11.2°和 10.9°（p≤0.001）。术前节段活动范围较大的患者，随访时活动范围也较大，具有统计学意义。对连续影像学的分析表明，在随访期间，全脊柱和节段脊柱的活动范围显著减少。Nathan 分级显示，超过三分之二的患者出现骨赘增生增加（p≤0.01）。随访时的全脊柱活动范围与 Nathan 分级显著相关。
虽然 OCC 保留了节段和全脊柱 ROM，但连续测量显示 ROM 逐渐减少，尽管没有临床恶化。这种 ROM 的减少可能与脊柱韧带的退行性骨化有关。
