Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka.
J Neurosurg Spine. 2013 Jun;18(6):545-52. doi: 10.3171/2013.2.SPINE12468. Epub 2013 Mar 29.
Modified cervical laminoplasty techniques have been developed to reduce postoperative axial neck pain and preserve function in patients with cervical spondylotic myelopathy (CSM). However, the previous studies demonstrating satisfactory surgical outcomes had a retrospective design. Here, the authors aimed to prospectively evaluate the 2-year outcomes of a modified cervical laminoplasty technique for CSM that preserves the paravertebral muscles.
Outcomes were analyzed for 40 patients (22 men and 18 women; mean age, 66.6 years; age range 44-92 years) with CSM who underwent C4-6 laminoplasty with C-3 and C-7 partial laminectomies or C-3 total and C-7 partial laminectomies and received hydroxyapatite spacers. Neurological, pain severity, and spinal radiographic evaluations were performed preoperatively and at 3, 6, 12, 18, and 24 months postoperatively. Plain radiography and MRI of the cervical spine were performed to evaluate the range of motion (ROM), sagittal alignment, and cross-sectional areas of the deep extensor muscles. The extent of bone-spacer bonding and bony union at the gutter was assessed by CT.
The mean preoperative Japanese Orthopaedic Association CSM score was 10.2, but it increased to 14.4 by 24 months after surgery. Eleven patients had axial neck pain preoperatively, but only 3 reported mild pain at 24 months, and in all 3 cases the pain was mild. The mean angle of lordosis was 11.7° preoperatively and 12.0° 2 years postoperatively. Although the ROM at the C2-7 levels was significantly reduced 3 months postoperatively, an increasing trend was observed up to 12 months, and 86% of the preoperative ROM was achieved by 2 years postoperatively. The mean paravertebral muscle cross-sectional areas were 833 ± 215 mm(2) preoperatively and 763 ± 197 mm(2) 24 months postoperatively, but the difference was not statistically significant. The rates of bone-spacer bonding and bony union at the gutter were low during the early stages but increased to 90% and 93%, respectively, by 2 years after surgery.
The modified laminoplasty technique used in this study ensured very good neurological status and ROM after 2 years and was associated with low incidences of axial neck pain and serious complications. This simple and easy operative method could benefit future laminoplasty protocols.
为了减少术后轴性颈痛并保留颈椎脊髓病（CSM）患者的功能，已经开发出改良的颈椎板成形术技术。然而，先前展示令人满意手术结果的研究具有回顾性设计。在这里，作者旨在前瞻性评估保留椎旁肌的改良颈椎板成形术治疗 CSM 的 2 年结果。
对 40 例 CSM 患者（22 名男性和 18 名女性；平均年龄 66.6 岁；年龄范围 44-92 岁）进行 C4-6 颈椎板成形术，行 C-3 和 C-7 部分椎板切除术或 C-3 全椎板切除术和 C-7 部分椎板切除术，并接受羟基磷灰石间隔物。在术前和术后 3、6、12、18 和 24 个月进行神经学、疼痛严重程度和脊柱影像学评估。进行颈椎的普通放射摄影和 MRI 以评估运动范围（ROM）、矢状位排列和深部伸肌的横截面积。通过 CT 评估骨-间隔物结合的程度和沟槽处的骨性融合。
术前日本矫形协会 CSM 评分平均为 10.2，但术后 24 个月增加至 14.4。11 例患者术前有轴性颈痛，但仅 3 例在 24 个月时报告轻度疼痛，所有 3 例疼痛均为轻度。术前平均前凸角为 11.7°，术后 2 年为 12.0°。尽管术后 3 个月 C2-7 节段的 ROM 显著降低，但观察到到 12 个月时呈上升趋势，并且术后 2 年达到术前 ROM 的 86%。术前椎旁肌横截面积平均为 833±215mm2，术后 24 个月为 763±197mm2，但差异无统计学意义。术后早期骨-间隔物结合率和沟槽处骨性融合率较低，但分别在术后 2 年增加至 90%和 93%。
本研究中使用的改良板成形术技术在 2 年后确保了非常好的神经状态和 ROM，并且与轴性颈痛和严重并发症的发生率较低相关。这种简单易行的手术方法可能有益于未来的板成形术方案。
