Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):E992-7. doi: 10.1097/BRS.0b013e3182972e1b.
Prospective study.
To analyze the effect of T1 slope on kyphotic alignment change after cervical laminoplasty in patients with cervical myelopathy.
Laminoplasty is a posterior method, and maintenance of both preoperative and postoperative lordotic alignment is prerequisite for the successful surgery. Unfortunately, patients who underwent laminoplasty tend to have kyphotic alignment change after operation despite sufficient preoperative lordosis, and such kyphotic alignment change after cervical laminoplasty can reduce surgical outcome and require additional surgery.
Consecutive patients who underwent cervical laminoplasty for cervical myelopathy were enrolled. Cervical spine lateral radiography in neutral, flexion, and extension were taken before surgery and at 2-year follow-up. Patients were divided into 2 groups according to the preoperative T1 slope, and postoperative cervical alignment change was compared according to the preoperative T1 slope.
A total of 51 patients were enrolled in this study. The mean age was 57.2 years (range, 39-88 yr). There were 39 male patients and 12 female patients. There were no differences in age, sex, the presence and type of ossification of posterior longitudinal ligament, and operation level between the patients with higher and lower preoperative T1 slope. Patients with higher preoperative T1 slope had more lordotic preoperative cervical alignment; however, they had more kyphotic alignment changes after laminoplasty (P < 0.001). After univariate logistic regression, only higher preoperative T1 slope was associated with significantly increased odds ratio for postoperative kyphotic alignment changes.
We hypothesized that kyphotic alignment change by posterior structural injury after cervical laminoplasty would be more marked in patients with high T1 slope, and demonstrated that patients with cervical myelopathy with high T1 slope had more kyphotic alignment changes after cervical laminoplasty at 2-year follow-up.
前瞻性研究。
分析颈椎管狭窄症患者颈椎板成形术后 T1 斜率对后凸排列变化的影响。
颈椎板成形术是一种后路方法，维持术前和术后的前凸排列是手术成功的前提。不幸的是，尽管术前存在足够的前凸，但接受板成形术的患者术后往往会出现后凸排列改变，颈椎板成形术后的这种后凸排列改变会降低手术效果，需要进行额外的手术。
连续纳入因颈椎管狭窄症而行颈椎板成形术的患者。在术前和 2 年随访时拍摄颈椎侧位 X 线片，包括中立位、前屈位和后伸位。根据术前 T1 斜率将患者分为 2 组，并根据术前 T1 斜率比较术后颈椎排列变化。
本研究共纳入 51 例患者。平均年龄为 57.2 岁（范围 39-88 岁）。男 39 例，女 12 例。术前 T1 斜率较高和较低的患者在年龄、性别、后纵韧带骨化的存在和类型以及手术节段方面无差异。术前 T1 斜率较高的患者术前颈椎排列更前凸，但板成形术后后凸排列变化更大（P <0.001）。单因素 logistic 回归后，仅术前 T1 斜率较高与术后后凸排列变化的显著增加相关。
我们假设颈椎板成形术后后结构损伤引起的后凸排列变化在 T1 斜率较高的患者中更为明显，并证明颈椎板成形术后 2 年随访时，颈椎管狭窄症患者 T1 斜率较高者后凸排列变化更多。
