Riew K Daniel, Raich Annie L, Dettori Joseph R, Heller John G
Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, United States.
Spectrum Research, Inc., Tacoma, Washington, United States.
Evid Based Spine Care J. 2013 Apr;4(1):42-53. doi: 10.1055/s-0033-1341606.
Study Design Systematic review. Objective In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression.
系统评价。目的：在18岁及以上患有脊髓型颈椎病或后纵韧带骨化症（OPLL）的患者中，与传统的C3至C7椎板成形术相比，保留C2肌肉附着点和/或保留C7的颈椎椎板成形术是否能减少术后轴向疼痛？这些结果是否因术后早期积极的颈椎活动而有所不同？方法：对1970年至2012年8月17日发表的英文文献进行系统评价。检索电子数据库和关键文章的参考文献列表，以确定评估保留C2/C3或保留C7的颈椎椎板成形术治疗成人脊髓型颈椎病（CSM）或OPLL的研究。排除涉及创伤性发病、颈椎骨折、感染、畸形或肿瘤的研究，以及非对照研究。两名独立的评审员使用推荐分级评估、发展和评价（GRADE）系统评估证据质量水平，分歧通过协商一致解决。结果：我们确定了11篇符合纳入标准的文章。只有随机对照试验（RCT）显示，比较保留C7棘突肌肉与不保留时，晚期轴向疼痛（12个月时）无显著差异。然而，其他七项回顾性队列研究显示，与未保留组相比，保留组疼痛明显减轻。保留组包括保留C7棘突和/或附着肌肉、深层伸肌或C2肌肉附着点和/或C3椎板切除术（与椎板成形术相对）的患者。一项包括保留C2或C7椎旁肌的研究发现，只有保留附着于C2的肌肉才能减轻术后疼痛。另一项包括保留C7棘突或深层伸肌的研究发现，只有保留C7才能减轻术后疼痛。结论：尽管关于保留C7和/或颈半棘肌附着于C2的重要性的数据存在冲突，但有足够的证据表明，外科医生应尽可能尝试保留这些结构，因为这样做似乎没有什么弊端，除非它会影响神经减压。
