Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.
J Neurosurg Spine. 2014 Aug;21(2):210-6. doi: 10.3171/2014.4.SPINE13545. Epub 2014 May 23.
OBJECT: Cervical laminoplasty is a surgical procedure for cervical compressive myelopathy (CCM), and satisfactory outcomes have been reported. However, few reports have examined the pathophysiology of improvements in spinal cord function. The aim of this study was to investigate the variation in central motor conduction time (CMCT) before and after cervical laminoplasty in patients with CCM. METHODS: Motor evoked potentials (MEPs) following transcranial magnetic stimulation and compound muscle action potentials (CMAPs) and F-waves following electrical stimulation of the ulnar and tibial nerves at the wrist and ankle were measured from the abductor digiti minimi muscle (ADM) and abductor hallucis muscle (AH) in 42 patients with CCM before and 1 year after cervical laminoplasty. The peripheral conduction time (PCT) was calculated as follows: (latency of CMAPs + latency of F-waves - 1)/2. The CMCT was calculated by subtracting the PCT from the onset latency of the MEPs. The CMCT recovery ratio was defined and calculated as the ratio of CMCT values 1 year after surgery to those before surgery. The CMCT data were analyzed as longer or shorter CMCT between the patients' right and left ADMs and AHs. The Japanese Orthopaedic Association (JOA) score for cervical myelopathy was obtained as a clinical outcome before and 1 year after surgery. The recovery rate (RR) 1 year after surgery was calculated using the following formula: (postoperative JOA score 1 year after surgery - preoperative JOA score)/(17 - preoperative JOA score) × 100. Correlations among CMCT parameters, patient age, JOA score, and RR were determined. RESULTS: The longer and shorter CMCTs from the ADM (longer, p = 0.000; shorter, p = 0.008) and the longer CMCT from the AH (longer, p = 0.000) before surgery decreased significantly 1 year after surgery; the shorter CMCT from the AH did not significantly differ (shorter, p = 0.078). The mean JOA score before surgery was 10.1 ± 3.0 and improved significantly to 12.9 ± 2.7 at 1 year after surgery (p = 0.000). The mean CMCT recovery ratio and RR were 0.91 ± 0.18 and 0.43 ± 0.27, respectively. The longer/shorter CMCT parameters in the ADM and AH before or 1 year after surgery correlated significantly with the JOA score both before and 1 year after surgery. The CMCT recovery ratio from the longer CMCT in the ADM correlated significantly with the RR (r = - 3090, p = 0.011). There were no significant correlations between age and any CMCT parameters or CMCT recovery ratios. CONCLUSIONS: These results suggest that cervical laminoplasty improves corticospinal tract function 1 year after surgery, which may be one of the reasons for the JOA score improvements in patients with CCM. The degree of improvement in corticospinal tract function did not correlate with patient age in this case series. The results demonstrated quantitative evidence of the pathophysiology of functional recovery in the corticospinal tract following cervical laminoplasty in patients with CCM.
目的:颈椎板成形术是一种治疗颈椎压迫性脊髓病(CCM)的手术方法,已有令人满意的疗效报道。然而,很少有研究探讨脊髓功能改善的病理生理学。本研究旨在探讨 CCM 患者颈椎板成形术后中央运动传导时间(CMCT)的变化。
方法:在 42 例 CCM 患者颈椎板成形术前和术后 1 年,采用经颅磁刺激和电刺激腕部和踝部尺神经和胫神经后测量拇短展肌(ADM)和拇展肌(AH)的运动诱发电位(MEP)和复合肌肉动作电位(CMAP)和 F 波。外周传导时间(PCT)计算如下:(CMAP 潜伏期+ F 波潜伏期-1)/2。CMCT 通过从 MEP 的起始潜伏期中减去 PCT 来计算。定义并计算 CMCT 恢复比,定义为手术后 1 年的 CMCT 值与手术前的 CMCT 值的比值。将 ADM 和 AH 的右侧和左侧的 CMCT 数据分析为较长或较短的 CMCT。颈椎脊髓病的日本骨科协会(JOA)评分作为手术前后的临床结果。使用以下公式计算手术后 1 年的恢复率(RR):(术后 1 年的 JOA 评分-术前的 JOA 评分)/(17-术前的 JOA 评分)×100。确定 CMCT 参数、患者年龄、JOA 评分和 RR 之间的相关性。
结果:术前 ADM 的较长和较短 CMCT(较长,p=0.000;较短,p=0.008)和 AH 的较长 CMCT(较长,p=0.000)在手术后 1 年显著下降;AH 的较短 CMCT 无显著差异(较短,p=0.078)。术前平均 JOA 评分为 10.1±3.0,术后 1 年显著改善至 12.9±2.7(p=0.000)。平均 CMCT 恢复比和 RR 分别为 0.91±0.18 和 0.43±0.27。术前和术后 1 年 ADM 和 AH 的较长/较短 CMCT 参数与术前和术后的 JOA 评分均有显著相关性。ADM 较长 CMCT 的 CMCT 恢复比与 RR 显著相关(r=-3090,p=0.011)。年龄与任何 CMCT 参数或 CMCT 恢复比均无显著相关性。
结论:这些结果表明,颈椎板成形术可改善术后 1 年皮质脊髓束功能,这可能是 CCM 患者 JOA 评分改善的原因之一。在本病例系列中,皮质脊髓束功能的改善程度与患者年龄无关。结果提供了 CCM 患者颈椎板成形术后皮质脊髓束功能恢复的病理生理学的定量证据。
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