颈椎整块椎板成形术后20余年随访

More Than 20 Years Follow-up After En Bloc Cervical Laminoplasty.

作者信息

Kawaguchi Yoshiharu, Nakano Masato, Yasuda Taketoshi, Seki Shoji, Hori Takeshi, Suzuki Kayo, Makino Hiroto, Kanamori Masahiko, Kimura Tomoatsu

机构信息

Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan.

Department of Human Science, University of Toyama, Toyama, Japan.

出版信息

Spine (Phila Pa 1976). 2016 Oct 15;41(20):1570-1579. doi: 10.1097/BRS.0000000000001579.

DOI:10.1097/BRS.0000000000001579

PMID:27035583

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

The aim of the study was to evaluate clinical outcomes and to clarify the potential risks of cervical laminoplasty by a long-term follow-up of more than 20 years.

SUMMARY OF BACKGROUND DATA

There is no follow-up report exceeding 20 years after cervical laminoplasty.

METHODS

Two hundred sixteen patients underwent en bloc cervical laminoplasty for the treatment of cervical compressive myelopathy due to cervical spondylosis or ossification of the posterior longitudinal ligament between 1981 and 1994. Of these, 148 patients with a follow-up of more than 20 years were retrospectively studied (68 survived patients and 80 dead patients). The neurological evaluation was graded using Japanese Orthopaedic Association (JOA) score and the recovery rate. Neurological recovery was defined by the increase in JOA score. Radiological examinations were carried out using pre- and postoperative radiographs. As for the dead patients, the cause and age of death were reviewed.

RESULTS

The JOA score and recovery rate increased to 14.2 ± 2.7% and 64.9 ± 28.6%, respectively, at 5 years. The JOA score and recovery rate were maintained at 13.9 ± 3.2% and 61.6 ± 34.6% at 10 years. The JOA score decreased to 11.4 ± 5.1 at the last follow-up. In 32 out of 65 patients (49.2%), the JOA scores worsened mainly due to other spinal lesions. Cervical alignment became kyphotic when comparing preoperatively and at the last follow-up (ossification of the posterior longitudinal ligament: 15.7 ± 12.2° and 6.9 ± 17.8°, cervical spondylosis: 11.0 ± 8.9° and 3.3 ± 9.4°). Range of motion (ROM) decreased and one of the causes of ROM reduction was interlaminar fusion. The mean age at death was 78.2 years. The most frequent cause of death was malignant tumor.

CONCLUSION

Spine surgeons must be aware that patients have a long postoperative lifetime when cervical laminoplasty is performed. A long postoperative follow-up should be carried out after laminoplasty.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性研究。

目的

本研究旨在通过20多年的长期随访评估颈椎板成形术的临床结果并阐明其潜在风险。

背景资料总结

尚无颈椎板成形术后超过20年的随访报告。

方法

1981年至1994年间，216例患者因颈椎病或后纵韧带骨化接受整块颈椎板成形术治疗颈椎压迫性脊髓病。其中，对148例随访超过20年的患者进行回顾性研究（68例存活患者和80例死亡患者）。使用日本骨科协会（JOA）评分和恢复率进行神经学评估。神经功能恢复以JOA评分增加来定义。术前和术后均进行X线检查。对于死亡患者，回顾其死亡原因和年龄。

结果

5年时，JOA评分和恢复率分别提高到14.2±2.7%和64.9±28.6%。10年时，JOA评分和恢复率维持在13.9±3.2%和61.6±34.6%。最后一次随访时，JOA评分降至11.4±5.1。65例患者中有32例（49.2%）JOA评分恶化，主要原因是其他脊柱病变。与术前和最后一次随访相比，颈椎排列出现后凸（后纵韧带骨化：15.7±12.2°和6.9±17.8°，颈椎病：11.0±8.9°和3.3±9.4°）。活动范围（ROM）减小，ROM降低的原因之一是椎板间融合。平均死亡年龄为78.2岁。最常见的死亡原因是恶性肿瘤。