椎板成形术后颈椎节段活动度增加与椎体滑脱相关。
Increased Segmental Range of Motion Is Correlated With Spondylolisthesis in the Cervical Spine After Laminoplasty.
作者信息
Shigematsu Hideki, Kura Tomohiko, Iwata Eiichiro, Okuda Akinori, Morimoto Yasuhiko, Masuda Keisuke, Tanaka Yasuhito
机构信息
Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
出版信息
Spine (Phila Pa 1976). 2017 Apr 1;42(7):E385-E391. doi: 10.1097/BRS.0000000000001828.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to determine the incidence of increased segmental range of motion (ROM) after laminoplasty and to clarify whether increased ROM is associated with spondylolisthesis. Finally, we explored the effect of increased segmental ROM on clinical results.
SUMMARY OF BACKGROUND DATA
Cervical laminoplasty for cervical spondylotic myelopathy causes reduced ROM, possibly due to the unintended contracture of the facet joint or a bony union. Although it is rarely studied, ROM may also increase following laminoplasty. Thus far, there are no reports describing the correlation between increased segmental ROM and segmental spondylolisthesis after laminoplasty.
METHODS
We evaluated 187 segments from 39 cervical spondylotic myelopathy patients who underwent bilateral open door laminoplasty from C2 to C7. The segmental ROM and spondylolisthesis were measured using dynamic radiographs that were obtained preoperatively and 2 years postoperatively. The Japanese Orthopedic Association (JOA) score was used for clinical evaluation. To compare the clinical results, we compared the cases with increased ROM in at least one segment with the remaining cases.
RESULTS
Increased segmental ROM (i.e., ≥5° increase) was observed in 25 of 187 segments (13.4%) from 14 cases. There was a strong correlation between increased ROM and spondylolisthesis. A high preoperative disc height was associated with increased segmental ROM 2 years postoperation. Regardless of the correlation with spondylolisthesis, there was no statistically significant correlation between increased segmental ROM and JOA score.
CONCLUSION
The decrease in segmental ROM after laminoplasty was not uniform. Approximately 13.4% of all segments showed increased ROM. The preoperative disc height might influence the risk for increased segmental ROM. Furthermore, increased ROM was correlated with spondylolisthesis in the segment, though it was not correlated with clinical results.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
本研究旨在确定椎板成形术后节段活动度（ROM）增加的发生率，并阐明ROM增加是否与椎体滑脱有关。最后，我们探讨了节段ROM增加对临床结果的影响。
背景数据总结
颈椎后路椎板成形术治疗脊髓型颈椎病会导致ROM降低，这可能是由于小关节意外挛缩或骨融合所致。尽管对此研究较少，但椎板成形术后ROM也可能增加。迄今为止，尚无关于椎板成形术后节段ROM增加与节段椎体滑脱之间相关性的报道。
方法
我们评估了39例接受C2至C7双侧开门椎板成形术的脊髓型颈椎病患者的187个节段。使用术前和术后2年获得的动态X线片测量节段ROM和椎体滑脱情况。采用日本骨科协会（JOA）评分进行临床评估。为比较临床结果，我们将至少一个节段ROM增加的病例与其余病例进行了比较。
结果
14例患者的187个节段中有25个（13.4%）出现节段ROM增加（即增加≥5°）。ROM增加与椎体滑脱之间存在强相关性。术前椎间盘高度较高与术后2年节段ROM增加相关。无论与椎体滑脱的相关性如何，节段ROM增加与JOA评分之间均无统计学显著相关性。
结论
椎板成形术后节段ROM的降低并不一致。所有节段中约13.4%显示ROM增加。术前椎间盘高度可能会影响节段ROM增加的风险。此外，节段ROM增加与该节段的椎体滑脱相关，尽管与临床结果无关。
证据级别
4级。
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