Cho Jae Hwan, Suk Kyung-Soo, Park Jong-Beom, Ha Jung-Ki, Hwang Chang Ju, Lee Choon Sung, Lee Dong-Ho
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Asian Spine J. 2016 Aug;10(4):663-70. doi: 10.4184/asj.2016.10.4.663. Epub 2016 Aug 16.
STUDY DESIGN: Survey based study. PURPOSE: To assess the degree of agreement in level selection of laminoplasty (LP) for the selected cervical myeloradiculopathy cases between experienced spine surgeons. OVERVIEW OF LITERATURE: Although, cervical LP is a widely used surgical technique for multi-level spinal cord compression, until now there is no consensus about how many segments or which segments should be opened to achieve a satisfactory decompression. METHODS: Thorough clinical and radiographic data (plain X-ray, computed tomography, and magnetic resonance imaging) of 30 patients who had cervical myelopathy were prepared. The data were provided to three independent spine surgeons with over 10 years experience in operation of their own practices. They were questioned about the most preferable surgical method and suitable decompression levels. The second survey was carried out after 6 months with the same cases. If the level difference between respondents was a half level or below, agreement was considered acceptable. The intraobserver and interobserver agreements in level selection were assessed by kappa statistics. RESULTS: Three respondents selected LP as an option for 6, 8, and 22 cases in the first survey and 10, 21, and 24 cases in the second survey. The reasons for selection of LP were levels of ossification of the posterior longitudinal ligament (p=0.004), segmental kyphotic deformity (p=0.036) and mean compression score (p=0.041). Intraobserver agreement showed variable results. Interobserver agreement was poor to fair by perfect matching (kappa=0.111-0.304) and fair to moderate by acceptable matching (kappa=0.308-0.625). CONCLUSIONS: The degree of agreement for level selection of LP was not high even though experienced surgeons would choose the opening segments on the basis of same criteria. These results suggest that more specific guidelines in determination of levels for LP should be required to decrease unnecessary wide decompression according to individual variance.
研究设计:基于调查的研究。 目的:评估经验丰富的脊柱外科医生对所选颈椎病性脊髓神经根病病例进行椎板成形术(LP)时在节段选择上的一致程度。 文献综述:尽管颈椎LP是一种广泛用于多节段脊髓压迫的手术技术,但迄今为止,对于打开多少节段或哪些节段才能实现满意的减压尚无共识。 方法:准备30例颈椎病患者的详细临床和影像学资料(普通X线、计算机断层扫描和磁共振成像)。将这些资料提供给三位在各自临床实践中有超过10年手术经验的独立脊柱外科医生。询问他们最优选的手术方法和合适的减压节段。6个月后对相同病例进行第二次调查。如果受访者之间的节段差异为半个节段或以下,则认为一致性可接受。通过kappa统计评估节段选择中的观察者内和观察者间一致性。 结果:在第一次调查中,三位受访者分别选择LP用于6例、8例和22例,在第二次调查中分别用于10例、21例和24例。选择LP的原因是后纵韧带骨化程度(p = 0.004)、节段性后凸畸形(p = 0.036)和平均压迫评分(p = 0.041)。观察者内一致性结果不一。观察者间一致性通过完全匹配为差到一般(kappa = 0.111 - 0.304),通过可接受匹配为一般到中等(kappa = 0.308 - 0.625)。 结论:即使经验丰富的外科医生会基于相同标准选择打开节段,LP节段选择的一致程度也不高。这些结果表明,需要更具体的LP节段确定指南,以根据个体差异减少不必要的广泛减压。
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