Desroches Asuka, Morishita Yuichiro, Yugue Itaru, Maeda Takeshi, Flouzat-Lachaniette Charles-Henri, Hernigou Philippe, Shiba Keiichiro
*Department of Orthopedic Surgery, Paris East University, Henri Mondor Hospital, Créteil, France †Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
Clin Spine Surg. 2017 Oct;30(8):E1169-E1173. doi: 10.1097/BSD.0000000000000434.
A retrospective evaluation of sagittal angular motion from cervical spinal flexion to extension.
To evaluate the kinematic effects of cervical laminoplasty for cervical spondylotic myelopathy (CSM) on the occipitoatlantoaxial junction.
The kinematic effects of cervical laminoplasty for CSM on the occipitoatlantoaxial junction remain controversial.
A total of 65 CSM patients who were treated with cervical laminoplasty ranging from the C3 to C7 vertebrae were included in the study. After surgery, all patients wore a Philadelphia collar for the first week and began cervical range of motion exercises as soon as possible. Functional plain radiographs were obtained preoperatively and at 1 and 3 years postoperatively. Sagittal angular motion from cervical spinal flexion to extension was measured using the Cobb technique at 7 cervical segments (Oc-C1, C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7). We defined the contribution of each segment's mobility to the total angular mobility of the cervical spine as percent segmental mobility.
Total cervical angular mobility significantly decreased after cervical laminoplasty. There were no significant differences in Oc-C2 angular mobility; however, C2-C7 angular mobility had significantly decreased by 3 years postoperatively. No significant differences in percent segmental mobility were observed at 1 year postoperatively except at the C3-C4 segment. By 3 years postoperatively, percent mobility at the Oc-C1 and C1-C2 segments had significantly increased, whereas that at the C3-C4 and C5-C6 segments had significantly decreased.
Our results suggest that, although the contribution of occipitoatlantoaxial junctional mobility to total cervical mobility increases, dynamic mechanical stress to the occipitoatlantoaxial junction does not increase following laminoplasty, and no adjacent segmental disorder at the occipitoatlantoaxial junction was observed within 3 years postoperatively. We hypothesized that early removal of the cervical collar and early cervical range of motion exercises may contribute to these kinematic changes.
对颈椎从屈曲到伸展的矢状面角运动进行回顾性评估。
评估颈椎椎板成形术治疗脊髓型颈椎病（CSM）对枕寰枢关节的运动学影响。
颈椎椎板成形术治疗CSM对枕寰枢关节的运动学影响仍存在争议。
本研究共纳入65例接受C3至C7椎体颈椎椎板成形术治疗的CSM患者。术后，所有患者在第一周佩戴费城颈托，并尽快开始颈椎活动度锻炼。在术前以及术后1年和3年获取功能位X线平片。使用Cobb技术在7个颈椎节段（枕骨-C1、C1-C2、C2-C3、C3-C4、C4-C5、C5-C6和C6-C7）测量颈椎从屈曲到伸展的矢状面角运动。我们将每个节段的活动度对颈椎总角活动度的贡献定义为节段活动度百分比。
颈椎椎板成形术后颈椎总角活动度显著降低。枕骨-C2节段的角活动度无显著差异；然而，术后3年C2-C7节段角活动度显著降低。术后1年，除C3-C4节段外，节段活动度百分比无显著差异。术后3年，枕骨-C1和C1-C2节段的活动度百分比显著增加，而C3-C4和C5-C6节段的活动度百分比显著降低。
我们的结果表明，尽管枕寰枢关节活动度对颈椎总活动度的贡献增加，但椎板成形术后枕寰枢关节的动态机械应力并未增加，且术后3年内未观察到枕寰枢关节出现相邻节段紊乱。我们推测早期去除颈托和早期进行颈椎活动度锻炼可能有助于这些运动学变化。
