前路减压融合术与后路单开门椎管扩大成形术治疗脊髓前方大压迫型脊髓型颈椎病的对比研究
A Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy Patients With Large Anterior Compression of the Spinal Cord.
作者信息
Hirai Takashi, Yoshii Toshitaka, Arai Yoshiyasu, Sakai Kenichiro, Torigoe Ichiro, Maehara Hidetsugu, Tomori Masaki, Taniyama Takashi, Sato Hirokazu, Okawa Atsushi
机构信息
*Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama †Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Clin Spine Surg. 2017 Oct;30(8):E1137-E1142. doi: 10.1097/BSD.0000000000000500.
STUDY DESIGN
This is a retrospective observational single-center study.
OBJECTIVES
To compare anterior decompression and fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM) patients with large anterior compression in terms of clinical and radiologic outcomes.
SUMMARY OF BACKGROUND DATA
We have reported that insufficient posterior decompression could be often seen after laminoplasty for CSM patients with preoperative anterior clearance of the spinal cord, defined as an interval <4 mm between the preoperative the modified K-line and anterior structure of the spinal canal at most compressive segment on sagittal T1-weighted magnetic resonance imaging. Here we conduct a study comparing ADF and LAMP for the treatment of CSM patients with such a risk factor.
MATERIALS AND METHODS
Of the 221 consecutive CSM patients treated with either ADF or LAMP between 2008 and 2012 at our hospital, 79 patients in whom the interval was <4 mm with age ranged from 50 to 79 years were enrolled. Patients with myelopathy caused by single-level disk herniation, tumor or ossification of posterior longitudinal ligament, or patients with a history of cervical spine injury were excluded. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy, recovery rate of the JOA score at the time of 2 years after surgery were investigated as clinical outcomes to compare these 2 groups.
RESULTS
Demographics were almost similar between ADF and LAMP groups. The mean preoperative and postoperative JOA scores were 10.9 and 13.8 points for ADF group and 10.1 and 12.4 points for LAMP group, indicating that the recovery rate of JOA score was significantly greater in ADF group (49.6%) than that in LAMP group (38.2%; P=0.047). In LAMP group, spinal cord deformity was a significant predictive factor for unsatisfactory clinical outcome.
CONCLUSION
ADF provided better surgical treatment for the patients with absence of preoperative anterior clearance of the spinal cord.
研究设计
这是一项回顾性观察性单中心研究。
目的
比较前路减压融合术（ADF）和椎板成形术（LAMP）在治疗存在较大前路压迫的脊髓型颈椎病（CSM）患者时的临床和影像学结果。
背景数据总结
我们曾报道，对于术前脊髓前方间隙（定义为矢状面T1加权磁共振成像上最受压节段术前改良K线与椎管前结构之间的间距<4mm）的CSM患者，椎板成形术后常可见后路减压不足。在此，我们开展一项研究，比较ADF和LAMP治疗具有此类危险因素的CSM患者的效果。
材料与方法
2008年至2012年期间在我院接受ADF或LAMP治疗的221例连续CSM患者中，选取79例该间距<4mm且年龄在50至79岁之间的患者。排除由单节段椎间盘突出、肿瘤或后纵韧带骨化引起脊髓病的患者，或有颈椎损伤史的患者。将日本骨科协会（JOA）脊髓病评分系统、术后2年时JOA评分的恢复率作为临床结果来比较这两组。
结果
ADF组和LAMP组的人口统计学特征几乎相似。ADF组术前和术后JOA评分的平均值分别为为10.9分和13.8分，LAMP组分别为10.1分和12.4分，表明ADF组JOA评分的恢复率（49.6%）显著高于LAMP组（38.2%；P = .047）。在LAMP组中，脊髓畸形是临床结果不理想的一个重要预测因素。
结论
对于术前脊髓前方间隙不足的患者，ADF提供了更好的手术治疗方法。
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