Jain Akshay, Rustagi Tarush, Prasad Gautam, Deore Tushar, Bhojraj Shekhar Y
Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.
Asian Spine J. 2017 Feb;11(1):24-30. doi: 10.4184/asj.2017.11.1.24. Epub 2017 Feb 17.
Retrospective analysis.
To compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis.
Laminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patients with segmental kyphosis, it is associated with risk of progression of kyphosis and poor outcome. Whether this loss of sagittal alignment affects functional outcome is not clear.
We retrospectively reviewed 68 patients who underwent laminectomy for CSM from 1998 to 2009. As per preoperative magnetic resonance images, 36 patients had preoperative lordosis (Group 1) and 32 had segmental kyphosis (Group 2). We studied age at the time of surgery, duration of preoperative symptoms, recovery rate, magnitude of postoperative backward shifting of spinal cord and loss of sagittal alignment.
Mean follow up was 5.05 years (range, 2-13 years) and mean age at the time of surgery 61.88 years. Group 1 had 20 men and 16 women and Group 2 had 19 men and 13 women. Mean recovery rate in Group 1 was 60.32%, in Group 2 was 63.7% without any statistical difference (-value 0.21, one tailed analysis of variance). Two patients of Group 1 had loss of cervical lordosis by five degrees. In Group 2 seven patients had progression of segmental kyphosis by 5-10 degrees and two patients by more than 10 degrees. Mean cord shift was more in Group 1 (mean, 2.41 mm) as compared to Group 2 (mean, -1.97 mm) but it had no correlation to recovery rate. Patients with younger age (mean, 57 years) and less duration of preoperative symptoms (mean, 4.86 years) had better recovery rate (75%).
Clinical outcome in CSM is not related to preoperative cervical spine alignment. Thus, lordosis is not mandatory for planning laminectomy in CSM. Good outcome is expected in younger patients operated earliest after onset of symptoms.
回顾性分析。
比较多节段压迫性颈椎病（CSM）患者在颈椎前凸与节段性后凸情况下行椎板切除术的结果。
椎板切除术是治疗颈椎前凸型CSM减压的既定手术方法。然而，对于节段性后凸患者，该手术与后凸进展风险及不良预后相关。矢状位对线的这种改变是否会影响功能预后尚不清楚。
我们回顾性分析了1998年至2009年期间因CSM接受椎板切除术的68例患者。根据术前磁共振成像，36例患者术前存在颈椎前凸（第1组），32例存在节段性后凸（第2组）。我们研究了手术时的年龄、术前症状持续时间、恢复率、脊髓术后向后移位程度以及矢状位对线的改变。
平均随访时间为5.05年（范围2 - 13年），手术时平均年龄为61.88岁。第1组有20名男性和16名女性，第2组有19名男性和13名女性。第1组的平均恢复率为60.32%，第2组为63.7%，无统计学差异（P值0.21，单尾方差分析）。第1组有2例患者颈椎前凸丢失5度。第2组有7例患者节段性后凸进展5 - 10度，2例患者进展超过10度。第1组的平均脊髓移位（平均2.41mm）高于第2组（平均 - 1.97mm），但与恢复率无关。年龄较轻（平均57岁）且术前症状持续时间较短（平均4.86年）的患者恢复率较好（75%）。
CSM的临床预后与术前颈椎对线无关。因此，在计划CSM的椎板切除术时，颈椎前凸并非必需。症状出现后尽早手术的年轻患者有望获得良好预后。
