对于患有C3-4节段脊髓病的老年患者，前路颈椎间盘切除融合术比后路椎板成形术能提供更好的手术效果。
Anterior Cervical Discectomy and Fusion Provides Better Surgical Outcomes Than Posterior Laminoplasty in Elderly Patients With C3-4 Level Myelopathy.
作者信息
Tamai Koji, Terai Hidetomi, Suzuki Akinobu, Toyoda Hiromitsu, Hoshino Masatoshi, Takahashi Shinji, Hayashi Kazunori, Ohyama Shoichiro, Nakamura Hiroaki
机构信息
Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
出版信息
Spine (Phila Pa 1976). 2017 Apr 15;42(8):548-555. doi: 10.1097/BRS.0000000000001874.
STUDY DESIGN
Retrospective analyses of prospectively collected data regarding 180 patients with cervical spondylotic myelopathy (CSM).
OBJECTIVE
To detect the characteristics of C3-4 level CSM in elderly patients (C3-4CSM) (main analysis) and to validate the postoperative outcomes of anterior cervical discectomy and fusion (ACDF) and of laminoplasty (LAMP) (subgroup analysis).
SUMMARY OF BACKGROUND DATA
It remains unclear which surgical technique offers the best outcomes for CSM.
METHODS
The main analysis included 180 patients with CSM, divided into two groups (C3-4CSM group, n = 46; conventional CSM group, n = 134) according to the findings of the preoperative physical examination and magnetic resonance imaging. The subgroup analysis included 46 patients with C3-4CSM, divided into two groups (ACDF group, n = 21; LAMP group, n = 25) according to surgical technique. Preoperative demographics and postoperative outcomes were compared.
RESULTS
The age at surgery was higher, disease duration was shorter, and preoperative Japanese Orthopaedic Association (JOA) score was lower in the C3-4CSM group than in the conventional CSM group. Although the C3-4 range of motion was significantly higher, that of other levels was significantly lower in the C3-4CSM group. The anteroposterior diameter for levels C3-C7 was significantly larger in the C3-4CSM group. In the subgroup analysis using the repeated-measures analysis of variance, the postoperative JOA scores, and visual analog scale of neck pain were significantly better in the ACDF group.
CONCLUSION
Higher age, shorter disease duration, and worse JOA scores appear to be characteristic of C3-4CSM. In the management of C3-4CSM, ACDF provided better surgical outcomes than did LAMP; hypermobility at the C3-4 level, a radiological characteristic of C3-4CSM, may be one of key factors affecting surgical outcome. The chance to diagnose C3-4CSM is increasing with the increasing healthy life expectancy. To enable effective resolution of symptoms, C3-4CSM must be distinguished from conventional CSM.
LEVEL OF EVIDENCE
研究设计
对前瞻性收集的180例脊髓型颈椎病（CSM）患者的数据进行回顾性分析。
目的
检测老年患者C3 - 4节段脊髓型颈椎病（C3 - 4CSM）的特征（主要分析），并验证颈椎前路椎间盘切除融合术（ACDF）和椎板成形术（LAMP）的术后疗效（亚组分析）。
背景数据总结
目前尚不清楚哪种手术技术对CSM能提供最佳疗效。
方法
主要分析纳入180例CSM患者，根据术前体格检查和磁共振成像结果分为两组（C3 - 4CSM组，n = 46；传统CSM组，n = 134）。亚组分析纳入46例C3 - 4CSM患者，根据手术技术分为两组（ACDF组，n = 21；LAMP组，n = 25）。比较术前人口统计学资料和术后疗效。
结果
C3 - 4CSM组的手术年龄更高，病程更短，术前日本骨科协会（JOA）评分低于传统CSM组。虽然C3 - 4CSM组C3 - 4节段的活动度显著更高，但其他节段的活动度显著更低。C3 - 4CSM组C3 - C7节段的前后径显著更大。在使用重复测量方差分析的亚组分析中，ACDF组术后JOA评分和颈部疼痛视觉模拟量表评分显著更好。
结论
年龄较大、病程较短和JOA评分较差似乎是C3 - 4CSM的特征。在C3 - 4CSM的治疗中，ACDF比LAMP提供了更好的手术疗效；C3 - 4节段的活动度过高是C3 - 4CSM的影像学特征，可能是影响手术疗效的关键因素之一。随着健康预期寿命的增加，诊断C3 - 4CSM的机会也在增加。为了有效缓解症状，必须将C3 - 4CSM与传统CSM区分开来。
证据级别
4级。
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