Ashana Adedayo O, Cohen Jeremiah R, Evans Brandon, Holly Langston T
Departments of *Orthopaedics †Neurosurgery, David Geffen UCLA School of Medicine, Los Angeles, CA.
Clin Spine Surg. 2017 Jun;30(5):E609-E614. doi: 10.1097/BSD.0000000000000233.
A retrospective case-control study.
To investigate whether posterior cervical laminectomy and fusion modifies the natural course of anterior disk-osteophyte complex in patients with multilevel cervical spondylotic myelopathy.
Dorsal migration of the spinal cord is the main purported mechanism of spinal cord decompression following cervical laminectomy and fusion but other potential mechanisms have received scant attention in the literature. This study was conducted to investigate whether cervical laminectomy and fusion affects the size of anterior disk-osteophyte complex.
The medical records and radiographic imaging of 44 patients who underwent cervical laminectomy and fusion for cervical spondylotic myelopathy between 2006 and 2013 were analyzed. The size of the anterior disk-osteophyte complex was measured preoperatively and postoperatively on MR images taken at an interval of >3 months apart. A control group consisted of 20 nonoperatively treated advanced cervical spondylosis patients. Patients in the control met the same inclusion and exclusion criteria and also had sequential magnetic resonance imaging (MRI) taken at an interval of >3 months apart.
The nonoperative and operative groups were statistically similar in the pertinent patient demographics and characteristics including sex, age, time to second MRI, size of anterior disk-osteophyte complex on baseline MRI, mean number of levels affected, and percentage of patients with T2 signal change. As expected the mJOA scores were significantly lower in the operative versus nonoperative cohort (13.6 vs. 16.5, P<0.01). A significant decrease in the size of anterior disk osteophyte was observed in the operative group postoperatively (P<0.01). In comparison, there was no statistically significant change in the size of the anterior disk-osteophyte complex in the control group (P>0.05). The magnitude of the change in disk size between the 2 groups was statistically significant (P<0.01).
The findings of this study suggest that regression of anterior disk-osteophyte complex occurs following cervical laminectomy and fusion, and likely provides another mechanism of spinal cord decompression.
一项回顾性病例对照研究。
探讨后路颈椎椎板切除术及融合术是否改变多节段脊髓型颈椎病患者前方椎间盘骨赘复合体的自然病程。
脊髓背侧移位是颈椎椎板切除术及融合术后脊髓减压的主要推测机制，但其他潜在机制在文献中很少受到关注。本研究旨在调查颈椎椎板切除术及融合术是否影响前方椎间盘骨赘复合体的大小。
分析2006年至2013年间因脊髓型颈椎病接受颈椎椎板切除术及融合术的44例患者的病历和影像学资料。在间隔超过3个月拍摄的磁共振图像上术前和术后测量前方椎间盘骨赘复合体的大小。对照组由20例非手术治疗的晚期颈椎病患者组成。对照组患者符合相同的纳入和排除标准，并且也间隔超过3个月进行连续的磁共振成像（MRI）检查。
非手术组和手术组在相关患者人口统计学和特征方面具有统计学相似性，包括性别、年龄、第二次MRI检查时间、基线MRI上前方椎间盘骨赘复合体的大小、平均受累节段数以及T2信号改变患者的百分比。正如预期的那样，手术组的改良日本骨科学会（mJOA）评分明显低于非手术组（13.6对16.5，P<0.01）。术后手术组前方椎间盘骨赘大小显著减小（P<0.01）。相比之下，对照组前方椎间盘骨赘复合体的大小没有统计学上的显著变化（P>0.05）。两组之间椎间盘大小变化的幅度具有统计学显著性（P<0.01）。
本研究结果表明，颈椎椎板切除术及融合术后前方椎间盘骨赘复合体发生退缩，并且可能提供了另一种脊髓减压机制。
