Department of Orthopedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Spine (Phila Pa 1976). 2018 Feb 15;43(4):E234-E241. doi: 10.1097/BRS.0000000000002289.
A retrospective observational study.
We evaluated the prevalence and clinical characteristics of tandem spinal stenosis (TSS) in patients with cervical myelopathy including ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL).
Concurrent cervical and lumbar spinal canal stenosis is generally reported as TSS. Most previous studies have used magnetic resonance imaging to evaluate spinal stenosis in the cervical and lumbar spine.
The authors performed a retrospective analysis of the outcomes of 297 myelography and cervical surgeries performed in myelopathic patients. We compared the non-TSS group (n = 125) with the TSS group (n = 172) in terms of multiple clinical parameters. In each group, we compared the cervical non-OPLL cases with the cervical OPLL cases. Moreover, we investigated the ratio and clinical outcomes of additional lumbar surgeries performed for TSS patients.
One hundred seventy-two cases (57.9%) were considered TSS. Forty-one patients (13.8%) underwent a lumbar operation during the follow-up period. The TSS group included a greater number of OPLL patients, elderly patients, diabetes mellitus, hypertension, and non-smokers than the non-TSS group. The postoperative C-JOA score and the C-JOA recovery rate in the TSS group were significantly lower than the non-TSS group. In the TSS group, the non-C-OPLL patients were significantly older than the C-OPLL patients. The C-OPLL patients had higher postoperative C-JOA scores than the non-C-OPLL patients in both the TSS and non-TSS groups. The additional lumbar surgery effectively improved both the C-JOA and L-JOA scores in TSS patients.
The prognosis for TSS patients with myelopathy was worse than that for patients with isolated cervical lesions. Younger C-OPLL patients, even those with TSS, showed higher recovery rates than non-C-OPLL patients. Aging and coexistent lumbar lesions may influence the recovery process following surgery for cervical myelopathy.
回顾性观察研究。
我们评估了伴有颈椎后纵韧带骨化（C-OPLL）的颈椎病患者中串联性椎管狭窄（TSS）的患病率和临床特征。
同时存在颈椎和腰椎椎管狭窄症通常被称为 TSS。大多数先前的研究都使用磁共振成像来评估颈椎和腰椎的椎管狭窄症。
作者对 297 例颈椎病患者行脊髓造影和颈椎手术的结果进行了回顾性分析。作者比较了非 TSS 组（n=125）与 TSS 组（n=172）的多项临床参数。在每组中，作者比较了颈椎非 OPLL 病例与颈椎 OPLL 病例。此外，作者还研究了 TSS 患者进行额外腰椎手术的比例和临床结果。
172 例（57.9%）被认为是 TSS。41 例（13.8%）在随访期间接受了腰椎手术。TSS 组的 OPLL 患者、老年患者、糖尿病、高血压和不吸烟者比非 TSS 组多。TSS 组的术后 C-JOA 评分和 C-JOA 恢复率明显低于非 TSS 组。在 TSS 组中，非 C-OPLL 患者明显比 C-OPLL 患者年龄大。在 TSS 和非 TSS 两组中，C-OPLL 患者的术后 C-JOA 评分均高于非 C-OPLL 患者。额外的腰椎手术可有效改善 TSS 患者的 C-JOA 和 L-JOA 评分。
颈椎病合并 TSS 患者的预后比单纯颈椎病变患者差。年轻的 C-OPLL 患者，即使合并 TSS，其恢复率也高于非 C-OPLL 患者。年龄增长和并存的腰椎病变可能会影响颈椎脊髓病手术后的恢复过程。
4 级。
