Ashana Adedayo O, Ajiboye Remi M, Sheppard William L, Sharma Akshay, Kay Andrew B, Holly Langston T
Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA.
Case Western Reserve School of Medicine, Cleveland, Ohio, USA.
World Neurosurg. 2017 Nov;107:445-450. doi: 10.1016/j.wneu.2017.07.173. Epub 2017 Aug 5.
Cervical spondylotic myelopathy (CSM) is a disorder that can cause neurologic deterioration. Studies on paraspinal muscular atrophy (PMA) in the lumbar spine have shown that these changes are caused by several perioperative factors. It is possible that PMA in the cervical spine could behave similarly. In this retrospective study, we compared the degree of PMA after laminoplasty versus laminectomy and fusion (LF) using a standard posterior approach to the cervical spine.
18 laminoplasty and 43 LF patients were included in this study. For each patient, preoperative and postoperative MRI files were obtained and transferred into OsiriX imaging software. Atrophy rate was obtained and reported as percentage change in cross-sectional area of the cervical paraspinal muscles from preoperative to postoperative imaging.
Mean cross-sectional cervical muscle atrophy rates were 6% and 13.1% for laminoplasty and LF, respectively, representing a 2.19 times increase in the degree of atrophy (P < 0.001). Independently, LF was associated with a 5.84% increase in the rate of PMA (P = 0.03). Involvement of C3 as the cephalad surgical level was associated with a 5.78% decrease in the rate of PMA (P = 0.03). For each degree increase in postoperative Cobb angle, there was a 0.66% decrease in the rate of PMA (P = 0.02).
PMA should be part of the decision making process when a posterior approach is considered, inasmuch as this study demonstrates that cervical laminoplasty was associated with significantly lower rates of PMA compared with cervical laminectomy and fusion. Additionally, these results suggest that minimizing PMA may help preserve cervical lordosis.
脊髓型颈椎病（CSM）是一种可导致神经功能恶化的疾病。对腰椎椎旁肌萎缩（PMA）的研究表明，这些变化是由多种围手术期因素引起的。颈椎的PMA可能表现相似。在这项回顾性研究中，我们采用标准的颈椎后路手术方法，比较了椎板成形术与椎板切除融合术（LF）后PMA的程度。
本研究纳入了18例行椎板成形术和43例行LF的患者。为每位患者获取术前和术后的MRI文件，并将其传输到OsiriX影像软件中。计算萎缩率，并报告为颈椎椎旁肌横截面积从术前到术后影像的百分比变化。
椎板成形术和LF术后颈椎肌肉平均横截面积萎缩率分别为6%和13.1%，萎缩程度增加了2.19倍（P < 0.001）。单独来看，LF与PMA发生率增加5.84%相关（P = 0.03）。作为头侧手术节段的C3受累与PMA发生率降低5.78%相关（P = 0.03）。术后Cobb角每增加一度，PMA发生率降低0.66%（P = 0.02）。
当考虑采用后路手术方法时，PMA应作为决策过程的一部分，因为本研究表明，与颈椎椎板切除融合术相比，颈椎椎板成形术的PMA发生率显著更低。此外，这些结果表明，尽量减少PMA可能有助于维持颈椎前凸。
