Takeuchi Kazunari, Yokoyama Toru, Numasawa Takuya, Itabashi Taito, Yamasaki Yoshihito, Kudo Hitoshi
Department of Orthopedic Surgery, Odate Municipal General Hospital, 3-1 Yutaka-cho, Odate, Akita, 017-0885, Japan.
Department of Orthopedic Surgery, Hachinohe City Hospital, 1 Tamukai Bisyamonntai, Hachinohe, Aomori, 031-8555, Japan.
Eur Spine J. 2018 Jun;27(6):1349-1357. doi: 10.1007/s00586-017-5402-2. Epub 2017 Nov 24.
To present a novel posterior approach in multilevel cervical posterior decompression and fusion (PDF) using C2 pedicle screws that preserves the rectus capitis posterior major, oblique capitis inferior, and semispinalis cervicis.
We analyzed 30 consecutive patients who underwent C2-T1 PDF using an approach that preserved these three muscles without resecting. We assessed O-C2 range of motion (ROM), cross-sectional area of the cervical posterior muscles, rotational ROM, visual analog scale (VAS) for axial pain, neck disability index (NDI), and limitations of activities of daily living (ADL) involving neck movements.
Mean preoperative O-C2 ROM (23.6°) was significantly increased postoperatively (33.0°). Mean atrophy rate of the cross-sectional area was 3.9%. Postoperatively, 69.8% of the preoperative rotational ROM (113.3°) was retained. The preoperative VAS for axial pain and the NDI did not increase postoperatively. The postoperative O-C2 ROM (33.9°) in 26 patients for whom extension ADL were possible was significantly larger than that in four patients for whom extension ADL were impossible (26.9°). The postoperative retained rate of rotational ROM (75.8%) in 18 patients for whom rotation ADL were possible was significantly larger than that in 12 patients for whom rotation ADL were impossible (62.3%).
This is potentially an effective approach for maintaining O-C2 ROM and rotational ROM, which enabled good levels of ADL after C2-T1 PDF. Axial pain and NDI were not worse after PDF.
介绍一种在多节段颈椎后路减压融合术（PDF）中使用C2椎弓根螺钉的新型后路入路方法，该方法可保留头后大直肌、头下斜肌和颈半棘肌。
我们分析了30例连续接受C2-T1节段PDF手术的患者，采用的入路方法保留了这三块肌肉而未进行切除。我们评估了枕-枢（O-C2）关节活动度（ROM）、颈后肌肉的横截面积、旋转ROM、轴性疼痛视觉模拟评分（VAS）、颈部功能障碍指数（NDI）以及涉及颈部活动的日常生活活动（ADL）受限情况。
术前O-C2平均ROM（23.6°）术后显著增加（33.0°）。横截面积的平均萎缩率为3.9%。术后，保留了术前旋转ROM（113.3°）的69.8%。术前轴性疼痛VAS和NDI术后未增加。26例能够进行伸展ADL的患者术后O-C2 ROM（33.9°）显著大于4例无法进行伸展ADL的患者（26.9°）。18例能够进行旋转ADL的患者术后旋转ROM保留率（75.8%）显著大于12例无法进行旋转ADL的患者（62.3%）。
这可能是一种维持O-C2 ROM和旋转ROM的有效方法，使得C2-T1节段PDF术后能有较好的ADL水平。PDF术后轴性疼痛和NDI并未恶化。
