Nori Satoshi, Shiraishi Tateru, Aoyama Ryoma, Ninomiya Ken, Yamane Junichi, Kitamura Kazuya, Ueda Seiji
Department of Orthopedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513, Japan.
Shiraishi Spine Clinic, 1-35-23 Sanno, Ota, Tokyo 143-0023, Japan.
J Clin Neurosci. 2018 Apr;50:226-231. doi: 10.1016/j.jocn.2018.01.067. Epub 2018 Feb 10.
Postoperative posterior spinal cord shift (PSS) has been considered a required radiographic endpoint of posterior decompression procedures. To achieve PSS, laminoplasty for cervical compressive myelopathy (CCM) has been consecutively performed on four or more laminae (C2-C7, C3-C7, or C3-C6). However, the clinical significance of PSS remains controversial. By selecting the surgically treated laminae, selective laminectomy (SL) can achieve adequate decompression without disturbing the extensor musculature and facet joints. The clinical features and radiological findings from 162 patients with CCM whose decompression included C4/5 level were investigated. The postoperative C2-C7 angle, PSS at C4/5 level, and laminectomy width were measured. Radiologic factors affecting PSS and the relationship between PSS and functional outcome were analyzed. Smaller PSS was observed in cases involving two or fewer consecutive laminectomies than in cases involving three or more consecutive laminectomies. The number of consecutive laminae (CLs) surgically treated and the postoperative C2-C7 angle correlated with PSS. Multiple linear regression analyses showed that the number of surgically treated CLs was the greatest predictor of PSS. No correlation was observed between PSS and the recovery rate (RR) of the Japanese Orthopaedic Association (JOA) score; RR of the JOA score was not affected even in patients with no PSS. PSS was affected by the number of CLs surgically treated and the postoperative C2-C7 angle. The magnitude of PSS never affected the RR of JOA score after SL. Therefore, for patients with CCM, PSS is not mandatory to obtain satisfactory functional recovery.
术后脊髓后移（PSS）被认为是后路减压手术所需的影像学终点。为实现PSS，对4个或更多节段（C2 - C7、C3 - C7或C3 - C6）进行颈椎压迫性脊髓病（CCM）的椎板成形术。然而，PSS的临床意义仍存在争议。通过选择手术治疗的节段，选择性椎板切除术（SL）可以在不干扰伸肌和小关节的情况下实现充分减压。对162例减压包括C4/5节段的CCM患者的临床特征和影像学表现进行了研究。测量术后C2 - C7角、C4/5节段的PSS和椎板切除宽度。分析影响PSS的放射学因素以及PSS与功能结局之间的关系。与连续3个或更多节段椎板切除术的病例相比，连续2个或更少节段椎板切除术的病例中观察到的PSS较小。手术治疗的连续节段数（CLs）和术后C2 - C7角与PSS相关。多元线性回归分析表明，手术治疗的CLs数量是PSS的最大预测因素。未观察到PSS与日本骨科协会（JOA）评分恢复率（RR）之间的相关性；即使在无PSS的患者中，JOA评分的RR也不受影响。PSS受手术治疗的CLs数量和术后C2 - C7角的影响。SL术后PSS的大小从未影响JOA评分的RR。因此，对于CCM患者，获得满意的功能恢复并非必须有PSS。
