Fujiwara Hiroyasu, Oda Takenori, Makino Takahiro, Moriguchi Yu, Yonenobu Kazuo, Kaito Takashi
Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Clin Spine Surg. 2018 May;31(4):E245-E251. doi: 10.1097/BSD.0000000000000619.
This is prospective observational study.
To prospectively investigate the correlation among axial neck pain; a newly developed patient-based quality of life outcome measure, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); and cervical sagittal alignment after open-door laminoplasty for cervical myelopathy.
Many studies have focused on postoperative axial neck pain after laminoplasty. However, the correlation among cervical sagittal alignment, neck pain, and JOACMEQ has not been investigated.
In total, 57 consecutive patients treated by open-door laminoplasty for cervical myelopathy were included (mean age, 63.7 y; 15 women and 42 men) and divided into 2 groups according to diagnosis [cervical spondylotic myelopathy (CSM) group: 35 patients, and ossification of the posterior longitudinal ligament (OPLL) group: 22 patients]. JOA score, a subdomain of cervical spine function (CSF) in the JOACMEQ, and the visual analog scale for axial neck pain were assessed preoperatively and 12 months postoperatively. Radiographic cervical sagittal parameters were measured by C2 sagittal vertical axis (C2 SVA), C2-C7 lordosis, C7 sagittal slope (C7 slope), and range of motion.
C2 SVA values in both groups shifted slightly anteriorly between preoperative and 12-month postoperative measurements (CSM: +19.7±10.9 mm; OPLL: +22.1±13.4 mm vs. CSM: +23.2±16.1 mm; OPLL: +28.7±15.4 mm, respectively). Postoperative axial neck pain in the OPLL group showed strong negative correlations with C2 SVA and C7 slope. Strong negative correlations were found between axial neck pain and CSF in both the preoperative CSM and OPLL groups (CSM: r=-0.45, P=0.01; OPLL: r=-0.61, P<0.01) and between axial neck pain and CSF in the postoperative OPLL group (r=-0.51, P=0.05).
This study demonstrated a significant negative correlation between neck pain and CSF in both the CSM and OPLL groups preoperatively and in the OPLL group postoperatively. Radiographic cervical sagittal alignment did not significantly correlate with preoperative or postoperative axial neck pain.
这是一项前瞻性观察性研究。
前瞻性研究颈髓型颈椎病患者颈后部疼痛、一种新开发的基于患者的生活质量评估指标——日本骨科协会脊髓型颈椎病评估问卷（JOACMEQ）以及开门式椎板成形术后颈椎矢状面排列之间的相关性。
许多研究都聚焦于椎板成形术后的颈后部疼痛。然而，颈椎矢状面排列、颈部疼痛和JOACMEQ之间的相关性尚未得到研究。
总共纳入了57例连续接受开门式椎板成形术治疗的颈髓型颈椎病患者（平均年龄63.7岁；女性15例，男性42例），并根据诊断分为两组[脊髓型颈椎病（CSM）组：35例患者，后纵韧带骨化（OPLL）组：22例患者]。术前和术后12个月评估JOA评分、JOACMEQ中颈椎功能（CSF）的一个子域以及颈后部疼痛的视觉模拟量表。通过C2矢状垂直轴（C2 SVA）、C2 - C7前凸、C7矢状斜率（C7斜率）和活动范围测量颈椎矢状面影像学参数。
两组的C2 SVA值在术前和术后12个月测量之间均略有向前移位（CSM组：+19.7±10.9毫米；OPLL组：+22.1±13.4毫米，而术前CSM组：+23.2±16.1毫米；OPLL组：+28.7±15.4毫米）。OPLL组术后的颈后部疼痛与C2 SVA和C7斜率呈强烈负相关。术前CSM组和OPLL组的颈后部疼痛与CSF之间均存在强烈负相关（CSM组：r = -0.45，P = 0.01；OPLL组：r = -0.61，P < 0.01），术后OPLL组的颈后部疼痛与CSF之间也存在负相关（r = -0.51，P = 0.05）。
本研究表明，术前CSM组和OPLL组以及术后OPLL组的颈部疼痛与CSF之间均存在显著负相关。颈椎矢状面影像学排列与术前或术后的颈后部疼痛无显著相关性。
