Wang Jizhou, Sun Tianwei, He Xiaoqi
Tianjin Medical University Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China.
Medicine (Baltimore). 2018 Aug;97(32):e11823. doi: 10.1097/MD.0000000000011823.
The present study is a retrospective study.Axial symptoms are frequently encountered complication after laminoplasty. Some studies have reported the influencing factors and preventive measures of axial symptoms after laminoplasty. However, impact of different laminae open angles on the postoperative axial symptoms remains unclear.The objective of the present study was to explore the effect of different laminae open angles on postoperative axial symptoms and to discuss the possible mechanisms of the impact of different open angles on axial symptoms.We retrospectively analyzed 124 patients with multilevel cervical compression myelopathy who were treated with expansive open-door laminoplasty from February 2012 to January 2015. The operational level ranged from C3-C7 in all patients. The laminae open angles at the C4, C5, and C6 levels were measured 1 week postoperative. The mean value was taken for statistical analysis. The patients were divided into 2 groups, group A (open angles < 40°, 71 patients including 44 males and 27 females) and group B (open angles ≥ 40°, 53 patients including 32 males and 21 females). C2-C7 Cobb angle, range of cervical motion (ROM), Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS) score for axial pain were compared between the 2 groups.All patients completed at least 2-year follow-up. Both groups gained significant JOA improvement postoperatively (P < .05). Preoperative and postoperative C2-C7 Cobb angle and ROM comparisons were significantly different (P < .05) in both groups. There were no significant difference for other clinical and radiography parameters between the groups (P > .05). At 2 weeks and 6 months after surgery, there was significant difference in axial symptoms between the 2 groups (P < .05). At final follow-up, the difference between the 2 groups was not statistically significant (P > .05).In different angles of the lamina open-door, incidence of axial symptoms has statistically difference between the 2 groups. When the lamina open-door angles are <40°, there are not only ensure adequate spinal cord decompression but reduces the incidence of early and midterm postoperative axial pain.
本研究为一项回顾性研究。轴性症状是椎板成形术后常见的并发症。一些研究报道了椎板成形术后轴性症状的影响因素及预防措施。然而，不同的椎板开门角度对术后轴性症状的影响仍不明确。本研究的目的是探讨不同椎板开门角度对术后轴性症状的影响，并讨论不同开门角度影响轴性症状的可能机制。我们回顾性分析了2012年2月至2015年1月期间接受扩大开门椎板成形术治疗的124例多节段颈椎管狭窄症患者。所有患者的手术节段均为C3-C7。术后1周测量C4、C5和C6节段的椎板开门角度，并取平均值进行统计分析。将患者分为两组，A组（开门角度<40°，71例，男性44例，女性27例）和B组（开门角度≥40°，53例，男性32例，女性21例）。比较两组之间的C2-C7 Cobb角、颈椎活动范围（ROM）、日本骨科学会（JOA）评分以及轴性疼痛的视觉模拟量表（VAS）评分。所有患者均完成了至少2年的随访。两组患者术后JOA评分均有显著改善（P<0.05）。两组术前和术后C2-C7 Cobb角及ROM比较差异均有统计学意义（P<0.05）。两组之间的其他临床和影像学参数无显著差异（P>0.05）。术后2周和6个月时，两组之间的轴性症状有显著差异（P<0.05）。末次随访时，两组之间的差异无统计学意义（P>0.05）。在不同的椎板开门角度下，两组之间轴性症状的发生率有统计学差异。当椎板开门角度<40°时，既能保证脊髓充分减压，又能降低术后早中期轴性疼痛的发生率。
