Rodriguez-Feo John A, Leas Daniel, Odum Susan M, Angerame Marc, Kurd Mark, Darden Bruce V, Milam R Alden
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
OrthoCarolina Research Institute Inc., Charlotte, North Carolina.
Int J Spine Surg. 2018 Dec 21;12(6):751-756. doi: 10.14444/5094. eCollection 2018 Dec.
Laminoplasty is a safe and effective procedure for multilevel degenerative cervical stenosis causing myelopathy, that allows for motion preservation. The purpose of this study was to determine the reoperation rate and associated risk factors after cervical laminoplasty.
We present a retrospective consecutive series of patients who underwent a laminoplasty procedure between January 1, 2005, and October 31, 2012, and had a minimum 2-year follow-up. Demographic data were collected and operative records were reviewed to determine the cervical levels involved in the laminoplasty procedure, any concomitant procedures, and estimated blood loss. Clinical records were reviewed and telephone interviews were conducted on those patients with less than 2-year in-person follow-up. Patients requiring reoperations and the reason for the reoperations were determined, as well as the incidence of postoperative C5 palsy.
A total of 222 of 266 patients (83%) with a minimum 2-year follow-up had an average follow-up of 4.97 years. Overall, 26 patients underwent 30 reoperations (13.5%). A total of 15 patients underwent 16 reoperations (7.2%) in the acute postoperative period for infection requiring at least 1 irrigation and debridement, hardware-related issues, or posterior cervical wound issues. A total of 13 patients had 14 reoperations (6.3%) outside of the acute postoperative period for the development of a new radiculopathy, recurrent myelopathy, neurologic symptoms with a kyphotic deformity, or a posttraumatic focal kyphotic deformity. Patients who had a concomitant laminectomy demonstrated a significantly ( = .03) higher reoperation rate than those who did not. There were no other statistically significant associations. The C5 palsy rate was 8.1% (18 of 222).
Although the preserved motion following laminoplasty may allow for the development of new neurologic symptoms, the reoperation rate continues to compare favorably with laminectomy and fusion and remains a reasonable option for the surgical management of multilevel cervical stenosis causing myelopathy.
椎板成形术是治疗多节段退行性颈椎管狭窄症导致脊髓病的一种安全有效的手术方法，可保留颈椎活动度。本研究的目的是确定颈椎椎板成形术后的再次手术率及相关危险因素。
我们回顾性连续纳入了2005年1月1日至2012年10月31日期间接受椎板成形术且至少随访2年的患者。收集人口统计学数据并查阅手术记录，以确定椎板成形术涉及的颈椎节段、任何同期手术及估计失血量。查阅临床记录并对随访时间不足2年的患者进行电话访谈。确定需要再次手术的患者及其再次手术的原因，以及术后C5麻痹的发生率。
266例患者中，共有222例（83%）至少随访2年，平均随访时间为4.97年。总体而言，26例患者接受了30次再次手术（13.5%）。共有15例患者在术后急性期因感染（至少需要1次冲洗和清创）、硬件相关问题或颈后伤口问题接受了16次再次手术（7.2%）。共有13例患者在术后急性期以外因新发神经根病、复发性脊髓病、伴有后凸畸形的神经症状或创伤后局灶性后凸畸形接受了14次再次手术（6.3%）。同期行椎板切除术的患者再次手术率显著高于未行椎板切除术的患者（P = 0.03）。无其他具有统计学意义的关联。C5麻痹发生率为8.1%（222例中有18例）。
尽管椎板成形术后保留的活动度可能会导致新的神经症状出现，但再次手术率仍优于椎板切除术和融合术，仍是治疗多节段颈椎管狭窄症导致脊髓病的合理手术选择。
4级。
