Malagi Sunil, Konar Subhas, Shukla Dhaval P, Bhat Dhananjaya I, Sadashiva Nishanth, Devi Bhagavatula I Indira
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2019 Jan-Mar;10(1):21-27. doi: 10.4103/jnrp.jnrp_254_18.
Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM.
This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score.
A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 ( = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome.
Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.
颈椎椎板切除术是一种广为人知的用于治疗颈椎压迫性脊髓病（CCM）的后路减压手术。我们的目的是评估后路减压性椎板切除术对重度CCM的功能效果。
本研究是一项对2010年1月至2015年12月期间接受减压性椎板切除术的重度CCM患者进行的观察性回顾性研究。纳入Nurick分级为4级和5级（需支撑行走或卧床）的患者。从病历中收集临床数据和放射学信息，并应用客观量表比较术前评分和术后评分的手术结果。
共有69例接受减压性椎板切除术治疗重度CCM的患者纳入研究。平均年龄为54.9岁，男女比例为5.3:1。后纵韧带骨化占52.6%的病例。57例（82.6%）患者有术后至少6个月的随访数据。与随访时的术前Nurick分级相比，57例患者中有40例（70.2%）术后改善至少一个等级。其余17例（29.8%）保持不变或进一步恶化。术前改良日本骨科协会平均评分为8.4±2.8，随访平均评分为11.8±0.3（ = 0.0001）。多因素分析显示，椎板切除节段数、术后恶化情况和麻醉分级是结果的预测因素。
减压性椎板切除术治疗重度脊髓病对改善功能结果有效。
