Takeuchi Kazunari, Yokoyama Toru, Wada Kan-Ichiro, Kudo Hitoshi
Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan.
Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan.
Spine Surg Relat Res. 2018 Jun 29;3(1):27-36. doi: 10.22603/ssrr.2018-0008. eCollection 2019 Jan 25.
The purpose of this study was to investigate the relationship between postoperative enlargement of the dural sac cross-sectional area at the symptomatic level and neurological improvements after laminoplasty.
The cross-sectional areas of the dural sac at the symptomatic level before and after laminoplasty and the expansion ratio (post-/preoperative cross-sectional area) were measured using magnetic resonance imaging in patients with ossification of the posterior longitudinal ligament (OPLL) (n = 25) and patients with cervical spondylotic myelopathy (CSM) (n = 49). The relationships between the expansion ratio and the Japanese Orthopedic Association (JOA) score, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and postoperative laminae morphology were investigated.
In the OPLL group, the expansion ratio was significantly positively correlated with the postoperative JOA score ( = 0.025), recovery rate of the JOA score ( = 0.026), and postoperative change in lower extremity sensory function according to the JOA score ( = 0.0375); furthermore, patients whose JOACMEQ responses indicated positive outcomes for lower extremity function had a significantly larger expansion ratio than patients with negative results ( = 0.027). In the CSM group, the expansion ratio showed no correlation with the JOA and JOACMEQ scores. The expansion ratio was significantly positively correlated with the width between bilateral gutters in both CSM ( = 0.025) and OPLL ( = 0.0451). In the OPLL group, the expansion ratio in those with a gutter position of less than 0.8 was significantly smaller than that those with a gutter position of more than 0.8 ( = 0.0156). However, there was no correlation between the gutter position and the recovery rate of the JOA score.
In OPLL, insufficient enlargement of the cross-sectional area of the dural sac at the symptomatic level leads to poor neurological improvements after laminoplasty.
本研究旨在探讨症状节段硬脊膜囊横截面积术后扩大与椎板成形术后神经功能改善之间的关系。
采用磁共振成像测量后纵韧带骨化症（OPLL）患者（n = 25）和脊髓型颈椎病（CSM）患者（n = 49）椎板成形术前、后症状节段硬脊膜囊的横截面积及扩大率（术后/术前横截面积）。研究扩大率与日本骨科协会（JOA）评分、JOA脊髓病评估问卷（JOACMEQ）及术后椎板形态之间的关系。
在OPLL组中，扩大率与术后JOA评分（P = 0.025）、JOA评分恢复率（P = 0.026）以及根据JOA评分的术后下肢感觉功能变化（P = 0.0375）显著正相关；此外，JOACMEQ下肢功能反应为阳性结果的患者扩大率显著大于阴性结果的患者（P = 0.027）。在CSM组中，扩大率与JOA和JOACMEQ评分无相关性。扩大率与CSM组（P = 0.这项研究的目的是调查在有症状水平的硬脊膜囊横截面积术后扩大与椎板成形术后神经功能改善之间的关系。
使用磁共振成像测量后纵韧带骨化症（OPLL）患者（n = 25）和脊髓型颈椎病（CSM）患者（n = 49）在椎板成形术前和术后有症状水平的硬脊膜囊横截面积以及扩大率（术后/术前横截面积）。研究扩大率与日本骨科协会（JOA）评分、JOA脊髓病评估问卷（JOACMEQ）以及术后椎板形态之间的关系。
在OPLL组中，扩大率与术后JOA评分（P = 0.025）、JOA评分恢复率（P = 0.026）以及根据JOA评分的术后下肢感觉功能变化（P = 0.0375）显著正相关；此外，JOACMEQ下肢功能反应为阳性结果的患者扩大率显著大于阴性结果的患者（P = 0.027）。在CSM组中，扩大率与JOA和JOACMEQ评分无相关性。扩大率与CSM组（P = 0.025）和OPLL组（P = 0.0451）双侧椎板沟之间的宽度显著正相关。在OPLL组中，椎板沟位置小于0.8的患者扩大率显著小于椎板沟位置大于0.8的患者（P = 0.0156）。然而，椎板沟位置与JOA评分恢复率之间无相关性。
在OPLL中，有症状水平的硬脊膜囊横截面积扩大不足导致椎板成形术后神经功能改善不佳。 025）和OPLL组（P = 0.0451）双侧椎板沟之间的宽度显著正相关。在OPLL组中，椎板沟位置小于0.8的患者扩大率显著小于椎板沟位置大于0.8的患者（P = 0.0156）。然而，椎板沟位置与JOA评分恢复率之间无相关性。
在OPLL中，有症状水平的硬脊膜囊横截面积扩大不足导致椎板成形术后神经功能改善不佳。
