Yu Zhiming, He Da, Xiong Jiachao, Pan Zhimin, Feng Lingxuan, Xu Jiang, Han Zhimin, Gragnaniello Cristian, Koga Hisashi, Phan Kevin, Azimi Parisa, Lee Jong-Joo, Ha Yoon, Cao Kai
Spine Center, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
Ann Transl Med. 2019 Sep;7(18):472. doi: 10.21037/atm.2019.08.17.
Laminectomy and laminoplasty are popularly used in posterior cervical spine surgery but still have involved complications. We aimed to compare the clinical outcomes of microscope-assisted extensor muscle-preserving laminectomy (MA-EMPL) and open-door laminoplasty (ODLP) in treating multilevel cervical spondylotic myelopathy (MCSM).
A prospective study was designed to enroll twenty patients with MCSM underwent MA-EMPL, and recruit twenty-four patients with MCSM received ODLP (control). Radiographic measurements, outcome indicators including Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were used to evaluate technical effectiveness. Surgical complications were documented to assess technical safety.
Postoperative cervical curvature index and range of neck motion (ROM) were not significantly changed except ROM in ODLP group. Postoperative JOA score and VAS in both groups showed improvements at final follow-up. There was no statistical difference in postoperative neurological recovery rates between two groups (67.6%±17.8% 70.15%±19.6%, P=0.632). However, VAS was significantly lower at postoperative 1 month in MA-EMPL group compared with ODLP group (P<0.001). The incidences of C5 palsy were 0 16.7% between MA-EMPL group and ODLP group. There was no axial symptom occurred in MA-EMPL group while six patients in ODLP group (0 25%, P=0.049). In addition, the mean blood loss and hospital stay were lesser in MA-EMPL group compared with ODLP group (P<0.001, P=0.002, respectively).
MA-EMPL is an effective, safe and minimally invasive method in treatment of MCSM. Compared with ODLP, MA-EMPL has advantage to decrease intraoperative blood loss, hospital stay, postoperative VAS and axial symptom, as well as preserve postoperative ROM.
椎板切除术和椎板成形术在颈椎后路手术中被广泛应用，但仍存在相关并发症。我们旨在比较显微镜辅助保留伸肌的椎板切除术（MA - EMPL）和开门式椎板成形术（ODLP）治疗多节段脊髓型颈椎病（MCSM）的临床疗效。
一项前瞻性研究纳入了20例行MA - EMPL的MCSM患者，并招募了24例行ODLP的MCSM患者作为对照。采用影像学测量、包括日本骨科协会（JOA）评分和视觉模拟评分（VAS）在内的结果指标来评估技术有效性。记录手术并发症以评估技术安全性。
除ODLP组的颈部活动度（ROM）外，术后颈椎曲度指数和颈部活动范围（ROM）无明显变化。两组术后JOA评分和VAS在末次随访时均有改善。两组术后神经功能恢复率无统计学差异（67.6%±17.8%对70.15%±19.6%，P = 0.632）。然而，MA - EMPL组术后1个月的VAS显著低于ODLP组（P < 0.001）。MA - EMPL组和ODLP组C5麻痹的发生率分别为0和16.7%。MA - EMPL组未出现轴性症状，而ODLP组有6例患者出现（0对25%，P = 0.049）。此外，MA - EMPL组的平均失血量和住院时间均少于ODLP组（分别为P < 0.001，P = 0.002）。
MA - EMPL是治疗MCSM的一种有效、安全且微创的方法。与ODLP相比，MA - EMPL在减少术中失血量、住院时间、术后VAS和轴性症状以及保留术后ROM方面具有优势。
