Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei City, 100, Taiwan.
Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan.
Eur Spine J. 2020 May;29(5):1052-1060. doi: 10.1007/s00586-019-06247-z. Epub 2019 Dec 13.
No standard strategy exists for managing cervical spondylotic myelopathy (CSM). The efficacy of spinous process-splitting laminoplasty, its impact on cervical alignment change and the incidence of postoperative neck pain remain unclear. We analyzed the parameters of cervical alignment and cord morphology in CSM.
The radiographic parameters investigated were pre- and postoperative C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (CSVA), T1 slope (TS), TS minus CL (TS - CL) and cervical spinal cord morphology. Myelopathy severity was measured using two different functional scores. Statistical analysis was performed to determine significant differences between preoperative and follow-up radiological findings and change in functional scores.
This retrospective study comprised 85 CSM patients from a single institute, with a minimum follow-up of 24 months. Overall, 63.5% (n = 54) of patients had improvement in their postoperative cervical lordotic alignment; 36.5% (n = 31) developed progressive aggravation of the cervical kyphotic alignment. Pearson correlation analysis showed that CSVA, TS and T1-CL were independent predictors of CL curve change. Based on the receiver operating characteristic curve, the cutoff value for CSVA was 2.89 cm with a postoperative visual analog scale (VAS) > 4. The cutoff value of the TS - CL was 20 degrees with a postoperative VAS > 4. CSVA, TS and TS - CL had a significant association with variation in CL. CSVA and TS - CL had a significant association with postoperative neck pain.
CSVA, T1 slope and T1-CL are good predictors of postoperative degenerative kyphotic change and neck pain. Careful consideration of their preoperative cutoff values can improve postoperative outcomes.
IV. These slides can be retrieved under Electronic Supplementary Material.
目前尚无治疗脊髓型颈椎病（CSM）的标准策略。棘突劈开椎板成形术的疗效、对颈椎曲度变化的影响以及术后颈部疼痛的发生率尚不清楚。我们分析了 CSM 患者颈椎曲度和脊髓形态的参数。
研究的影像学参数包括术前和术后 C2-C7 前凸角（CL）、C2-C7 矢状垂直轴（CSVA）、T1 斜率（TS）、TS 与 CL 的差值（TS-CL）以及颈椎脊髓形态。采用两种不同的功能评分来测量颈椎病的严重程度。对术前和随访的影像学结果以及功能评分的变化进行统计学分析，以确定其差异是否具有统计学意义。
本回顾性研究纳入了来自单一机构的 85 例 CSM 患者，随访时间至少为 24 个月。总体而言，63.5%（n=54）的患者术后颈椎前凸角得到改善；36.5%（n=31）的患者出现颈椎后凸曲度进行性加重。Pearson 相关分析显示，CSVA、TS 和 T1-CL 是 CL 曲线变化的独立预测因子。根据受试者工作特征曲线，CSVA 的截断值为 2.89cm，术后视觉模拟评分（VAS）>4。TS-CL 的截断值为 20 度，术后 VAS>4。CSVA、TS 和 TS-CL 与 CL 的变化有显著相关性。CSVA 和 TS-CL 与术后颈部疼痛有显著相关性。
CSVA、TS 和 TS-CL 是术后退行性后凸变化和颈部疼痛的良好预测因子。术前仔细考虑这些指标的临界值有助于改善术后效果。
IV。这些幻灯片可以在电子补充材料中获取。
