Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan.
Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
J Clin Neurosci. 2020 Jun;76:100-106. doi: 10.1016/j.jocn.2020.04.034. Epub 2020 Apr 10.
Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP), and several studies have investigated its predictors. In these studies, a kyphotic Cobb angle of 0°-5° between C2 and C7 at a certain postoperative time-point was often used to detect kyphotic deformity. However, studies considering the amount of cervical lordosis loss compared to the preoperative measurement are scarce. This study aimed to elucidate risk factors for kyphotic change after CLP by comparing patients with and without marked loss of cervical lordosis postoperatively. The study population was divided into seven patients with and 92 patients without a loss of >10° of the C2-7 angle during the follow-up period compared to the preoperative measurements [cervical lordosis loss (CLL) group and no CLL (NCLL) group, respectively]; demographic characteristics, surgical information, preoperative radiographic sagittal parameters of the cervical spine, and posterior paravertebral muscle morphology evaluated by magnetic resonance imaging were compared between two groups. A univariate analysis revealed that the CLL group had significantly greater flexion range of motion (fROM) than the NCLL group (43.0° vs. 25.8°, P < 0.001); however, no statistical significance was identified for other parameters. The fROM had a high capacity to discriminate between the CLL and NCLL groups (area under the receiver-operating characteristic curve, 0.880; P < 0.001; 95% confidence interval, 0.589-0.974) with an optimal cutoff point of 37°. This study suggests that greater fROM is a risk factor for the development of kyphotic changes after CLP. For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated.
颈椎板成形术后（CLP）后出现后凸畸形是一种罕见但严重的并发症，已有多项研究探讨了其预测因素。在这些研究中，通常使用术后特定时间点 C2 到 C7 之间的 Cobb 角为 0°-5°来检测后凸畸形。然而，考虑到与术前测量相比颈椎前凸丢失量的研究较少。本研究旨在通过比较术后颈椎前凸丢失量大于或等于 10°的患者与无丢失的患者，阐明 CLP 后后凸变化的危险因素。研究人群分为七例术后 C2-7 角丢失量大于 10°的患者和 92 例无丢失的患者（颈椎前凸丢失（CLL）组和无 CLL 组（NCLL）组）；比较两组之间的人口统计学特征、手术信息、术前颈椎矢状位影像学参数以及磁共振成像评估的后椎体旁肌肉形态。单因素分析显示，CLL 组的前屈活动度（fROM）明显大于 NCLL 组（43.0°比 25.8°，P<0.001）；然而，其他参数无统计学意义。fROM 对区分 CLL 组和 NCLL 组具有较高的能力（ROC 曲线下面积，0.880；P<0.001；95%置信区间，0.589-0.974），最佳截断点为 37°。本研究表明，较大的 fROM 是 CLP 后发生后凸变化的危险因素。对于术前 fROM 超过 40°的患者，应谨慎考虑行 CLP。
