Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Spine (Phila Pa 1976). 2020 Sep 15;45(18):E1142-E1149. doi: 10.1097/BRS.0000000000003528.
Retrospective cohort study.
The aim of this study was to evaluate the impact of cervical disc degeneration (CDD) severity on 2-year postoperative outcomes following laminoplasty.
The impact of CDD on postoperative outcomes of cervical laminoplasty has not been well established.
A total of 144 patients who underwent open-door laminoplasty for cervical spondylotic myelopathy (CSM) were enrolled. Six cervical discs were independently analyzed for degeneration severity using a previously reported grading system (grade 0: none, grade 3: severest). The relationship between the segmental range of motion (ROM) and the severity of CDD was evaluated. Subsequently, after dividing overall patients into mild and severe CDD groups by the average of CDD scores, the mixed-effect model was applied to assess 2-year postoperative outcomes, including physician-assessed myelopathy scores, patient-reported outcomes, and preoperative radiographic parameters. Finally, as additional analysis, the severe CDD group was further divided into two groups: group 1 included patients with a grade 3 CDD change in their most stenotic level and group 2 included the others. The 2-year postoperative myelopathy score was compared between groups 1 and 2.
The cervical segments with grade 3 CDD showed significantly smaller ROM compared with those with grade 0, 1, or 2 CDD (P < 0.01). There were no significant differences in postoperative improvements in myelopathy, pain, patient-reported physical and mental status, and radiographic parameters, except for quality of life (QOL) scores between CDD groups. A significant (P = 0.02) postoperative improvement in QOL scores was noted in the severe CDD group. In an additional analysis, myelopathy score at 2 years postoperatively was significantly higher in group 1 than group 2 (P = 0.041).
The severity of CDD did not negatively impact 2-year postoperative laminoplasty outcomes. The postulated reason is that the decreased segmental instability in the level with severe CDD may affect surgical outcomes positively.
回顾性队列研究。
本研究旨在评估颈椎间盘退变（CDD）严重程度对开门式椎板成形术后 2 年疗效的影响。
CDD 对颈椎椎板成形术后疗效的影响尚未得到充分证实。
共纳入 144 例行颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病（CSM）的患者。采用先前报道的分级系统，对 6 个颈椎间盘的退变严重程度进行独立分析（0 级：无，3 级：最重）。评估节段活动度（ROM）与 CDD 严重程度的关系。随后，根据 CDD 评分的平均值将所有患者分为 CDD 轻度组和重度组，应用混合效应模型评估 2 年术后疗效，包括医生评估的脊髓病评分、患者报告的结局以及术前影像学参数。最后，作为附加分析，将重度 CDD 组进一步分为两组：组 1 包括狭窄最重节段 CDD 为 3 级改变的患者，组 2 包括其他患者。比较组 1 和组 2 患者的 2 年术后脊髓病评分。
CDD 3 级的颈椎节段 ROM 明显小于 CDD 0、1 或 2 级的颈椎节段（P＜0.01）。除生活质量（QOL）评分外，CDD 组间术后脊髓病、疼痛、患者报告的躯体和精神状态以及影像学参数的改善无显著差异。重度 CDD 组术后 QOL 评分显著提高（P=0.02）。在附加分析中，术后 2 年，组 1 的脊髓病评分显著高于组 2（P=0.041）。
CDD 的严重程度并不影响椎板成形术后 2 年的疗效。推测原因是严重 CDD 水平的节段不稳定性降低可能对手术结果产生积极影响。
3 级。
