Department of Neurological Surgery, Universitaetsmedizin Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
Department of Neurological Surgery, Stadt Krankenhaus Korbach gGmbH, Dr.-Hartwig-Str. 19, 34497, Korbach, Germany.
Acta Neurochir (Wien). 2020 Sep;162(9):2069-2074. doi: 10.1007/s00701-020-04453-z. Epub 2020 Jun 25.
Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. In this study, we investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement.
Patients undergoing OLD due to CSM were prospectively enrolled in this study and then matched to and compared with a historic cohort of patients with CSM treated by laminoplasty. An independent sample t test was performed to analyze whether the volumetric gain in the two separate groups was statistically significant. Patients in the OLD cohort were clinically evaluated with the mJOA score preoperatively and 3 months postoperatively. To assess clinical improvement, a paired sample t test was performed.
A total of 38 patients were included in the analysis: 19 underwent OLD and 19 underwent laminoplasty. Both groups were well matched in terms of sex, age, preoperative spinal canal volume, and involved levels. Both surgical methods yielded statistically significant volumetric gain in the cervical spinal canal, but a trend towards a greater volume gain was seen in the OLD group. In the OLD group, a statistically significant clinical improvement was also demonstrated.
Our study reveals that OLD can yield a comparable extent of decompression to laminoplasty in CSM while also delivering statistically significant clinical improvement.
颈椎脊髓病（CSM）是颈椎的退行性病变，需要手术减压以防止神经功能恶化。虽然前路和后路都能取得满意的效果，但对于多节段疾病，后路减压更为首选。2015 年，我们描述了一种通过半椎板切除术（OLD）进行双侧骨-韧带减压的肌肉保护、新颖的 CSM 治疗技术。在这项研究中，我们研究了这种技术在椎管扩大方面是否与椎板成形术具有相当的容积效果，以及这种技术是否可以产生显著的临床改善。
前瞻性地招募因 CSM 而行 OLD 的患者，并与接受 CSM 椎板成形术治疗的历史队列患者进行匹配和比较。采用独立样本 t 检验分析两组之间的容积增加是否具有统计学意义。OLD 组的患者在术前和术后 3 个月进行 mJOA 评分的临床评估。为了评估临床改善，进行了配对样本 t 检验。
共纳入 38 例患者进行分析：19 例行 OLD，19 例行椎板成形术。两组在性别、年龄、术前椎管容积和受累节段方面均匹配良好。两种手术方法均使颈椎椎管的容积明显增加，但 OLD 组的容积增加趋势更大。在 OLD 组，也显示出统计学上显著的临床改善。
我们的研究表明，OLD 可以在 CSM 中达到与椎板成形术相当的减压程度，同时也能带来统计学上显著的临床改善。
