颈椎后路单开门椎管扩大成形术后因迟发性神经功能恶化再次手术治疗：颈椎病与后纵韧带骨化病例的比较。
Reoperation for Late Neurological Deterioration After Laminoplasty in Individuals With Degenerative Cervical Myelopathy: Comparison of Cases of Cervical Spondylosis and Ossification of the Posterior Longitudinal Ligament.
机构信息
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Orthopedic Surgery, Konankosei Hospital, Konan, Aichi, Japan.
出版信息
Spine (Phila Pa 1976). 2020 Aug 1;45(15):E909-E916. doi: 10.1097/BRS.0000000000003408.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
The objective of this study was to elucidate the rate and causes of reoperation for late neurological deterioration after cervical laminoplasty by comparing cases of cervical spondylotic myelopathy (CSM) with those of ossification of the posterior longitudinal ligament (OPLL).
SUMMARY OF BACKGROUND DATA
Although the long-term surgical outcomes of cervical laminoplasty in patients with CSM or OPLL are satisfactory, reoperation is sometimes required for late neurological deterioration after laminoplasty. However, limited information is available about long-term follow-up in such cases.
METHODS
This retrospective cohort study included 623 patients who underwent cervical laminoplasty for cervical myelopathy (average follow-up duration, 6.1 [range, 2-15] years). The rate of reoperations for late neurological deterioration (>6 mo after the initial surgery) was investigated.
RESULTS
Primary diagnoses were CSM and OPLL in 522 (83.8%) and 101 (16.2%) patients, respectively. During the follow-up period, 10 (1.6%) patients required reoperation: 7 (1.3%) in the CSM group and 3 (3.0%) in the OPLL group. No significant difference was found between the CSM and OPLL groups regarding patients requiring reoperation (P = 0.26). The mean elapsed time between primary surgery and reoperation was 4.7 ± 3.2 and 10.0 ± 5.7 years in the CSM and OPLL groups, respectively. The predicted risk percentages of reoperation at 10 years after primary surgery were 2.9% and 1.0% in the CSM and OPLL group, respectively. The causes of reoperation for CSM were C5 palsy in five, severe radiculopathy in one, and restenosis due to instability after laminoplasty in one case; the cause of reoperation for OPLL was enlargement of ossification in all three cases.
CONCLUSION
Although the clinical outcomes of laminoplasty were favorable in most patients, reoperation for late neurological deterioration was required in approximately 1.0% to 3.0% of CSM and OPLL cases within 10 years after laminoplasty.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究旨在通过比较颈椎病（CSM）和后纵韧带骨化（OPLL）患者，阐明颈椎板成形术后晚期神经恶化的再手术率及其原因。
背景资料总结
虽然 CSM 或 OPLL 患者颈椎板成形术的长期手术效果令人满意，但颈椎板成形术后有时仍需要进行晚期神经恶化的再手术。然而，关于此类病例的长期随访，信息有限。
方法
本回顾性队列研究纳入了 623 例因颈椎脊髓病而行颈椎板成形术的患者（平均随访时间为 6.1[范围：2-15]年）。调查了晚期神经恶化（初次手术后>6 个月）患者的再手术率。
结果
522 例（83.8%）患者的原发诊断为 CSM，101 例（16.2%）患者的原发诊断为 OPLL。在随访期间，有 10 例（1.6%）患者需要再次手术：CSM 组 7 例，OPLL 组 3 例。CSM 组和 OPLL 组患者需要再手术的比例无显著差异（P=0.26）。CSM 组和 OPLL 组初次手术后再手术的平均时间分别为 4.7±3.2 年和 10.0±5.7 年。CSM 组和 OPLL 组患者在初次手术后 10 年的再手术预测风险百分比分别为 2.9%和 1.0%。CSM 组再手术的原因是 5 例 C5 神经病、1 例严重神经根病和 1 例颈椎板成形术后不稳定引起的再狭窄；OPLL 组再手术的原因是 3 例骨化扩大。
结论
虽然颈椎板成形术的临床效果在大多数患者中是良好的，但在颈椎板成形术后 10 年内，CSM 和 OPLL 患者中约有 1.0%至 3.0%需要进行晚期神经恶化的再手术。
证据等级
4 级
Zotero 插件