Department of Neurosurgery, International St. Mary's Hospital, Kwandong University College of Medicine, Incheon, Republic of Korea.
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2020 Nov 1;45(21):1476-1484. doi: 10.1097/BRS.0000000000003604.
Retrospective study.
The preoperative parameters for predicting the loss of lordosis after cervical laminoplasty were investigated in the present study.
Cervical laminoplasty is an effective surgical method to decompress the cervical spinal cord. Maintaining cervical lordosis after laminoplasty is an important factor to ensure the successful surgical treatment. To know the preoperative parameters for predicting loss of lordosis after cervical laminoplasty is important for better outcome after laminoplasty.
In this retrospective study, 106 patients who underwent cervical laminoplasty from 2011 to 2015 were reviewed. The preoperative parameters; T1 slope (TS), Cobb lordotic angle (CLA) and sagittal vertical axis (SVA) at C2-C7, relative cross-sectional area (RCSA), and fatty degeneration of deep extensor muscles (DEMs) were measured. Visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores were used for clinical assessment. Correlation analysis was performed between the postoperative CLA change and preoperative parameters. The patients were divided into the decreased- or maintained-lordosis groups based on the difference between postoperative and preoperative CLA. All preoperative parameters were compared between groups.
Based on correlation analysis, preoperative TS (P = 0.001), TS-CLA (P = 0.046), RCSA at C7-T1 (P < 0.001), and fatty degeneration of DEMs (P < 0.001) were correlated with loss of lordosis. Among the 106 patients, 68 showed decreased-lordosis and 38 maintained-lordosis. Preoperative TS (P = 0.003), SVA (P = 0.014), TS-CLA (P = 0.015), and RCSA at C7-T1 (P = 0.005) were significantly different between groups. In both correlation and comparative analyses, higher TS and TS-CLA and less RCSA at C7-T1 were associated with loss of lordosis. Neck pain VAS (P < 0.001) and mJOA scores (P < 0.001) were significantly improved in the maintained-lordosis group.
Maintaining cervical lordosis is important for clinical outcomes after laminoplasty. Preoperative higher TS, TS-CLA, and less RCSA at C7-T1 were considered as predictors for loss of lordosis. These characteristics should be considered when choosing the surgical method to help maintain cervical lordosis.
回顾性研究。
本研究旨在探讨颈椎板成形术后颈椎前凸丢失的术前预测参数。
颈椎板成形术是一种有效的脊髓减压手术方法。颈椎板成形术后保持颈椎前凸是确保手术成功的重要因素。了解颈椎板成形术后前凸丢失的术前预测参数对于更好的板成形术后效果很重要。
本回顾性研究纳入了 2011 年至 2015 年期间接受颈椎板成形术的 106 例患者。测量了术前参数：T1 斜率（TS）、颈椎前凸角（CLA）和 C2-C7 矢状垂直轴（SVA）、相对横截面积（RCSA）和深部伸肌脂肪变性（DEMs）。采用视觉模拟评分（VAS）和改良日本骨科协会（mJOA）评分进行临床评估。对术后 CLA 变化与术前参数进行相关性分析。根据术后和术前 CLA 的差值，将患者分为术后前凸减少或保持组。比较两组间所有术前参数。
基于相关性分析，术前 TS（P=0.001）、TS-CLA（P=0.046）、C7-T1 处 RCSA（P<0.001）和 DEMs 脂肪变性（P<0.001）与前凸丢失相关。在 106 例患者中，68 例出现前凸减少，38 例保持前凸。术前 TS（P=0.003）、SVA（P=0.014）、TS-CLA（P=0.015）和 C7-T1 处 RCSA（P=0.005）在两组间有显著差异。在相关性和对比分析中，较高的 TS 和 TS-CLA 以及 C7-T1 处较低的 RCSA 与前凸丢失相关。颈部疼痛 VAS（P<0.001）和 mJOA 评分（P<0.001）在保持前凸组显著改善。
颈椎板成形术后保持颈椎前凸对临床效果很重要。术前较高的 TS、TS-CLA 和 C7-T1 处较低的 RCSA 被认为是前凸丢失的预测因素。在选择手术方法以帮助维持颈椎前凸时应考虑这些特征。
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