Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, Shanxi, China.
Eur Spine J. 2020 Nov;29(11):2831-2837. doi: 10.1007/s00586-020-06563-9. Epub 2020 Aug 10.
Posterior cervical expansive open-door laminoplasty (LAMP) is a mature surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but there are few studies on the changes in cervical sagittal balance. This study aimed to analyze the imaging and clinical data of patients who underwent LAMP and to explore the effect of this procedure on the cervical sagittal balance.
This was a retrospective study of the patients who underwent LAMP between 01/2014 and 12/2017. The C0-C2 Cobb angle, sagittal vertical angle (SVA), C2-C7 Cobb angle, and T1-slope were measured. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) were used.
There were 69 males and 39 females. The mean age was 61.3 ± 5.3 years. The C0-C2 Cobb angle increased from 11.3 ± 5.5° to 26.8 ± 4.8° (P = 0.186). The C2-C7 Cobb angle decreased from 13.9 ± 8.6° to 10.65 ± 10.7° P = 0.016). SVA increased from 21.0 ± 5.8 mm to 25.4 ± 11.5 mm (P = 0.001). The preoperative average JOA score was 11.1 ± 2.2 points, and the postoperative score was 14.0 ± 2.1 points, with an average improvement rate of JOA of 46.5 ± 3.8%. The NDI score decreased from preoperative 15.6 ± 5.4 points to 11.3 ± 7.9 points, and the VAS score was decreased from 4.6 ± 1.8 points to 3.3 ± 1.6 points (all P < 0.05).
LAMP improved the neurological function and quality of life of patients with CSM. The cervical vertebrae show a tendency of tilting forward, suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.
后路颈椎扩大开门椎管成形术（LAMP）是治疗颈椎脊髓病（CSM）的一种成熟手术方法，但关于颈椎矢状平衡变化的研究较少。本研究旨在分析接受 LAMP 治疗的患者的影像学和临床资料，并探讨该手术对颈椎矢状平衡的影响。
这是一项回顾性研究，研究对象为 2014 年 1 月至 2017 年 12 月期间接受 LAMP 的患者。测量 C0-C2 Cobb 角、矢状垂直角（SVA）、C2-C7 Cobb 角和 T1 斜率。使用日本矫形协会（JOA）评分、颈部残疾指数（NDI）和视觉模拟评分（VAS）。
男性 69 例，女性 39 例。平均年龄 61.3±5.3 岁。C0-C2 Cobb 角从 11.3±5.5°增加到 26.8±4.8°（P=0.186）。C2-C7 Cobb 角从 13.9±8.6°减少到 10.65±10.7°（P=0.016）。SVA 从 21.0±5.8mm 增加到 25.4±11.5mm（P=0.001）。术前平均 JOA 评分为 11.1±2.2 分，术后评分为 14.0±2.1 分，JOA 平均改善率为 46.5±3.8%。NDI 评分从术前 15.6±5.4 分降至 11.3±7.9 分，VAS 评分从 4.6±1.8 分降至 3.3±1.6 分（均 P<0.05）。
LAMP 改善了 CSM 患者的神经功能和生活质量。颈椎表现出前倾的趋势，这表明上颈椎的过度伸展可能用于维持颅骨的重心和水平视力。
