Lee Jong Joo, Lee Nam, Oh Sung Han, Shin Dong Ah, Yi Seong, Kim Keung Nyun, Yoon Do Heum, Shin Hyun Chul, Ha Yoon
Department of Neurosurgery, Bundang Jesaeng Hospital, Seongnam, Korea.
Department of Neurosurgery, Yonsei Cheok Hospital, Busan, Korea.
Quant Imaging Med Surg. 2020 Nov;10(11):2112-2124. doi: 10.21037/qims-20-220.
BACKGROUND: Cervical spondylotic myelopathy (CSM) is one of the most common causes of spinal cord impairment in elderly patients. However, a consensus has yet to be reached on the ideal method of surgical intervention. In this study, we investigated serial changes of radiological findings after three-level anterior cervical discectomy and fusion (ACDF) and multilevel laminoplasty and attempted to identify the radiological parameters affecting long-term clinical outcomes in CSM. METHODS: Of the 152 patients with multilevel CSM treated with three-level ACDF and multilevel laminoplasty, 42 had complete radiological parameters both before and 2 years after surgery (three-level ACDF, 22 patients; multilevel laminoplasty, 20 patients). Radiological parameters included spinal cord signal intensity (SI) changes on magnetic resonance imaging (MRI). Clinical outcomes including the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), Oswestry disability index (ODI), and 36-Item Short Form Health Survey score were measured. RESULTS: The ACDF group showed significant restoration of segmental lordosis postoperatively (preoperatively: 2.21°, 6 months: 8.37°, P=0.026), and segmental and cervical range of motion (ROM) was markedly reduced and well maintained until the final follow-up (preoperatively: 25.48°, 24 months: 4.35°, P<0.001; preoperatively: 41.71°, 24 months: 20.18°, P<0.001). The recovery rates of the JOA score were 42.85% and 57.40% in the ACDF and laminoplasty groups, respectively, although this difference was not statistically significant. Multivariate regression analysis demonstrated that signal change on MRI significantly affected the recovery rate (P=0.003). The visual analog scale (VAS) score and NDI decreased considerably only in the laminoplasty group, and device complications were confirmed only in the ACDF group (incidence rate =36.5%). CONCLUSIONS: Multilevel laminoplasty showed better radiological and similar clinical outcomes. ACDF had more surgical complications. Spinal cord SI change on preoperative MRI was the independent risk factor for poor clinical outcomes. We recommend laminoplasty instead of three-level ACDF to treat multilevel CSM.
背景：脊髓型颈椎病（CSM）是老年患者脊髓损伤最常见的原因之一。然而，对于理想的手术干预方法尚未达成共识。在本研究中，我们调查了三级前路颈椎间盘切除融合术（ACDF）和多节段椎板成形术后影像学表现的系列变化，并试图确定影响CSM长期临床结局的影像学参数。 方法：在152例行三级ACDF和多节段椎板成形术治疗的多节段CSM患者中，42例患者在术前和术后2年均有完整的影像学参数（三级ACDF组22例；多节段椎板成形术组20例）。影像学参数包括磁共振成像（MRI）上脊髓信号强度（SI）的变化。测量临床结局，包括日本骨科协会（JOA）评分、颈部残疾指数（NDI）、Oswestry残疾指数（ODI）和36项简短健康调查评分。 结果：ACDF组术后节段性前凸明显恢复（术前：2.21°，6个月：8.37°，P = 0.026），节段性和颈椎活动度（ROM）明显降低并在末次随访时保持良好（术前：25.48°，24个月：4.35°，P < 0.001；术前：41.71°，24个月：20.18°，P < 0.001）。ACDF组和椎板成形术组JOA评分的恢复率分别为42.85%和57.40%，尽管差异无统计学意义。多因素回归分析表明，MRI上的信号变化显著影响恢复率（P = 0.003）。视觉模拟量表（VAS）评分和NDI仅在椎板成形术组显著降低，器械并发症仅在ACDF组得到证实（发生率 = 36.5%）。 结论：多节段椎板成形术显示出更好的影像学表现和相似的临床结局。ACDF有更多手术并发症。术前MRI上脊髓SI变化是临床结局不佳的独立危险因素。我们建议采用椎板成形术而非三级ACDF治疗多节段CSM。
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