Department of Spine Surgery, Tianjin Hospital, Tianjin, China.
J Neurol Surg A Cent Eur Neurosurg. 2021 Mar;82(2):169-175. doi: 10.1055/s-0040-1719102. Epub 2020 Dec 22.
Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment.
Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group ( = 28) and a conventional titanium plate fixation (CPF) group ( = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups.
There were no significant differences in operative time and intraoperative blood loss between the groups ( > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery ( < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, > 0.05). There was no significant loss of cervical ROM in either group ( > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups ( < 0.05). Alternatively, CCI was significantly reduced in the CRP group ( < 0.05) but unchanged in the RPF group ( > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group ( < 0.05) but maintained in the RPF group ( > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group ( < 0.05).
Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.
颈椎脊髓病（CSM）是一种常见的退行性疾病，主要发生在老年患者中，导致不同程度的神经功能障碍。脊髓受累主要分布在 C3-C7 节段，但也可能累及 C2 水平。本研究旨在评估使用新的伸肌附着点重建技术进行开门式椎板成形术治疗 C2 节段 CSM 的临床疗效和安全性。
回顾性纳入 59 例 C2 节段 CSM 患者，均行开门式椎板成形术。根据手术中使用的钛板，将患者分为重建钛板固定（RPF）组（n=28）和常规钛板固定（CPF）组（n=31）。比较两组患者的神经功能改善、颈椎活动度（ROM）、颈椎曲度指数（CCI）、后颈椎肌肉质量保留和轴向症状。
两组患者的手术时间和术中出血量无显著差异（P>0.05）。两组术后日本骨科协会（JOA）评分均显著提高（P<0.05）；两组神经恢复率相似（64.1±13.3%比 65.9±14.7%，P>0.05）。两组颈椎 ROM 均无明显丢失（P>0.05）。两组 C2 水平硬膜囊前后径均显著增大（P<0.05）。相反，CRP 组 CCI 显著降低（P<0.05），而 RPF 组 CCI 无变化（P>0.05）。CPF 组颈后肌群横截面积也显著减小（P<0.05），而 RPF 组无变化（P>0.05）。最后，CPF 组轴向症状较 RPF 组严重（P<0.05）。
椎板成形术是治疗 C2 节段 CSM 的有效手术方法。与常规钛板相比，重建钛板在维持颈椎曲度、减少肌肉萎缩和轴向症状严重程度方面具有优势。
