Paracino Riccardo, Fasinella Maria Rossella, Mancini Fabrizio, Marini Alessandra, Dobran Mauro
Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Marche, Italy.
Surg Neurol Int. 2021 Feb 3;12:44. doi: 10.25259/SNI_788_2020. eCollection 2021.
We reviewed the literature comparing the indications/efficacy of laminectomy (LA) with or without fusion versus laminoplasty (LP) in the treatment of cervical spondylotic myelopathy (CSM).
We identified 14 studies in PubMed/Medline to include in our analysis. Outcomes were assessed utilizing the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), Neck Disability Index, and Nurick scale. Variables studied included ossification of the posterior longitudinal ligament (OPLL), cervical range of motion (ROM), the C2-C7 sagittal Cobb angle, the Ishihara index, and the Hirabayashi scale. Patients with cervical trauma/fracture, infection, or tumor were excluded from the study.
In these 14 studies, there were no significant differences between LA and LP groups in terms of preoperative versus postoperative: JOA scores (e.g., including the improvement rate), VAS scores, and ROM. However, the LA patients demonstrated greater postoperative cervical lordosis versus those in the LP group.
At present, there are no guidelines for choosing LA versus LP for treating CSM. Factors that should be considered when choosing one procedure over the other should include the patients' preoperative clinical status, the type of CSM, the pathological extent of OPLL, and whether there is a sufficient cervical lordotic curvature.
我们回顾了比较单纯椎板切除术（LA）与椎板切除术联合融合术及椎板成形术（LP）治疗脊髓型颈椎病（CSM）的适应证/疗效的文献。
我们在PubMed/Medline数据库中检索到14项研究纳入分析。采用日本矫形外科学会（JOA）评分、视觉模拟量表（VAS）、颈部功能障碍指数和努里克量表评估结果。研究变量包括后纵韧带骨化（OPLL）、颈椎活动度（ROM）、C2-C7矢状面Cobb角、石原指数和平林量表。颈椎创伤/骨折、感染或肿瘤患者被排除在研究之外。
在这14项研究中，LA组和LP组在术前与术后的JOA评分（如包括改善率）、VAS评分和ROM方面无显著差异。然而，LA组患者术后颈椎前凸大于LP组。
目前，尚无关于选择LA还是LP治疗CSM的指南。在选择一种手术方式而非另一种时应考虑的因素包括患者的术前临床状况、CSM的类型、OPLL的病理范围以及颈椎前凸曲度是否足够。
