Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY.
Spine (Phila Pa 1976). 2021 Sep 1;46(17):1197-1205. doi: 10.1097/BRS.0000000000003973.
A retrospective cohort analysis.
The aim of this study was to investigate the impact of piecemeal versus en bloc laminectomies on spinal cord in thoracic ossification of ligamentum flavum (TOLF) through intraoperative changes of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs).
Surgical treatment is indicated for symptomatic TOLF, and both piecemeal and en bloc laminectomies are commonly used methods. However, few studies compared both intraoperative interference and prognostic impact of these two laminectomies on spinal cord in TOLF patients.
MEPs were recorded from abductor hallucis (AH) and tibialis anterior, and SEPs were performed on tibial nerve in 55 TOLF patients (piecemeal vs. en bloc: 23 vs. 32). Patients were categorized based on MEP/SEP improvement, deterioration, and no change, and MEP/SEP improvement rates were measured in the improvement group. Additionally, all patients were assessed by American Spinal Injury Association (ASIA) scores, Ashworth scores, and modified Japanese Orthopedic association (mJOA) scores before and after operation.
The incidences of both MEP/SEP improvement and deterioration were similar between the two laminectomy groups (P > 0.05), and no significant difference is noted in both MEP and SEP amplitudes between the baseline and different critical manipulations in both laminectomy groups (P > 0.05). In the improvement group, patients receiving en bloc laminectomy exhibited increased improvement rates of both MEPs in bilateral AH and left-side SEPs compared to piecemeal laminectomy (P < 0.05). Clinically, all functional scales clearly improved in both laminectomy groups after operation (P < 0.05), and postoperative 1-year mJOA improvement rates were highly correlated with MEP improvement rates (P < 0.05).
Intraoperative changes of MEPs and SEPs potentially provide a valid method for quantitatively evaluating the safety of different intraoperative manipulations and their prognostic impacts on spinal cord. Both laminectomies are safe and effective methods to treat TOLF, and en bloc laminectomy may cause relatively better spinal cord functional recovery.Level of Evidence: 3.
回顾性队列分析。
本研究旨在通过术中运动诱发电位（MEPs）和体感诱发电位（SEPs）的变化，探讨节段性与整块椎板切除术对胸段黄韧带骨化（TOLF）脊髓的影响。
对于有症状的 TOLF，手术治疗是指征，节段性和整块椎板切除术都是常用的方法。然而，很少有研究比较这两种椎板切除术对 TOLF 患者脊髓的术中干扰和预后影响。
在 55 例 TOLF 患者（节段性 vs. 整块：23 例 vs. 32 例）中记录拇展肌（AH）和胫骨前肌的 MEPs，并进行胫神经 SEPs。根据 MEPs/SEPs 的改善、恶化和无变化对患者进行分类，并在改善组中测量 MEPs/SEPs 的改善率。此外，所有患者在术前和术后均进行美国脊髓损伤协会（ASIA）评分、Ashworth 评分和改良日本矫形协会（mJOA）评分评估。
两种椎板切除术组 MEPs/SEPs 的改善和恶化发生率相似（P＞0.05），两种椎板切除术组基线和不同关键操作之间的 MEPs 和 SEPs 幅度均无显著差异（P＞0.05）。在改善组中，与节段性椎板切除术相比，整块椎板切除术患者双侧 AH 的 MEPs 和左侧 SEPs 的改善率均增加（P＜0.05）。临床方面，两种椎板切除术组术后所有功能评分均明显改善（P＜0.05），术后 1 年 mJOA 改善率与 MEPs 改善率高度相关（P＜0.05）。
MEPs 和 SEPs 的术中变化可能为定量评估不同术中操作的安全性及其对脊髓的预后影响提供了一种有效方法。两种椎板切除术都是治疗 TOLF 的安全有效的方法，整块椎板切除术可能会导致相对更好的脊髓功能恢复。
3 级
