Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, CLINTEC, K54, Karolinska Institutet, 141 86, Stockholm, Sweden.
Department of Reconstructive Orthopedics, Karolinska University Hospital, 141 86, Stockholm, Sweden.
Eur Spine J. 2022 May;31(5):1300-1308. doi: 10.1007/s00586-022-07159-1. Epub 2022 Mar 14.
The effectiveness of laminectomy with fusion and laminectomy alone in degenerative cervical myelopathy was compared.
Individuals treated with laminectomy with fusion or laminectomy alone at or below the second cervical vertebra were identified in the Swedish spine registry. 66 individuals treated with laminectomy and instrumented fusion were age matched to 132 individuals treated with laminectomy alone. The European Myelopathy Scale (EMS), the Neck Disability Index (NDI), the Numeric Rating Scale (NRS) for neck pain and the EQ-5D index were available at baseline, and at 1 and 2 year follow-ups. Statistical analyses were performed with Mann-Whitney U tests and paired T tests. Effect sizes were described with Cohen's D.
Data at baseline did not differ significantly between the groups with the exception of a longer laminectomy in the fusion group (4.2 vs 3.4 vertebras; p < 0.001). Both groups improved EMS, NDI, NRS and EQ-5D from baseline to 1 year (p ≤ 0.011), with no additional improvement between 1 and 2 years (all p ≥ 0.09). Effect sizes for change from baseline were small to medium in both groups. At 2 years the laminectomy with fusion group and the laminectomy alone group had a median (25th;75th percentile) EMS of 13 (11;13) and 13 (11;15) (p = 0.77), NDI of 39 (24;54) and 27 (10;41) (p = 0.045), NRS of 4 (1;2) and 2 (0;5) (p = 0.048), and EQ-5D index of 0.67 (0.25;0.73) and 0.66 (0.17;0.76) (p = 0.96).
The results of this study suggest similar effectiveness of laminectomy with instrumented fusion and laminectomy alone in degenerative cervical myelopathy.
III.
比较颈椎退变性脊髓病患者行椎板切除术联合融合与单纯椎板切除术的疗效。
在瑞典脊柱登记处中，确定了在第二颈椎以下接受椎板切除术联合融合或单纯椎板切除术治疗的患者。将 66 例接受椎板切除术和器械融合治疗的患者与 132 例接受单纯椎板切除术治疗的患者进行年龄匹配。在基线时以及 1 年和 2 年随访时，可获得欧洲脊髓病量表（EMS）、颈部残疾指数（NDI）、颈部疼痛数字评分量表（NRS）和 EQ-5D 指数。采用 Mann-Whitney U 检验和配对 t 检验进行统计学分析。用 Cohen's D 描述效应大小。
除融合组的椎板切除术长度较长（4.2 比 3.4 个椎体；p<0.001）外，两组在基线时的数据无显著差异。两组患者的 EMS、NDI、NRS 和 EQ-5D 评分均从基线改善到 1 年（p≤0.011），1 年至 2 年之间无进一步改善（p≥0.09）。两组的变化从基线开始的效应大小为小到中等。2 年时，椎板切除术联合融合组和单纯椎板切除术组的 EMS 中位数（25%；75%）分别为 13（11；13）和 13（11；15）（p=0.77），NDI 中位数（25%；75%）分别为 39（24；54）和 27（10；41）（p=0.045），NRS 中位数（25%；75%）分别为 4（1；2）和 2（0；5）（p=0.048），EQ-5D 指数中位数（25%；75%）分别为 0.67（0.25；0.73）和 0.66（0.17；0.76）（p=0.96）。
本研究结果表明，颈椎退变性脊髓病患者行椎板切除术联合器械融合与单纯椎板切除术的疗效相似。
III 级。
