Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan; Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan.
Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan.
Acta Orthop Traumatol Turc. 2022 Mar;56(2):131-137. doi: 10.5152/j.aott.2022.21217.
This study aimed to investigate whether disruption of the repaired nuchal ligament (NL) affects clinical outcomes following posterior cervical spine surgery.
This retrospective study included 101 patients (65 males, 36 females) who underwent posterior cervical spine surgery, 69 of whom received laminoplasty (LP), and 32 posterior decompression and fusion (PDF). The NL was split during the surgical approach and repaired at the time of wound closure. The frequency and spinal levels of NL disruption at one month, six months, and one year postoperatively were evaluated on mid-sagittal and axial magnetic resonance images. Postoperative axial symptoms, Neck Disability Index, T1 slope, flexion and extension angle, C2-C7 lordotic angle, and decrease rate of C2-C7 range of motion (ROM) were examined at six months and/or one year postoperatively. Based on the NL disruption levels, the patients were divided into the upper group (C2-C5), lower group (C6-T1), and non-disruption group.
Although the lower group contained patients with NL disruption (10%) after LP at final follow-up, all PDF patients belonged to the non-disruption group. For the LP patients, the postoperative axial symptoms, Neck Disability Index, T1 slope, flexion and extension angle, and C2-C7 lordotic angle did not significantly differ between the lower and non-disruption groups; however, the rate of C2-C7 ROM decrease in the lower group (48%) was considerably larger than that in the non-disruption group (33%) after LP.
Evidence from this study has shown that postoperative disruption of the repaired NL has no significant effect on postoperative axial symptoms and C2-C7 alignment, but it can affect the rate of decrease in C2-C7 ROM after LP.
Level III, Therapeutic Study.
本研究旨在探讨修复后的项韧带（NL）断裂是否会影响颈椎后路手术后的临床结果。
本回顾性研究纳入了 101 例（65 例男性，36 例女性）接受颈椎后路手术的患者，其中 69 例行椎板成形术（LP），32 例行后路减压融合术（PDF）。手术入路时切开 NL 并在伤口关闭时修复。术后 1 个月、6 个月和 1 年时，在矢状位和轴位磁共振图像上评估 NL 断裂的频率和脊柱节段。术后 6 个月和/或 1 年时，检查轴向症状、颈痛残疾指数（NDI）、T1 斜率、屈伸角度、C2-C7 前凸角和 C2-C7 活动度（ROM）下降率。根据 NL 断裂水平，将患者分为上组（C2-C5）、下组（C6-T1）和无断裂组。
尽管在最终随访时 LP 后下组（10%）患者存在 NL 断裂，但所有 PDF 患者均属于无断裂组。对于 LP 患者，下组和无断裂组之间的术后轴向症状、NDI、T1 斜率、屈伸角度和 C2-C7 前凸角无显著差异；然而，LP 后下组（48%）的 C2-C7 ROM 下降率明显大于无断裂组（33%）。
本研究结果表明，修复后的 NL 术后断裂对术后轴向症状和 C2-C7 排列无显著影响，但可能影响 LP 后 C2-C7 ROM 下降率。
III 级，治疗性研究。
