Uehara Toru, Tsushima Eiki, Yamada Shota, Kimura Shingo, Satsukawa Yuya, Yoshihara Akira, Inada Atsushi, Hayakawa Takashi
Department of Rehabilitation, Nagoya City University West Medical Center, Nagoya, Japan.
Graduate School of Health Sciences, Hirosaki University, Hirosaki, Japan.
Spine Surg Relat Res. 2021 Oct 11;6(2):123-132. doi: 10.22603/ssrr.2021-0110. eCollection 2022.
Cervical isometric muscle strengthening and cervical range of motion (ROM) training are recommended after laminoplasty (LP). However, their preventive effects on axial pain are unclear. We examined whether neck extension muscle strengthening and cervical ROM training from the early postoperative period effectively suppress postoperative axial pain.
Sixty-one patients undergoing a muscle-preserving LP attached to C2 and C7 for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament were randomly allocated to the cervical exercise (33 patients) or nonexercize (28 patients) groups. Postoperative cervical collars were not worn in any cases. The cervical exercise group underwent neck extension isometric muscle strengthening and cervical ROM exercises for 3 months starting on postoperative day 2. Changes in axial pain (visual analog scale [VAS]) from baseline at 2 weeks and 3 months after surgery were evaluated as the primary outcome. Cervical muscle strength, cervical ROM, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores were evaluated as secondary outcomes.
Axial pain was significantly exacerbated at 2 weeks after LP compared with before surgery, and then, a significant improvement was observed at 3 months after surgery. No significant interaction was observed between the intervention and nonintervention groups. There was no difference in secondary outcomes between groups. The change in the VAS of axial pain from before surgery to 3 months after surgery showed a greater decreased neck extension muscle strength resulting in severer axial pain.
Cervical muscle strengthening and cervical ROM exercise from the early postoperative period did not relieve axial pain at 2 weeks and 3 months after a muscle-preserving LP attached to C2 and C7. No significant difference in neck extension muscle and cervical movement was observed between the intervention and nonintervention groups. Therefore, a muscle-preserving LP attached to C2 and C7 is a good strategy to prevent axial pain in the early postoperative period.
Clinical Trials Registration Number: UMIN000040692.
椎板成形术（LP）后建议进行颈椎等长肌肉强化训练和颈椎活动度（ROM）训练。然而，它们对轴性疼痛的预防作用尚不清楚。我们研究了术后早期进行颈后伸肌强化训练和颈椎ROM训练是否能有效抑制术后轴性疼痛。
61例因脊髓型颈椎病或后纵韧带骨化症接受C2至C7节段保留肌肉的LP手术的患者被随机分为颈椎运动组（33例）和非运动组（28例）。所有患者术后均未佩戴颈托。颈椎运动组从术后第2天开始进行颈后伸等长肌肉强化训练和颈椎ROM训练，为期3个月。将术后2周和3个月时轴性疼痛（视觉模拟量表[VAS]）相对于基线的变化作为主要结局进行评估。将颈椎肌肉力量、颈椎ROM和日本骨科协会脊髓型颈椎病评估问卷（JOACMEQ）评分作为次要结局进行评估。
与手术前相比，LP术后2周时轴性疼痛显著加重，随后在术后3个月时观察到显著改善。干预组和非干预组之间未观察到显著的交互作用。两组的次要结局无差异。从手术前到术后3个月，轴性疼痛VAS的变化显示颈后伸肌力量下降越大，轴性疼痛越严重。
在C2至C7节段保留肌肉的LP术后2周和3个月时，术后早期进行颈椎肌肉强化训练和颈椎ROM训练并不能缓解轴性疼痛。干预组和非干预组之间在颈后伸肌和颈椎活动方面未观察到显著差异。因此，C2至C7节段保留肌肉的LP是预防术后早期轴性疼痛的良好策略。
临床试验注册号：UMIN000040692。
