J Neurosurg Spine. 2022 Jul 1;37(6):794-801. doi: 10.3171/2022.5.SPINE22168. Print 2022 Dec 1.
Residual anterior spinal cord compression (RASCC) after cervical laminoplasty, which has been confirmed on postoperative MRI, is reportedly associated with poor clinical outcomes. To date, only a few studies have described the risk factors associated with RASCC. The aim of this study was to identify the factors that can predict the occurrence of RASCC after laminoplasty for cervical spondylotic myelopathy (CSM), focusing on the location of the most stenotic segment.
In this retrospective, single-center study, 120 patients who underwent C3-7 laminoplasty for multilevel CSM were included. Different techniques were used for C3 decompression, i.e., partial (dome-laminotomy) or complete (laminoplasty/laminectomy) decompression. RASCC was diagnosed using MRI conducted 3 weeks postoperatively. The patients were divided into two groups according to the segment with the most severe stenosis (Seg-MSS; C3-4 vs C4-7). Demographics, radiological data, and C3 decompression technique were compared between the two groups. Furthermore, intergroup comparisons were performed based on Seg-MSS. A logistic regression model was constructed to identify the factors predicting RASCC after patient stratification according to Seg-MSS.
Forty patients (33.3%) had RASCC. The patients with Seg-MSS at C3-4 (51.3%) had a significantly higher incidence of RASCC (p = 0.003) than those with Seg-MSS at C4-7 (24.7%). Logistic regression analysis showed that in patients with Seg-MSS at C3-4, C3 partial decompression demonstrated a greater association with RASCC as opposed to complete decompression. Conversely, in patients with Seg-MSS at C4-7, kyphotic segmental lordotic angle was associated with an increased risk of RASCC.
The risk factors for RASCC differed depending on the location of the most stenotic segment (C3-4 vs C4-7). If there is segmental kyphosis at the most stenotic segment at C4-7, anterior decompression and fusion should be considered. If C3-4 is the most stenotic segment, anterior surgery is also recommended, but alternatively, one can choose laminoplasty with complete C3 laminectomy and resection of the C2-3 ligamentum flavum.
颈椎板成形术后残留的前方脊髓压迫（RASCC）在术后 MRI 上得到证实，据报道与不良的临床结果有关。迄今为止，只有少数研究描述了与 RASCC 相关的危险因素。本研究的目的是确定与颈椎后路板成形术治疗多节段颈椎病（CSM）后 RASCC 发生相关的因素，重点关注最狭窄节段的位置。
在这项回顾性、单中心研究中，纳入了 120 例因多节段 CSM 而行 C3-7 颈椎板成形术的患者。不同的技术用于 C3 减压，即部分（穹顶切开术）或完全（板成形术/椎板切除术）减压。使用术后 3 周的 MRI 诊断 RASCC。根据最严重狭窄节段（Seg-MSS；C3-4 与 C4-7）将患者分为两组。比较两组之间的人口统计学、影像学数据和 C3 减压技术。此外，根据 Seg-MSS 进行组间比较。根据 Seg-MSS 对患者进行分层后，构建逻辑回归模型以确定预测 RASCC 的因素。
40 例患者（33.3%）发生 RASCC。Seg-MSS 为 C3-4 的患者（51.3%）的 RASCC 发生率显著高于 Seg-MSS 为 C4-7 的患者（24.7%）（p = 0.003）。逻辑回归分析显示，在 Seg-MSS 为 C3-4 的患者中，与完全减压相比，C3 部分减压与 RASCC 更相关。相反，在 Seg-MSS 为 C4-7 的患者中，颈椎后凸节段前凸角与 RASCC 风险增加相关。
RASCC 的危险因素取决于最狭窄节段的位置（C3-4 与 C4-7）。如果 C4-7 处最狭窄节段存在节段性后凸，则应考虑前路减压融合术。如果 C3-4 是最狭窄的节段，则也建议进行前路手术，但也可以选择 C3 全椎板切除和 C2-3 黄韧带切除术的颈椎板成形术。
