Qian Shengjun, Wang Zhan, Ren Ying, Chew Ian, Jiang Guangyao, Li Wanli, Chen Weishan
Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou China.
Department of Orthopedic Surgery, Orthopedics Research Institute of Zhejiang University, Hangzhou China.
Front Surg. 2022 Aug 8;9:906839. doi: 10.3389/fsurg.2022.906839. eCollection 2022.
After laminoplasty, the cervical sagittal curvature of some patients tend to be lordotic, this phenomenon cannot be explained by the theory of laminoplasty, and the reason remains unknown. We explored the possible role played by pinching cervical spondylotic myelopathy (PCSM) in the cervical sagittal curvature change in patients after laminoplasty.
From April 2017 to May 2019, we studied 122 patients undergoing laminoplasty with cervical spondylotic myelopathy (CSM). All patients were divided into Group A (anterior compression only, without PCSM) and Group B (both anterior and posterior compression, with PCSM). The visual analogue scale (VAS) was used to measure pain, and modified Japanese Orthopedic Association (mJOA) score was derived. The cervical global angle (CGA) and the range of cervical motion (ROM) were compared. The clinical and imaging results were compared between Group A and Group B.
After laminoplasty, both the mean VAS and mJOA scores improved significantly in Group A and Group B, the mJOA recovery rate of Group B was better than that of Group A (). The mean CGA and ROM decreased in Group A, but increased in Group B. MRI revealed that the ligamentum flavum of Group A was significantly thinner than that of Group B ().
Because of the hypertrophic and folded ligamentum flavum compressing the dorsal spinal cord, patients with PCSM may maintain a compulsive kyphotic posture. After laminoplasty, the cervical sagittal curvature of these patients tend to be lordotic due to the release of dorsal spinal cord compression.
在椎板成形术后，部分患者的颈椎矢状面曲度趋于前凸，这种现象无法用椎板成形术的理论来解释，原因仍然不明。我们探讨了钳夹型颈椎病（PCSM）在椎板成形术后患者颈椎矢状面曲度变化中可能发挥的作用。
2017年4月至2019年5月，我们研究了122例接受椎板成形术治疗颈椎病（CSM）的患者。所有患者分为A组（仅前方受压，无PCSM）和B组（前后方均受压，有PCSM）。采用视觉模拟量表（VAS）测量疼痛，并得出改良日本骨科协会（mJOA）评分。比较颈椎整体角度（CGA）和颈椎活动范围（ROM）。比较A组和B组的临床及影像学结果。
椎板成形术后，A组和B组的平均VAS和mJOA评分均显著改善，B组的mJOA恢复率优于A组（）。A组的平均CGA和ROM降低，而B组升高。MRI显示A组的黄韧带明显比B组薄（）。
由于肥厚折叠的黄韧带压迫脊髓背侧，PCSM患者可能保持强迫性驼背姿势。椎板成形术后，由于脊髓背侧压迫解除，这些患者的颈椎矢状面曲度趋于前凸。
