H Waddell William, M Weisenthal Benjamin, Golinvaux Nicholas, L Henry Abigail, Pennings Jacquelyn, P Wanner John, Gupta Rishabh, Yoshii Toshitaka, Feifei Zhou, F Stephens Byron
Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, USA.
University of Minnesota Medical School, Minneapolis, USA.
Spine Surg Relat Res. 2022 Feb 10;6(5):460-463. doi: 10.22603/ssrr.2021-0210. eCollection 2022 Sep 27.
Laminoplasty is a well-established technique used to manage cervical myelopathy (CM). Nevertheless, the degree to which United States surgeons have adopted laminoplasty from Japan to treat CM is less clear. The purpose of this study was to compare operative management strategies for CM in the United States (US) with Japan.
This study used a retrospective cohort of 16,084 patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and 389,872 patients from the Japanese Diagnosis Procedure Combination (DPC) database from 2007 to 2015. Patients with the following diagnoses were collected: spondylosis with myelopathy (ICD-19; 721.1, ICD-10; M47.12) and disk herniation with myelopathy (ICD-9; 722.71, ICD-10; M50.00). The proportion of surgeries between Japan and the US was compared using a linear regression model controlling for year.
US surgeons utilized anterior procedures in 70% of cases compared to 9% in Japan (p<.001). In contrast, Japan had significantly more laminoplasties than the US (43% vs. 4%, respectively, p<.001). The percentage of laminoplasty in Japan (43%) relative to the percentage in the US (4%) was significantly different (p<.001). Accounting for increases in the number of total surgeries per year seen in the ACS-NSQIP and DPC databases, no specific surgery demonstrated a significant increase or decrease over the 8 years.
Japanese surgeons employ laminoplasty to treat CM approximately ten times more frequently than US surgeons who prefer anterior procedures.
椎板成形术是治疗脊髓型颈椎病（CM）的一种成熟技术。然而，美国外科医生从日本采用椎板成形术治疗CM的程度尚不清楚。本研究的目的是比较美国和日本治疗CM的手术管理策略。
本研究使用了回顾性队列研究，数据来自美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中的16084例患者以及2007年至2015年日本诊断程序组合（DPC）数据库中的389872例患者。收集了以下诊断的患者：脊髓型颈椎病（ICD-9；721.1，ICD-10；M47.12）和伴有脊髓病的椎间盘突出症（ICD-9；722.71，ICD-10；M50.00）。使用控制年份的线性回归模型比较了日本和美国之间的手术比例。
美国外科医生在70%的病例中采用前路手术，而日本为9%（p<0.001）。相比之下，日本的椎板成形术明显多于美国（分别为43%和4%，p<0.001）。日本椎板成形术的百分比（43%）相对于美国的百分比（4%）有显著差异（p<0.001）。考虑到ACS-NSQIP和DPC数据库中每年手术总数的增加，在8年期间没有特定的手术显示出显著增加或减少。
日本外科医生使用椎板成形术治疗CM的频率大约是更喜欢前路手术的美国外科医生的十倍。
