Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Spine (Phila Pa 1976). 2023 Sep 15;48(18):1308-1316. doi: 10.1097/BRS.0000000000004610. Epub 2023 Feb 28.
Retrospective observational study.
The objective of this study was to investigate factors associated with cervical kyphosis after laminoplasty.
Many factors are reportedly associated with the deterioration of cervical curvature after laminoplasty, including cervical lordosis angle, cervical spine range of motion (ROM), T1 slope, and C2-C7 sagittal vertical axis. Postlaminoplasty kyphosis or deterioration of cervical curvature is likely caused by multiple factors. There is currently no consensus on these issues.
Data of patients treated with laminoplasty for degenerative cervical myelopathy at our institution during 2008-2018 were reviewed. The following variables were collected for each patient: age and sex; follow-up time; surgery involving C3 (yes or no); surgery involving C7 (yes or no); distribution of segments operated on; number of laminae operated on; flexion, extension, and total ROM; cervical lordotic angle; longitudinal distance index; curvature index; C2-C7 sagittal vertical axis; and T1 slope. Logistic regression analysis was used to assess possible risk factors for postoperative kyphosis. Receiver operating characteristic curves were constructed to determine the cutoff values of risk factors.
The study cohort comprised 151 patients. Logistic regression analysis indicated that sex, number of laminae operated on, and preoperative extension ROM were significantly associated with postoperative cervical kyphosis ( P <0.05). There was significantly greater postoperative kyphosis in women than in men; the more segments operated on, the greater the risk of postoperative kyphosis, and the larger the preoperative extension ROM, the lower the risk of postlaminoplasty kyphosis. Receiver operating characteristic curve analysis showed that the cutoff value for preoperative extension ROM is 22.1°.
Preoperative extension ROM may be associated with the development of postoperative kyphosis. The cutoff value of preoperative extension ROM that suggested the prospect of postoperative kyphosis in our sample was 22.1°.
回顾性观察研究。
本研究旨在探讨颈椎管狭窄症后路单开门椎管扩大成形术后颈椎后凸的相关因素。
许多因素被报道与后路单开门椎管扩大成形术后颈椎曲度恶化有关，包括颈椎前凸角、颈椎活动度（ROM）、T1 斜率和 C2-C7 矢状垂直轴。术后颈椎后凸或颈椎曲度恶化可能是由多种因素引起的。目前，这些问题尚无共识。
回顾了我院 2008-2018 年间因退行性颈椎脊髓病行单开门椎管扩大成形术的患者资料。收集了每位患者的以下变量：年龄和性别；随访时间；手术涉及 C3（是或否）；手术涉及 C7（是或否）；手术节段分布；手术的椎板数量；屈伸及总 ROM；颈椎前凸角；纵向距离指数；曲率指数；C2-C7 矢状垂直轴；T1 斜率。采用 Logistic 回归分析评估术后后凸的可能危险因素。构建受试者工作特征曲线以确定危险因素的临界值。
本研究队列包括 151 例患者。Logistic 回归分析表明，性别、手术椎板数量和术前伸展 ROM 与术后颈椎后凸显著相关（P <0.05）。女性术后后凸较男性更明显；手术节段越多，术后后凸风险越大，术前伸展 ROM 越大，术后发生单开门椎管扩大成形术后后凸的风险越低。受试者工作特征曲线分析显示，术前伸展 ROM 的临界值为 22.1°。
术前伸展 ROM 可能与术后后凸的发生有关。在本样本中，术前伸展 ROM 的临界值为 22.1°，提示术后可能发生后凸。
