Departments of Orthopedic Surgery.
Neurologic Surgery, Mayo Clinic, Rochester, MN.
Clin Spine Surg. 2023 Apr 1;36(3):127-133. doi: 10.1097/BSD.0000000000001444. Epub 2023 Mar 13.
Retrospective review.
The purpose of this study was to investigate the surgical outcomes in a cohort of patients with severe preoperative axial neck pain undergoing laminoplasty for cervical spondylotic myelopathy (CSM).
No study has investigated whether patients with severe axial symptoms may achieve satisfactory neck pain and disability outcomes after laminoplasty.
We performed a retrospective review of 91 patients undergoing C4-6 laminoplasty for CSM at a single academic institution between 2010 and 2021. Patient-reported outcome measures (PROMs), including Neck Disability Index (NDI), visual analog scale (VAS) Neck, and VAS Arm, were recorded preoperatively and at 6 months and 1 year postoperatively. Patients were stratified as having mild pain if VAS neck was 0-3, moderate pain if 4-6, and severe pain if 7-10. PROMs were then compared between subgroups at all the perioperative time points.
Both the moderate and severe neck pain subgroups demonstrated a substantial improvement in VAS neck from preoperative to 6 months postoperatively (-3.1±2.2 vs. -5.6±2.8, respectively; P <0.001), and these improvements were maintained at 1 year postoperatively. There was no difference in VAS neck between subgroups at either the 6-month or 1-year postoperative time points. Despite the substantially higher mean NDI in the moderate and severe neck pain subgroups preoperatively, there was no difference in NDI at 6 months or 1 year postoperatively ( P =0.99). There were no differences between subgroups in the degree of cord compression, severity of multifidus sarcopenia, sagittal alignment, or complications.
Patients with moderate and severe preoperative neck pain undergoing laminoplasty achieved equivalent PROMs at 6 months and 1 year as patients with mild preoperative neck pain. The results of this study highlight the multifactorial nature of neck pain in these patients and indicate that severe axial symptoms are not an absolute contraindication to performing laminoplasty in well-aligned patients with CSM.
回顾性研究。
本研究旨在探讨一组严重术前轴向颈痛的脊髓型颈椎病（CSM）患者接受颈椎板成形术的手术结果。
尚无研究调查严重轴性症状的患者在颈椎板成形术后是否能获得满意的颈痛和残疾结果。
我们在一家学术机构回顾性分析了 2010 年至 2021 年间接受 C4-6 颈椎板成形术治疗 CSM 的 91 例患者。记录患者报告的结果测量（PROMs），包括颈部残疾指数（NDI）、视觉模拟量表（VAS）颈部和 VAS 手臂，术前及术后 6 个月和 1 年。如果 VAS 颈部为 0-3，则将患者分为轻度疼痛；如果为 4-6，则为中度疼痛；如果为 7-10，则为重度疼痛。然后在所有围手术期时间点比较亚组之间的 PROMs。
中度和重度颈部疼痛亚组的 VAS 颈部均从术前到术后 6 个月显著改善（分别为-3.1±2.2 和-5.6±2.8；P<0.001），这些改善在术后 1 年仍保持。在术后 6 个月或 1 年时，亚组之间的 VAS 颈部无差异。尽管中度和重度颈部疼痛亚组术前的 NDI 均值明显较高，但术后 6 个月和 1 年时 NDI 无差异（P=0.99）。亚组之间的脊髓压迫程度、多裂肌萎缩严重程度、矢状位排列或并发症无差异。
接受颈椎板成形术的中度和重度术前颈部疼痛患者在术后 6 个月和 1 年时获得了与轻度术前颈部疼痛患者相同的 PROMs。本研究结果强调了这些患者颈部疼痛的多因素性质，并表明在矢状位排列良好的 CSM 患者中，严重的轴向症状不是行颈椎板成形术的绝对禁忌症。
