Wakao Norimitsu, Sakai Yoshihito, Osada Naoaki, Sugiura Takaya, Iida Hiroki, Ozawa Yuto, Hirasawa Atsuhiko
Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Spine Surg Relat Res. 2022 Oct 13;7(2):149-154. doi: 10.22603/ssrr.2022-0123. eCollection 2023 Mar 27.
Although thoracic spondylotic myelopathy (TSM) without ossification or disc disorder has been associated with some dynamic factors in the thoracolumbar area, a detailed investigation is yet to be published. Thus, in this study, we investigated the segmental motion and sagittal alignment of the thoracolumbar area in patients with and without TSM.
Patients with TSM who were treated from 2013 to 2020 were enrolled in this study. The non-TSM group consisted of sex- and age-matched patients with spinal disorders other than TSM. Segmental mobility from T10-L2 during passive maximum flexion and extension following myelography and the sagittal cobb angles of T10-L1 and L1-L5 in the standing position were measured using multidetector computed tomography (CT). The mobility of each segment was set as the difference in the angles between the two positions.
In total, 10 patients (8 males and 2 females, mean age 65.8 years) with TSM and 20 without TSM were enrolled. The most stenotic level was observed at T10-T11 in four cases and T11-T12 in six. The average mobility at this segment in the TSM group (5.8°) was significantly greater than that in the non-TSM group (2.1°) (p<0.001). In the TSM group, the cobb angles of T10-L1 and L1-L5 were 2.3° and 17.4° of lordosis, respectively, which differed significantly from those in the non-TSM group, which were 8° of kyphosis and 32.2° of lordosis, respectively (p<0.001 and p=0.001, respectively).
Compared with those without TSM, patients with TSM were found to have greater segmental mobility at the most stenotic level, thoracolumbar lordosis, and decreased lumbar lordosis.
虽然没有骨化或椎间盘病变的胸椎脊髓病（TSM）与胸腰段的一些动态因素有关，但尚未发表详细的研究报告。因此，在本研究中，我们调查了患有和未患有TSM的患者胸腰段的节段运动和矢状面排列情况。
本研究纳入了2013年至2020年接受治疗的TSM患者。非TSM组由性别和年龄匹配的、患有除TSM以外的脊柱疾病的患者组成。在脊髓造影后的被动最大屈伸过程中，使用多排螺旋计算机断层扫描（CT）测量T10-L2节段的活动度，以及站立位时T10-L1和L1-L5的矢状面 Cobb角。每个节段的活动度设定为两个位置之间角度的差值。
总共纳入了10例TSM患者（8例男性和2例女性，平均年龄65.8岁）和20例非TSM患者。在4例患者中，最狭窄的节段位于T10-T11，6例位于T11-T12。TSM组该节段的平均活动度（5.8°）显著大于非TSM组（2.1°）（p<0.001）。在TSM组中，T10-L1和L1-L5的Cobb角分别为2.3°和17.4°的前凸，与非TSM组分别为8°的后凸和32.2°的前凸有显著差异（分别为p<0.001和p=0.001）。
与未患有TSM的患者相比，患有TSM的患者在最狭窄节段的节段活动度更大，胸腰段前凸增加，腰椎前凸减小。
