Department of Orthopaedics, Ningbo No. 6 Hospital, Ningbo, China.
Department of Orthopaedics, Ningbo University School of Medicine, Ningbo, China.
Orthop Surg. 2023 Jul;15(7):1781-1789. doi: 10.1111/os.13772. Epub 2023 May 30.
The prevalence of multi-level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS-TCISCI) is low, and the optimal surgical approach remains unclear. Open-door laminoplasty combined with bilateral lateral mass screw fixation (ODL-BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS-TCISCI has not been well-established. This study aims to assess the clinical value of ODL-BLMSF against MCSS-TCISCI.
We retrospectively analyzed 20 cases of MCSS-TCISCI treated with ODL-BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2-C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t-test was utilized for statistical analysis.
All included patients were followed up for an average period of 26.5 months (range: 24-30 months) after ODL-BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 ± 0.1 preoperatively to 1.13 ± 0.1 and 1.12 ± 0.04 at 6 months postoperatively and at the last follow-up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 ± 2.6 before surgery to 11.65 ± 4.3 and 12.1 ± 4.3 at 6 months postoperatively and at the last follow-up (t = 9.6, -9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 ± 1.3 (preoperative) to 1.65 ± 1.22 and 1.5 ± 1.2 (6 months postoperatively and at last follow-up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 ± 4.3 preoperatively to 13.2 ± 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 ± 8.6 at the final follow-up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 ± 1.5 preoperatively to 1.5 ± 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 ± 0.7 at the final follow-up (t = 10.356, p < 0.001).
ODL-BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS-TCISCI.
多节段颈椎管狭窄合并创伤性颈椎失稳和脊髓损伤（MCSS-TCISCI）的患病率较低，其最佳手术入路仍不明确。开门椎管成形术联合双侧侧块螺钉固定术（ODL-BLMSF）是一种相对较新的手术技术，但它在治疗 MCSS-TCISCI 中的临床效果尚未得到充分证实。本研究旨在评估 ODL-BLMSF 治疗 MCSS-TCISCI 的临床价值。
我们回顾性分析了 2016 年 7 月至 2020 年 6 月期间采用 ODL-BLMSF 治疗的 20 例 MCSS-TCISCI 患者。所有纳入患者的影像学改变均采用 X 线平片、CT 扫描和 MRI 扫描进行测量。颈椎前凸通过 C2-C7 Cobb 角和侧位 X 线片上的颈椎曲度指数（CCI）以及 C5 水平的 Pavlov 比值进行评估，神经功能恢复通过日本矫形协会（JOA）评分和 Nurick 分级进行评估，颈肩症状通过颈痛残疾指数（NDI）和视觉模拟量表（VAS）进行评估。采用配对 t 检验进行统计学分析。
所有纳入患者在接受 ODL-BLMSF 治疗后平均随访 26.5 个月（范围：24-30 个月）。C5 水平的平均 Pavlov 比值从术前的 0.57±0.1 显著改善至术后 6 个月的 1.13±0.1 和 1.12±0.04 以及末次随访时的 1.12±0.04（t=16.347，16.536，p<0.001）。重要的是，该方法显著提高了 JOA 评分，从术前的 5.0±2.6 提高至术后 6 个月的 11.65±4.3 和 12.1±4.3 以及末次随访时的 12.1±4.3（t=9.6，-9.600，p<0.001），平均 JOA 恢复率为 59.1%；Nurick 残疾评分从术前的 3.0±1.3 降低至术后 6 个月的 1.65±1.22 和 1.5±1.2 以及末次随访时的 1.5±1.2（t=5.111，1.831，p<0.001）。同时，NDI 评分从术前的 30.3±4.3 降低至术后 6 个月的 13.2±9.2（t=12.305，p<0.001），末次随访时的 12.45±9.6（t=13.968，p<0.001），VAS 评分从术前的 4.0±1.5 降低至术后 6 个月的 1.5±0.7（t=9.575，p<0.001），末次随访时的 1.15±0.7（t=10.356，p<0.001）。
ODL-BLMSF 可有效扩张狭窄的椎管，使脊髓减压，维持良好的颈椎对线和稳定性，改善神经功能和颈部功能的恢复。该技术适用于治疗特定的 MCSS-TCISCI 病例。
