脊髓型颈椎病和后纵韧带骨化症多节段椎板成形术后颈椎生理前凸减小的危险因素差异：一项初步研究
Differences in Risk Factors for Decreased Cervical Lordosis after Multiple-Segment Laminoplasty for Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Pilot Study.
作者信息
Inoue Takaki, Maki Satoshi, Furuya Takeo, Okimatsu Sho, Yunde Atsushi, Miura Masataka, Shiratani Yuki, Nagashima Yuki, Maruyama Juntaro, Shiga Yasuhiro, Inage Kazuhide, Orita Sumihisa, Eguchi Yawara, Ohtori Seiji
机构信息
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.
出版信息
Asian Spine J. 2023 Aug;17(4):712-720. doi: 10.31616/asj.2022.0408. Epub 2023 Jul 6.
STUDY DESIGN
Retrospective study.
PURPOSE
To compare the radiographic risk factors for decreased cervical lordosis (CL) after laminoplasty, focusing on the difference between cervical spondylotic myelopathy (CSM) and cervical ossification of the posterior longitudinal ligament (C-OPLL).
OVERVIEW OF LITERATURE
A few reports compared the risk factors for decreased CL between CSM and C-OPLL although these two pathologies have their characteristics.
METHODS
This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2-7 Cobb angles. Radiographic parameters included preoperative neutral C2-7 Cobb angles, C2-7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively.
RESULTS
C2-7 SVA (p =0.018) and DER (p =0.002) were significantly correlated with decreased CL in CSM, while C2-7 Cobb angle (p =0.012) and C2-7 SVA (p =0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2-7 SVA (B =0.22, p =0.026) and small DER (B =-0.53, p =0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2-7 SVA (B =0.36, p =0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p <0.001).
CONCLUSIONS
C2-7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.
研究设计
回顾性研究。
目的
比较椎板成形术后颈椎生理前凸（CL）降低的影像学危险因素，重点关注脊髓型颈椎病（CSM）和后纵韧带骨化症（C-OPLL）之间的差异。
文献综述
尽管这两种疾病有各自的特点，但已有一些报告比较了CSM和C-OPLL中CL降低的危险因素。
方法
本研究纳入了50例行多节段椎板成形术的CSM患者和39例行多节段椎板成形术的C-OPLL患者。CL降低定义为术前与术后2年中立位C2-7 Cobb角的差值。影像学参数包括术前中立位C2-7 Cobb角、C2-7矢状垂直轴（SVA）、T1斜率（T1S）、动态伸展储备（DER）和活动范围。对CSM和C-OPLL中CL降低的影像学危险因素进行了研究。此外，术前和术后2年评估日本骨科协会（JOA）评分。
结果
CSM中，C2-7 SVA（p =0.018）和DER（p =0.002）与CL降低显著相关，而C-OPLL中，C2-7 Cobb角（p =0.012）和C2-7 SVA（p =0.028）与CL降低相关。多元线性回归分析显示，CSM中，更大的C2-7 SVA（B =0.22，p =0.026）和更小的DER（B = -0.53，p =0.002）与CL降低显著相关。相比之下，C-OPLL中，更大的C2-7 SVA（B =0.36，p =0.031）与CL降低显著相关。CSM和C-OPLL患者的JOA评分均显著改善（p <0.001）。
结论
CSM和C-OPLL中，C2-7 SVA均与术后CL降低相关，但DER仅与CSM中CL降低相关。CL降低的危险因素因病情病因略有不同。
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