Takasawa Eiji, Iizuka Yoichi, Mieda Tokue, Inoue Hirokazu, Kimura Atsushi, Takeshita Katsushi, Sonoda Hiroyuki, Takakura Kenta, Sorimachi Yasunori, Ara Tsuyoshi, Arai Atsushi, Shida Kosuke, Nakajima Takashi, Tsutsumi Satoshi, Arai Hidekazu, Moridaira Hiroshi, Taneichi Hiroshi, Funayama Toru, Noguchi Hiroshi, Miura Kousei, Kobayashi Ryoichi, Iizuka Haku, Chazono Masaaki, Chikuda Hirotaka
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan.
Eur Spine J. 2023 Oct;32(10):3575-3582. doi: 10.1007/s00586-023-07902-2. Epub 2023 Aug 25.
This study aimed to investigate the recent 10-year trends in cervical laminoplasty and 30-day postoperative complications.
This retrospective multi-institutional cohort study enrolled patients who underwent laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament. The primary outcome was the occurrence of all-cause 30-day complications. Trends were investigated and compared in the early (2008-2012) and late (2013-2017) periods.
Among 1095 patients (mean age, 66 years; 762 [70%] male), 542 and 553 patients were treated in the early and late periods, respectively. In the late period, patients were older at surgery (65 years vs. 68 years), there were more males (66% vs. 73%), and open-door laminoplasty (50% vs. 69%) was the preferred procedure, while %CSM (77% vs. 78%) and the perioperative JOA scores were similar to the early period. During the study period, the rate of preservation of the posterior muscle-ligament complex attached to the C2/C7-spinous process (C2, 89% vs. 93%; C7, 62% vs. 85%) increased and the number of laminoplasty levels (3.7 vs. 3.1) decreased. While the 30-day complication rate remained stable (3.9% vs. 3.4%), C5 palsy tended to decrease (2.4% vs. 0.9%, P = 0.059); superficial SSI increased significantly (0% vs. 1.3%, P = 0.015), while the decreased incidence of deep SSI did not reach statistical significance (0.6% vs. 0.2%).
From 2008 to 2017, there were trends toward increasing age at surgery and surgeons' preference for refined open-door laminoplasty. The 30-day complication rate remained stable, but the C5 palsy rate halved.
本研究旨在调查颈椎椎板成形术的近10年趋势及术后30天并发症情况。
这项回顾性多机构队列研究纳入了因脊髓型颈椎病（CSM）或后纵韧带骨化症接受椎板成形术的患者。主要结局是全因30天并发症的发生情况。对早期（2008 - 2012年）和晚期（2013 - 2017年）的趋势进行了调查和比较。
在1095例患者（平均年龄66岁；762例[70%]为男性）中，早期和晚期分别有542例和553例患者接受治疗。在晚期，手术时患者年龄更大（65岁对68岁），男性更多（66%对73%），且开门式椎板成形术（50%对69%）是首选术式，而CSM患者比例（77%对78%）和围手术期日本骨科学会（JOA）评分与早期相似。在研究期间，附着于C2/C7棘突的后肌肉韧带复合体保留率（C2，89%对93%；C7，62%对85%）增加，椎板成形术节段数（3.7对3.1）减少。虽然30天并发症发生率保持稳定（3.9%对3.4%），但C5麻痹有下降趋势（2.4%对0.9%，P = 0.059）；浅表手术部位感染显著增加（0%对1.3%，P = 0.015），而深部手术部位感染发生率下降未达到统计学意义（0.6%对0.2%）。
2008年至2017年，手术年龄有增加趋势，且外科医生更倾向于改良开门式椎板成形术。30天并发症发生率保持稳定，但C5麻痹发生率减半。
