Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Geriatric Diseases, Beijing, China.
BMC Surg. 2024 May 14;24(1):155. doi: 10.1186/s12893-024-02431-1.
The relationships between preoperative cervical spine range of motion (ROM) and postoperative cervical sagittal alignment (CSA), and clinical outcomes after laminoplasty (LMP) have been widely studied. However, the impact of ROM changes on postoperative CSA and clinical outcomes after LMP remains unclear. Herein, patients with cervical spondylotic myelopathy (CSM) were retrospectively analyzed to explore the association between postoperative cervical ROM changes and CSA and surgical outcomes.
Patients who underwent cervical LMP at our hospital between January 2019 to June 2022 were retrospectively reviewed. CSA parameters were measured before the surgery and at the final follow-up. Loss of cervical lordosis (LCL) was defined as preoperative cervical lordosis (CL) - postoperative CL. An increase in the cervical sagittal vertical axis (I-cSVA) was defined as postoperative cervical sagittal vertical axis (cSVA) - preoperative cSVA. We defined the changes in cervical flexion range of motion (△Flex ROM, preoperative Flex ROM minus postoperative Flex ROM) > 10° as L- Flex ROM group, and △Flex ROM ≤ 10° as S- Flex ROM group. Japanese Orthopedic Association (JOA) score and visual analog score (VAS) were used to assess the surgical outcomes.
The study comprised 74 patients and the average follow-up period was 31.83 months. CL, total ROM, and Flex ROM decreased and cSVA increased after cervical LMP. LCL and I-cSVA were positively correlated with △Flex. Multiple linear regression analysis showed that a decrease in the Flex ROM was a risk factor for LCL and I-cSVA after LMP. LCL and I-cSVA were higher in the L-Flex ROM group than in the S-Flex ROM group. Postoperative JOA and the JOA recovery rate were worse in the L-Flex ROM group than in the S-Flex ROM group.
Cervical total and Flex ROM decreased after cervical LMP. The reduction of Flex ROM was associated with LCL and I-cSVA after surgery. The preservation of cervical Flex ROM helps maintain CSA after LMP. Therefore, more attention should be paid to maintaining cervical ROM to obtain good CSA and surgical effects after cervical LMP.
术前颈椎活动度（ROM）与术后颈椎矢状位平衡（CSA）以及后路颈椎板成形术（LMP）后的临床结果之间的关系已得到广泛研究。然而，ROM 变化对 LMP 后 CSA 和临床结果的影响仍不清楚。在此，对患有颈椎病（CSM）的患者进行回顾性分析，以探讨术后颈椎 ROM 变化与 CSA 和手术结果之间的关系。
回顾性分析 2019 年 1 月至 2022 年 6 月在我院行 LMP 的患者。测量术前和末次随访时的 CSA 参数。颈椎前凸丢失（LCL）定义为术前颈椎前凸（CL）减去术后 CL。颈椎矢状垂直轴增加（I-cSVA）定义为术后颈椎矢状垂直轴（cSVA）减去术前 cSVA。我们将颈椎前屈活动范围的变化（△Flex ROM，术前 Flex ROM 减去术后 Flex ROM）定义为＞10°为 L- Flex ROM 组，△Flex ROM≤10°为 S- Flex ROM 组。日本骨科协会（JOA）评分和视觉模拟评分（VAS）用于评估手术结果。
本研究共纳入 74 例患者，平均随访时间为 31.83 个月。LMP 后 CL、总 ROM 和 Flex ROM 减少，cSVA 增加。LCL 和 I-cSVA 与△Flex 呈正相关。多线性回归分析显示，Flex ROM 的减少是 LMP 后 LCL 和 I-cSVA 的危险因素。L-Flex ROM 组的 LCL 和 I-cSVA 高于 S-Flex ROM 组。L-Flex ROM 组的术后 JOA 和 JOA 恢复率均较 S-Flex ROM 组差。
后路颈椎板成形术后颈椎总 ROM 和 Flex ROM 减少。Flex ROM 的减少与术后 LCL 和 I-cSVA 有关。保持颈椎 Flex ROM 有助于维持 LMP 后 CSA。因此，在进行 LMP 时，应更加注意保持颈椎 ROM，以获得良好的 CSA 和手术效果。
