Chen Szu-Wei, Yeh Kuang-Ting, Peng Cheng-Huan, Chang Chia-Ming, Chen Hao-Wen, Yu Tzai-Chiu, Chen Ing-Ho, Wang Jen-Hung, Yang Wan-Ting, Wu Wen-Tien
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
Medicina (Kaunas). 2024 Dec 13;60(12):2057. doi: 10.3390/medicina60122057.
: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. : A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2-C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2-C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. : MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient.
多节段脊髓型颈椎病（MCSM）给手术治疗带来了复杂的挑战，尤其是对于伴有后凸畸形或严重前路病变的患者。本研究旨在评估改良扩大开门椎板成形术（MEOLP）联合短节段颈椎前路融合术（ACF）在九年随访期内提供减压、维持对线和保持活动范围（ROM）的长期疗效。
对2011年至2015年间接受MEOLP联合ACF治疗的124例MCSM患者进行了回顾性分析。MEOLP是一种保留肌肉的后路手术方法，与ACF联合使用以纠正矢状面错位并解决前路压迫问题。主要观察指标包括帕夫洛夫比值、C2-C7角度、日本骨科学会（JOA）评分以及颈部疼痛视觉模拟量表（VAS）。在长期随访中对患者进行相邻节段退变（ASD）及其他术后变化的监测。术后九年，患者在减压和颈椎对线方面有显著改善。平均C2-C7角度增加，反映出前凸曲度增强，而帕夫洛夫比值显示椎管扩张得以维持。JOA评分显著改善，表明脊髓病症状减轻，颈部疼痛的VAS评分降低，反映出症状缓解。尽管有这些积极结果，但仍观察到ASD，尤其是术前椎间盘高度降低的患者，这凸显了减轻相邻节段退变策略的必要性。
MEOLP联合短节段ACF是治疗复杂MCSM病例的一种可行且持久的选择，可提供有效的减压、对线矫正和ROM保留。本研究的局限性，包括其回顾性、单中心设计以及缺乏生活质量评估，强调了未来进行具有更广泛观察指标的多中心研究的必要性。这些发现支持在传统椎板成形术可能不足的情况下，MEOLP联合ACF作为一种替代方法。
