Hammoor Bradley T, Cohen Lara L, Xiong Grace X, Lightsey Harry M, Lindsey Matthew, Fogel Harold A, Tobert Daniel G, Hershman Stuart H
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States.
Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States.
N Am Spine Soc J. 2024 Nov 24;21:100575. doi: 10.1016/j.xnsj.2024.100575. eCollection 2025 Mar.
Laminectomy and fusion (LF) and laminoplasty (LP) are common treatments for cervical spondylotic myelopathy and myeloradiculopathy. While both procedures show similar clinical improvement, LF requires bony fusion while LP offers motion preservation. Cervical sagittal alignment and horizontal gaze maintenance are key outcome measures, but their comparative effects between LF and LP remain unclear. This study evaluated postoperative horizontal gaze and cervical sagittal alignment in patients undergoing either procedure.
In this retrospective cohort study at 2 academic centers, patients underwent either LF or LP. Pre/postoperative cervical sagittal alignment parameters were collected, including C2-7 lordosis, C2-7 SVA, Occiput-C2 angle, and T1-slope. The McGregor slope measured horizontal gaze, with 8° flexion to 13° extension as normal range. Primary outcome was horizontal gaze maintenance at minimum 1-year follow-up. Secondary outcomes included changes in cervical spine alignment parameters.
Sixty-four patients (30 LF, 34 LP) completed minimum 1-year follow-up. Pre/postoperative sagittal alignment measures showed no significant differences between groups. Within cohorts, LP increased C2-7 sagittal vertical axis (29.1-37.6 mm, p=.04) while LF decreased C2-7 lordosis (11.5°-5.00°, p=.04). Postoperatively, LF showed significantly more optimally aligned patients (90.0%) versus LP (57.8%) (p<.01). Multivariate analysis indicated LP predicted postoperative horizontal gaze malalignment (OR 13.90 [2.10-286.62], p=.022).
While both procedures yielded comparable cervical sagittal alignment outcomes, LF demonstrated superior maintenance of horizontal gaze. These findings suggest that laminectomy and fusion may preserve horizontal gaze better than laminoplasty. III.
椎板切除术和融合术（LF）以及椎板成形术（LP）是治疗脊髓型颈椎病和神经根型颈椎病的常用方法。虽然这两种手术都显示出相似的临床改善效果，但LF需要进行骨融合，而LP则可保留颈椎活动度。颈椎矢状位对线和水平凝视维持是关键的疗效指标，但它们在LF和LP之间的比较效果仍不清楚。本研究评估了接受这两种手术的患者术后的水平凝视和颈椎矢状位对线情况。
在2个学术中心进行的这项回顾性队列研究中，患者接受了LF或LP手术。收集术前/术后颈椎矢状位对线参数，包括C2-7前凸、C2-7矢状面垂直轴（SVA）、枕骨-C2角和T1斜率。McGregor斜率用于测量水平凝视，正常范围为8°屈曲至13°伸展。主要结局是在至少1年的随访中维持水平凝视。次要结局包括颈椎对线参数的变化。
64例患者（30例行LF，34例行LP）完成了至少1年的随访。术前/术后矢状位对线测量结果显示两组之间无显著差异。在各队列中，LP使C2-7矢状面垂直轴增加（29.1 - 37.6 mm，p = 0.04），而LF使C2-7前凸减小（11.5° - 5.00°，p = 0.04）。术后，LF术后颈椎对线最佳的患者比例（90.0%）显著高于LP（57.8%）（p < 0.01）。多因素分析表明LP是术后水平凝视失调的预测因素（比值比13.90 [2.10 - 286.62]，p = 0.022）。
虽然两种手术在颈椎矢状位对线结局方面相当，但LF在维持水平凝视方面表现更优。这些发现表明椎板切除术和融合术可能比椎板成形术更好地保留水平凝视。III.
