脊髓型颈椎病后路手术技术比较：椎板切除融合术、椎板成形术及椎板成形融合术

Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion.

作者信息

Han Seung Hyeon, Kim Sang Hyun, Noh Sung Hyun, Lee Jong Joo, Ha Yoon, Cho Pyung Goo

机构信息

Department of Neurosurgery, Ajou University Hospital, Suwon-si, Republic of Korea.

Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.

出版信息

Spine J. 2025 Apr 25. doi: 10.1016/j.spinee.2025.04.017.

DOI:10.1016/j.spinee.2025.04.017

PMID:40288759

Abstract

BACKGROUND CONTEXT

Laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF) are three techniques for posterior cervical decompression. LF can provide stability, but postoperative dural membrane adhesion and fusion failure can occur. LP can prevent postoperative dural membrane adhesion, but it can lead to kyphotic change. To address the disadvantages and further enhance the strengths of each, the LPF technique can be a good option.

PURPOSE

This study aimed to confirm whether LPF can overcome the disadvantages of LF and LP.

STUDY DESIGN

Single-center, retrospective cohort study.

PATIENT SAMPLE

Twenty patients for each technique were randomly selected.

OUTCOME MEASURES

Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, and fusion success rate were measured for radiologic outcomes. Preoperative and postoperative Japanese Orthopedic Association (JOA) scores and recovery rates (RRs) were measured for clinical outcomes.

METHODS

Patients who underwent LF, LP, or LPF between 2012 and 2023 were enrolled, and 20 patients for each technique were randomly selected. Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, fusion success rate, complications, operation time, blood loss, JOA scores, visual analog scale (VAS) scores, and RRs were measured.

RESULTS

Δ C2-7 Cobb's angle (LPF, -2.62±5.0; LP, -6.43±4.9; p=.020) and Δ C2-7 SVA (LPF, 6.48±8.3; LP, 13.84±9.9; p=.015) were significantly different between LPF and LP. No significant changes in Δ spinal canal length between LPF and LP were observed (LPF, 2.93±1.3; LP, 3.05±1.5; p=.780). The fusion success rate with LPF was higher than that with LF (LPF, 80.0%; LF, 45.0%; p=.027). The JOA RR was the highest with LPF (LPF, 49.96%±24.7; LF, 31.70%±27.8; LP, 29.31%±30.8, p=.045).

CONCLUSIONS

LPF can overcome the disadvantages of LF and LP while retaining their benefits.

摘要

背景

椎板切除融合术（LF）、椎板成形术（LP）和椎板成形融合术（LPF）是三种颈椎后路减压技术。LF可提供稳定性，但术后可能发生硬脊膜粘连和融合失败。LP可预防术后硬脊膜粘连，但会导致后凸改变。为克服各自的缺点并进一步增强优势，LPF技术可能是一个不错的选择。

目的

本研究旨在确认LPF是否能克服LF和LP的缺点。

研究设计

单中心回顾性队列研究。

患者样本

每种技术随机选取20例患者。

观察指标

测量C2-7矢状垂直轴（SVA）变化、T1斜率变化、C2-7 Cobb角变化、椎管长度变化及融合成功率以评估影像学结果。测量术前和术后日本骨科学会（JOA）评分及恢复率（RRs）以评估临床结果。

方法

纳入2012年至2023年间接受LF、LP或LPF手术的患者，每种技术随机选取20例患者。测量C2-7矢状垂直轴（SVA）变化、T1斜率变化、C2-7 Cobb角变化、椎管长度变化、融合成功率、并发症、手术时间、失血量、JOA评分、视觉模拟量表（VAS）评分及RRs。

结果

LPF与LP之间，C2-7 Cobb角变化（LPF，-2.62±5.0；LP，-6.43±4.9；p = 0.020）和C2-7 SVA变化（LPF，6.48±8.3；LP，13.84±9.9；p = 0.015）有显著差异。LPF与LP之间椎管长度变化无显著差异（LPF，2.93±1.3；LP，3.05±1.5；p = 0.780）。LPF的融合成功率高于LF（LPF，80.0%；LF，45.0%；p = 0.027）。LPF的JOA恢复率最高（LPF，49.96%±24.7；LF，31.70%±27.8；LP，29.31%±30.8，p = 0.045）。