Qu Ruomu, Wang Ben, Pan Shengfa, Liu Zexiang, Yang Yiyuan, Zhou Hua, Dang Lei, Sun Yu, Zhou Feifei, Jiang Liang
Orthopedic Department, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China.
BMC Musculoskelet Disord. 2025 Aug 19;26(1):801. doi: 10.1186/s12891-025-09013-z.
Several modified muscle-sparing laminoplasty (LP) techniques have been developed to prevent axial symptoms in the treatment of multilevel degenerative cervical myelopathy (MDCM). However, the postoperative changes in posterior muscle volume (PMV) and cervical alignment following these procedures remain controversial. This study aimed to compare the short-term postoperative changes in PMV and cervical alignment between conventional LP and three types of muscle-sparing LPs: unilateral muscle-preservation laminoplasty (UL), double-door laminoplasty (DL), and intermuscular "raising roof" laminoplasty (RL).
Consecutive MDCM patients who underwent LP, DL, UL, or RL between February 2022 and May 2022 at a same ward were enrolled. Baseline data and surgical characteristics were collected. Preoperative and postoperative PMV were semiautomatically segmented and evaluated, and cervical alignment was measured. The PMV loss ratio was calculated as the change in PMV divided by the preoperative PMV.
A total of 79 MDCM patients were included in this study (LP: 20, DL: 20, UL:23, RL:16). No significant differences were observed in the preoperative demographic data, surgical characteristics and radiological variables. The preoperative C2-7 cobb angles of four groups were 11.59 ± 8.80, 9.54 ± 11.18, 11.08 ± 11.32 and 10.75 ± 10.90, respectively(p = 0.962). The preoperative PMV were 2.726 ± 0.79, 2.607 ± 0.752, 2.808 ± 0.724, 2.686 ± 0.674*10mm, respectively(p = 0.802). At 1-year follow-up, all four groups showed favorable and comparable JOARR(p = 0.443). The postoperative PMV of four groups were 2.430 ± 0.68, 2.355 ± 0.621, 2.416 ± 0.667, and 2.602 ± 0.666 *10mm(p = 0.606), and the PMV loss ratio were 10.0%±12.9%, 8.7%±9.6%, 13.6%±10.4%, and 2.8%±11.0%, respectively (p = 0.033). The modified LP groups did not present significant difference in PMV loss or cervical alignment parameters compared with LP. After adjustment, the RL group presented significant lower PMV loss ratio (p = 0.035) compared with LP. Multivariate regression revealed that the loss in cervical alignment was correlated to the PMV loss ratio.
The DL group has significant lower postoperative CL-E loss than LP. After adjustment, the RL procedure demonstrated better efficacy in PMV preservation compared to conventional LP. The loss of cervical lordosis at neutral and extension positions was associated with the PMV loss ratio.
为预防多节段退变性颈椎病（MDCM）治疗过程中的轴性症状，已研发出多种改良的保留肌肉的椎板成形术（LP）技术。然而，这些手术术后的后肌体积（PMV）变化和颈椎排列情况仍存在争议。本研究旨在比较传统LP与三种保留肌肉的LP术式：单侧肌肉保留椎板成形术（UL）、双开门椎板成形术（DL）和肌间隙“掀盖式”椎板成形术（RL）术后短期内PMV和颈椎排列的变化。
纳入2022年2月至2022年5月在同一病房接受LP、DL、UL或RL手术的连续性MDCM患者。收集基线数据和手术特征。术前和术后的PMV通过半自动分割进行评估，并测量颈椎排列情况。PMV损失率计算为PMV的变化量除以术前PMV。
本研究共纳入79例MDCM患者（LP组：20例，DL组：20例，UL组：23例，RL组：16例）。术前人口统计学数据、手术特征和放射学变量无显著差异。四组术前C2-7 Cobb角分别为11.59±8.80、9.54±11.18、11.08±11.32和10.75±10.90（p = 0.962）。术前PMV分别为2.726±0.79、2.607±0.752、2.808±0.724、2.686±0.674×10mm（p = 0.802）。随访1年时，四组的日本骨科协会疗效评分（JOARR）均良好且相当（p = 0.443）。四组术后PMV分别为2.430±0.68、2.355±0.621、2.416±0.667和2.602±0.666×10mm（p = 0.606），PMV损失率分别为10.0%±12.9%、8.7%±9.6%、13.
