Prediction of lower limb functional recovery after laminoplasty for cervical myelopathy: focusing on the 10-s step test

Objective

Operative decompression is indicated for progressive neurological deterioration in patients with cervical compressive myelopathy (CCM). However, the best timing to ensure clinical recovery has not been determined because of the lack of a suitable method. 10 s step (“step”) test is an easily performed physical test to assess the severity of CCM, particularly for the severity of lower limb dysfunction. The purpose of this study was to analyze the predictive value of preoperative step test results in relation to the results of expansive laminoplasty in patients with CCM.

Materials and methods

Clinical and imaging data were prospectively collected from 101 patients who underwent cervical expansive laminoplasty for CCM. The Japanese Orthopedic Association (JOA) score and the lower limb function section of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ-L) were used to evaluate surgical outcomes. Cutoff value was determined by receiver operating characteristic curve analysis to predict clinical recovery after surgery. JOA recovery rate exceeding 50% was defined as an effective clinical result. The treatment was judged to be effective in 30 patients based on the JOACMEQ-L. The cutoff value of the step test was 14.5 in cases of an effective judgment with JOA and JOACMEQ-L. Multivariate analysis showed that preoperative patient age and duration of symptoms were predictive parameters for effectively judging JOA scores. A preoperative step test result of greater than or equal to 14.5 and male gender were significant predictive parameters for an effective judgment with JOACMEQ-L.

Conclusions

Preoperative step test results significantly reflected the effective results of JOACMEQ-L and were predictive of improved lower limb function after laminoplasty in patients with CCM. Patients with a score of greater than or equal to 14.5 can experience effective lower limb functional recovery.     

Centerpiece单开门椎板成形术和椎板切除融合术治疗多节段颈脊髓病的临床疗效对比分析

目的：比较多节段颈脊髓病2种后路手术方式的临床疗效。方法回顾分析80例因多节段颈脊髓病行椎板成形术（A组）和椎板切除融合术（B组）的患者的资料,对2组患者术前、术后及随访时影像学资料和临床评价指标进行比较。结果术后1周2组日本骨科学会（ Japanese Orthopaedic Association , JOA）评分平均改善率差异无统计学意义（P＞0．05）,A组疼痛视觉模拟量表（visual analogue scale, VAS）评分、颈椎曲度与术前相比差异无统计学（P＜0．05）,B组则显著改善（P＜0．05）。术后1年B组JOA评分较术后1周显著降低（P＜0．05）,B组与术前颈椎活动度的差值显著大于A组（P＜0．01）。随访期间,A组C5神经麻痹的发生率为2．8％（1/36）,B组为12．5％（3/24）,差异有统计学意义（χ2＝3．35,P＜0．05）。结论2种方法早期都可取得良好的神经功能改善,在颈椎曲度、颈痛和活动度的影响上,两者各有优劣。     

颈椎前路减压融合术与后路单开门椎管成形术治疗多节段脊髓型颈椎病的临床对比研究

目的：比较颈椎前路减压融合术（anterior cervical discectomy and fusion,ACDF）与后路单开门椎管成形术（laminoplasty,LMP）治疗多节段脊髓型颈椎病的临床疗效。方法：2013年5月—2017年6月因多节段脊髓型颈椎病于本院接受颈椎ACDF或后路LMP手术治疗的患者102例。其中ACDF组45例,LMP组57例。术后至少连续随访1年,收集两组患者的临床资料及影像学检查结果并进行统计分析。结果：ACDF组患者术中失血量明显减少（P＜0.001）、住院天数缩短（P=0.022）。两组患者术后日本骨科协会（JOA）评分较术前明显提升（P < 0.001）,而组间比较无统计学差异（P > 0.05）。多因素回归分析显示术前椎管占有率（OR）及JOA评分显著影响患者术后功能评价结果（P＜0.05）。ACDF组术后颈椎前凸角、手术节段颈椎前凸角及T1倾斜角较术前明显增大（P < 0.05）。ACDF组术后颈椎活动度减少11.8°,明显大于LMP组的5.1°（P < 0.001）。两组患者术后并发症发生率无明显差异（P > 0.05）。结论：ACDF及LMP术治疗多节段脊髓型颈椎病安全有效。相比于LMP术,ACDF术中失血量减少、术后住院天数缩短、矢状位的稳定性提升;然而,ACDF术后颈椎活动度丢失较多;术前的OR及JOA评分是影响患者术后疗效的主要风险因素。     

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

Purpose

The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw.

Methods

Sixty patients who presented with local kyphosis exceeding 5° were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2 years or longer. Preoperative local kyphosis angles in LP and PR were 8.3° ± 4.4° and 8.8° ± 5.7°, respectively. Preoperative C2–7 angles in LP, PR and controls were −1.7° ± 9.6°, −0.4° ± 7.2° and −12.0° ± 5.6°, respectively. The recovery rate of the JOA score, local kyphosis angle and C2–7 angle at post-op and follow-up were compared between the groups.

Results

The recovery rate of the JOA score in the LP group (32.6 %) was significantly worse than that in the PR group (44.5 %) and that of controls (53.8 %). Local kyphosis angles in the PR and LP groups at follow-up were 4.0° ± 8.6° and 8.0° ± 6.0°, respectively. However, although the C2–7 angle at follow-up was improved to −11.1° ± 12.7° in PR, and maintained at −11.6° ± 6.2° in controls, it deteriorated to 0.5° ± 12.7° in LP.

Conclusions

The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2–7 angle until follow-up in the PR group.     

双开门椎管扩大成形术中椎板开门角度与椎管矢状径增加值的关系

【摘要】 目的：探讨双开门椎管扩大成形术中椎板开门角度与椎管矢状径增加值之间的关系。方法：根据三角函数知识推理双开门椎管扩大成形术中椎板开门角度与椎管矢状径增加值之间关系的公式：d=h×（sinβ/sinα-1）,α角是术前椎板与冠状面的夹角,β角是术后椎板与冠状面的夹角,h是双开门椎弓正中劈开点到两侧椎板开门处连线的垂直距离,d是术后椎管矢状径增加值。在2010年9月~2014年4月期间实施双开门椎管扩大成形术治疗多节段脊髓型颈椎病患者32例,其中C3～C7节段20例,C3～C6节段12例。术前及术后1周时在C3～C7节段各椎弓根层面的CT轴位片上应用PACS软件测量α、β、h、d。根据所测量的C3～C7各节段α、β、h值,应用公式计算相应节段的d值。应用配对t检验及Pearson相关分析比较各节段PACS软件直接测量所得的椎管矢状径增加值和公式计算得出的椎管矢状径增加值两组数据,以验证此公式的正确性。结果：C3~C7各节段公式计算得出的椎管矢状径增加值分别为5.15±0.47mm、5.39±0.47mm、5.22±0.37mm、5.25±0.25mm、4.35±0.35mm;PACS软件直接测量所得的椎管矢状径增加值分别为5.17±0.40mm、5.43±0.52mm、5.27±0.44mm、5.29±0.28mm、4.38±0.33mm;将各节段的两组数据分别进行配对t检验分析,t值分别为0.42,0.68,1.58,1.38,1.11,各节段的两组数据间差异均无统计学意义（P>0.05）;将各节段的两组数据分别进行Pearson相关性分析,r值分别为0.8953,0.8155,0.9159,0.7821,0.9238,各节段的两组数据间有相关关系（P<0.001）。结论：公式d=h×（sinβ/sinα-1）准确反映了双开门椎管扩大椎板成形术中椎板开门角度与椎管矢状径增加值之间的关系,在双开门椎管扩大成形术中,应用公式根据椎板开门的角度能预测椎管矢状径的增加值。     

单开门椎管成形术与全椎板减压融合内固定术治疗脊髓型颈椎病的临床疗效比较

目的探讨颈后路单开门椎管成形术与全椎板减压侧块螺钉植骨融合内固定术治疗脊髓型颈椎病的临床疗效。方法 2006年9月-2009年9月,对143例多节段(≥3个)脊髓型颈椎病患者分别采用颈后路单开门扩大椎管成形术(A组,87例)及全椎板减压侧块螺钉植骨融合内固定术(B组,56例)治疗,两组患者性别、年龄、病程、病变分型、病变节段等一般资料比较差异均无统计学意义(P>0.05),具有可比性。随访观察并比较两组患者手术时间、术中出血量、术后神经功能恢复[采用日本骨科协会(JOA)17分评分法]及手术并发症发生情况,并对两组患者手术前后颈椎曲率指数(cervical curvature index,CCI)、颈椎活动度(range of motion,ROM)及颈肩部疼痛[采用疼痛视觉模拟评分(VAS)及颈椎功能障碍指数量表(NDI)评分]等指标进行评估。结果两组患者手术时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间18～30个月,平均24个月。A、B组术后分别有4例(4.60%)和5例(8.93%)出现C5神经根麻痹症状,比较差异无统计学意义(χ2=0.475,P=0.482)。两组术后均无深部感染、假关节形成及螺钉松动需再手术等并发症发生。A组患者术后均无椎板再关门发生;B组患者末次随访时无螺钉脱出、断裂及继发神经损伤等发生。末次随访时A、B组分别有35例(40.23%)和11例(19.64%)有颈部轴性症状,比较差异有统计学意义(χ2=6.612,P=0.009)。两组患者术前JOA评分、CCI、颈椎ROM及VAS评分比较差异均无统计学意义(P>0.05);末次随访时两组JOA评分、颈椎ROM、VAS评分及A组CCI均较术前有显著改善(P<0.05)。末次随访时,A、B组间JOA评分及改善率、VAS评分比较差异均无统计学意义(P>0.05);A组ROM大于B组,CCI小于B组,差异有统计学意义(P<0.05);末次随访时NDI评分,A组在疼痛程度、上举能力、工作、驾车、反应及总分方面均显著优于B组(P<0.05)。结论两种手术方式在术后神经功能改善率上无明显差异,全椎板减压植骨融合内固定术能有效缓解术前疼痛,但颈椎活动度降低较大;单开门椎管成形术并发症较少,近期疗效满意。     

涉及C2水平的长节段颈椎后纵韧带骨化症的手术疗效观察

目的 探讨涉及C₂水平的长节段颈椎后纵韧带骨化(OPLL)症的手术方式及疗效。方法 对2011年5月—2014年11月第二军医大学附属长征医院脊柱外科手术治疗的42例涉及C₂水平长节段OPLL症患者的临床资料进行回顾性研究。其中男22例、女20例,平均年龄56.2岁。依术式不同将其分为A、B两组,A组21例行单纯C_3～7后路椎管扩大成形术,B组21例行C_3～7后路椎管扩大成形加C₂椎板下缘减压术,比较两组患者术后JOA评分及评分改善率、颈椎曲度及C_2～3椎体间活动度。结果 42例患者均顺利完成手术。A组中1例术后发生C₅神经根麻痹,A组中1例、B组中2例术后出现轴性疼痛,予相应处理后痊愈。术后随访6个月～4年,平均随访2.1年。术后3个月及末次随访时B组JOA评分及评分改善率均高于A组,差异均有统计学意义(t值分别为7.203、6.644,P值均＜0.01)。术后3个月及末次随访时两组患者颈椎曲度及C_2~3椎体间活动度差异均无统计学意义(P值均＞0.05)。结论 对于涉及C₂水平长节段颈椎OPLL症患者,若K线阳性,行C_3~7后路椎管扩大成形加C₂椎板下缘减压术,可以取得满意疗效。     

颈椎后路两种手术方式治疗多节段颈椎后纵韧带骨化症的疗效分析

目的 观察对比在后路椎板切除减压融合内固定术和后路椎管成形术治疗OPLL术后临床疗效.方法 2012年9月至2017年12月,采用椎板切除减压融合术治疗82例,采用后路椎管成形术治疗132例.椎板切除减压融合组82例行椎板切除减压融合侧块螺钉内固定术;椎管成形术组132例行单开门椎管成形术.全部214例患者术后获得24...     

Impact of deep extensor muscle-preserving approach on clinical outcome of laminoplasty for cervical spondylotic myelopathy: comparative cohort study

Introduction

This study aimed to compare patients undergoing deep extensor muscle-preserving laminoplasty and conventional open-door laminoplasty for the treatment of cervical spondylotic myelopathy (CSM). We specifically assessed axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 3 years.

Patients and methods

Ninety patients were divided into two groups and underwent either conventional open-door laminoplasty (CL group) or laminoplasty using the deep extensor muscle-preserving approach (MP group). The latter approach was undertaken by preserving the multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and resuturing of the bisected spinous processes at each decompression level. The mean follow-up period was 7.7 years (range, 36–128 months). Preoperative and follow-up evaluations included the Japanese Orthopaedic Association (JOA) score, a tentative version of the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) including cervical spine function and QOL, and a visual analog scale (VAS) for axial pain. Radiological analyses included cervical lordosis and flexion–extension range of motion (C2–7), as well as deep extensor muscle areas on axial magnetic resonance imaging (MRI).

Results

The mean number of decompressed laminae was 3.9 and 3.3 in CL and MP groups, respectively, which was statistically equivalent. Japanese Orthopaedic Association recovery was statistically equivalent between the two groups. The MP group demonstrated a superior QOL score (57 vs. 46 %) compared with the CL group at final follow-up (p < 0.05). Mean VAS scores at final follow-up were 2.2 and 4.3 in MP and CL groups, respectively (p < 0.05). Cervical lordosis and flexion–extension range of motion were statistically equivalent. The percentage deep muscle area on MRI was significantly lesser in the CL group compared with the MP group (58 vs. 102 %; p < 0.01).

Conclusion

We demonstrated the superiority of deep extensor muscle-preserving laminoplasty in terms of postoperative axial pain, QOL, and prevention of atrophy of the deep extensor muscles over conventional open-door laminoplasty for the treatment of CSM.