Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients
Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients
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DOI：
10.3171/spi-07/07/013
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发表时间：
2007-07-01
影响因子：
2.8
通讯作者：
Kokubun, Shoichi
中科院分区：
文献类型：
--
作者：
Aizawa, Toshimi;Sato, Tetsuro;Kokubun, Shoichi
Object.与颈椎病相比，胸椎病是不常见的。在这项研究中，获得的数据在胸椎脊髓病引起的退行性病变的脊柱进行了回顾性分析，以澄清手术结果，并检查影响术后改善的各种因素。在1988年至2002年期间，132例胸椎脊髓病患者接受了手术治疗，并进行了至少2年的观察。临床数据收集自医疗和手术记录，并在X线片上测量脊柱的矢状位。使用改良的日本骨科协会（乔亚）量表（最高评分11）在术前和术后对患者进行评估。同时分析影响脊髓病术前严重程度的各种因素与术后改善的关系。人群包括97名男性（手术时平均年龄为58岁）和35名女性（手术时平均年龄为62岁）。脊髓病由73例黄韧带骨化（OLF）、21例后纵韧带骨化（OPLL）、10例合并OLF-OPLL、15例椎间盘突出（IDH）、11例后骨刺和各1例OLF合并IDH或后骨刺引起。手术结局相对较好：术前平均乔亚评分为5.3分，末次随访时平均评分为7.8分，术后平均50个月。然而，OPLL引起的胸椎脊髓病与术后评分和恢复率较低相关。在超过一半的患者中，作者记录了所有小于2度的后凸增加。术前症状持续时间较短、脊髓病变程度较轻的患者术后神经功能状况明显改善，提示对出现时间较早、致残程度较轻的患者应建议及时手术治疗，但OPLL的手术治疗仍存在诸多问题。
Object. Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement.Methods. Between 1988 and 2002, 132 patients with thoracic myelopathy underwent surgery and a minimum 2-year observation period. Clinical data were collected from medical and operative records, and sagittal alignment of the spine was measured on radiographs. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors affecting the preoperative severity of myelopathy and postoperative improvement were also examined.Results. The population consisted of 97 men (mean age at surgery was 58 years) and 35 women (mean age at surgery 62 years). Myelopathy was caused by ossification of the ligamentum flavum (OLF) in 73 patients, ossification of the posterior longitudinal ligament (OPLL) in 21, combined OLF-OPLL in 10, intervertebral disc herniation (IDH) in 15, posterior bone spur in 11, and OLF with IDH or posterior bone spur in one patient each. The surgical outcome was relatively good: a mean preoperative JOA score of 5.3 improved to a mean score of 7.8 at the last follow-up, 50 months on average after surgery. Thoracic myelopathy caused by OPLL, however, was associated with lower postoperative scores and recovery rates. In more than half of the patients the authors documented ail increase of kyphosis of less than 2 degrees.Conclusions. Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the Surgical treatment for OPLL still involves many problems.