Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy -: An independent matched cohort analysis
Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy -: An independent matched cohort analysis
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DOI：
10.1097/00007632-200106150-00013
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发表时间：
2001-06-15
期刊：
影响因子：
3
通讯作者：
Rodts, GE
中科院分区：
文献类型：
--
作者：
Heller, JG;Edwards, CC;Rodts, GE
研究设计。椎板成形术和椎板切除术融合治疗多节段脊髓型颈椎病的匹配队列临床和放射学回顾性分析。目的。比较越来越多地用于治疗多节段脊髓型颈椎病的两种手术的临床和放射学结果。背景数据摘要。据报道，治疗多节段脊髓型颈椎病的传统方法（椎板切除术和椎体切除术）的并发症发生率很高。椎板成形术和椎板切除术融合已被认为是更好的手术。这两种技术的比较研究尚未见报道。方法。我们回顾了 1994 年至 1999 年间在我们机构接受椎板成形术或椎板切除融合术治疗的所有多节段脊髓型颈椎病患者的医疗记录。 13 名接受椎板切除融合术的患者与 13 名接受椎板成形术的患者相匹配。所有患者和放射线照片均由一位医生在最近的随访中独立评估。结果。根据患者年龄、症状持续时间和手术前脊髓病的严重程度（Nurick 分级），队列进行了良好匹配。平均独立随访时间相似（25.5 个月和 26.2 个月）。在椎板成形术队列中，患者功能（努里克评分）的客观改善和报告力量、灵巧性、感觉、疼痛和步态主观改善的患者数量往往更多。虽然椎板成形术队列中没有出现并发症，但接受椎板切除术融合的 9 名患者出现了 14 例并发症。并发症包括脊髓病的进展、骨不连、器械故障、出现明显的后凸排列、持续的骨移植采集部位疼痛、需要再次手术的下方退化以及深度感染。结论。这些匹配队列之间在并发症和功能改善方面的显着差异表明，作为多节段脊髓型颈椎病的后路手术，椎板成形术可能优于椎板切除术并融合。
Study Design. A matched cohort clinical and radiographic retrospective analysis of laminoplasty and laminectomy with fusion for the treatment of multilevel cervical myelopathy.Objectives. To compare the clinical and radiographic outcomes of two procedures increasingly used to treat multilevel cervical myelopathy.Summary of Background Data. Traditional methods of treating multilevel cervical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two techniques has not been reported.Methods. Medical records of all patients treated for multilevel cervical myelopathy with either laminoplasty or laminectomy with fusion between 1994 and 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent laminoplasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician.Results. Cohorts were well matched based on patient age, duration of symptoms, and severity of myelopathy (Nurick grade) before surgery. Mean independent follow-up was similar (25.5 and 26.2 months). Both objective improvement in patient function (Nurick score) and the number of patients reporting subjective improvement in strength, dexterity, sensation, pain, and gait tended to be greater in the laminoplasty cohort. Whereas no complications occurred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included progression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, subjacent degeneration requiring reoperation, and deep infection.Conclusions. The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.