Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty
Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty
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DOI：
10.1097/brs.0b013e318178e607
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发表时间：
2008-06-15
期刊：
影响因子：
3
通讯作者：
Matsuda, Hideki
中科院分区：
文献类型：
--
作者：
Kato, Minori;Nakamura, Hiroaki;Matsuda, Hideki
研究设计.一项回顾性临床研究。评价选择性椎板成形术中保留附着于C2或C7棘突的椎旁肌对术后轴性疼痛的影响。已经报道了几种改良椎板成形术的方法，例如选择性减压和/或重建分离的椎旁肌。然而，目前还不清楚哪些后肌需要保留以减少术后问题。研究组包括145例接受颈椎椎板成形术的患者。根据术前颈椎磁共振成像确定减压水平。棘突肌肉脱离的平面从颅侧至减压平面，从尾侧至减压平面。根据日本骨科协会（乔亚）评分的改善率评价临床结局。此外，对术后轴性疼痛的危险因素进行多因素Logistic回归分析。113例C2椎旁肌分离，C3椎板抬高，乔亚评分改善率为56.0%。32例保留肌肉，无C3椎板抬高，保留率为54.8%。在112例患者中，C7椎旁肌分离，C7椎板抬高，在33例患者中保留肌肉;这两组的乔亚评分改善率分别为56.7%和52.4%。各组间临床结局无显著差异。年龄较大（优势比：保留C2棘突附着肌（OR：0.13，95%CI：0.02-0.98）可降低术后轴性疼痛的风险。保留肌肉的选择性椎板成形术在颈椎压迫性脊髓病中的临床结局等同于传统的C3-C7椎板成形术。保留C2处附着的肌肉可减少术后轴性疼痛。
Study Design. A retrospective clinical study.Objective. To evaluate the effect of preservation of paraspinal muscles attached at the spinous process of C2 or C7 in selective laminoplasty on postoperative axial pain.Summary of Background Data. Several methods of modified laminoplasty such as selective decompression and/or reconstruction of detached paraspinal muscles have been reported. It is still unclear, however, which posterior muscles need to be preserved to reduce postoperative problems.Methods. The study group consisted of 145 patients who underwent cervical laminoplasty. The level of decompression was decided based on preoperative cervical magnetic resonance imaging. The level of detachment of muscle from the spinous process was from 1 cranial to the decompression level and to the same level caudal to the level of decompression. Clinical outcome was evaluated based on improvement ratio of Japanese Orthopedic Association (JOA) score. In addition, the risk factors for postoperative axial pain were examined by multivariate logistic regression analysis.Results. In 113 patients, C2 paraspinal muscles were detached, with elevation of the C3 lamina, and the improvement ratio of JOA score was 56.0%. In 32 patients, the muscles were preserved, without elevation of the C3 lamina, with corresponding ratio of 54.8%. In 112 patients, C7 paraspinal muscles were detached, with elevation of the C7 lamina, and in 33 patients the muscles were preserved; the improvement ratios of JOA score for these groups were 56.7% and 52.4%, respectively. There were no significant differences in clinical outcome among the groups. Older age (odds ratios: 0.17, 95% confidence intervals: 0.04-0.72) and preservation of muscles attached at the C2 spinous process (OR: 0.13, 95% CI: 0.02-0.98) decreased the risk of postoperative axial pain.Conclusion. Muscle-preserving selective laminoplasty yielded clinical outcomes equivalent to those of conventional C3-C7 laminoplasty in cervical compression myelopathy. Preservation of the muscles attached at C2 resulted in reduction of postoperative axial pain.