Life expectancy after cervical en bloc laminoplasty: Analysis of data following more than 20 years. Spine.
Life expectancy after cervical en bloc laminoplasty: Analysis of data following more than 20 years. Spine.
复制标题
宫颈整块椎管扩大成形术后的预期寿命：20 多年的数据分析。
DOI：
10.1097/brs.0000000000001843
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kimura T
中科院分区：
文献类型：
--
作者：
Kawaguchi Y;Nakano M;Yasuda T;Seki S;Hori T;Suzuki K;Makino H;Kimura T
研究设计。病例系列。目的：澄清以下问题颈椎板成形术后患者死亡的时间？死因是什么？神经功能障碍的严重程度是否与早期死亡有关？背景资料摘要。颈椎病患者的预期寿命尚不清楚。1981年至1994年间，216例患者接受了颈椎板成形术。对148名患者进行了20多年的随访。方法：对最后随访时死亡的患者，采用Kaplan-Meier图分析其生存率；比较颈椎病（CS）患者与后纵韧带骨化（OPLL）患者的结果。对死亡原因进行了评估。神经学评估采用日本骨科协会（JOA）设计的评分进行评分。比较死亡组（D组）和存活组（S组）患者的术前、术后评分。手术至死亡的平均时间为13.4±7.4年。CS患者与OPLL患者的生存率无差异。死亡原因以恶性肿瘤居多，其次为缺血性心脏病。D组术前JOA评分低于S组。结论CS和OPLL合并压迫性脊髓病行颈椎椎板成形术的患者预期寿命较长，平均寿命超过13年。CS患者和OPLL患者的预期寿命没有差异。神经功能缺陷并不直接影响预期寿命。证据水平：4尽管一项研究表明脊髓损伤（SCI）患者的预期寿命明显低于正常受试者，但脊髓病患者的预期寿命尚不清楚。预期寿命的长短取决于脊髓损伤的程度和等级。1 SCI患者容易出现并发症，如肺炎引起的败血症、尿路感染、压疮等。此外，他们的重要器官可能由于运动系统的不活动而功能障碍。由颈椎病（CS）和后纵韧带骨化（OPLL）引起的颈椎病通常是脊髓的慢性功能障碍。先前的一篇文章表明，重度颈脊髓病患者的累积生存率低于轻度或中度脊髓病患者。在我们最近的研究中，我们分析了整体颈椎板成形术在20多年的随访中的手术效果。这些存活患者和死亡患者的数据可以应用于当前的分析。本研究通过对颈椎椎板成形术后存活患者和死亡患者的比较数据，阐明以下几点：颈椎椎板成形术后存活时间、死亡原因以及神经功能障碍严重程度与早期死亡的关系。材料与方法1981年至1994年间，我校医院共216例患者行颈椎椎板成形术治疗CS或OPLL所致的颈椎压缩性脊髓病。临床诊断基于体格检查、x线平片、计算机断层扫描、脊髓造影和磁共振成像。本研究仅使用CS或…
Study Design.Case series.Objective.To clarify the following questions How long after cervical laminoplasty did the patients die? What were the causes of the death? Was the severity of the neurological dysfunction related to early death?Summary of Background Data.Life expectancy in patients with cervical myelopathy is unclear. Cervical laminoplasty was performed in 216 patients between 1981 and 1994. It was possible to follow 148 patients for more than 20 years. We used the data of the 68 survivors and the 80 patients had already died.Methods.As for the patients who died by the final follow-up, the survival rate was analyzed by a Kaplan-Meier plot; the results were compared between the patients with cervical spondylosis (CS) and the patients with ossification of the posterior longitudinal ligament (OPLL). The causes of the death were assessed. The neurological evaluation was graded using the score devised by the Japanese Orthopaedic Association (JOA). The pre-and postoperative scores were compared between the patients in the died group (D group) and the surviving patients group (S group).Results.The mean period from surgery to death was 13.4±7.4 years. There was no difference in the survival rate between patients with CS and patients with OPLL. The most frequent cause of death was malignant tumor followed by ischemic heart disease. Preoperative JOA score in the D group was lower than that in the S group. There was no statistical difference in postoperative JOA score between the two groups.Conclusion.The patients who underwent cervical laminoplasty caused by compression myelopathy due to CS and OPLL had a long life expectancy, averaging more than 13 years. Life expectancy did not differ between patients with CS and patients with OPLL. Neurological deficit did not directly affect the life expectancy.Level of Evidence: 4The life expectancy in patients with cervical myelopathy remains unclarified, despite a study which has shown that the life expectancy in patients with spinal cord injury (SCI) is significantly lower than that in normal subjects. 1 The length of life expectancy depends on the level and grade of SCI. 1 Patients with SCI tend to have complications, such as septicemia due to pneumonia, urinary tract infection, and pressure sores. In addition, their vital organs may dysfunction due to inactivity of the motor system. Cervical myelopathy caused by cervical spondylosis (CS) and ossification of the posterior longitudinal ligament (OPLL) is generally a chronic dysfunction of the spinal cord. A previous article has demonstrated that the cumulative survival rate of patients with severe cervical myelopathy is less than that in patients with slight or moderate myelopathy. 2 In our recent study, we analyzed the surgical outcomes of en bloc cervical laminoplasty in a follow-up of more than 20 years. 3 These data on the surviving patients and the patients who died could be applied to the current analysis. The present study was undertaken to clarify the following points using the comparative data of surviving patients and patients who died after cervical laminoplasty: the length of survival after cervical laminoplasty, the cause of death, and the relation of the severity of neurological dysfunction and early death.MATERIALS AND METHODSFor the treatment of cervical compressive myelopathy due to CS or OPLL, 216 patients underwent en bloc cervical laminoplasty between 1981 and 1994 at our university hospital. The clinical diagnosis was made based on physical examination, plain radiography, computed tomography, myelography, and magnetic resonance imaging. The present study was carried out using data only from patients with CS or …