Long-term results of double-door laminoplasty for cervical stenotic myelopathy
Long-term results of double-door laminoplasty for cervical stenotic myelopathy
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DOI：
10.1097/00007632-200103010-00010
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发表时间：
2001-03-01
期刊：
影响因子：
3
通讯作者：
Nakamura, K
中科院分区：
文献类型：
--
作者：
Seichi, A;Takeshita, K;Nakamura, K
研究设计：回顾性研究了双开门椎板成形术（Kurokawa方法）治疗后纵韧带骨化和颈椎病引起的脊髓病患者的长期结果。了解双开门椎板成形术的短期疗效是否能维持10年以上，如果不能维持，晚期恶化的原因。关于椎管成形术治疗颈椎狭窄性脊髓病的长期随访研究很少。在这项研究中，35例颈椎后纵韧带骨化引起的脊髓型颈椎病和25例脊髓型颈椎病患者，包括5例手足徐动型脑瘫患者，从1980年至1988年接受了双开门椎板成形术，并随访了10年。后纵韧带骨化患者的平均随访时间为153个月（范围，120-200个月），脊髓型颈椎病患者的平均随访时间为156个月（范围，121-218个月）。使用日本骨科协会提出的评分系统（乔亚评分）评估手术前后的神经功能缺损。晚期恶化的患者接受进一步检查，包括颈椎计算机断层扫描和磁共振成像;结果。在32例后纵韧带骨化症患者和23例脊髓型颈椎病患者中，脊髓病在手术后得到改善。在26例后纵韧带骨化患者和21例脊髓型颈椎病患者中，日本骨科协会评分的改善一直保持到最终随访评估。10例后纵韧带骨化患者术后平均8年出现晚期神经功能恶化，4例脊髓型颈椎病患者术后平均11年出现晚期神经功能恶化，其中包括3例手足徐动样脑瘫患者。后纵韧带骨化症患者病情恶化的主要原因是后纵韧带骨化症引起的颈髓残留压迫和胸椎黄韧带骨化引起的胸椎脊髓病患者的轻微创伤。颈椎狭窄性脊髓病椎板成形术的短期结果在78%的后纵韧带骨化患者和大多数脊髓型颈椎病患者中维持了10年以上，手足徐动样脑瘫患者除外。双开门椎板成形术是治疗颈椎管狭窄症的可靠方法。
Study Design, A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed.Objective. To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration.Summary of Background Data. There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy.Methods. In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine;Results. In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine.Conclusions. The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10 years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopthy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.