Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy
Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy
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DOI：
10.1097/00007632-199802150-00006
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发表时间：
1998-02-15
期刊：
影响因子：
3
通讯作者：
Deburge, A
中科院分区：
文献类型：
--
作者：
Guigui, P;Benoist, M;Deburge, A
研究设计。对58例患者的X线平片和病历资料进行回顾性分析。目的：描述成人颈椎病所致脊髓病患者多节段椎板切除术后颈椎畸形和不稳的发生率和后果，并确定术前动态X线片在预防术后不稳定中的作用。广泛的颈椎椎板切除术已广泛应用于治疗继发于椎管狭窄的进行性脊髓病。该手术的并发症包括脊柱不稳加速椎弓峡部改变，术后脊柱畸形，硬膜外瘢痕组织形成造成的硬脑膜狭窄。然而，人们已经认识到，这些并发症的频率可能被高估了，而且它们对临床结果的影响尚不清楚。对58例年龄在30岁以上的脊髓型颈椎病患者进行了三个节段以上的椎板切除术，术后平均随访3.6年。根据日本骨科协会的评分系统对功能结果进行评估。分析中立位、屈曲和伸展位颈椎侧位X线片，并与最后一次随访相比较，以确定颈椎曲度、颈椎活动范围、椎间角活动度和椎体前后移位的变化，最终量化脊柱不稳的发生率。在18名患者(31%)中，术后颈椎曲度类型的变化有15名患者(25%)有一个或多个节段的不稳定。手术后发生的颈椎畸形似乎没有引起症状或神经异常，失稳需要再次手术3名患者。在术前动态X线片上，所有显示为不稳定的节段在术前动态X线片上均表现为高活动度。-术前无高活动度的滑脱不是术后不稳定的危险因素。术前动态X线片的使用：应该改善椎板切除术治疗多节段颈椎压迫的患者的选择。动态X线片也可能加强诸如融合和内固定等辅助程序的必要性，以防止术后不稳定。术前在矢状面或水平面活动过度的滑脱必须进行融合和内固定。
Study Design. A retrospective radiographic and medical record analysis of 58 patients.Objectives. To describe the incidence and consequences of cervical spinal deformity and instability after multilevel laminectomy in adult patients with myelopathy caused by cervical spondylosis and to determine the usefulness of preoperative dynamic roentgenographic films in the prevention of postoperative destabilization.Summary of Background Data. Extensive cervical laminectomy has been widely used in the treatment of progressive myelopathy secondary to stenotic conditions. Complications of this procedure, including spinal instability accelerated spondylotic changes, postoperative spinal deformity, and constriction of the dura mater by formation of extradural scar tissue formation have. been recognized, However, the frequency of these complications is probably overestimated, and their effect on clinical outcome remains unknown.Methods. Fifty-eight patients older than 30 years who underwent a laminectomy at more than three levels without fusion for myelopathy secondary to cervical spondylosis were reviewed retrospectively with an average follow-up of 3.6 years. Functional results were evaluated according to the Japanese Orthopaedic Association's scoring system. Lateral views in neutral position, in flexion, and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up films to identify the changes in the curvature of the cervical column, in the range of motion of the neck and in the intervertebral angular mobility and anteroposterior displacement of the vertebral bodies and finally to quantify the incidence of spinal instability.Results. In 18 patients (31%), postoperative changes in the type of cervical spine curvature developed fifteen patients (25%) had destabilization at one or more levels. Deformities of the cervical spine occurring after surgery do not appear to cause symptoms or neurologic abnormalities, Destabilization required repeat surgery in 3 patients. All the levels appearing to be destabilized on the postoperative films were hypermobile on the preoperative dynamic radiographs.-Preoperative olisthesis Without hypermobility is not, a factor of risk in postoperative destabilization.Conclusions. The use of preoperative dynamic radiographs:should improve the selection of patients undergoing laminectomy for the treatment of multilevel cervicord compression. Dynamic radiographs may also reinforce the need for such adjunctive procedures as fusion and instrumentation to prevent postoperative destabilization. Preoperative olisthesis with hypermobility in sagittal or horizontal planes must be fused and instrumented.