Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis.
Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis.
复制标题
微创选择性椎板切除术治疗脊髓型颈椎病对退行性脊柱滑脱的影响。
DOI：
10.1097/bsd.0000000000001161
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发表时间：
2022
期刊：
影响因子：
1.9
通讯作者：
Yamashita T.
中科院分区：
文献类型：
--
作者：
Kurihara K;Iba K;Teramoto A;Emori M;Hirota R;Oshigiri T;Ogon I;Iesat N;Terashima T;Takashima H;Yoshimoto M;Takebayashi T;Yamashita T.
研究设计：回顾性分析前瞻性收集的观察数据。目的：本研究旨在评估患有脊髓型颈椎病（CSM）伴退行性脊椎前移（DS）的患者在选择性椎板切除术（SL）后的滑脱、矢状面对准和活动范围（ROM）。背景资料概要：已报道了腰椎DS减压和融合手术的临床结果。材料与方法：本研究包括178例颈椎滑脱患者，均行SL治疗。后纵韧带骨化者除外。滑脱> 2 mm定义为脊椎前移，脊椎前移进展定义为中性X线片上额外位移> 2 mm。术前和术后≥ 2年检查滑脱、平移运动、C2-C7角、局部脊柱后凸和ROM。影像学参数进行了评价，根据滑动方向和椎板removed.Results的数量：DS观察29例（16.3%），24例，其中9和15的前滑脱组和后滑脱组，分别成功地随访了2年以上。无论椎板切除数量如何，两组术前和术后的滑脱、平移运动、C2-C7角、局部后凸和ROM的影像学变化均不显著。任何一组患者均不需要因DS进展和对线恶化而进行翻修手术。结论：SL不影响DS、矢状面对线或ROM，无论滑脱方向和椎板切除数量如何，即使术后2年以上也不影响。考虑到保留后元素，SL可能是一种有效的治疗CSM与DS。证据等级：IV级。脊髓型颈椎病（CSM）可能会导致脊髓压迫引起的各种病理，如肥大的黄韧带，椎间盘退变，关节突关节。此外，颈椎退行性滑脱（DS）是导致CSM的重要因素，因为骨性椎管的矢状径减小。1，2研究报告宫颈DS的总体患病率范围为5.2%-11%，3，4，在18.9%的症状性患者中观察到。5
Study Design:Retrospective analysis of prospectively collected observational data.Objective:This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS).Summary of Background Data:Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis.Materials and Methods:This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage> 2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement> 2 mm on a neutral radiograph. The slippage, translational motion, C2–C7 angle, local kyphosis, and ROM were examined before and≥ 2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed.Results:DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2–C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group.Conclusions:SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after> 2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS.Level of Evidence:Level IV.Cervical spondylotic myelopathy (CSM) may result from spinal cord compression caused by various pathologies, such as the hypertrophy of the ligamentum flavum, disc degeneration, and arthrosis of the facet joints. Furthermore, cervical degenerative spondylolisthesis (DS) is an important factor that causes CSM because the sagittal diameter of the osseous spinal canal is reduced. 1, 2 Studies report the overall prevalence of cervical DS to range between 5.2% and 11%, 3, 4 and it is observed in 18.9% of symptomatic patients. 5