Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies
Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies
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DOI：
10.1016/j.spinee.2016.08.019
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发表时间：
2017-01-01
期刊：
影响因子：
4.5
通讯作者：
Kopjar, Branko
中科院分区：
文献类型：
--
作者：
Fehlings, Michael G.;Santaguida, Carlo;Kopjar, Branko
背景情况：对于因退行性颈椎病（DCM）接受后路减压的患者，颈椎椎板成形术（LP）是否优于颈椎椎板切除融合术（LF）仍不清楚。目得：本研究的目的是比较LP和LF的结果。研究设计/设置：这是一项多中心的国际前瞻性队列研究。患者样本：共266例手术治疗的症状性DCM患者接受了LP（N=100）或LF（N=166）的颈椎减压术。结局指标：结果指标为改良的日本骨科协会评分（mJOA）、Nurick分级、颈部残疾指数（NDI）、简表36 v2（SF 36 v2）、住院时间，在重症监护室的停留时间、治疗并发症和再次手术。方法：采用方差分析和协方差分析对LP组和LF组之间的结局差异进行分析。所有分析中的因变量是基线和24个月随访之间的变化评分，自变量是手术操作（LP或LF）。在协方差分析中，队列之间的结果进行了比较，同时调整性别，年龄，吸烟，手术水平，症状持续时间，地理区域和基线scores.Results：有没有年龄，性别，吸烟状况，手术水平，基线Nurick，NDI和SF 36 v2评分之间的LP和LF组的数量没有差异。LP组的术前mJOA低于LF组（分别为11.52 +/- 2.77和12.30 +/- 2.85，p= 0.0297）。术后24个月，两组患者的mJOA、Nurick分级、NDI和SF 36 v2身心健康评分均显著改善（p
BACKGROUND CONTEXT: It remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM). PURPOSE: The objective of this study is to compare outcomes of LP and LF.STUDY DESIGN/SETTING: This is a multicenter international prospective cohort study.PATIENT SAMPLE: A total of 266 surgically treated symptomatic DCM patients undergoing cervical decompression using LP (N=100) or LF (N=166) were included.OUTCOME MEASURES: The outcome measures were the modified Japanese Orthopaedic Association score (mJOA), Nurick grade, Neck Disability Index (NDI), Short-Form 36v2 (SF36v2), length of hospital stay, length of stay in the intensive care unit, treatment complications, and reoperations. METHODS: Differences in outcomes between the LP and LF groups were analyzed by analysis of variance and analysis of covariance. The dependent variable in all analyseswas the change score between baseline and 24-month follow-up, and the independent variable was surgical procedure (LP or LF). In the analysis of covariance, outcomes were compared between cohorts while adjusting for gender, age, smoking, number of operative levels, duration of symptoms, geographic region, and baseline scores.RESULTS: There were no differences in age, gender, smoking status, number of operated levels, and baseline Nurick, NDI, and SF36v2 scores between the LP and LF groups. Preoperative mJOA was lower in the LP compared with the LF group (11.52 +/- 2.77 and 12.30 +/- 2.85, respectively, p=.0297). Patients in both groups showed significant improvements in mJOA, Nurick grade, NDI, and SF36v2 physical and mental health component scores 24 months after surgery (p