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Abstract：
OBJECTIVE: This study aimed to compare cervical sagittal parameters and clinical outcomes between patients undergoing cervical laminoplasty(CL) and those undergoing lateral mass screw fixation(LMS).
METHODS: We retrospectively studied 67 patients with multilevel ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent lateral mass screw fixation (LMS = 36) and cervical laminoplasty (CL = 31). We analyzed cervical sagittal parameters (C2-7 sagittal vertical axis (C2-7 SVA), C0-2 Cobb angle, C2-7 Cobb angle, C7 slope (C7s), T1 slope (T1s), and spino-cranial angle (SCA)) and clinical outcomes (visual analog scale [VAS], neck disability index [NDI], Japanese Orthopaedic Association [JOA] scores, recovery rate (RR), and minimum clinically significant difference [MCID]). The cervical sagittal parameters at the last follow-up were analyzed by binary logistic regression. Finally, we analyzed the correlation between the cervical sagittal parameters and each clinical outcome at the last follow-up after surgery in both groups.
RESULTS: At the follow-up after posterior decompression in both groups, the mean values of C2-C7 SVA, C7s, and T1s in the LMS group were more significant than those in the CL group (P ≤ 0.05). Compared with the preoperative period, C2-C7 SVA, T1s, and SCA gradually increased, and the C2-C7 Cobb angle gradually decreased after surgery (P < 0.05). The improvement in the JOA score and the recovery rate was similar between the two groups, while the improvement in the VAS-N score and NDI score was more significant in the CL group (P = 0.001; P = 0.043). More patients reached MCID in the CL group than in the LMS group (P = 0.036). Binary logistic regression analysis showed that SCA was independently associated with whether patients reached MCID at NDI postoperatively. SCA was positively correlated with cervical NDI and negatively correlated with cervical JOA score at postoperative follow-up in both groups (P < 0.05); C2-7 Cobb angle was negatively correlated with cervical JOA score at postoperative follow-up (P < 0.05).
CONCLUSIONS: CL may be superior to LMS in treating cervical spondylotic myelopathy caused by OPLL. In addition, smaller cervical SCA after posterior decompression may suggest better postoperative outcomes.
METHODS: We retrospectively studied 67 patients with multilevel ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent lateral mass screw fixation (LMS = 36) and cervical laminoplasty (CL = 31). We analyzed cervical sagittal parameters (C2-7 sagittal vertical axis (C2-7 SVA), C0-2 Cobb angle, C2-7 Cobb angle, C7 slope (C7s), T1 slope (T1s), and spino-cranial angle (SCA)) and clinical outcomes (visual analog scale [VAS], neck disability index [NDI], Japanese Orthopaedic Association [JOA] scores, recovery rate (RR), and minimum clinically significant difference [MCID]). The cervical sagittal parameters at the last follow-up were analyzed by binary logistic regression. Finally, we analyzed the correlation between the cervical sagittal parameters and each clinical outcome at the last follow-up after surgery in both groups.
RESULTS: At the follow-up after posterior decompression in both groups, the mean values of C2-C7 SVA, C7s, and T1s in the LMS group were more significant than those in the CL group (P ≤ 0.05). Compared with the preoperative period, C2-C7 SVA, T1s, and SCA gradually increased, and the C2-C7 Cobb angle gradually decreased after surgery (P < 0.05). The improvement in the JOA score and the recovery rate was similar between the two groups, while the improvement in the VAS-N score and NDI score was more significant in the CL group (P = 0.001; P = 0.043). More patients reached MCID in the CL group than in the LMS group (P = 0.036). Binary logistic regression analysis showed that SCA was independently associated with whether patients reached MCID at NDI postoperatively. SCA was positively correlated with cervical NDI and negatively correlated with cervical JOA score at postoperative follow-up in both groups (P < 0.05); C2-7 Cobb angle was negatively correlated with cervical JOA score at postoperative follow-up (P < 0.05).
CONCLUSIONS: CL may be superior to LMS in treating cervical spondylotic myelopathy caused by OPLL. In addition, smaller cervical SCA after posterior decompression may suggest better postoperative outcomes.
摘要：
目的：本研究旨在比较颈椎椎板成形术（CL）和侧块螺钉固定术（LMS）患者的颈椎矢状面参数和临床结果。
方法：我们回顾性研究了67例颈椎后纵韧带（OPLL）多节段骨化患者，这些患者接受了侧块螺钉固定（LMS=36）和颈椎椎板成形术（CL=31）。我们分析了颈椎矢状面参数（C2-7矢状面垂直轴（C2-7SVA），C0-2Cobb角,C2-7Cobb角,C7坡度(C7s),T1斜率(T1s),和脊柱-颅角（SCA））和临床结果（视觉模拟量表[VAS]，颈部残疾指数[NDI]，日本骨科协会[JOA]评分，回收率(RR)，和最小临床显著差异[MCID])。采用二元logistic回归分析末次随访时的宫颈矢状参数。最后,我们分析了两组术后末次随访时宫颈矢状参数与各项临床结局之间的相关性.
结果：两组患者后路减压术后随访，C2-C7SVA的平均值，C7s,LMS组T1s与CL组比较,差异有统计学意义(P≤0.05)。与术前相比，C2-C7SVA,T1,SCA逐渐增加，术后C2-C7Cobb角逐渐减小(P<0.05)。两组间JOA评分和恢复率的改善相似，而CL组VAS-N评分和NDI评分的改善更为显著(P=0.001;P=0.043)。CL组达到MCID的患者多于LMS组（P=0.036）。二元logistic回归分析显示，SCA与患者术后NDI是否达到MCID独立相关。两组患者术后随访时SCA与宫颈NDI呈正相关，与宫颈JOA评分呈负相关（P<0.05）；术后随访时C2-7Cobb角与宫颈JOA评分呈负相关（P<0.05）。
结论：CL治疗OPLL引起的脊髓型颈椎病可能优于LMS。此外,后路减压后宫颈SCA较小可能提示术后结局较好.
方法：我们回顾性研究了67例颈椎后纵韧带（OPLL）多节段骨化患者，这些患者接受了侧块螺钉固定（LMS=36）和颈椎椎板成形术（CL=31）。我们分析了颈椎矢状面参数（C2-7矢状面垂直轴（C2-7SVA），C0-2Cobb角,C2-7Cobb角,C7坡度(C7s),T1斜率(T1s),和脊柱-颅角（SCA））和临床结果（视觉模拟量表[VAS]，颈部残疾指数[NDI]，日本骨科协会[JOA]评分，回收率(RR)，和最小临床显著差异[MCID])。采用二元logistic回归分析末次随访时的宫颈矢状参数。最后,我们分析了两组术后末次随访时宫颈矢状参数与各项临床结局之间的相关性.
结果：两组患者后路减压术后随访，C2-C7SVA的平均值，C7s,LMS组T1s与CL组比较,差异有统计学意义(P≤0.05)。与术前相比，C2-C7SVA,T1,SCA逐渐增加，术后C2-C7Cobb角逐渐减小(P<0.05)。两组间JOA评分和恢复率的改善相似，而CL组VAS-N评分和NDI评分的改善更为显著(P=0.001;P=0.043)。CL组达到MCID的患者多于LMS组（P=0.036）。二元logistic回归分析显示，SCA与患者术后NDI是否达到MCID独立相关。两组患者术后随访时SCA与宫颈NDI呈正相关，与宫颈JOA评分呈负相关（P<0.05）；术后随访时C2-7Cobb角与宫颈JOA评分呈负相关（P<0.05）。
结论：CL治疗OPLL引起的脊髓型颈椎病可能优于LMS。此外,后路减压后宫颈SCA较小可能提示术后结局较好.
