RADIOGRAPHIC EVOLUTION AND CERVICAL SAGITAL BALANCE OF LAMINOPLASTY VERSUS LAMINECTOMY IN PATIENTS WITH CERVICAL SPONDYLOTIC MYELOPATHY

ABSTRACT Objective To compare radiographic findings of patients who underwent laminoplasty and laminectomy with arthrodesis for spondylotic cervical myelopathy. Methods Who were submitted to laminectomy with arthrodesis or laminoplasty to treat cervical spondylotic myelopathy with minimum follow-up of 6 months. The radiographic parameters related to the cervical spine evaluated were C0C2 lordosis (C0C2), cervical lordosis (CL), T1 slope (T1S), thoracic inlet angle (TIA), neck tilt (NT), cervical sagittal vertical axis (CSVA), and T1S – CL mismatch (T1S-CL). Results We evaluated 34 patients, 23 (68%) of whom were men. The mean age was 65 years (SD ± 13). There was no statistical difference in any of the preoperative radiographic parameters. Considering the patients submitted to laminectomy alone, a significant difference was observed for C0C2 (P = 0.045), CSVA (P = 0.0008), with differences between IPO and POS times (P = 0.026) and between PRE and POS (P = 0.0013) and T1S – CL mismatch (P = 0.0004), with a difference between IPO and POS (P = 0.0076) and between PRE and POS (P=0.001). Considering the patients submitted to laminoplasty alone, there was no difference over time for any radiographic parameters considered. Comparing the radiographic parameters between the laminectomy and laminoplasty groups in the three time periods, there was no significant difference for any of them. Conclusion This study suggests that patients with cervical spondylotic myelopathy who underwent laminectomy with instrumentation may present worse radiographic evolution as regards cervical sagittal alignment over time when compared to patients who underwent laminoplasty. Level of evidence III; Retrospective case series.

摘要
目的：对比接受椎板切除融合术（laminectomy with arthrodesis）与椎管成形术（laminoplasty）治疗脊髓型颈椎病（spondylotic cervical myelopathy）患者的影像学表现。
方法：纳入因脊髓型颈椎病接受椎板切除融合术或椎管成形术，且随访时长至少6个月的患者。本研究评估的颈椎相关影像学参数包括：C0-C2前凸角（C0C2 lordosis, C0C2）、颈椎前凸角（cervical lordosis, CL）、T1倾斜角（T1 slope, T1S）、胸廓入口角（thoracic inlet angle, TIA）、颈倾斜角（neck tilt, NT）、颈椎矢状垂直轴（cervical sagittal vertical axis, CSVA）以及T1S-CL失配（T1S – CL mismatch, T1S-CL）。
结果：共纳入34例患者，其中23例为男性（占比68%），平均年龄65岁（标准差±13）。术前所有影像学参数均无统计学差异。仅接受椎板切除融合术的患者中，C0C2（P=0.045）、颈椎矢状垂直轴（CSVA，P=0.0008）存在显著差异，且术中即刻与术后即刻参数间存在差异（P=0.026），术前与术后即刻参数间亦存在差异（P=0.0013）；同时T1S-CL失配（P=0.0004）也存在显著差异，术中即刻与术后即刻参数间差异显著（P=0.0076），术前与术后即刻参数间差异同样显著（P=0.001）。仅接受椎管成形术的患者中，所有纳入的影像学参数随时间推移均无显著差异。在术前、术中即刻、术后即刻三个时间点对两组患者的影像学参数进行比较，所有参数均未发现显著差异。
结论：本研究表明，与接受椎管成形术的脊髓型颈椎病患者相比，接受椎板切除融合术的患者术后颈椎矢状位序列的影像学演变情况更差。
证据等级：Ⅲ级；回顾性病例系列。