Factors Negatively Influencing Postoperative Improvement After Laminoplasty in Degenerative Cervical Myelopathy

医学 椎板成形术 脊髓病 外科 骨科手术 禁忌症 单变量分析 生活质量(医疗保健) 回顾性队列研究 多元分析 内科学 替代医学 护理部 病理 精神科 脊髓
作者
Hiroyuki Inose,Toshitaka Yoshii,Atsushi Kimura,Katsushi Takeshita,Hirokazu Inoue,Asato Maekawa,Kenji Endo,Takeo Furuya,Akira Nakamura,Kanji Mori,Shunsuke Kanbara,Shiro Imagama,Shoji Seki,Shunji Matsunaga,Atsushi Okawa
出处
期刊:Clinical spine surgery [Ovid Technologies (Wolters Kluwer)]
卷期号:35 (1): E230-E235 被引量:7
标识
DOI:10.1097/bsd.0000000000001207
摘要

This was a retrospective study of prospectively collected data.In this study, we aimed to characterize a population of patients with degenerative cervical myelopathy (DCM) and a history of poor postoperative neurological recovery and to identify risk factors associated with poor neurological recovery after laminoplasty.Kyphotic cervical alignment has been considered a relative contraindication to laminoplasty in recent years; hence, laminoplasty has been decreasingly performed for the treatment of DCM in patients with cervical kyphosis. However, the effect of global spinal alignment on postoperative outcomes has not been extensively investigated.We prospectively enrolled patients who were scheduled for laminoplasty for DCM. Outcome (at enrollment and 1 y after surgery) and risk factor analyses were performed by comparing the good recovery and poor recovery groups. The Spearman correlation coefficient was used to evaluate the relationships between the recovery rate and the preoperative radiographic factors.In total, 101 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life-5 Dimensions, and Neck Disability Index scores improved postoperatively. The recovery rate was significantly correlated with the preoperative sagittal vertical axis (SVA). The patients in the poor recovery group were older than those in the good recovery group. Univariate analyses showed that the SVA and T1 pelvic angle were significantly higher in the poor recovery group. Lastly, stepwise logistic regression analysis showed that a higher SVA was an independent predictor of poor recovery after laminoplasty.The SVA and T1 pelvic angle were significantly higher in the poor recovery group. A high preoperative SVA is an independent predictor for poor recovery after laminoplasty. Therefore, indications for laminoplasty in elderly DCM patients with a high preoperative SVA should be carefully considered.Level III.

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