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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (11) : 1066 -1069. doi: 10.3877/cma.j.issn.1674-0785.2024.11.014

综述

颈椎椎板成形术对脊柱矢状位平衡的影响
唐冲1,2, 周非非1, 李危石1,()   
  1. 1.100191 北京,北京大学第三医院骨科
    2.100144 北京,北京大学首钢医院骨科
  • 收稿日期:2024-10-02 出版日期:2024-11-15
  • 通信作者: 李危石

Effect of cervical laminoplasty on spinal sagittal balance

Chong Tang1,2, Feifei Zhou1, Weishi Li1,()   

  1. 1.Department of Orthopedics, Peking University Third Hospital, Beijing 100089, China
    2.Department of Orthopedics, Peking University Shougang Hospital, Beijing 100144, China
  • Received:2024-10-02 Published:2024-11-15
  • Corresponding author: Weishi Li
引用本文:

唐冲, 周非非, 李危石. 颈椎椎板成形术对脊柱矢状位平衡的影响[J/OL]. 中华临床医师杂志(电子版), 2024, 18(11): 1066-1069.

Chong Tang, Feifei Zhou, Weishi Li. Effect of cervical laminoplasty on spinal sagittal balance[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(11): 1066-1069.

颈椎椎板成形术通过扩大骨性椎管的面积,增加椎管的有效空间,使颈脊髓向后漂移,从而实现对颈脊髓的间接减压,缓解临床症状。这是一种常用的治疗多节段脊髓型颈椎病和颈椎后纵韧带骨化症的手术方式。经过近半个世纪的发展,颈椎椎板成形术已经演变出多种改良术式,且手术疗效得到了肯定,远期效果令人满意。然而,该手术需要部分剥离颈椎后方的椎旁肌,破坏颈椎的骨性结构及棘突-肌肉-韧带复合体,导致颈椎后柱结构在传递和分担荷载方面的功能部分丧失,难以维持术后颈椎的新矢状位平衡,从而为了减少颈部后方肌群的负荷消耗,颈椎重心前移,加速了颈椎局部力学失衡。本综述重点总结了颈椎椎板成形术对颈椎矢状位平衡的影响及其一系列代偿机制,并展望了该手术对全脊柱及脊柱-骨盆矢状位平衡影响及代偿机制研究的前景,为今后的临床治疗方案选择提供理论依据。

Cervical laminoplasty can make the cervical spinal cord drift backward by expanding the area of the bony spinal canal and increasing the effective space of the spinal canal, so as to achieve indirect decompression of the cervical spinal cord and relieve the clinical symptoms. It is a common surgical procedure for the treatment of multilevel cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament. After nearly half a century of development, there has been a variety of improved cervical laminoplasty methods, resulting in positive surgical outcomes and satisfactory long-term results. However, cervical laminoplasty requires partial dissection of the cervical paraspinal muscles, which destroys the cervical bone structure and spinous process-muscle-ligament complex, resulting in partial loss of the function of the posterior column of the cervical spine to transfer and share load. It is difficult to maintain the new cervical sagittal balance after laminoplasty. In order to reduce the load consumption of the posterior cervical muscles, the gravity of the cervical spine moves forward, which accelerates the local cervical sagittal imbalance. This review focuses on the effects of cervical laminoplasty on cervical sagittal alignment and the subsequent compensatory mechanisms, and discusses the prospects for research on the effects of cervical laminoplasty on the whole spine and spinal-pelvic sagittal balance and relevant compensatory mechanisms,with an aim to provide a theoretical basis for the clinical treatment decision in the future.

1
Hale JJ, Gruson KI, Spivak JM. Laminoplasty: a review of its role in compressive cervical myelopathy [J]. Spine J, 2006, 6(6 Suppl):289S-298S.
2
Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive opendoor laminoplasty for cervical myelopathy--average 14-year follow-up study [J]. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
3
Seichi A, Takeshita K, Ohishi I, et al. Long-term results of doubledoor laminoplasty for cervical stenotic myelopathy [J]. Spine (Phila Pa 1976), 2001, 26(5): 479-487.
4
Miyazaki K, Kirita Y. Extensive simultaneous multisegment laminectomy for myelopathy due to the ossification of the posterior longitudinal ligament in the cervical region [J]. Spine (Phila Pa 1976),1986, 11(6): 531-542.
5
Oyama M, Hattori S, Moriwaki N. A new method of cervical laminoplasty [J]. Centr Jpn J Orthop Traumatic Surg, 1973, 16: 792-794.
6
Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy [J]. Spine (Phila Pa 1976), 1983, 8(7): 693-639.
7
Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty [J]. Spine (Phila Pa 1976), 1988,13(7): 870-876.
8
Lee TT, Green BA, Gromelski EB. Safety and stability of open-door cervical expansive laminoplasty [J]. J Spinal Disord, 1998, 11(1):12-15.
9
Itoh T, Tsuji H. Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine [J]. Spine (Phila Pa 1976), 1985, 10(8): 729-736.
10
Wang JM, Roh KJ, Kim DJ, et al. A new method of stabilising the elevated laminae in open-door laminoplasty using an anchor system [J].J Bone Joint Surg Br, 1998, 80(6): 1005-1008.
11
O’Brien MF, Peterson D, Casey AT, et al. A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis [J].Spine (Phila Pa 1976), 1996, 21(4): 474-83.
12
Park AE, Heller JG. Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion--surgical technique [J]. J Spinal Disord Tech, 2004, 17(4): 265-271.
13
Kurokawa T. Enlargement of the spinal canal by the sagittal splitting of spinous processes [J]. Bessatsu Seikeigeka, 1982, 2: 249-52.
14
Haddas R, Satin A, Lieberman I. What is actually happening inside the “cone of economy”: compensatory mechanisms during a dynamic balance test [J]. Eur Spine J, 2020, 29(9): 2319-2328.
15
Louis R. Spinal stability as defined by the three-column spine concept[J]. Anat Clin, 1985, 7(1): 33-42.
16
Pal GP, Sherk HH. The vertical stability of the cervical spine [J]. Spine(Phila Pa 1976), 1988, 13(5): 447-449.
17
Ling FP, Chevillotte T, Leglise A, et al. Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review [J].Eur Spine J, 2018, 27(Suppl 1): 8-15.
18
林圣荣, 周非非, 孙宇, 等. 颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化 [J]. 中华医学杂志, 2014, 94(35): 2726-2730.
19
Mun HW, Yuk CD, Kim TH, et al. Cervical sagittal imbalance after cervical laminoplasty in elderly patients [J]. Biomed Res Int, 2020,2020: 8810540.
20
Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2012,71(3):662-669.
21
Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults [J]. J Spinal Disord Tech, 2012, 25(2): E41-7.
22
Sakai K, Yoshii T, Hirai T, et al. Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty [J]. Eur Spine J, 2017,26(1): 104-112.
23
Abelin-Genevois K. Sagittal balance of the spine [J]. Orthop Traumatol Surg Res, 2021, 107(1S): 102769.
24
Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine [J]. Spine J, 2010,10(11): 994-998.
25
Kim TH, Lee SY, Kim YC, et al. T1 slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy [J]. Spine (Phila Pa 1976), 2013, 38(16): E992-7.
26
Lin BJ, Hong KT, Lin C, et al. Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty [J]. Medicine (Baltimore), 2018, 97(45):e13111.
27
Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis [J]. J Spinal Disord Tech, 2007, 20(8): 571-576.
28
Kotani Y, Abumi K, Ito M, et al. Impact of deep extensor musclepreserving approach on clinical outcome of laminoplasty for cervical spondylotic myelopathy: comparative cohort study [J]. Eur Spine J,2012, 21(8): 1536-1544.
29
Sun Y, Zhang F, Wang S, et al. Open door expansive laminoplasty and postoperative axial symptoms: a comparative study between two different procedures [J]. Evid Based Spine Care J, 2010, 1(3): 27-33.
30
周非非, 孙宇. 颈后路保留一侧肌肉韧带复合体单开门椎管扩大椎板成形术 [J]. 中国脊柱脊髓杂志, 2020, 30(3): 278-281.
31
周帅, 周非非, 赵衍斌, 等. 颈后路经肌间隙入路"升顶式"椎管扩大椎板成形术后早期颈椎矢状面平衡的变化 [J]. 中国脊柱脊髓杂志, 2021, 31(12): 1121-1128.
32
Zhou S, Xu F, Wang W, et al. Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters [J]. Eur Spine J, 2020,29(3): 396-404.
33
Tang Y, Zhao W, Liu X, et al. Normative values of cervical sagittal alignment according to global spine balance: based on 126 asymptomatic Chinese young adults [J]. Eur Spine J, 2021, 30(9):2427-2433.
34
Smith JS, Shaffrey CI, Lafage V, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy [J]. J Neurosurg Spine, 2012, 17(4):300-307.
35
Lafage R, Smith JS, Sheikh Alshabab B, et al. When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery [J]. J Neurosurg Spine, 2022, 36(4): 616-623.
36
Kim JH, Park JY, Yi S, et al. Anterior cervical discectomy and fusion alters whole-spine sagittal alignment [J]. Yonsei Med J, 2015, 56(4):1060-1070.
37
肖士鹏, 徐帅, 李士春, 等. T1 倾斜角-颈椎前凸角(T1S-CL)在三节段颈椎前路椎间盘切除融合术中的意义 [J/OL]. 中华临床医师杂志(电子版), 2022, 16(6): 558-565.
38
Ames CP, Blondel B, Scheer JK, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy [J]. Spine (Phila Pa 1976), 2013,38(22 Suppl 1): S149-60.
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