2015 年 29 巻 3 号 p. 315-322
Object : We examined 50 cases of cervical spondylotic myelopathy with some instability and assessed outcomes of expansive laminoplasty and/or posterior decompression and fixation. We compared the outcomes of the operative treatments and examined operative indications and the problems in each operation.
Materials and Methods : We retrospectively evaluated 20 cases of expansive laminoplasty with ceramic spacers and 30 cases of one-stage posterior decompression and posterior lateral fixation (PDLF) with instrumentation, according to the Japanese Orthopedics Association (JOA) score for neurological symptoms. To assess the alignment changes and mobile range, the C2-7 Cobb angle and C2-7 sagittal vertical axis were investigated.
Results : The expansive laminoplasty cases showed 75% improvement in neurological symptoms and 50% improvement in the JOA score (recovery rate [RR]). One-stage PDLF cases demonstrated 93% improvement in neurological symptoms and 67.5% RR. The improvements in neurological symptoms and RR were higher in the one-stage PDLF cases than in the PD cases. The C2-7 Cobb angle was maintained in the one-stage PDLF cases. In the cases where fixation was performed three or more times, range of motion was decreased after surgery.
Conclusions : In the cases with spondylotic change in three or more levels and instability, additional fixation (one-stage PDLF) at the appropriate level improved the results. Decreased range of motion after fixation remains a problem, which causes complaints and induces new lesions at the adjacent level.
