今日の臨床サポート

頚椎症性脊髄症

著者: 木村敦 自治医科大学 整形外科

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2021/03/24
参考ガイドライン:
  1. 日本整形外科学会日本脊椎脊髄病学会:頚椎症性脊髄症診療ガイドライン2015 改訂第2版
  1. 頚椎症性脊髄症診療ガイドライン2020(改訂第3版)
  1. AO Spine North America and the Cervical Spine Research Society: A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy
患者向け説明資料

概要・推奨   

  1. 軽度および中等度の頚椎症性脊髄症に対する保存療法は症状の進行を遅らせる可能性があり、施行することを弱く推奨する(推奨度2)
  1. 重症および進行性の頚椎症性脊髄症には手術治療が推奨される(推奨度2)。
  1. 前方除圧固定術と後方除圧術の有用性の比較に関しては十分なエビデンスがなく、明確な推奨はできない。ただし後弯症例や前方の圧迫要素が大きな症例では前方法が、多椎間病変(主に3椎間以上)に対しては後方除圧術がより適している可能性があり、症例に応じた術式選択を行うことが重要である
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
木村敦 : 未申告[2021年]
監修:酒井昭典 : 講演料(旭化成ファーマ(株),第一三共(株),中外製薬(株)),奨学(奨励)寄付など(旭化成ファーマ(株),第一三共(株),中外製薬(株))[2021年]

改訂のポイント:
  1. 頚椎症性脊髄症診療ガイドライン2020(改訂第3版)に基づき、概要・推奨の修正を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 頚椎症とは、頚椎の椎間板変性、骨棘形成、椎間関節の変性、脊柱靭帯(後縦靭帯か黄色靭帯)の肥厚、さらにこれらの変化に伴って発生する頚椎不安定性など、頚椎の加齢現象により疼痛や神経症状が生じた状態である。
 
頚椎症の発生要因

図示した要因が頚椎症の実態であり、これらが脊髄障害を引き起こしたものが頚椎症性脊髄症である。

 
  1. 頚椎症によって、頚椎内の脊髄の通り道である脊柱管に狭小化が生じ、内部の脊髄組織が圧迫されることによって、四肢体幹のしびれ、筋力低下、膀胱直腸障害などの神経症状が発生した病態が「頚椎症性脊髄症」である。
  1. 日本人の頚椎手術対象疾患のなかで、最も手術頻度の高い疾患である。
  1. 疫学に関する質の高い論文がなく、わが国での有病者数は不明である。
  1. 頚部脊柱管の前後径が狭いことが発症の重要な素因である。
問診・診察のポイント  
問診:
  1. 発症時期、転倒など外傷の関与の有無を確認する。

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文献 

著者: Hirotaka Chikuda, Atsushi Seichi, Katsushi Takeshita, Naoki Shoda, Takashi Ono, Ko Matsudaira, Hiroshi Kawaguchi, Kozo Nakamura
雑誌名: Eur Spine J. 2010 Oct;19(10):1684-9. doi: 10.1007/s00586-010-1364-3. Epub 2010 Mar 13.
Abstract/Text A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with cervical myelopathy, focusing on those with increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI). The relationship between prevalence of the pyramidal signs and the severity of myelopathy was investigated. We reviewed the records of 275 patients with cervical myelopathy who underwent surgery. Of these, 143 patients were excluded from this study due to comorbidities that might complicate neurological findings. The MR images of the remaining 132 patients were evaluated in a blinded fashion. The neurological findings of 120 patients with ISI (90 men and 30 women; mean age 61 years) were reviewed for hyperreflexia (patellar tendon reflex), ankle clonus, Hoffmann reflex, and Babinski sign. To assess the severity of myelopathy, the motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopaedic Association (m-JOA score) were used. The most prevalent signs were hyperreflexia (94%), Hoffmann reflex (81%), Babinski sign (53%), and ankle clonus (35%). Babinski sign (P < 0.001), ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. Conversely, no association was found with the upper m-JOA score. In patients with cervical myelopathy, hyperreflexia showed the highest sensitivity followed by Hoffmann reflex, Babinski sign, and ankle clonus. The prevalence of the pyramidal signs correlated with increasing severity of myelopathy. Considering their low sensitivity in patients with mild disability, the pyramidal signs may have limited utility in early diagnosis of cervical myelopathy.

PMID 20229121  Eur Spine J. 2010 Oct;19(10):1684-9. doi: 10.1007/s0058・・・
著者: Atsushi Seichi, Katsushi Takeshita, Hiroshi Kawaguchi, Ko Matsudaira, Akiro Higashikawa, Naoshi Ogata, Kozo Nakamura
雑誌名: Spine (Phila Pa 1976). 2006 May 20;31(12):1338-43. doi: 10.1097/01.brs.0000219475.21126.6b.
Abstract/Text STUDY DESIGN: A cross-sectional analysis.
OBJECTIVE: To elucidate the accuracy of neurologic level diagnosis of cervical stenotic myelopathy.
SUMMARY OF BACKGROUND DATA: Neurologic level diagnosis in cervical myelopathy has not been well established.
METHODS: A total of 106 patients with cervical stenotic myelopathy, with a single-level intramedullary high-intensity area confirmed on both preoperative and postoperative T2-weighted magnetic resonance imaging (MRI), were included in this study. We performed a level diagnosis on the basis of neurologic signs (the uppermost muscle with weakness, diminished or exaggerated deep tendon reflex, the uppermost level of sensory disturbance of the upper extremities) and compared it with a level diagnosis made by T2-weighted MRI. The sensitivity, specificity, and accuracy of neurologic signs on our index corresponding to each intervertebral level were calculated.
RESULTS: The averages of sensitivity, specificity, and accuracy were 42%, 80%, and 70%, respectively, in the uppermost muscle with weakness, 66%, 89%, and 83% in deep tendon reflex, and 74%, 91%, and 87% in the sensory disturbance area. The positive and negative predictive values were 40% and 91%, respectively, in the uppermost muscle with weakness, 66% and 89% in deep tendon reflex, and 74% and 91% in the sensory disturbance area. Accuracy of a diagnosis based on muscle weakness was less high, the reason being that in many patients, the uppermost muscle with weakness was extensor digiti communis or the intrinsic muscles of the hands, and this led to a lower sensitivity.
CONCLUSIONS: The average accuracy of neurologic level diagnosis based on the index we proposed was > or =70%. The level diagnosis by a sensory disturbance area showed the highest accuracy (87%).

PMID 16721296  Spine (Phila Pa 1976). 2006 May 20;31(12):1338-43. doi:・・・
著者: Michael G Fehlings, Lindsay A Tetreault, K Daniel Riew, James W Middleton, Bizhan Aarabi, Paul M Arnold, Darrel S Brodke, Anthony S Burns, Simon Carette, Robert Chen, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, James S Harrop, Langston T Holly, Sukhvinder Kalsi-Ryan, Mark Kotter, Brian K Kwon, Allan R Martin, James Milligan, Hiroaki Nakashima, Narihito Nagoshi, John Rhee, Anoushka Singh, Andrea C Skelly, Sumeet Sodhi, Jefferson R Wilson, Albert Yee, Jeffrey C Wang
雑誌名: Global Spine J. 2017 Sep;7(3 Suppl):70S-83S. doi: 10.1177/2192568217701914. Epub 2017 Sep 5.
Abstract/Text Study Design: Guideline development.
Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy.
Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM).
Results: Our recommendations were as follows: (1) "We recommend surgical intervention for patients with moderate and severe DCM." (2) "We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve." (3) "We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically." (4) "Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above."
Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

PMID 29164035  Global Spine J. 2017 Sep;7(3 Suppl):70S-83S. doi: 10.11・・・
著者: K Yonenobu, K Abumi, K Nagata, E Taketomi, K Ueyama
雑誌名: Spine (Phila Pa 1976). 2001 Sep 1;26(17):1890-4; discussion 1895. doi: 10.1097/00007632-200109010-00014.
Abstract/Text STUDY DESIGN: The inter- and intraobserver reliabilities of an assessment scale for cervical compression myelopathy were examined statistically. This scoring system consists of seven categories: motor function of fingers, shoulder and elbow, and lower extremity; sensory function of upper extremity, trunk and lower extremity; and function of the bladder. It evaluates the severity of myelopathy by allocating points based on degree of dysfunction in each category.
OBJECTIVES: To determine the inter- and intraobserver reliabilities of the revised scoring system (17 - 2 points) for cervical compression myelopathy proposed by the Japanese Orthopedic Association.
SUMMARY OF BACKGROUND DATA: Several scales to assess clinical outcome from treatment of cervical compression myelopathy have been proposed. Most of these scales include items evaluated by observers. However, no system, including the Japanese Orthopedic Association scoring system, has yet been validated in terms of interobserver reliability.
METHODS: From five different university hospitals, 10 spine surgery specialists, 10 orthopedic surgeons who had just passed the board examination of the Japanese Orthopedic Association, and 13 residents in the first or second year of orthopedic residency programs were chosen. The participants in this study were 29 patients with myelopathy secondary to ossification of the posterior longitudinal ligament selected from five participating university hospitals. Several surgeons interviewed each patient twice at intervals of 1 to 6 weeks. Inter- and intraobserver reliabilities of the total score for all categories were evaluated by the intraclass correlation coefficient. The extension of the kappa coefficient of Kraemer also was calculated for each category to assess reliability of multivariate categorical data.
RESULTS: The interobserver reliability of the total score for the first interview (intraclass correlation coefficient = 0.813) and the intra- and interobserver reliabilities of the total score (intraclass correlation coefficient = 0.826) were high. The level of experience and the hospital slightly affected the reliability of the Japanese Orthopedic Association scoring system. The kappa values for intraobserver data generally were high in each category, whereas the kappa values for interobserver data were relatively low for the categories of shoulder-elbow motor function and lower extremity sensory function.
CONCLUSIONS: The inter- and intraobserver reliabilities of the Japanese Orthopedic Association scoring system for cervical myelopathy were high, suggesting that this system is useful for assessment of cervical myelopathy in comparative studies of treatment.

PMID 11568701  Spine (Phila Pa 1976). 2001 Sep 1;26(17):1890-4; discus・・・
著者: Yasushi Oshima, Atsushi Seichi, Katsushi Takeshita, Hirotaka Chikuda, Takashi Ono, Satoshi Baba, Jiro Morii, Hiroyuki Oka, Hiroshi Kawaguchi, Kozo Nakamura, Sakae Tanaka
雑誌名: Spine (Phila Pa 1976). 2012 Oct 15;37(22):1909-13. doi: 10.1097/BRS.0b013e318259a65b.
Abstract/Text STUDY DESIGN: A retrospective comparative study.
OBJECTIVE: To investigate natural course and prognostic factors in patients with mild forms of cervical spondylotic myelopathy (CSM), focusing on intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging.
SUMMARY OF BACKGROUND DATA: Long-term natural course of mild forms of CSM, especially with ISI on magnetic resonance imaging, remains uncertain.
METHODS: Patients with CSM who visited our institution between 1992 and 2004 and did not undergo surgery at first visit were retrospectively reviewed. The inclusion criteria were as follows: (1) motor function Japanese Orthopedic Association scores of 3 or more in both upper and lower extremities and (2) cervical spinal cord compression with ISI on T2-weighted magnetic resonance imaging. There were 45 patients, with a mean follow-up period of 78 months (range, 24-208). We investigated long-term natural history by setting the timing of conversion to surgery due to neurological deterioration as an end point. We further compared prognostic parameters between patients who converted to surgery and those who continued to be followed up nonsurgically.
RESULTS: Sixteen patients gradually deteriorated and underwent decompression surgery, whereas 27 patients did not. Apart from these, 2 patients with acute spinal cord injury after minor trauma underwent surgery. Kaplan-Meier survival analysis revealed that 82% or 56% of patients did not require surgery 5 or 10 years after the initial treatment, respectively. As for prognostic factors, Cox proportional hazard analysis revealed that total cervical range of motion (hazard ratio: 3.25), segmental kyphosis in the maximum compression segment (hazard ratio: 4.51), and local slip (hazard ratio: 4.67) were statistically significant.
CONCLUSION: Fifty-six percent of patients with clinically mild CSM with ISI had not deteriorated or undergone surgery at 10 years. Large range of motion, segmental kyphosis, and instability at the narrowest canal were considered to be adverse prognostic factors.

PMID 22511231  Spine (Phila Pa 1976). 2012 Oct 15;37(22):1909-13. doi:・・・
著者: Z Kadanka, J Bednarík, S Vohánka, O Vlach, L Stejskal, R Chaloupka, D Filipovicová, D Surelová, B Adamová, O Novotný, M Nemec, V Smrcka, I Urbánek
雑誌名: Eur Spine J. 2000 Dec;9(6):538-44.
Abstract/Text A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up.

PMID 11189924  Eur Spine J. 2000 Dec;9(6):538-44.
著者: A Seichi, K Takeshita, I Ohishi, H Kawaguchi, T Akune, Y Anamizu, T Kitagawa, K Nakamura
雑誌名: Spine (Phila Pa 1976). 2001 Mar 1;26(5):479-87.
Abstract/Text STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed.
OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration.
SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy.
METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine.
RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine.
CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.

PMID 11242374  Spine (Phila Pa 1976). 2001 Mar 1;26(5):479-87.
著者: Atsushi Kimura, Atsushi Seichi, Hirokazu Inoue, Yuichi Hoshino
雑誌名: Eur Spine J. 2011 Sep;20(9):1560-6. doi: 10.1007/s00586-011-1724-7. Epub 2011 Feb 19.
Abstract/Text No previous studies have reported 10-year follow-up results for double-door laminoplasty using hydroxyapatite (HA) spacers. The purpose of this study was therefore to explore the long-term results of double-door laminoplasty using HA spacers and to determine if non-union or breakage of HA spacers is related to restenosis of the enlarged cervical canal. The study group consisted of 68 patients with a minimum of 10 years of follow-up after double-door laminoplasty using HA spacers. The average postoperative Japanese Orthopaedic Association score improved significantly after surgery and was maintained until the final follow-up. The average range of motion decreased by 42.6% in patients with cervical spondylotic myelopathy (CSM) and 65.8% in patients with ossification of the posterior longitudinal ligament (OPLL). The enlarged cervical canal area was preserved almost until the final follow-up. The average non-union rates of HA spacers were 21% in CSM and 17% in OPLL, and the average breakage rates were 24 in CSM and 21% in OPLL at the final follow-up. Although non-union and breakage of HA spacers were common, neither of these factors were correlated with restenosis of the enlarged cervical canal.

PMID 21336508  Eur Spine J. 2011 Sep;20(9):1560-6. doi: 10.1007/s00586・・・
著者: Samuel C Overley, Robert K Merrill, Evan O Baird, Joshua J Meaike, Samuel K Cho, Andrew C Hecht, Sheeraz A Qureshi
雑誌名: Global Spine J. 2018 Feb;8(1):40-46. doi: 10.1177/2192568217697318. Epub 2017 Apr 7.
Abstract/Text Study Design: Prospective randomized control trial.
Objective: To investigate the role of cervical collars in postoperative care following 1- and 2-level instrumented anterior cervical discectomy and fusion (ACDF).
Methods: The Cervical Spine Research Society Resident Fellow Grant funded this project. Fifty consecutive patients undergoing 1- or 2-level ACDF surgery were randomized into groups receiving either no brace or a cervical brace for 6 weeks postoperatively. Neck Disability Index scores were recorded preoperatively and at regular follow-up visits up to 1 year. Computed tomography scans were read 1 year postoperatively to determine fusion rates, and subsidence was measured as change in middle vertebral distance between initial postoperative and 6-month follow-up lateral cervical radiographs.
Results: Twenty-two patients were in the no-brace group, and 22 patients were in the brace group at final follow-up, with an average age of 50 and 55 years, respectively. The no-brace group had a total of 32 operative levels, whereas the brace group had 38 operative levels. There was no statistically significant difference in 1-year postoperative Neck Disability Index scores between the brace (9.30) and no-brace (6.95) groups (P = .28), in 6-month subsidence of all operative levels between the brace (0.85 mm) and no-brace (0.79 mm) groups (P = .72), or in the proportion of fused levels between the brace (89%) and no-brace (97%) groups (P = .37).
Conclusions: Our results suggest no advantage in wearing a cervical brace following 1- or 2-level ACDF surgery with respect to 1-year outcome scores, 1-year fusion rates, and 6-month subsidence.

PMID 29456914  Global Spine J. 2018 Feb;8(1):40-46. doi: 10.1177/21925・・・
著者: E Wada, S Suzuki, A Kanazawa, T Matsuoka, S Miyamoto, K Yonenobu
雑誌名: Spine (Phila Pa 1976). 2001 Jul 1;26(13):1443-7; discussion 1448.
Abstract/Text STUDY DESIGN: A retrospective study was conducted.
OBJECTIVE: To compare the long-term outcomes of subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy.
SUMMARY OF BACKGROUND DATA: No study has compared the long-term outcomes between subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy.
METHODS: In this study, 23 patients treated with subtotal corpectomy and 24 patients treated with laminoplasty were followed up for 10 to 14 years after surgery. Neurologic recovery, late deterioration, axial pain, radiographic results (degenerative changes at adjacent levels, alignment, and range of motion of the cervical spine), and surgical complications were compared between the two groups.
RESULTS: No significant difference in neurologic recovery was found between the two groups 1 and 5 years after surgery, or at the latest follow-up assessment. Neurologic status deteriorated in one patient of the subtotal corpectomy group because of adjacent degeneration, and in one patient of the laminoplasty group because of hyperextension injury. Axial pain was observed in 15% of the corpectomy group and in 40% of the laminoplasty group (P < 0.05). In the corpectomy group, listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, and osteophyte formation at 54% of the lower adjacent levels. In the laminoplasty group, kyphotic deformity developed in one patient (6%) after surgery. In the corpectomy group, the mean vertebral range of motion had decreased from 39.4 degrees to 19.2 degrees (49%) by the final follow-up assessment. In the laminoplasty group, the mean vertebral range of motion had decreased from 40.2 degrees to 11.6 degrees (29%) by the final follow-up assessment. Neurologic complications related to the surgery occurred in two patients (one myelopathy from bone graft dislodgement and one C5 root palsy from bone graft fracture) of the corpectomy group and four patients (C5 root palsy) of the laminoplasty group. All of these patients recovered over time. The corpectomy group needed longer operative time (P < 0.001) and tended to have more blood loss (P = 0.24). Six patients in the corpectomy group needed posterior interspinous wiring because of pseudarthrosis.
CONCLUSIONS: Subtotal corpectomy and laminoplasty showed an identical effect from a surgical treatment for multilevel cervical spondylotic myelopathy. These neurologic recoveries usually last more than 10 years. In the subtotal corpectomy group, the disadvantages were longer surgical time, more blood loss, and pseudarthrosis. In the laminoplasty group, axial pain occurred frequently, and the range of motion was reduced severely.

PMID 11458148  Spine (Phila Pa 1976). 2001 Jul 1;26(13):1443-7; discus・・・
著者: Atsushi Seichi, Katsushi Takeshita, Hiroshi Kawaguchi, Susumu Nakajima, Toru Akune, Kozo Nakamura
雑誌名: Spine (Phila Pa 1976). 2004 Jul 1;29(13):1478-82; discussion 1482.
Abstract/Text STUDY DESIGN: A cohort study.
OBJECTIVE: To determine the frequency of swelling of the spinal cord with an intramedullary lesion occurring after laminoplasty for nontraumatic cervical myelopathy and the possible mechanism of postoperative motor paresis of the upper extremity.
SUMMARY OF BACKGROUND DATA: Postoperative enlargement of the spinal cord with an intramedullary lesion after decompression surgery for cervical stenotic myelopathy has been reported. But the frequency of the incidence remains unknown. Postoperative motor paresis occurring mainly in the C5 and C6 segments is known but various theories on its etiology exist, including the root involvement hypothesis and the spinal cord impairment hypothesis. Thus, the etiology is controversial.
METHODS: One hundred fourteen patients with cervical stenotic myelopathy were included in this study. All of them underwent preoperative magnetic resonance imaging and postoperative magnetic resonance imaging 3 weeks after surgery. We watched for the occurrence of postoperative neurologic deterioration including paralysis of the upper extremities. We also observed the presence or absence of postoperative abnormal expansion of T2 high-signal intensity areas on magnetic resonance imaging in the spinal cord.
RESULTS: Seven patients (6.1%) showed postoperative abnormal expansion of the T2 high-signal intensity area; 3 of the 7 were asymptomatic. A total of 9 patients (7.9%) experienced unilateral upper motor paresis after surgery. In 4 of the 9 cases, paresis of the unilateral deltoid, biceps and brachialis muscles (proximal paresis) occurred between 4 and 6 days after surgery. None of the 4 showed postoperative abnormal expansion of the T2 high-signal intensity area. In 3 other of the 9 patients, distal paresis occurred just after surgical intervention. Two of the 3 showed postoperative abnormal expansion of the T2 high-signal intensity area and 1 showed slight expansion of the area. In the other 2 cases, diffuse paresis occurred, and their postoperative magnetic resonance imaging showed abnormal expansion of the T2 high-signal intensity area.
CONCLUSIONS: Spinal cord enlargement with abnormal expansion of the T2 high-signal intensity area, although not common, is an unpreventable complication after laminoplasty. This was strongly related with distal and diffuse type of postoperative paresis of the upper extremity without deterioration of lower motor function, but was little associated with a proximal type of paresis, so-called C5 and C6 palsies.

PMID 15223942  Spine (Phila Pa 1976). 2004 Jul 1;29(13):1478-82; discu・・・

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