Range of motion loss after cervical laminoplasty: a prospective study with minimum 5-year follow-up data

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• 作者：Seung-Jae Hyun ; MD ; PhD^a ; K. Daniel Riew ; MD^b ; Seung-Chul Rhim ; MD ; PhD^c ; ^{scrhim@amc.seoul.kr}
• 关键词：Spondylosis ; Ossification of the posterior longitudinal ligament ; Cervical spine ; Laminoplasty ; Range of motion
• 刊名：The Spine Journal
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：13
• 期：4
• 页码：384-390
• 全文大小：599 K

文摘

Background context

Although numerous studies have reported on the loss of flexion-extension range of motion (ROM) associated with laminoplasty, few have reported on the time course of this loss of motion for a long-term follow-up period.

Purpose

We previously reported our early data on postlaminoplasty cervical ROM. In this article, we describe our minimum 5-year follow-up data to identify the time-dependent change in ROM after cervical laminoplasty.

Study design

A prospective cohort study.

Patient sample

The procedure was performed in 23 patients. Eighteen patients with a minimum 5-year follow-up were included in the study.

Outcome measures

The time-dependent neck ROM changes observed in the neutral, flexion, and extension radiographs were used to measure the radiological outcome. The Japanese Orthopaedic Association classification and a numerical rating scale of axial neck pain and arm pain were used to evaluate clinical outcome.

Methods

Twenty-three patients who received unilateral open-door laminoplasties, including miniplate fixation over three levels, were serially evaluated at regular set intervals postoperatively. Eighteen patients with a minimum 5-year follow-up were included in the study. The mean follow-up period was 68.1 months (range, 60-78 months). Nine patients had ossification of posterior longitudinal ligament (OPLL) and nine patients had cervical spondylotic myelopathy (CSM). Enrolled patients were divided into subgroups (OPLL vs. CSM; autofusion vs. nonautofusion) to compare the ROM between the groups. We evaluated the time-dependent neck ROM changes by taking neutral, flexion, and extension radiographs preoperatively and at 1, 3, 6, 9, 12, 18, and 24 months postoperatively. Follow-up radiographs were taken annually after a 2-year follow-up.

Results

The preoperative and 1-, 3-, 6-, 12-, 24-, 36-, 48-, and 60-month postoperative ROM figures were 39.9¡À11.2¡ã, 35.0¡À9.2¡ã, 33.0¡À11.0¡ã, 30.1¡À10.4¡ã, 25.8¡À13.1¡ã, 24.7¡À10.0¡ã, 23.8¡À6.5¡ã, 24.6¡À8.3¡ã, and 23.6¡À9.4¡ã, respectively, and at the most recent follow-up, ROM was 24.5¡À10.1¡ã. Thus, the mean ROM decreased by 15.4¡À8.4¡ã (38.5 % ) by the last follow-up (p<.0001). In the OPLL group, we observed a more limited cervical ROM than in the CSM group (47.2 % vs. 72.7 % ). As expected, in the laminar autofusion group, the ROM decreased significantly (55.6 % decrease), whereas in the nonautofusion group, the ROM decreased less significantly (13.4 % decrease) at the last follow-up. Postoperative axial pain did not correlate with the cervical ROM.

Conclusions

These results suggest that the loss of cervical ROM after laminoplasty is time-dependent, and patients with OPLL and laminar autofusion had less ROM. Postlaminoplasty ROM reduction can recover after several years, unless laminar autofusion occurs.