Risk factors for axial symptoms after posterior cervical double door laminoplasty / 中华骨科杂志

ABSTRACT

Objective To explore and analyze the risk factors of axial symptoms after posterior cervical laminoplasty.Methods Retrospectively follow up the patients taking posterior cervical laminoplasty in Jishuitan Hospital during May 2005 to July 2011,due to multi-segmental cervical stenosis or (and) cervical ossification of posterior longitudinal ligament.All patients' gender,diagnosis,age,preoperative neck and shoulder pain,VAS score,course of disease,presence or absence of root symptoms,medical complications,operation time,operation method,blood loss,postoperative neck support time,presence or absence of C5 nerve root paralysis,preoperative JOA and postoperative best JOA,preoperative C2-C7 Cobb angle in neutral position,flexion position,post-extension and calculate the activity were collected.Record the process of axial symptoms in details and statistically analysis by SPSS.Results All of 146 patients were followed up for 58-134 months with an average of 89.5±18.4 months.There were 57 cases of axial symptoms,the overall incidence was 39.0％;except for 7 cases with symptom relief in 6 months,the other 50 cases (34.25％ of the total number of follow-up) of the axial symptoms continued by the time of follow-up.35 patients (23.97％) were characterized by stiffness and 22 patients (18.49％) showed pain,traction and tightness.36 patients (24.66％) showed axial symptoms on the shoulder and back,10 (6.85％) appeared around the wound and 11 (7.53％) appeared on both the shoulder and the wound.Univariate logistic regression analysis showed that intraoperative blood loss (P=0.019,odds ratio(OR) 1.857,95％ CI 1.107-3.116) and postoperative best JOA score (P=0.008,0R=0.780,95％ CI0.650-0.936) significantly affected the occurrence of postoperative axial symptoms.Multifactor Logistic regression analysis was carried out by stepwise forward method.It was found that besides the intraoperative blood loss and postoperative best JOA score,the following factors also affected the incidence of axial symptoms after operation (P＜0.05)diagnosis,preoperative age,the extension of C2-C7 Cobb angle before operation,and the operation destruction of C7 spinous process muscle stops.The diagnosis of ossification of the posterior longitudinal ligament,preoperative age,and the extension of C2-C7 Cobb angle before operation were the protective factors for the axial symptoms,and the diagnosis of multiple segments of the cervical spinal stenosis and the operation destruction of C7 spinous process were the risk factors for the axial symptoms after the operation.Conclusion Younger,less preoperative C2-C7 Cobb extension,the operation destroys the C7 spinous process muscle stop point,more intraoperative blood loss,lower postoperative best JOA score and patients with multi-segment cervical stenosis more are more easily to have axial symptoms after posterior cervical double door laminoplasty.