다분절 경추증에서 경추 후궁 성형술과 경추 후궁 절제술 및 유합술의 결과 비교 = Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Spondylosis

다국어 초록 (Multilingual Abstract)

Study Design: This is a retrospective study.
Objectives: We wanted to compare the clinical and radiographic outcomes of laminoplasty and laminectomy & fusion to treat multilevel cervical spondylosis.
Summary of the Literature Review: Laminoplasty and laminectomy & fusion are being increasingly used to treat multilevel cervical spondylosis, but definitive guidelines have not yet been established.
Materials and Methods: Fifty eight patients who were followed up for more than a year and who were treated for multilevel cervical spondylosis with either laminoplasty or laminectomy & fusion between March 2000 and March 2009 were reviewed. Twenty eight patients who underwent laminectomy & fusion were matched with 30 patients who underwent laminoplasty.
Results: The laminoplasty group showed statistically significant improvements in the Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) score. The cervical lordosis for the preoperative and latest sagittal alignment in the laminoplasty group decreased from 14 degrees to 5 degrees and the cervical kyphosis in the laminectomy & fusion group increased from 10 degrees to 15degrees with no statistically significant difference. However, 3 cases with less than 5 degrees of cervical lordosis in the laminoplasty group showed progression of kyphosis at the last follow-up.
Conclusion: The clinical outcomes of laminoplasty for multilevel cervical spondylosis were better than those of laminectomy & fusion.
However, it is considered that additional study for laminectomy & fusion is needed to prevent the long-term progress of cervical kyphosis in cases with preoperatively decreased cervical lordosis of less than 5 degrees, though it is impossible to make such comparisons with the small number of cases in our study.

국문 초록 (Abstract)

연구계획: 다분절 경추증의 치료에서 경추 후궁 성형술과 경추 후궁 절제술 및 유합술의 임상적 및 방사선학적 결과를 비교하는 후향적 연구.
목적: 다분절 경추증의 치료에서 우수한 방법으로 점진적으로 사용이 증가되고 있는 경추 후궁 성형술과 경추 후궁 절제술 및 유합술에 대한 임상적 및방사선학적 결과를 비교하여 평가하고자 한다.
선행문헌의 요약: 다분절 경추증의 치료에서 경추 후궁 성형술과 경추 후궁 절제술 및 유합술의 사용이 증가되고 있지만 이에 대한 명확한 치료 지침이확립되어 있지 않다.
대상 및 방법: 2000년 3월부터 2009년 3월까지 다분절 경추증의 치료에서 경추 후궁 성형술과 경추 후궁 절제술 및 유합술을 시행한 환자 중 1년 이상추시 가능한 58명을 대상으로 하였다. 이 중 30명은 경추 후궁 성형술을 시행하였고, 28명은 경추 후궁 절제술 및 유합술을 시행하였다.
결과: Japanese Orthopaedic Association (JOA) score와 Visual analogue scale (VAS) score는 경추 후궁 성형술 군에서 통계적으로 우수한 것으로 나타났다. 그리고 수술 전과 최종 추시시의 시상 정렬은 경추 후궁 성형술 군의 경우 경추 전만곡이 14도에서 5도로 감소하였고, 경추 후궁 절제술 및 유합술 군의 경우 경추 후만곡이 10도에서 15도로 증가하였으며 이는 통계적 유의성이 없었다. 그러나 본 연구에서 경추 후궁 성형술을 시행한 군 중 경추전만곡이 5도 이하인 3예에서 최종 추시시에 경추 후만곡이 진행되었다.
결론: 다분절 경추증의 치료에서 경추 후궁 성형술이 경추 후궁 절제술 및 유합술보다 임상적 평가에서 우수한 결과를 보였다. 그러나 5도 이하로 전만각이 감소한 경우에는 장기적인 경과관찰이 필요하며 경추 후만곡의 진행을 방지하기 위해 경추 후궁 절제술 및 유합술에 대한 추가 연구가 필요할 것으로 사료된다.

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