다발성 경추 척수증의 치료로 시행한 후방 감압술 후 척추관 팽창과 관련된 수술 전 인자 분석 = Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective analysis Objectives: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy.
Summary of Literature Review: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent.
Materials and Methods: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty.
Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final followup.
Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores.
Results: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors.
Conclusions: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.
Key Words: Cervical myelopathy, Posterior decompression, Spinal canal expansion, MRI, Cobb angle

국문 초록 (Abstract)

연구 계획: 후향적 연구목적: 다분절 경추 척수증 환자에서 후방 감압술 후 척추관 팽창과 관련된 수술 전 인자 및 임상적 연관성을 분석하고자 하였다.
선행 연구문헌의 요약: 다분절 경추 척수증 환자에서 후방 감압술의 궁극적 목표는 척추관 팽창과 관련된 인자들에 대해서는 서로 상이한 결과를 보여주고 있고, 임상적 결과와 관련도 명확히 제시하지 못하고 있다.
대상 및 방법: 다분절 경추 척수증으로 후궁 절제술이나 성형술을 시행한 67예를 대상으로 하였다. 방사선학적으로 수술 전, 최종 추시 상 단순 방사선 사진을 이용한 C2-7 Cobb angle, 굴곡-신전 상 경추 운동 범위를, 자기공명영상을 이용하여 술 후 6주 척추관의 팽창 정도를 측정하여 수술 전과 비교하였다. 수술 후 척추관의 팽창에 영향을 미치는 인자를 분석하기 위하여 연령, 성별, 수술 분절 수, 수술 방법 및 방사선학적 분석 결과를 대상으로 다변량 회귀 분석, 상관 분석을 시행하였다. 임상적 결과는 수술 전과 최종 추시 상 목 불능 지수(NDI), JOA score 변화를 분석하였다.
결과: 수술 후 추시 MRI 상 척추관 팽창은 시상면 상 4.76 mm, 관상면 상은 4.31 mm로 수술 전 인자 중 남성, 수술 전 압박이 큰 경우 더 많았다(p=0.004, <0.001). 수술 전 cobb angle이 전만각을 보일수록 수술 후 척추관 팽창 정도가 많고 JOA score가 더 호전되었으나 통계학적 의미는 없었다.
수술 후 NDI는 18.3에서 14.8으로 JOA score는 수술 전 10.81에서 술 후 14.6으로 호전되었고 수술 전 인자들에 따른 차이는 없었다.
결론: 다분절 경추 척수증에서 후방 감암술 후 척추관은 수술 전 압박이 심한 경우 더 많이 팽창되었으나 이에 따른 척추관 팽창 정도나 임상적 결과의 차이는 없었다.
약칭 제목: 후방 감압술 후 척추관 팽창 관련 인자

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