頚椎椎弓形成術における頚半棘筋C2棘突起付着部温存の臨床的意義

Clinical Efficacy of Preservating the Attachments of the Semispinalis Cervicis to the C2 Spinous Process and the C2-3 Complex during Cervical Laminoplasty

　背景：頚椎椎弓形成術後の軸性疼痛や頚椎アライメント悪化の予防には，頚部深層伸筋である頚半棘筋のC2棘突起付着部を温存することが重要であると報告されている．

　対象と方法：術後1年以上経過観察可能であった28例を対象に，C2棘突起付着部を完全に温存した10例とC2棘突起付着部を骨片付きで切離後再建した18例を比較検討した．

　結果：術後1年時の臨床成績，軸性疼痛の発生率，矢状面アライメントの変化に2群間で有意差はなかった．

　まとめ：頚椎椎弓形成術におけるC2棘突起付着部温存の臨床的意義は認められなかった．

　Background：The purpose of this study was to assess the efficacy of preserving the semispinalis cervicis attachments to the C2 spinous process and the C2-3 complex during cervical laminoplasty.

　Methods：We reviewed the cases of 28 patients who underwent cervical laminoplasty (midline enlargement).　The muscle attachments to the C2 spinous process and the C2-3 complex were completely preserved in 10 patients, whereas in the other 18 patients the semispinalis cervicis was detatched from the C2 spinous process and C2-C3 complex together with small bone fragments, and the attachments were reconstructed at the end of the procedure.

　Results：There were no significant differences between the two groups in the JOA score recovery rate, the incidence of postoperative axial pain, or changes in the cervical curvature morphology during the follow-up period.

　Conclusion：Contrary to expectation, we found no evidence of any clinical benefit of preserving the semispinalis cervicis attachments to the C2 spinous process and the C2-3 complex during cervical laminoplasty.