RESUMEN
Expansive laminoplasty of the cervical spine was performed for 15 patients with subaxial lesion (SAL) in rheumatoid arthritis (RA) with or without symptomatic occipitocervical pathology. Clinical results were satisfactory, and radiographic evaluation revealed that the range of movement of the cervical spine decreased to 56.3%, spinal alignment was well preserved, and intervertebral slipping advanced only slightly. Therefore, expansive laminoplasty is shown to be clinically effective in decompressing the subaxial spinal cord without the need for fusion of this region, yet it avoids exacerbating or creating significant instability. We found that it can serve as a useful procedure for treating spinal cord compression caused by SAL in RA. For patients with upper cervical instability, laminoplasty with upper cervical fusion appears to be an effective option. In a case in which kyphosis was observed preoperatively, its deformity became worse after laminoplasty. Thus, it may be advisable to consider subaxial fusion in such cases.
Asunto(s)
Artritis Reumatoide/cirugía , Articulación Atlantoaxoidea/cirugía , Vértebras Cervicales/cirugía , Laminectomía , Compresión de la Médula Espinal/cirugía , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/patología , Articulación Atlantoaxoidea/patología , Vértebras Cervicales/patología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Compresión de la Médula Espinal/patología , Resultado del TratamientoRESUMEN
STUDY DESIGN: The gait of patients with neurogenic intermittent claudication was analyzed before and after surgery using a ground reaction force plate. OBJECTIVES: To analyze the gait characteristics of patients with neurogenic intermittent claudication, to evaluate quantitatively their gait improvement after surgical treatment, and to examine the differences in gait characteristics and postoperative improvement among different types of neuropathy. SUMMARY OF BACKGROUND DATA: A number of reports have been published on the pathophysiology or treatment of neurogenic intermittent claudication. However, almost no detailed reports exist on the gait abnormalities associated with this condition. METHODS: The subjects were 60 lumbar canal stenosis patients with intermittent claudication who underwent surgery at the authors' hospital. A ground reaction force plate was used for the analysis, and factors related to time and distance (speed, stride, interval, and pitch) were analyzed, as well as factors related to the style of walking (symmetry, reappearance, smoothness, sway, rhythm, and impact). RESULTS: Before surgery, there were abnormalities of various factors related to the style of walking soon after the patients began to walk. Gait analysis also showed that the pattern of gait abnormality and its improvement after surgery varied depending on the type of neuropathy. CONCLUSIONS: Gait analysis permits objective and quantitative evaluation of the gait characteristics of patients with lumbar canal stenosis and is useful for evaluating responses to surgical treatment in these patients.