颈椎前路增高植骨对老年人颈神经根管形态改变的实验研究

目的：评价老年人颈椎前路增高植骨后3—4颈椎(C3—4)和5—6颈椎(C5—6)神经根管形态改变。方法：取老年人颈椎标本10具，摄X线片，然后进行CT平扫，三维重建C3—4、C5—6神经根管。所有标本均在C3—4和C5—6节段进行颈椎前路椎间盘摘除术(ACDF)，取同标本胸椎椎体增高植骨2．5mm。术后于术前同等条件下重建颈椎相关神经根管。实验统计数据包括：颈椎椎间盘前方高度、后方高度、神经根管高度、神经根管内口、外口面积及周径。结果：实施手术节段20个，C3-4、C5-6各10个。术后C3—4、C5—6神经根管分别增高11．2％、7．8％，C3—4神经根管内口、外口面积分别增加22．5％、23．3％，C5—6神经根管内口、外口面积分别增加18．2％、25．0％，C3—4神经根管周径内口增大11．0％、12．4％，C5—6神经根管周径内口、外口分别增大10．9％、17．0％。结论：在体外进行老年人ACDF并增高植骨2．5mm，有效地增加了双侧颈神经根管的高度以及内、外口的面积和周径，该术式能使相应神经根管得到扩张。

Morphological study on cervical spinal neuroforamen after anterior incremental interbody bone-grafting in elder people

Objective To investigate the morphological changes of neuro foramen of C 3 4 and C 5 6 after anterior incremental interbody bone grafting. Methods Cervical spine specimens were obtained from 10 cadavers. All spine showed spondylopathy at radiographic figure. Reconstruction of neuro foramen at each side of C 3 4 and C 5 6 were performed for all specimens before and after anterior cervical disc fusion(ACDF). Anterior incremental 2 5mm grafting based on ACDF was applied at C 3 4 and C 5 6 in 10 degenerative cadaver cervical spines. Re performed radio technique figure was analyzed in the same way as pre operation. Data for statistics included anterior and posterior height of disc space, height of neuro foramen, area and circumference of internal and external os of neuro foramen. Results After grafting of 20 segments, the height of neuro foramen increased by 11 2% at C 3 4 and by 7 8% at C 5 6 The neuroforaminal areas significantly increased by 22 5% at internal os and by 23 3% at external os for C 3 4 , 18 2% at internal os and 25 0% at external os for C 5 6 . The neuroforaminal circumferences significantly increased by 11 0% at internal os and 12 4% at external os for C 3 4 , 10 9% at internal os and 17 0% at external os for C 5 6 . Conclusions The incremental grafting can significantly enlarge neuroforaminal height, areas and circumference of internal and external os in elder people, providing adequate space for the nerve root and improving neuroforaminal stenosis. As a result, the procedure can be applied to the elderly patients with myeloradiculopathy.