Postoperative changes at the lower end of cervical laminoplasty: for preservation of the C7 spinous process in laminoplasty

INTRODUCTION: C3-C7 laminoplasty has been the standard treatment for cervical myelopathy, although several recent reports described C3-C6 laminoplasty for preserving the muscles inserting in C7 and reducing postoperative axial symptoms. However, postoperative changes at C6/C7 of the lower end of C3-C6 laminoplasty, especially regarding a possibility of postoperative spinal canal narrowing have not been measured. The purpose of this study was to clarify postoperative changes at the lower end of laminoplasty. METHODS: Pre and postoperative spinal dura diameter at the lower end of conventional C3-C7 laminoplasty using MRI, and the related factors for spinal dura diameter and the causes of postoperative dura narrowing were investigated. RESULTS: At the last follow-up after C3-C7 laminoplasty, dura diameter at C7/T1 was significantly wider after operation than before operation, and postoperative narrowing of dura diameter, which was found in 20% of patients, was a maximum amount of one millimeter. No pre and postoperative factor significantly correlated with dura diameter at C7/T1. The causes of postoperative narrowing at the lower end of laminoplasty were disc protrusion and/or posterior scar, or segmental angulation of the spinal cord. CONCLUSION: In conclusion, the presence of preoperative subarachnoid space over one millimeter at C6/C7 may be able to be one of the radiological indications for C3-C6 laminoplasty.     

Effect of multilevel open-door laminoplasty and laminectomy on flexibility of the cervical spine: an experimental investigation

STUDY DESIGN.: A biomechanical comparison of 2 commonly used posterior surgical procedures for spinal cord decompression in the cervical spine: laminoplasty (open door) and laminectomy. OBJECTIVE.: To delineate differences in cervical motion after laminoplasty (2-level and multilevel) and laminectomy. SUMMARY OF BACKGROUND DATA.: Cervical spondylotic myelopathy is a common spinal cord disorder in persons aged 55 years or older. Laminectomy and laminoplasty are the 2 common posterior-based techniques used for decompression of spinal cord. There is lack of adequate literature data on the intersegmental rotations at the operated and adjacent levels. METHODS.: Five human cadaveric specimens were tested sequentially as follows: (1) intact, (2) laminoplasty at C5-C6, (3) laminoplasty at C3-C6, and (4) laminectomy at C3-C6, each subjected to 2 N·m moments in flexion/extension, right/left lateral bending, and right/left axial rotation. For laminoplasty, the laminae of the involved vertebrae were stabilized with standard 10-mm plates and screws. The total and segmental motions of the specimens were measured before and after the surgical procedures. Statistical analysis was performed using repeated measures analysis of variance, with P < 0.05 as the level of significance. RESULTS.: Two-level laminoplasty led to minimal decrease (<7% in the 3 loading modes) in C2-T1 motion. Multilevel laminoplasty resulted in a minimal increase during lateral bending (4%) and axial rotation (6%). During flexion/extension, both C4-C5 and C2-C3 showed a decrease of 20% (P > 0.05) and 17% (P > 0.05) after 2-level and multilevel laminoplasty, respectively. Laminectomy resulted in a statistically significant (P < 0.05) increase in the C2-T1 range of motion compared with the intact condition during the 3 loading modes (21% in flexion/extension, 8% in lateral bending, and 15% in axial rotation). CONCLUSION.: Both 2-level and multilevel laminoplasty preserved the C2-T1 range of motion. Laminectomy resulted in a significant increase in C2-T1 motion due to the loss of the posterior structures.     

Delayed segmental motor paralysis following laminoplasty: two case reports

STUDY DESIGN: Two patients who experienced the onset of segmental motor paralysis several years after laminoplasty are presented. OBJECTIVES: To discuss the mechanism of development of delayed segmental motor paralysis following laminoplasty. SETTING: A department of orthopaedic surgery in Japan. METHODS: One patient experienced motor weakness in his deltoid and biceps muscles on the left side 5 years after laminoplasty. The other patient noticed motor weakness in his deltoid and biceps on the right side 7 years after laminoplasty. CT myelography revealed posterior spur formation and hypertrophic facet joints on the hinged side at the C4-C5 level in both patients. RESULTS: Posterior foraminotomy was performed at the C4-C5 level on the hinged side in both patients. Postoperatively, motor weakness in the deltoid and biceps muscles was improved in both patients. CONCLUSIONS: Although spondylotic changes, including spur formation and disc herniation, have occasionally developed in operated segments after laminoplasty, few patients have required additional surgery for treatment of relapse of neurological deficits. It has been believed that spinal cord is rarely compressed by the spondylotic changes since it shifts posteriorly in the enlarged spinal canal. However, laminoplasty disturbs the facet joints since the medial portion of dorsal cortex and cancellous bone in facet joints is drilled out to make a trough. Facet joints disturbed in this fashion undergo degeneration over time after surgery. Nerve roots may occasionally be compressed by degenerated facet joints and spurs that have developed at the entrance of root canal, resulting in segmental motor paralysis several years after laminoplasty. Careful long-term observation is necessary after this procedure.     

Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft

STUDY DESIGN: A retrospective study of cervical expansive laminoplasty for cervical myelopathy from a clinicoradiologic perspective. OBJECTIVE: To clarify the correlation among sagittal curvature of the cervical spine, cervical range of motion, sagittal plane translation, spinal cord atrophy, and myelopathic symptoms in patients who have undergone laminoplasty. SUMMARY OF BACKGROUND DATA: Laminoplasties were developed to diminish the undesirable effects of laminectomy, which include postoperative kyphotic changes and instability. However, the superiority of laminoplasty over laminectomy remains controversial. METHODS: Fifty-one patients with cervical spondylotic myelopathy or ossification of the cervical posterior longitudinal ligament who underwent laminoplasty were radiologically assessed before and after surgery. The index of the sagittal curvature, intervertebral range of motion, listhesis, and the transverse area of the spinal cord at the site of maximal compression were measured to evaluate interrelations among those parameters and myelopathic symptoms. RESULTS: There were no patients with kyphotic curvature before surgery. The postoperative curvature tended to be less lordotic. This tendency did not adversely affect postoperative symptoms. The intervertebral range of motion was significantly decreased except at C1-C2. The final C4-C5 range of motion and the postoperative myelopathic symptoms were negatively correlated. A significant correlation was observed between the postoperative spinal cord atrophy and the final myelopathic symptoms. CONCLUSIONS: The decrease in the lordotic curvature index and the decrease in the intervertebral range of motion after laminoplasty did not cause neurologic deterioration. In the C4-C5 intervertebral segment with a high incidence of listhesis, the restriction of the C4-C5 range of motion improved the clinical myelopathic symptoms. The radiologic prognostic factors were the postoperative restriction of intervertebral range of motion in preoperatively unstable segments and the anatomic reversibility of spinal cord insult.     

Minimally invasive lateral mass plating in the treatment of posterior cervical trauma: surgical technique

OBJECTIVE: The technique of lateral mass fixation restores the posterior tension band and provides effective stabilization in patients with many types of traumatic injuries. However, postoperative wound pain is not uncommon. The objective of this work is to describe a modified technique of minimally invasive lateral mass plating for cervical spine trauma. METHODS: Patient 1 was a 64-year-old woman who had been in a motor vehicle accident and sustained bilateral C5-C6 facet dislocation with posterior C5-C6 distraction. She was otherwise neurologically intact, and attempts at closed reduction were not successful. Patient 2 was a 16-year-old girl who had also been in a motor vehicle accident but had an incomplete spinal cord injury. She had an unstable burst fracture of C7 with posterior C5-C6 distraction. Both patients underwent anterior cervical fusion followed by staged minimally invasive posterior fusion with good results. A dilator tubular retractor system (METRX) was used to access the bilateral lateral masses through a small midline incision under fluoroscopic guidance. Lateral mass screws were then placed by using a modified Magerl technique, securing two-hole plates on each side onto the lateral masses, performed through the METRX system. We also successfully performed four-level lateral mass plating in a cadaveric cervical spine using a 2-cm skin incision. CONCLUSIONS: We describe successful placement of lateral mass screw and plate constructs with the use of a minimally invasive approach by means of a tubular dilator retractor system. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine.     

颈椎后纵韧带骨化症病变范围涉及第二颈椎时后路减压与伸肌重建策略

目的 探讨颈椎后纵韧带骨化症(OPLL)病变范围涉及第二颈椎时行后路减压和伸肌重建的方法.方法 2002至2006年治疗OPLL病变范围涉及C2者10例,均行保留颈后方韧带复合体、重建颈伸肌群附着点、单开门颈椎板成形术,椎板成形减压范围C2～C7.测量手术前后CT片上C2有效椎管矢状径,计算减压程度;测量手术前后X线片上C2～C7角,对比生理曲度维持情况;记录手术前后和随访时JOA评分.结果 平均随访14个月,C2有效椎管矢状径术前平均5.6 mm(4.0～8.8 mm)、术后平均13.4 mm(10.0～18.2mm)(与术前相比P<0.01);中立位C2～C7角术前6.5°(-2°～12°)、术后7.4°(3°～14°)、末次随访7.0°(2°～15°)(与术前相比P>0.05);JOA评分术前6～12分(平均9.6分)、术后8～14分(平均10.9分)、末次随访10～17分(平均13.2分)(与术前相比P<0.05).结论 保留颈后方韧带复合体重建颈伸肌群附着点单开门颈椎板成形术,对病变范围涉及第二颈椎的OPLL是适宜的手术方法,可以达到减压彻底、维持颈椎生理曲度的目的 .     

Morphological features and clinical significance of epidural membrane in the cervical spine

STUDY DESIGN.: A prospective clinical study. OBJECTIVE.: To elucidate the histomorphological features and clinical significance of the epidural membrane (EM) in the cervical spine based on operative and histological findings. SUMMARY OF BACKGROUND DATA.: The anatomical features of the EM have been mostly discussed on the basis of cadaver studies in the whole spine. However, the histomorphological features and clinical significance of the EM in the cervical spine based on operative findings have never been reported. METHODS.: Eighty-seven patients with cervical spondylotic myelopathy who had undergone an expansive open-door laminoplasty under microscopy were evaluated with a more than 2-year follow-up period. The most damaged spinal segment was determined in each patient from the preoperative neurological and image findings along with the remaining symptoms at follow-up. The morphological features of the EM were observed and recorded in each patient during decompression. For histology, specimens of common and remarkable types of the EM obtained from 16 patients were examined. RESULTS.: The age at surgery averaged 64.5 years; there were 58 men and 29 women. With regard to the most damaged spinal segment, there were 14 cases at the C3-C4 level, 37 at the C4-C5 level, 32 at the C5-C6 level, and 4 at the C6-C7 level. The EM was an adipo-fibro-vascular tissue with various histomorphologies, blending with the periradicular sheath. Some EMs showed notable findings: obstructing dural tube expansion (13 cases, 14.9%), compressing a nerve root or disturbing its mobility (4 cases, 4.6%), and the combined type (1 case, 1.1%). All of them were located at approximately the most damaged spinal segment. In addition, some EMs had interesting histological features, such as harboring many small arteries, calcified debris, and metaplastic bone fragments. CONCLUSION.: The EM can develop into remarkable structures with spondylosis and aging in patients with cervical spondylotic myelopathy, affecting surgical outcomes as well as successful decompression procedures. A sound understanding of the histomorphological features of the EM is required to obtain satisfactory surgical outcomes in the limited field afforded by minimally invasive surgery.     

Comparison of enlargement of the spinal canal after cervical laminoplasty: open-door type and double-door type

The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. The width of the spinal canal and the inclination angle of the lamina at the C5 and C6 levels were measured using a computer software program (Image J) and pre- and postoperative CT films. Concerning the degree of enlargement of the spinal canal, the mean expansion ratio at the C5 level was 148.9% in TBL and 148.2% in DDL, and there was no significant difference between them. However, at the C6 level, it was 159.0% in TBL and 140.3% in DDL, which was significantly larger in TBL than DDL (p < 0.05). The increase of inclination angle of the lamina was 11.0° in TBL and 19.0° in DDL at the C5 level, and 9.2° in TBL and 19.3° in DDL at the C6 level. At both the C5 and C6 levels, it was significantly larger in DDL than TBL (p < 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery.     

Centerpiece钛板内固定在单开门颈椎管扩大成形术中的应用

目的:探讨Centerpiece钛板内固定在单开门颈椎管扩大成形术的临床应用。方法:自2009年1月至2010年12月采用单开门颈椎管扩大成形Centerpiece内固定术治疗颈椎管狭窄症患者25例,男16例,女9例;年龄44～75岁,平均(57.2±6.7)岁。其中多节段脊髓型颈椎病8例,颈椎后纵韧带骨化症12例,发育性颈椎管狭窄症5例。以JOA评分(17分法)及其改善率评价术后神经功能改善情况;术后复查颈椎X线、CT,在术前及术后6个月的颈椎侧位X线片上测量C5节段椎管矢状径,计算椎管扩大率,评价椎管扩大和维持情况及门轴侧骨融合情况。结果:手术时间为(165.5±35.6)min;术中出血量为(325.0±75.1)ml。随访时间6～18个月,平均(7.3±3.8)个月。术前JOA评分为9.3±1.1;术后6个月为14.7±2.1(t=4.12,P<0.05),JOA改善率为(64.5±10.2)%。术后随访X线片及CT示椎管扩大满意,门轴侧均骨性愈合,均未见椎板塌陷和再关门现象,术前C5节段椎管矢状径为(9.0±1.5)mm,术后6个月为(14.3±2.0)mm(t=7.61,P<0.05),椎管扩大率为(67.6±11.8)%。结论:Centerpiece钛板内固定应用在单开门颈椎管扩大成形术中是安全有效的,在抬起椎板获得即刻稳定的同时,可以恢复椎管的完整性。     

颈后路单开门椎管成形术治疗脊髓型颈椎病

目的:观察颈后路单开门椎管扩大成形术对颈椎管狭窄合并钳夹型脊髓型颈椎病的临床效果和可行性。方法:采用颈后路椎管扩大成形术治疗颈椎管狭窄合并钳夹型脊髓型颈椎病30例,男19例,女11例,常规C3-C7减压,棘突打孔10号线固定在门轴侧侧块关节囊上12例,门轴侧C3、C5、C7侧块螺钉固定悬吊椎板18例,术前和术后通过日本骨科学会JOA评分(17分法)评估临床疗效。结果:30例均获得随访,随访时间6～76个月,平均25个月。按照JOA评分:优8例,良14例,可6例,差2例,优良率73.33%(22/30)。其中3例术后3个月内发生C4或C5神经根麻痹,经保守治疗痊愈。2例在2年内因疗效不佳再行前路手术。结论:颈后路单开门椎管扩大成形术治疗颈椎管狭窄合并钳夹型脊髓型颈椎病是一种简单、有效可行的方法,尤其适应于老年人。     

Dome-like expansive laminoplasty for the second cervical vertebra

The second cervical vertebra (C2) is in a pivotal position for the alignment and stability of the cervical vertebrae as a whole. Since its spinal canal is wider at the cranial and narrower at the caudal end, a dome-like excision of the inner side of the spinal canal from the caudal toward the cranial end results in the decompression of the lesion, preserving the dorsal part of the C2. The authors performed this C2 dome-like expansive laminoplasty on 33 patients (25 cases of the ossification of the posterior longitudinal ligament, six of developmental spinal canal stenosis, and two of spondylosis) and kept them under follow-up observation, which ranged from 1 to 7 years (mean, 3.5 years). The result was satisfactory in terms of the decompression and stability of the cervical vertebrae: even 5 years after the operation, no osteogenesis was noted in the expanded spinal canal to induce compression again. It thus may be concluded that this method is good enough to replace conventional laminectomy.     

颈椎板成形术后的脊髓扩大和后移

目的 研究反成形术后脊髓的形态学改变和疗效的相互关系。方法 对２０例颈脊髓病口才在行椎管扩大椎板成形术前后进行颈ＣＴ脊髓成像术,测量脊髓的矢状径、横径和横截面的变化。结果 颈椎板成形术后脊髓的Ｃ５水平脊髓矢状径增大约０．８ｍｍ,但横径减小约０．９ｍｍ,脊髓横截面面积增大７．４％,在Ｃ５水平脊髓向后移动２．８ｍｍ。。结论管扩大椎板成形术可使脊髓减压,而术后脊髓是否后移可能是决定椎管成形术减压效果的重     

微型钛板改良单开门颈椎管扩大成形术治疗脊髓型颈椎病的临床效果

【摘要】〓目的〓评价微型钛板改良单开门颈椎管扩大椎板成形术治疗脊髓型颈椎病的临床效果。方法〓2008年1月~2012年2月,观察46例多节段脊髓型颈椎病(MCSM)行微型钛板改良单开门颈椎管扩大椎板成形术的脊髓型颈椎病患者,对比术前及术后JOA评分,在CT上测量C5节段椎管术前、术后6个月的矢状径,计算椎管扩大率[(术后椎管矢状径-术前椎管矢状径)/(术前椎管矢状径)×100%],观察单开门门轴侧骨融合情况。结果〓平均随访18个月(6~24个月)。术前平均JOA评分8.2分,术后平均JOA评分14.8分。C5节段椎管矢状径术前为8.6±1.1 mm,术后6个月为16.1±0.9 mm,椎管扩大率为(74.3±14.4)%。术后6个月,可以观察到单开门门轴侧骨融合,无螺钉松动及再“关门”现象。结论〓微型钛板改良单开门椎管成形术治疗脊髓型颈椎病临床效果满意,防止再关门。     

改良的单开门椎板成形术治疗脊髓型颈椎病

目的介绍一种改良的单开门椎板成形术并观察其疗效和对颈椎稳定性的影响。方法对19例颈椎病患者进行改良的单开门手术,手术前和随访时进行JOA评分并了解颈肩痛的发生率和持续时间,CT／MRI测量椎管的矢状径,动力位摄片观察颈椎的稳定性,测量C2-C7 Cobb角观察颈椎前凸的变化。结果平均随访时间为13个月,JOA评分自术前平均为8．76提高到随访时12．12分,改善率平均为45．4％;颈肩痛发生率26.3％;各节段椎管矢状径均有明显增大,而最大的增幅出现在C5水平;颈椎前凸并没有发生明显改变;随访时的动力位摄片没有发现颈椎节段性不稳定。结论这种应用羟基磷灰石spacer并进行后方韧带重建的改良的单开门手术治疗脊髓性颈椎病效果良好,由于保留了后方的棘突和韧带并进行了重建,术后颈椎的生理弧度和稳定性良好。     

微型钛钉-钛板固定行颈椎管扩大成形术的初步临床报告

目的：探讨微型螺钉-钛板固定行颈椎管扩大成形术的可行性,报告其临床应用的初步效果.方法：利用微型钛钉-钛板固定方法行颈椎后路单开门手术治疗颈椎病22例,手术减压节段包括C3～C7 5个节段20例,C2～C7 6个节段2例,手术方式均采用单开门,椎板抬起（开门）后,剪取合适大小及形状的钛板,利用微型钛钉将其分别固定在抬起的椎板及侧块上.结果：术中及术后均未见因钛板及钛钉置入引起的脊髓、神经根及血管损伤.随访3～18个月,手术后3个月时JOA评分从术前的9.3分提高到13.5分.随访期间未见钛板及钛钉脱落移位;14例患者术后行CT检查,未见椎板塌陷或再关门现象,门轴侧椎板切除及骨折处骨质再生融合13例,1例术后3个月时尚未完全融合,但骨质已经开始生长.结论：在颈椎管扩大成形手术中,利用微型钛钉-钛板固定是一种简单、可靠、安全、有效的方法,在抬起的椎板获得即刻稳定的同时,可以恢复椎管的完整性.     

Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report

OBJECTIVE AND IMPORTANCE: Adjacent segment disc disease is a well-described phenomenon that occurs after anterior cervical spinal fusion. One of the advantages of cervical laminoplasty over anterior approaches is that although the treated segments are stiffened, no formal fusion is performed. This is thought to reduce the biomechanical stresses placed on adjacent levels and thus decrease the likelihood of adjacent level degeneration. CLINICAL PRESENTATION: A 62-year-old man presented with myelopathy attributable to cervical spondylosis and underwent a C3-C7 laminoplasty. Improvements in gait were followed 2 years later by symptomatic disc degeneration and spinal cord compression at T1-T2, which rendered him wheelchair bound. INTERVENTION: The patient was treated with a laminectomy at the level of stenosis accompanied by posterior instrumentation and fusion from C5 to T3. This resulted in clinical improvement, and the patient was returned to his baseline ambulatory status. CONCLUSION: Adjacent segment disease is an uncommon complication that occurs after laminoplasty. Careful attention to preserving facet joint motion in the cervical spine may minimize the stresses placed on adjacent motion segments.     

Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities.

BACKGROUND CONTEXT: There is no report in the literature of two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis/paralysis exclusively in the bilateral lower extremities. PURPOSE: To identify the clinical characteristics of specific myelopathy resulting from C6-C7 disc herniation through a case with spastic paresis in the lower extremities without upper extremities symptoms due to separate disc herniation in the cervical and thoracic spine, which was surgically removed in two stages. STUDY DESIGN/SETTING: A case report. METHODS: A 48-year-old man developed a gait disturbance as well as weakness and numbness in the lower extremities. Thoracic magnetic resonance imaging (MRI) showed a T11-T12 disc herniation, which was removed under the surgical microscope through a minimally invasive posterior approach. He improved, but 2 months after surgery developed recurrent numbness and spasticity. On this occasion, no evidence of recurrence of the thoracic disc herniation could be identified, but cervical MRI demonstrated a compressed spinal cord at the C6-C7 level. The patient had no neurological findings in the upper extremities. The herniated disc at C6-C7 was removed under the surgical microscope with laminoplasty. RESULTS: The symptoms gradually improved after surgery. At the present time, 2 years and 9 months after the initial operation, the patient had a stable gait and was able to work. CONCLUSIONS: Our experience suggests that in the diagnosis of patients with spastic paresis and sensory disturbances in the lower extremities, spinal cord compression should be explored by imaging studies not only in the thoracic spine but also in the cervical spine, especially at the C6-C7 level, even if the symptoms and abnormal neurological findings are absent in the upper extremities.     

颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究

目的探讨颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎不稳定的颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床疗效。方法自2006-06--2011-03纳入颈椎管狭窄伴无骨折脱位型颈脊髓损伤44例。包括脊髓中央综合征26例,前脊髓损伤综合征12例,Brown-Sequard综合征4例,其他2例。结果所有患者均顺利完成手术。获12—60个月随访40例,平均（25．2±17．6）个月,末次随访时JOA脊髓功能评分改善率为68．5％;但双上肢功能恢复较差,出现双手不同程度肌肉萎缩5例;X线片检查显示颈椎生理曲度良好,无断钉、断棒及颈椎失稳;CT检查显示螺钉位置良好,椎管扩大成形满意,无门轴断裂及再关门。结论颈椎椎弓根钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎不稳定的颈椎管狭窄伴无骨折脱位型颈脊髓损伤可取得较满意疗效。     

两种固定方法在颈椎单开门椎管扩大椎板成形术中的比较研究

目的通过对门轴侧锚定法与开门侧支撑法两组病例的比较研究,评价纳米仿生骨"Y"形板在颈椎后路单开门椎管扩大椎板成形术中的应用价值。方法 2013年1月—2015年6月,本院收治椎管狭窄症(29例)和后纵韧带骨化症(OPLL,13例)颈椎后路手术适应证患者42例,均经后路行单开门椎管扩大椎板成形术,按手术时间顺序交替采用纳米仿生骨"Y"形板固定开门侧(A组,21例)及锚定法改良单开门(B组,21例)。记录手术时间、术中出血量及并发症发生情况。以颈椎功能障碍指数(NDI)及疼痛视觉模拟量表(VAS)评分评价患者手术前后生活质量;在术后即刻及末次随访的CT片上测量椎板掀开角度;在术前及末次随访CT片上测量C5节段椎管矢状径,椎管扩大率=(术后椎管矢状径-术前椎管矢状径)/术前椎管矢状径×100%。结果全部病例均获随访,随访时间12~24个月,平均16.5个月。2组患者手术时间、术中出血量及并发症发生情况差异无统计学意义(P0.05)。2组患者术前NDI、VAS评分、椎板掀开角度及C5节段椎管矢状径差异无统计学意义(P0.05)。A组末次随访时NDI、VAS评分及C5节段椎管矢状径与术前相比,差异有统计学意义(P0.05);椎管扩大率51.1%;末次随访时椎板掀开角度与术后即刻相比,差异无统计学意义(P0.05)。B组末次随访时NDI、VAS评分及C5节段椎管矢状径与术前相比,差异有统计学意义(P0.05);椎管扩大率48.4%;末次随访时椎板掀开角度与术后即刻相比,差异有统计学意义(P0.05)。末次随访时,2组间NDI、VAS评分及C5节段椎管矢状径差异无统计学意义(P0.05);椎板掀开角度差异有统计学意义(P0.05)。结论两种固定方式在颈椎后路单开门椎管扩大椎板成形术中均获满意的近期临床疗效。纳米仿生骨"Y"形板的应用能够更好地防止"再关门"现象发生,是一种安全、简便的方案,可作为微型钛板固定的补充。     

Square cervical laminoplasty incorporating spinous process: surgical technique

BACKGROUND: We have used a laminoplasty technique in multilevel cervical canal stenosis that incorporates spinous process in the neural arch and does not require free graft or foreign material. METHODS:In this technique, laminae and spinous processes were used to enlarge stenotic cervical spinal canal. Three patients (mean age 34.6 years) formed the study group with a mean follow-up period of 24.6 months. Postoperative computed tomography (CT) and lateral radiographs were used to assess results in terms of bony union, canal diameter, and alignment of cervical spine. RESULTS: All patients noted some improvement in both sensory and motor functions. The average increase in sagittal diameter of cervical spinal canal was 4.2 mm, and decrease in range of motion (ROM) was 13.2 degrees. Bony fusions at the gutters were seen after 6 months. CONCLUSION: This new technique of cervical laminoplasty is safe, effective, relatively easy, and avoids complications related to free grafts or metallic or nonmetallic foreign materials used in other techniques