Dural laceration

OBJECT: The authors describe 4 cases of delayed dural laceration by hydroxyapatite (HA) spacer causing tetraparesis following double-door laminoplasty. There are few reports of iatrogenic spinal cord lesions developing after double-door laminoplasty, although some complications such as postoperative C-5 paralysis or axial symptoms have been reported. The purpose of this report is to draw attention to the possibility of delayed dural laceration and its triggering mechanism. METHODS: One hundred thirty patients treated for cervical myelopathy were followed up for an average of 2 years and 9 months after laminoplasty. RESULTS: Four patients experienced aggravation of cervical myelopathy. Anterior dislodgement of HA spacers was shown on plain lateral radiographs. Follow-up T2-weighted magnetic resonance imaging demonstrated that the dislodged HA spacers were surrounded by cerebrospinal fluid at the time of aggravation. The dislodged HA spacers were removed and the dural membrane defects were repaired by patching with the fascia of the gluteus maximus muscle. The preoperative symptoms improved after the second operation in all patients. CONCLUSIONS: It is hypothesized that the loosening of the HA spacer in split spinous processes could occur with the movement of the cervical spine and/or the breakage of the suture before bone bonding. Anterior dislodgement of the HA spacer toward the spinal canal would cause dural laceration by direct friction between the dural membrane and the dislodged HA spacer, resulting in clinical aggravation. Despite the well-documented advantages of using HA spacers for double-door laminoplasty, possible laceration due to a dislodged HA spacer should be considered as a late complication.     

Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty

OBJECT: The authors describe 4 cases of delayed dural laceration by hydroxyapatite (HA) spacer causing tetra-paresis following double-door laminoplasty. There are few reports of iatrogenic spinal cord lesions developing after double-door laminoplasty, although some complications such as postoperative C-5 paralysis or axial symptoms have been reported. The purpose of this report is to draw attention to the possibility of delayed dural laceration and its triggering mechanism. METHODS: One hundred thirty patients treated for cervical myelopathy were followed up for an average of 2 years and 9 months after laminoplasty. RESULTS: Four patients experienced aggravation of cervical myelopathy. Anterior dislodgement of HA spacers was shown on plain lateral radiographs. Follow-up T2-weighted magnetic resonance imaging demonstrated that the dislodged HA spacers were surrounded by cerebrospinal fluid at the time of aggravation. The dislodged HA spacers were removed and the dural membrane defects were repaired by patching with the fascia of the gluteus maximus muscle. The preoperative symptoms improved after the second operation in all patients. CONCLUSIONS: It is hypothesized that the loosening of the HA spacer in split spinous processes could occur with the movement of the cervical spine and/or the breakage of the suture before bone bonding. Anterior dislodgement of the HA spacer toward the spinal canal would cause dural laceration by direct friction between the dural membrane and the dislodged HA spacer, resulting in clinical aggravation. Despite the well-documented advantages of using HA spacers for double-door laminoplasty, possible laceration due to a dislodged HA spacer should be considered as a late complication.     

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.     

Treatment of myelopathy due to cervicothoracic OPLL via open door laminoplasty

STUDY DESIGN: Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. OBJECTIVES: Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature. SUMMARY OF BACKGROUND DATA: OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine. METHODS: The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography. RESULTS: Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury. CONCLUSIONS: Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.     

Double-door laminoplasty in managing multilevel myelopathy: technique description and literature review

Cervical laminoplasty has become a popular technique for the treatment of cervical myelopathy resulting from multilevel canal stenosis. The goal of this technique is to increase the spinal canal space and to reconstruct the posterior bony arch at the same time. The most common reason for laminoplasty failure is restenosis because of hinge closure. In the present report, the authors describe a variation of the double-door laminoplasty using a specifically tailored plate. The present technique is a modification of the double-door laminoplasty by using a specifically developed plate (Senegas' Plate--by Stryker Technology, Kalamazoo, MI), which allows to fix the two hemilamina in an open and expanded position re-establishing also the posterior canal arch. This procedure was implemented in a series of 22 patients. The device has been successfully implanted in all patients. At a mean follow-up of 21.1 months all patients showed a remarkable neurological improvement documented by serial clinical and radiological investigations. The present study indicates that this specific device effectively preserves the postoperative sagittal cervical canal diameter and provides a rigid construct, and in addition, it is very easy and fast to apply minimizing the risk of iatrogenic injuries, blood loss, and operative time.     

Analysis of the cervical spine alignment following laminoplasty and laminectomy

Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling-type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using a program we developed for analysis of the buckling-type alignment. Sixty-four patients who underwent laminoplasty and 37 patients who underwent laminectomy were reviewed retrospectively. The subjects comprised patients with cervical spondylotic myelopathy (CSM) and those with ossification of the posterior longitudinal ligament (OPLL). The postoperative observation period was 6 years and 7 months on average after laminectomy, and 5 years and 6 months on average following laminoplasty. Development of the buckling-type alignment was found in 33% of patients following laminectomy and only 6% after laminoplasty. Development of buckling-type alignment following laminoplasty appeared markedly less than following laminectomy in both CSM and OPLL patients. These results favor laminoplasty over laminectomy from the aspect of mechanics.     

单开门颈椎椎管扩大成型术的远期疗效观察

目的 了解单开门颈椎椎管扩大成型术治疗颈椎椎管狭窄症的远期效果。方法 对９８例颈椎椎管狭窄症患者施行了单开门颈椎椎管扩大成型术,其中６１例获得随访,平均随访１１年８个月。结果 颈椎后纵韧带骨化症（ＯＰＬＬ）组３２例,发育性颈椎椎管狭窄（ＤＣＳ）组２０例脊髓型颈椎病（ＣＳＭ）组８例,三组均在术后３年时疗效最佳,ＪＯＡ评分平均改善率分别为７２．３０％～６７．８％和（ＣＳＭ）组８例,三组均在术后３年时疗     

Long-term results of double-door laminoplasty for cervical stenotic myelopathy

STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy. METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine. CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.     

Laser-assisted anterior cervical corpectomy versus posterior laminoplasty for cervical myelopathic patients with multilevel ossification of the posterior longitudinal ligament

OBJECTIVE: This study reports on the comparative results of a series of patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL) who were treated with laser-assisted anterior corpectomy or laminoplasty. METHODS: Forty-eight patients (21 patients with anterior corpectomy and 27 patients with laminoplasty) with cervical OPLL involvement of three or more vertebral bodies were retrospectively reviewed. Both pre- and postoperatively neurological status was graded according to the Nurick grading system. The anteroposterior (AP) diameter change at the narrowest part of the spinal canal, the change in the regional and the overall cervical Cobb's angle, and the change in cervical range of motion (ROM) were all measured. The mean follow-up periods were 21.8 mo and 29.1 mo for the corpectomy and laminoplasty patients, respectively. RESULTS: The mean changes in the pre- to postoperative Nurick grades were 1.9 for the corpectomy group and 1 for the laminoplasty group (p < 0.05). The mean changes in the pre- to postoperative spinal canal AP diameters were 9.1 mm and 4.11 mm, respectively, for the corpectomy group and the laminoplasty group (p < 0.05). The mean changes of the regional Cobb's angle were 1.7 degrees and -3.1 degrees (p = 0.06), and the mean changes of the overall cervical Cobb's angle were 1.1 degrees and -1.6 degrees , respectively, for the corpectomy group and the laminoplasty group (p > 0.05). The changes in the cervical degree of ROM were -19.6 degrees and -19.7 degrees , respectively, for the corpectomy group and the laminoplasty group (p > 0.05). CONCLUSIONS: Direct decompression of the spinal cord by laser-assisted anterior cervical corpectomy was shown to be a better surgical option on long-term follow-up, yielding more recovery of neurological deficits, achieving adequate decompression of the spinal canal, and preventing the development of regional kyphosis at the operated level of the spine, in patients with multilevel cervical OPLL.     

New titanium spacer for cervical laminoplasty: initial clinical experience. Technical note

Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty.     

双开门椎管扩大椎板成形术中椎管矢状径增加值的预测

 目的 推导双开门椎管扩大椎板成形术中椎板开门宽度与椎管矢状径增加值关系的公式,根据椎板开门宽度预测椎管矢状径和椎管横截面积的增加值。方法 2010年9月至2013年1月期间,实施双开门椎管扩大椎板成形术治疗多节段脊髓型颈椎病20例,C₃~C₇节段9例,C₃~C₆节段11例,共89个节段。推导椎板开门宽度与椎管矢状径增加值关系的公式。根据此20例患者手术前后CT片应用pacs软件测量各项参数,应用公式预测椎板开门宽度分别为6、8、10、12 、14、16 mm时椎管矢状径和椎管横截面积的增加值。结果 C₃~C₇相同节段不同椎板开门宽度时椎管矢状径增加值、椎管横截面积增加值差异均有统计学意义;C₃~C₆相同节段不同椎板开门宽度时各椎管矢状径增加值的差异有统计学意义;C₇节段椎板开门宽度14 mm与16 mm时椎管矢状径增加值的差异无统计学意义;随着椎板开门宽度的增加,椎管矢状径增加值相应增加,但椎管矢状径增加值的增加趋势逐渐减弱。结论 在双开门椎管扩大椎板成形术中,应用公式根据椎板开门宽度能准确预测椎管矢状径与椎管横截面积的增加值,从而指导术者进行精确地选择个体化的开门宽度,能避免过分开门或开门不足。     

颈椎单开门桥式植骨椎板成形术治疗脊髓型颈椎病

目的:探讨改良单开门桥式植骨椎板扩大成形术治疗脊髓型颈椎病的疗效及其相关影响因素。方法:采用改良单开门手术,C4、C6两处“桥式”植骨椎板扩大成形治疗61例脊髓型颈椎病患者。结果:随访2～8年,平均4.3年。JOA评分由术前的8.4±1.9分提高到随访时的12.4±3.0分(P<0.01)。其中优15例(24.6%),良16例(26.2%),可24例(39.4%),差6例(9.8%)。C3~C7曲度术后平均减少了8.7°(P<0.01)。CT测量骨性椎管面积术后平均增加67mm2(P<0.01)。矢状径术后平均增加4.1mm(P<0.01)。术后JOA评分改善率与术后骨性椎管面积的改善率两者的相关系数r=0.027。结论:改良单开门“桥式”植骨椎板成形术是一种安全和有效的术式;椎管骨性面积的增加是神经功能改善的基础,术后椎管矢状径扩大以4~5mm为宜。     

螺旋CT三维重建技术评估下颈椎多节段椎管狭窄合并创伤性颈椎不稳的手术效果

目的应用螺旋CT（multi-spiral computerized tomography,MSCT）三维重建技术评估下颈椎多节段椎管狭窄合并创伤性颈椎不稳（multilevel degenerative stenosis with traumatic instability,MDSTI）的手术效果。方法2006年9月-2007年8月,本院应用颈椎椎弓根钉固定及同种异体骨植骨双开门椎管戚形术治疗9例MDSTI患者,结合MSCT三维重建技术量化评估螺钉穿破情况、术后椎管矢状径及横切面积增加情况。结果9例置入椎弓根钉44枚,1级穿破72．7％（32／44）,2级穿破27．3％（12／44）,无3级穿破及置钉不当需重新置钉病例。42个节段行双开门椎管成形术,术后椎管矢状径及横切面积较术前显著增加（P〈0．05）。术后6个月,76．2％（32／42）的患者植骨块完全融合,23．8％（10／42）的患者植骨块部分吸收,所有节段双侧开槽区域均达到坚强融合。结论应用MSCT三维重建技术可量化评估颈椎椎弓根钉固定的准确性和双开门椎管成形术的扩大比例。     

单开门椎管扩大椎板成形术在颈椎病再手术中的应用及疗效分析

目的 评价应用单开门椎管扩大椎板成形术进行颈椎病再手术的适应证及临床疗效.方法 自2003年2月至2009年6月,对15例颈椎前路融合术后症状复发或加重的患者行后路单开门椎管扩大椎板成形术.分析再手术的原因和疾病进展过程,采用日本骨科学会制定的JOA评分系统评估患者脊髓神经功能恢复情况,Nurick分级评价患者行走功能.结果 1例失随访,1例术后随访时间过短,未统计入本组.其余13例患者随访时间13～52个月,平均26个月.前后两次手术间隔时间为5个月～6年,平均24个月.再手术原因包括:邻近节段退变压迫颈髓2例,首次手术减压不彻底5例,后纵韧带骨化症(OPLL)误诊颈椎病4例,局限型OPLL进展2例.再手术均采用C3-6或C7后路单开门椎管扩大椎板成形术.13例患者JOA评分术前和末次随访时分别为10.5和13.8分(P＜0.05),平均神经功能改善率为53.0%.Nurick分级术前和随访时分别为3.1和1.9级(P＜0.05),平均改善1.2级.术后并发症包括脑脊液漏1例,颈肩部轴性痛1例,C5神经根麻痹l例.结论 对于颈椎前路融合术后减压不彻底、邻近节段退变或OPLL进展导致症状复发者采用后路单开门椎管扩大椎板成形术可以有效缓解脊髓压迫,改善脊髓神经功能,避免再次经前方入路引起的手术风险.     

Impact of longitudinal distance of the cervical spine on the results of expansive open-door laminoplasty

STUDY DESIGN: A retrospective study in patients who underwent expansive open-door laminoplasty (ELAP) for cervical myelopathy and in whom the cervical alignment was nonlordotic at the final follow-up to analyze the correlation between the longitudinal distance of the cervical spine and surgical results. OBJECTIVES: To determine the impact of longitudinal distance of the cervical spine on surgical results of ELAP and to propose a new concept, the redundant spinal cord, that may influence patient selection for ELAP. SUMMARY OF BACKGROUND DATA: Results in many studies have demonstrated that postoperative cervical alignment has significant effect on surgical results, and spines that are malaligned are thought to deteriorate. The current surgical data showed that not all patients with postoperative malalignment had poor surgical results. Patients with cervical spondylotic myelopathy (CSM) tended to have better clinical results than those with ossification of the posterior longitudinal ligament (OPLL). METHODS: Results in 70 patients who underwent ELAP for cervical myelopathy with postoperative cervical malalignment were investigated. The longitudinal distance index (LDI) was defined as the length of a vertical line between the posteroinferior edges of C2 and C7 divided by the anteroposterior diameter of C4 and was measured on lateral neutral radiographs at final follow-up. Correlation between LDI and surgical results represented by Japanese Orthopedic Association scores and percentage of recovery were analyzed statistically in each patient. RESULTS: Patients with CSM had smaller LDI and better surgical results than those with OPLL. Weak but significant negative correlation was detected between LDI and percentage of recovery, indicating that longitudinal distance of the cervical spine may have some degree of impact on the surgical results of ELAP. CONCLUSION: A decrease in LDI represents shortening of the cervical spine caused by multiple disc degeneration and may influence surgical results of ELAP by inducing redundancy of the spinal cord in patients with postoperative malalignment.     

Results of surgical treatment of cervical spondylotic myelopathy in patients aged 75 years or more: a comparative study of operative methods

Introduction

The number of surgical procedures in elderly patients has been increasing as the population has grown older; recently, spine surgeons have been more likely to encounter elderly patients with cervical myelopathy in need of surgical treatment. There are many reports about surgical treatment of elderly patients with cervical spondylotic myelopathy (CSM); however, there are no studies about the proper selection of surgical methods and comparison of their results in CSM patients aged ≥75 years. The objective of this study was to review the results of operative methods in CSM patients aged ≥75 years.

Methods

Forty-three consecutive cases with an average age of 79 years that underwent surgical treatment were included in this study. The neurological severity was assessed using the Japanese Orthopaedic Association score for cervical myelopathy (JOA). The JOA scores were evaluated before surgery and at final follow-up. There were 21 laminoplasty procedures (from C3 to C7), 13 selective laminoplasty procedures (one above and one below the affected intervertebral level), and nine anterior decompression and fusion procedures. A selective laminoplasty was performed in cases with general complications and was diagnosed as one intervertebral level both clinically and electrophysiologically. Surgical results were compared among the three treatment groups.

Results

The average preoperative JOA score was 7.7 points and the average JOA recovery rate was 45 %. There were three cases of C5 palsy and one wound infection. Operative time and intraoperative bleeding in the selective laminoplasty group were significantly smaller than those in the other groups. There was no significant difference in the JOA recovery rates among the groups.

Conclusions

Selective laminoplasty is less invasive and the surgical results in our study were almost good. It also has good short-term results. However, the indication for surgery has to be selected carefully in elderly CSM patients.     

56例无骨折脱位型颈髓损伤手术疗效分析

目的 :探讨无骨折脱位型颈髓损伤早期手术治疗效果。方法 :自 1996年收集我院 5 6例无骨折脱位颈髓损伤病人。入院后给予 MRI和 X线检查 ,其中后纵韧带骨化 17例 ,特发性弥漫性骨肥厚症 4例 ,黄韧带骨化 8例 ,颈椎管狭窄 15例 ,其中 2 3例于伤后 3d内手术。19例为晚期手术 ,14例保守治疗。结果 :早期手术满意 ,较大于 72 h手术与保守治疗的效果明显改善 (P<0 .0 5 ) ,术后未见颈椎不稳与再关门 ,所有病人均在入院后进行 Frankel分级 ,2 w后出院再次评分 ,早期手术组改善率明显高于其他两组 ,X线显示颈椎内径增加 ,椎管扩大 MRI显示颈椎后侧减压明显。结论 :无骨折脱位型颈髓损伤早期正确诊断 ,手术可获得满意疗效     

单开门棘突重建颈椎管扩大成形术治疗脊髓型颈椎病

目的：探讨单开门棘突重建颈椎管扩大成形术治疗脊髓型颈椎病的疗效。方法：应用上述术式治疗脊髓型颈椎病21例,男16例,女5例,平均年龄49岁,临床疗效采用JOA进行评分。结果：平均随访2年6个月,JOA评分平均改善率为76.3%,无一例发生再关门现象或颈椎反曲畸形。结论：单开门棘突重建椎扩大成形术治疗脊髓型颈椎病效果较好,棘突重建是防止颈椎不稳及反曲畸形的有效措施。     

Medium-term outcomes of C3�C6 laminoplasty for cervical myelopathy: a prospective study with a minimum 5-year follow-up

C3–6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3–6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3–6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3–6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for ≥5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3–6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for ≥5 years postoperatively.     

颈后路双开门椎管扩大成形术联合C2穹隆式减压治疗颈椎管狭窄症

目的：探讨颈后路双开门椎管扩大成形术联合C₂穹隆式减压治疗颈椎管狭窄症的临床疗效。方法：回顾性分析2016年6月至2018年6月行颈椎后路双开门椎管扩大成形术联合C₂穹隆式减压治疗的28例患者的临床资料,男17例,女11例,年龄39~74（61.0±6.7）岁。根据JOA评分、轴性症状、颈椎活动度、颈脊髓压迫程度等方面进行疗效评价。结果：所有患者获得随访,时间6~12个月,平均10.2个月。术后末次随访JOA评分均明显改善（P<0.05）。手术前后患者颈椎活动度分别为（41.8±15.3）°,（36.3±18.2）°,差异无统计学差异（P>0.05）。C₂-C₃椎管水平最狭窄部位矢状径手术前后分别为（8.38±1.16）mm和（16.20±1.82）mm,术后颈椎管矢状径明显扩大（P<0.05）。4例术后出现轴性症状,发生率14.29%（4/24）。结论：颈后路双开门椎管扩大成形术联合C₂穹隆式减压可以直接扩大C₂-C₃椎管容积,解除脊髓及神经根压迫,同时又尽可能地减少了对颈椎后方韧带复合体的损伤,保持了颈椎序列的稳定性,减少了术后轴性症状的发生,且术式相对简单,无需使用金属内固定。