单开门颈椎管扩大成形术开口间距与疗效对比观察

目的了解颈椎管扩大成形术后椎管扩大程度及开口大小与疗效的关系. 方法对于脊髓型颈椎病、颈椎后纵韧带骨化、发育性颈椎管狭窄等患者共72例行单开门颈椎管扩大成形术,其中58例获得随访,手术前、后均行CT扫描测量颈椎管矢状径,术后平均随访时间35.9个月. 结果 JOA评分优良率79.3%.术后疗效随C3～7椎管平均矢状径增加而改善,当椎管平均矢状径增加至80%左右时疗效最佳,继续增加椎管平均矢状径疗效无明显改善.结论颈后入路单开门椎管扩大成形术并非开口间距越大疗效越好,当开口大小超过一定范围,术后症状改善不再明显,并发症增加.     

颈椎管狭窄症

颈椎管狭窄症是由先天或后天因素造成的颈椎椎管、神经根管的容量减少 ,导致脊髓及神经根受压而产生临床症状的一组综合征。本文综述该症的病因、病理及临床问题     

椎板成形术治疗颈椎椎管狭窄性疾病

颈椎椎管狭窄有原发性(发育性)和继发性狭窄。前者由于椎弓根、关节小面和椎板这三个决定椎管矢状径的因素发育异常所致,后者则由于广泛的骨质增生、后纵韧带骨化、黄韧带肥厚等继发性病变所引起。颈前路手术不能解除椎管狭窄,广泛的椎板切除术是解除狭窄的合理方法,但有造成颈椎不稳定,半脱位,鹅颈畸形,瘢痕压迫脊髓以及病人颈后怕受压和心理上不安全感。为此,很多学者设计椎管成形术以扩大椎管而又保持椎管完整。我院自1986年5月至1988年5月共进行5例,并作了改进,效果较好,     

椎板开窗潜挖式椎管扩大术治疗椎管狭窄症临床分析

目的探讨椎板开窗潜挖式椎管扩大治疗椎管狭窄症的临床效果。方法回顾2009-01-2011-02采用椎板间开窗潜行扩大减压术治疗腰椎管狭窄症患者69例进行分析。结果 69例患者均顺利完成手术,术中未出现脊髓、神经及血管损伤,无间隙感染、脊柱不稳及症状复发。依据Naka l评分标准进行疗效评价,优40例,良11例,可14例,差4例,总优良率94.20%。结论采取椎板开窗潜挖式椎管扩大治疗椎管狭窄症具有创伤小、减压充分、保留腰椎后部结构,维持了腰椎稳定性和活动程度。     

神经根管减压术治疗腰椎神经根管狭窄症

腰椎神经根管狭窄症通常又被称作侧隐窝狭窄、侧隐窝神经卡压综合征[1],临床研究发现其主要原因是韧带肥厚增生,小关节增生内聚。本研究中对患者进行全面检查,结合相关影像学诊断分析,有针对性地开展椎板开窗术进行治疗,通过手术的方式清除增生肥大的关节突关节、黄韧带等,消除压迫神经的因素,具体介绍如下。     

脊柱内镜下半椎板切除术与ACDF治疗颈椎管狭窄症的对比分析

目的 对比分析脊柱内镜下半椎板切除术和颈椎前路椎间盘切除融合术（ACDF）治疗颈椎管狭窄症（CSS）的疗效。方法 回顾性分析2015年1月至2019年12月手术治疗的50例单节段或双节段CSS的临床资料。26例行ACDF（ACDF组）,24例行脊柱内镜下半椎板切除术（内镜组）。50例术后随访6~62个月,其中内镜组平均随访（24.4±16.4）个月,ACDF组平均随访（25.7±18.0）个月。结果 内镜组手术时间、术中出血量与住院时间较ACDF组均明显减少（P<0.05）。两组末次随访日本骨科协会（JOA）评分、颈椎功能障碍指数量表评分及视觉模拟量表评分较术前均明显改善（P<0.05）,但两组之间均无明显差异（P>0.05）。两组JOA评分改善率、临床疗效均无统计学差异（P>0.05）。结论 脊柱内镜下半椎板切除术和ACDF治疗CSS的疗效相当,但脊柱内镜下半椎板切除术具有创伤小、风险低、恢复快等优点。     

后路椎板成形并突出髓核摘除治疗颈椎管狭窄并颈椎间盘突出症

目的 探讨单开门后路减压并突出髓核摘除治疗颈椎管狭窄并颈椎间盘突出症的疗效.方法 1999年8月至2008年8月,采用后路单开门减压并突出髓核摘除治疗19例颈椎管狭窄并颈椎间盘突出症患者,18例获得平均46个月(3-108个月)的随访,观察比较手术前后神经功能(JOA评分)的变化情况.结果 18例患者术后JOA评分(14.22±1.86)分,与术前(6.72±2.42)分比较差异有统计学意义(P<0.01),术后神经功能平均改善77%.结论 后路单开门减压并突出髓核摘除治疗颈椎管狭窄并颈椎间盘突出症安全可靠.     

"高架桥式"椎管扩大成形术行脊髓减压(13例报告)

目的 发育性椎管狭窄、连续型后纵韧带骨化、广泛椎管内占位预计不能全切除时,为避免椎管切除造成的脊柱后凸畸形或椎管单开门成形术后椎板塌陷对脊髓造成新的压迫,特设计本术式.方法 俯卧位,切开皮肤,剥离两侧脊旁肌到小关节突,显露需减压的脊椎节段.用超声骨刀截断两侧的椎板根部,将整个椎板取下.手术结束后,取长度合适的微型双孔钛钢连接桥片将离断侧的椎板架起后,固定在小关节突上,使椎管扩大成型.结果 "高架桥"术式13例各部位椎管狭窄6例;颈椎后纵韧带骨化4例;地毯样脊膜瘤1例;髓内肿瘤次全切除2例.手术效果良好,术后影像学检查见椎管扩大,脊髓蛛网膜下腔恢复.结论 "高架桥式"钛片固定椎管成形术能稳定固定椎板,防止了以往椎管成形术后椎板塌陷对脊髓造成新的压迫.椎管扩大成形确切牢靠,不影响小儿的脊柱发育.为第二次手术保留了完整的手术剥离路径.     

腰椎管狭窄症62例手术治疗分析

目的 探讨腰椎管狭窄症的手术治疗方法和减压范围。方法 自1996-06～2002-06手术治疗腰椎管狭窄症62例，对大部分病例采取选择性椎管减压术，对发育性椎管狭窄和症状严重的退行性椎管狭窄行全椎板切除减压术。结果 随访8个月～6年，优44例，良13例，进步5例，优良率92％。结论 腰椎管减压手术应该具备神经减压彻底、组织损伤小、保持和重建腰椎稳定性这三个基本条件。手术成功的关键是解决椎管狭窄和神经通道狭窄。     

单开门椎管成形显微手术治疗颈椎管髓外硬膜内肿瘤的研究

目的探讨单开门椎管成形显微手术治疗颈椎管髓外硬膜内肿瘤围术期护理方法及疗效。方法对2005-01—2015-01在我院治疗的91例颈椎管髓外硬膜内肿瘤患者的临床资料进行回顾性分析,所有患者给予单开门椎管成形显微手术治疗并进行围术期护理。结果椎板开门节段(2.52±0.46)个,手术时间(97.42±16.95)min,失血量(81.38±21.07)mL;疾病类型:神经鞘瘤57例,脊膜瘤15例,肠源性囊肿4例,脂肪瘤15例。经1a随访治愈76例,改善15例,治疗前后颈椎曲度比较差异无统计学意义(P0.05)。结论针对颈椎管髓外硬膜内肿瘤患者采用单开门椎管成形显微手术治疗并配合围术期护理取得良好效果,有效恢复脊椎原有结构,防止术后脊椎畸形,对脊柱影响小。     

责任节段颈后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病

目的 对比广泛式与责任节段颈后路单开门椎管扩大成形术（EOLP）治疗多节段脊髓型颈椎病（MCSM）的临床效果。方法 回顾性分析自2013年3月至2015年5月接受EOLP治疗的41例MCSM的临床资料。采用广泛式EOLP治疗24例（广泛式组）,采用责任节段EOLP治疗17例（责任节段组）。结果 广泛式组术后随访（17.63±4.12）个月,责任节段组术后随访（18.15±3.92）个月。责任节段组手术时间、术中出血量、术后引流量、术后住院时间均明显减少（P<0.05）。术后12个月,广泛式组日本骨科协会（JOA）评分[（14.78±1.25）分]与责任节段组[（14.57±1.31）分]无统计学差异（P>0.05）;末次随访,广泛式组JOA评分[（15.01±1.34）分]与责任节段组组[（14.76±1.28）分]无统计学差异（P>0.05）。末次随访,责任节段组明显轴性症状比例（17.65%,3/17）明显低于广泛式组（50.00%,12/24;P<0.05）。结论 广泛式与责任节段EOLP治疗MCSM疗效均肯定,但后者具有损伤小、恢复快、可明显降低术后颈椎轴性症状等优势。     

Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty

To investigate the clinical and radiographic fate of fractured hinges in open-door cervical laminoplasty, 135 segments of 36 patients who had undergone follow-up for more than two years after open-door cervical laminoplasty due to compressive cervical myelopathy were reviewed clinically and radiographically. Hinge fractures were identified by the intraoperative finding of obvious instability or click sounds (an obvious fracture), or by immediate postoperative computed tomography (CT) images showing a discontinuity of both the inner and outer cortex or a displacement of more than 1 mm at the lamina hinge site (an occult fracture). At two years post-surgery, union and displacement of the fractured hinges were evaluated with CT and the clinical outcome was assessed by the Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) scores. Immediate postoperative CT scans revealed 28 hinge fractures in 16 patients. Only three fractures were identified during surgery, with most being identified on postoperative CT. Nineteen laminae showed non-displaced cortical discontinuity, five were anteriorly displaced by more than 1 mm, and four were displaced posteriorly. Twenty-five laminae (89.3%) had achieved union according to the two-year postoperative CT scan. No de novo neurologic symptoms were found to be associated with hinge fracture. The two-year postoperative JOA and NDI scores did not differ significantly between patients with or without a hinge fracture. Most fractures at the hinge site occurred without intraoperative recognition, and usually re-unified without significant displacement or adverse clinical effects. When hinge fractures occur, careful observation without additional intervention is recommended.     

改良椎板成形术在颈椎管内肿瘤切除术中的应用

目的评价经改良颈椎管扩大成形术切除椎管内肿瘤的手术疗效及手术后颈椎的生物力学变化。方法自2001年6月至2006年1月,16例颈椎管内肿瘤经后路切除。手术中,整体取下所累节段之椎板及相应后方结构,待肿瘤切除后再将此结构回置,以钛钉-钛板固定,将椎管扩大成形。分析此术式对肿瘤的显露与切除效果,评价手术后患者的神经功能,随访患者远期颈椎生理曲度、颈椎运动度及稳定性。结果16例患者中髓内室管膜瘤5例,髓外-硬膜下神经鞘瘤9例、脊膜瘤2例。椎板成形2～5节段(平均3.5节段),肿瘤全切率100%。术后随访时间6个月至5年(平均19.5个月),JOA评分从术前的(9.21±3.28)分提高到(15.38±1.29)分。颈椎管矢状径较术前增加3.8mm(P=0.004)。颈椎曲度恶化发生率为12.5%;颈椎不稳定发生率为0;颈椎总运动度减少2°,与手术前对比差异无统计学意义(P=0.71)。结论经改良颈椎管扩大成形术入路,手术对椎管内病变显露及切除效果满意,同时扩大了椎管前后径。由于部分保持了颈椎后方张力带,对脊柱的生物力学影响较小。     

Dropped head syndrome after cervical laminoplasty: A case control study

Dropped head syndrome (DHS) is characterized by apparent neck extensor muscle weakness and difficulty extending the neck to raise the head against gravity. The aim of the present study was to elucidate possible risk factors for DHS after cervical laminoplasty. Five patients who developed DHS after cervical laminoplasty (DHS group) and twenty age-matched patients who underwent laminoplasty without DHS after surgery (control group) were compared. The surgical procedure was single-door laminoplasty with strut grafting using resected spinous processes or hydroxyapatite spacers from C3 to C6 or C7. Analyses of preoperative images including the C2–C7 angle, C7–T1 kyphosis, T1 tilt, center of gravity line from the head–C7 sagittal vertical axis (CGH–C7 SVA) were performed on lateral plain cervical spine radiographs. Preoperative T2-weighted MRI at the C5 vertebral level was used to measure the cross-sectional area of the deep extensor muscles. Widths of the lateral gutters were assessed postoperatively using CT scans of the C5 vertebral body. The average preoperative C2–C7 angle was significantly smaller in the DHS group compared with the control group. The average preoperative C7–T1 angle was significantly larger in the DHS group compared with the control group. The average preoperative CGH–C7 SVA was significantly larger in the DHS group compared with the control group. In conclusion, patients with more pronounced preoperative C2–C7 kyphosis, C7–T1 kyphosis, and CGH–C7 SVA are more likely to develop DHS following laminoplasty.     

Plate-only open-door laminoplasty with fusion for treatment of multilevel degenerative cervical disease

Adequate fixation of the opened laminar arch is the key indicator of a successful laminoplasty surgery; poor outcomes, including secondary narrowing of the spinal canal and a high risk of axial neck pain are possible when using a suturing method during conventional laminoplasty. Rigid fixation including spacers or bone struts yields satisfactory clinical outcomes. However, this approach is also associated with a longer surgical time and an increased risk of instrumentation dislodgement. Plate-only fixation with fusion was developed in our hospital to improve conventional laminoplasty; in addition, the supraspinous ligament is preserved in this procedure. We evaluated both the safety and efficacy of the procedure. Twenty-six patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was placed on the hinge side to promote fusion, without bone struts on the open side. The Japanese Orthopedic Association (JOA) score, X-ray, three-dimensional CT scan and MRI were used for the pre- and postoperative evaluations. The mean follow-up period was 22 months (range=12-34 months), and all patients achieved osseous fusion within six months of the operation. Patients who underwent open-door laminoplasty showed an improvement in the JOA score of 60.7%; a 23.0% incidence of axial neck pain and a 3.2° loss of range of motion (ROM) were also observed. No instrumentation failure or clinical deterioration was observed in our study. Thus, open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical ROM, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion.     

Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference

The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42–91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12–66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705–0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.     

A case of cervical myelopathy treated by "open-door laminoplasty

A case of cervical myelopathy is reported. In the treatment "open-door" laminoplasty was applied using titanium implants after laminoplasty for stabilization of the posterior bone block. The "open-door" laminoplasty is an easy and safe method making possible avoiding of such complications after laminectomy as instability, kyphotic deformity and development of scar compressing the spinal cord.