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41.
《Neurocirugía (Asturias, Spain)》2021,32(5):224-230
ObjectiveThe open-door laminoplasty technique is widely used in the treatment of multilevel cervical myelopathy. Despite the satisfactory functional and radiological results of this technique, postoperative C5 palsy is still a severe and disabling complication with a variable incidence in the literature. The objective of this article is to describe and demonstrate the surgical technique step by step with the addition of unilateral C4-5 foraminotomy and to evaluate the results obtained to date, with special emphasis on C5 palsy.Material and methodsRetrospective study of 20 patients operated on for cervical myelopathy using the “extended” laminoplasty technique, which is described step by step.ResultsBetween January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series.ConclusionThe extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy. 相似文献
42.
背景:颈椎后路椎管扩大成形术后脊髓功能波动会影响患者的远期疗效,但关于如何预测术后出现脊髓功能波动的研究较少。目的:探讨扩散张量成像(DTI)预测颈椎后路椎管扩大成形术后脊髓功能波动的价值。方法:前瞻性选择2017年1~12月收治的行颈椎后路椎管扩大成形术的颈椎退行性疾病患者。术前采集患者日本骨科协会(JOA)评分及脊髓压迫最重节段(LMC)与C2椎体后方正常脊髓的DTI参数;术后3个月、1年随访采集患者JOA评分并进行常规MRI扫描。比较术后脊髓功能波动组与无波动组患者术前DTI参数差异,并绘制术前DTI参数预测术后脊髓功能波动的受试者操作特征(ROC)曲线。结果:本研究最终纳入65例患者。术后11例患者(16.9%)发生脊髓功能波动(术后脊髓功能波动组),而54例患者(83.1%)未发生(术后脊髓功能无波动组)。术后脊髓功能波动组患者术前C2椎体后方正常脊髓的轴向扩散系数(AD)值低于无波动组患者,且差异有统计学意义(P<0.05)。ROC曲线显示,C2椎体后方正常脊髓的AD值预测术后脊髓功能波动的阈值为1.4×10^-3 mm^2/s,敏感度为90.0%,特异度为56.9%。结论:AD值能够在术前提示颈椎后路椎管扩大成形术后患者脊髓功能波动。 相似文献
43.
Shingo Morishita Toshitaka Yoshii Atsushi Okawa Kiyohide Fushimi Takeo Fujiwara 《The spine journal》2019,19(4):610-616
BACKGROUND CONTEXT
Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.PURPOSE
To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database.STUDY DESIGN
A retrospective cohort study with propensity score matching analysis.PATIENT SAMPLE
Overall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed.OUTCOME MEASURES
The occurrence of postoperative complications during hospitalization.METHODS
We compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis.RESULTS
One-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups.CONCLUSION
The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group. 相似文献44.
45.
46.
目的系统评价保留C_(7)棘突肌肉韧带复合体改良椎管扩大成形与传统椎管扩大成形手术治疗多节段颈椎病的临床疗效。方法计算机检索PubMed、Cochrane Central、EMbase、the ISI Web of Knowledge Database、知网、维普、万方数据库。检索时间为建库时间至2020年12月1日。纳入关于保留C_(7)棘突改良椎管扩大成形与传统椎管扩大成形两种手术方法治疗脊髓型颈椎病疗效比较的随机对照试验、前瞻性或回顾性研究。利用Rev-Man 5.3软件进行Meta分析。结果共有10篇研究符合纳入标准,共603例患者,改良组268例,传统组335例。Meta分析结果显示:改良组术后轴性症状发生率、VAS评分低于传统手术组(P<0.05),术后JOA评分改善率两者差异无统计学意义(P>0.05)。结论保留C_(7)棘突改良椎管扩大成形术与传统椎管扩大成形术治疗脊髓型颈椎病均的疗效相当,均可有效改善各项评分,前者可以有效降低术后轴性症状的发生率。 相似文献
47.
Da-Jiang Ren Fang Li Zhi-Cheng Zhang Guan Kai Jian-Lin Shan Guang-Min Zhao Tian-Sheng Sun 《中华医学杂志(英文版)》2015,128(15):2054-2058
Background:Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM).Each posterior technique has its own advantages and disadvantages.In the presen... 相似文献
48.
Akihito Minamide Munehito Yoshida Hiroshi Yamada Yukihiro Nakagawa Kazuhiro Maio Masaki Kawai Hiroshi Iwasaki 《European spine journal》2010,19(3):487-493
Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The
purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment
of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges
for the aspiring endoscopic surgeons, the most critical of which is mastering hand–eye coordination. With training in live
animal and cadaver surgery, the technical progress has reduced the problem of morbidity following surgery. The authors have
performed microendoscopic decompression surgery on more than 2,000 patients for lumbar spinal canal stenosis. Fifty-one patients
underwent the posterior decompression surgery using microendoscopy for cervical myelopathy at authors’ institute. The average
age was 62.9 years. The criteria for exclusion were cervical myelopathy with tumor, trauma, severe ossification of posterior
longitudinal ligament, rheumatoid arthritis, pyogenic spondylitises, destructive spondylo-arthropathies, and other combined
spinal lesions. The items evaluated were neurological evaluation, recovery rates; these were calculated following examination
using the Hirabayashi’s method with the criteria proposed by the Japanese Orthopaedic Association scoring system (JOA score).
The mean follow-up period was 20.3 months. The average of JOA score was 10.1 points at the initial examination and 13.6 points
at the final follow-up. The average recovery rate was 52.5%. The recovery rate according to surgical levels was, respectively,
56.5% in one level, 46.3% in two levels and 54.1% in more than three levels. The complications were as follows: one patient
sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery, one patient developed an epidural
hematoma 3 days after surgery, and two patients had the C5 nerve root palsy after surgery. The epidural hematoma was removed
by the microendoscopy. All two C5 palsy improved with conservative therapy, such as a neck collar. These four patients on
complications have returned to work at the final follow-up. This observation suggests that the clinical outcomes of microendoscopic
surgery for cervical myelopathy were excellent or showed good results. This minimally invasive technique would be helpful
in choosing a surgical method for cervical myelopathy. 相似文献
49.
Siamak Asgari Hischam Bassiouni Nagi Massoud Marc Schlamann Dietmar Stolke I. Erol Sandalcioglu 《Acta neurochirurgica》2009,151(7):739-749
Purpose The aim of the study was to evaluate patients with multisegmental cervical spondylotic myelopathy (MCM) surgically treated
via a dorsal approach. Two different laminoplasty techniques were compared by assessment of enlargement of the spinal canal
and the neurological outcome.
Methods Thirteen patients (mean age 49 years, 11 males) underwent decompressive laminoplasty over a 7-year period. The average duration
of symptoms was 21 months. The pre- and postoperative degree of myelopathy was assessed by both the Nurick grading and the
Japanese Orthopaedic Association myelopathy score (JOA score). Preoperatively, the mean Nurick grade was 3.1 and the mean
JOA score was 11. Two different techniques of expansive laminoplasty were used. Six patients underwent a bilateral cutting
(BL) technique with retropositioning of the laminae and bilateral mini-plating (BL group). Seven patients were operated on
by simple open-door (OD) laminoplasty with unilateral mini-plating (OD group). Postoperatively, CT scans were obtained for
all patients to measure the sagittal diameter of the spinal canal. The mean clinical and radiological follow-up was 33 months.
Results Four to five laminae were involved in all patients.The mean operation time was 180 min. Complications occurred in two patients
of BL group, with immediate postoperative neurological deterioration due to ventral displacement of the laminae. Overall,
the average sagittal diameter (SD) of the spinal canal increased from 9.2 ± 1.3 mm to 12.4 ± 1.3 mm after surgery. The average
enlargement of SD was significantly higher for the OD group (p < 0.0075 ). In total, the improvement rate was 38% according to the Nurick grading and 69% according to the JOA score. For
the OD group, improvement rates were 57% (Nurick) and 71% (JOA).
Conclusions Decompressive laminoplasty is comparable with anterior surgery in neurological outcome. The OD technique seems to be superior
to our BL technique regarding both the enlargement of SD and complication rate. 相似文献
50.
三种后路手术治疗多节段脊髓型颈椎病的临床研究 总被引:1,自引:0,他引:1
目的:对颈椎后路单开门悬吊椎管扩大成形术、单开门骨块支撑椎管扩大成形术、双开门植骨椎管扩大成形术治疗多节段脊髓型颈椎病(Multi-level cervical myelopathy,MCM)进行临床疗效计影像学评估。方法:需要手术治疗的MCM45例,其中单开门悬吊椎管扩大成形术15例(A组)。后路单开门骨块支撑椎管扩大成形术15例(B组)。双开门棘突间植骨椎管扩大成形术15例(C组)。术前术后计随访期间摄CT片,比较三组病例手术时间、术中出血量,术后并发症,症状改善率、椎管面积、椎管矢状径扩大情况。结果:A组平均手术时间、平均出血量均少于B、C两组(P〈0.05);三组症状改善率、并发症发生率差异无统计学意义(P〉0.05);C组术后各期椎管矢状径扩大率大于A、B两组(P〈0.05),A、B两组之间无统计学差异(P〉0.05);C组术后椎管面积扩大率与A、B两组之间有统计学意义(P〈0.05),A、B两组之间无统计学差异(P〉0.05);椎管面积扩大率与症状改善率之间无明显相关性(r=0.199)。结论:三种后路手术是治疗MCM重要而有效的方法。但单开门悬吊术手术时间短,出血量少。是治疗多节段CSM较理想的术式之一。 相似文献