颈椎椎板切除术后神经根病

目的　报道一组多节段颈椎椎板切除术后神经根病并探讨其机理。　方法　２８７ 例颈椎椎板切除术患者中３７ 例（１２．９％ ） 出现手术后神经根病。其中男２７ 例,女１０ 例,平均年龄５６ 岁。其中颈椎病２５ 例, 后纵韧带骨化１２ 例。发病时间为手术后４ 小时～６ 天,最常见类型为颈５（Ｃ５） 、颈６（Ｃ６） 神经根,以运动障碍为主。　结果　完全缓解时间平均为５ ．４ 个月（２ 周～３ 年）。完全缓解时间与脊髓运动功能恢复率呈负相关（ｒ＝ －０ ．８３２, Ｐ＜ ０．０１）,颈椎病患者预后优于后纵韧带骨化（ｔ＝２ ．９６０, Ｐ＜ ０．０１）。　结论　手术后神经根病可能因颈椎后路减压后神经根栓系引起;前路减压及融合手术既可直接切除致压物,又能稳定脊柱,因而可有效预防手术后神经根病

Radiculopathy after cervical laminectomy

Objective To investigate radiculopathy after multilevel laminectomy in patients with cervical compression myelopathy and underlying mechanism. Methods We retrospectively reviewed 287 consecutive patients with cervical compression myelopathy treated by multilevel cervical laminectomy and identified 37 patients (12.9%) with postoperative radiculopathy. There were 27 men and 10 women, with an average age of 56 years at time of surgery.The diagnosis was either cervical spondylosis (25 patients) or ossification of the posterior longitudinal ligament (12 patients). Results Radiculopathy was observed from 4 hours to 6 days after surgery. The most frequent patterns of paralysis were C 5 and C 6 root involvements of the motor dominant type. All patients showed complete recovery in 2 weeks to 3 years (average, 5 4 months). Follow up results showed that the recovery rate was negatively related to the duration of complete recovery of postoperative radiculopathy ( r =-0 832, P <0 01) and the patients with spondylotic myelopathy had a significantly better clinical recovery rate than those with ossification of the posterior longitudinal ligament ( t =2.960, P <0 01). Conclusions Postoperative radiculopathy is complicated with posterior cervical decompression and associated with tethering effect upon the nerve root. More logical procedures for prevention of postoperative radiculopathy are decompression through an anterior decompressive procedure in conjunction with a spinal fusion, which may achieve stabilization and directly remove all of the anterior spinal cord compression at multiple levels.