Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy
Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy
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DOI：
10.1007/s00586-005-0025-4
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发表时间：
2006-09-01
影响因子：
2.8
通讯作者：
Sakai, Hiroya
中科院分区：
文献类型：
--
作者：
Zhang, Junwei;Hirabayashi, Shigeru;Sakai, Hiroya
对颈椎病患者行张力带椎板成形术(TBL)同时或不同时行颈1椎板切除手术节段与减压效果的关系进行了回顾性研究。168例患者按手术节段分为三组：A组C2~C7椎板切除72例，C组C2~C7椎板切除60例，C组C3~C7椎板切除36例。采用日本整形外科协会(JOA)评分系统进行神经功能评定。通过术前、术后X线片和磁共振成像分析脊柱和脊髓的排列变化。并用磁共振成像技术分析手术前后的前蛛网膜下腔(D-ASAS)、脊髓直径(D-CORD)、硬脑膜袖径(D-DURA)在手术前后的差异。各组患者的JOA评分均有改善。对于脊柱的排列，任何一组手术前后均无明显变化，三组间也无明显差异。各组颈髓前凸度均有不同程度的降低。在C_1~C_5水平，A组D-AAS大于B组(P&t；0.05)，在C_1~C2、C_4~C_5水平，D-CORD、D-DURA均大于B组(P&t；0.05)。在C_1~C_4水平，A组D-AAS大于C组(P&t；0.05)，在C_1~C_5水平，D-CORD和D-DURA也大于C组(P&t；0.05)。综上所述，包括C2-C7节段的椎板成形术同时切除C2-C7椎板，可以使脊髓在C5或更高节段的加宽硬膜套内发生最大程度的后移，而不会显著改变脊柱的走向。
A retrospective study to investigate the relationship between the surgical levels and decompression effects was performed in patients with cervical myelopathy who had undergone Tension-band laminoplasty (TBL) with/without simultaneous C1 laminectomy. One hundred and sixty-eight patients (115 males, 53 females; age: 31-80 years, average 58.9 years; follow-up period: 12-120 months, average 20 months) were divided into three groups according to the range of the surgical levels: seventy-two patients in group A underwent TBL at the C2-C7 levels with C1 laminectomy; 60 patients in group B underwent TBL at the C2-C7 levels; 36 patients in group C underwent TBL at the C3-C7 levels. Neurological evaluation was performed by using the Japanese Orthopedic Association (JOA) scoring system. The alignment changes of the spinal column and the spinal cord were analyzed using pre- and post-operative roentgenograms and MRIs. The differences in the pre- and post-operative anterior subarachnoid spaces (D-ASAS), the spinal cord diameters (D-CORD), and the dural sleeve diameters (D-DURA) at the C1-C7 levels were also analyzed by using MRIs. The JOA scores improved in all groups. As for the spinal alignment, neither significant changes between pre- and post-operation in any group nor significant differences among the three groups were found. The lordosis of the cervical spinal cord was decreased in all groups. D-ASAS of group A was larger than that of group B at the C1-C5 levels (P < 0.05), as were those of D-CORD and D-DURA at the C1-C2 and C4-C5 levels (P < 0.05). D-ASAS of group A was larger than that of group C at the C1-C4 levels (P < 0.05), as were those of D-CORD and D-DURA at the C1-C5 levels (P < 0.05). In conclusion, laminoplasty including the C2-C7 levels with simultaneous C1 laminectomy was proven to allow the most posterior shift of the spinal cord within the widened dural sleeve at C5 or higher levels without significantly changing the spinal alignment.