Segmental motor paralysis after expansive open-door laminoplasty
Segmental motor paralysis after expansive open-door laminoplasty
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DOI：
10.1097/00007632-200210010-00006
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发表时间：
2002-10-01
期刊：
影响因子：
3
通讯作者：
Hirabayashi, K
中科院分区：
文献类型：
--
作者：
Chiba, K;Toyama, Y;Hirabayashi, K
研究设计。目的探讨颈椎病扩大开门椎管成形术后发生节段性运动瘫痪的原因。目的：提出脊髓参与节段性运动瘫痪发生的可能机制。脊髓型颈椎病患者在接受开门扩大椎板成形术后偶尔会出现运动性瘫痪，长期以来一直被认为是由创伤性手术技术或减压后脊髓过度后移引起的拴系效应引起的神经根损伤。在英文文献中并不建议涉及脊髓病理。研究组包括15名患者(11名男性和4名女性)，在至少2年的随访中，这些患者在扩大开门椎板成形术后出现节段性运动瘫痪。他们手术时的平均年龄为56岁。回顾分析患者瘫痪的特点、临床症状、手术前后日本骨科学会评分计算的恢复率、放射学表现(包括手术前后的磁共振图像)，并与126例非节段性瘫痪患者行椎板扩大成形术进行比较。瘫痪主要发生在C5，但不仅发生在C5，8名患者有多节段受累，主要在铰链侧，而2名患者有双侧瘫痪。瘫痪发生的平均时间为4.6天。15例患者中，14例患者术前有严重的手部麻木或感觉障碍，上肢感觉障碍的平均恢复率低于无瘫痪患者。术后磁共振成像显示所有患者的脊髓内均有T2高信号区。这些异常信号区的水平与15例患者中10例瘫痪节段的水平相对应。11例瘫痪完全缓解。迟发性瘫痪、上肢感觉障碍和T2高信号区的存在提示脊髓灰质的一定损伤可能在术后节段性运动瘫痪的发生发展中起重要作用。
Study Design. A retrospective study was conducted to investigate patients in whom segmental motor paralysis developed after expansive of open-door laminoplasty for cervical myelopathy.Objective. To propose the involvement of the spinal cord as a possible mechanism in the development of segmental motor paralysis.Summary of Background Data. Semental motor paralysis is seen occasionally in patients who undergo expansive open-door laminoplasty for cervical myelopathy and has long been attributed to nerve root lesions caused by either traumatic surgical techniques or a tethering effect induced by excessive posterior shift of the spinal cord after decompression. Involvement of spinal cord pathology is not suggested in the English literature.Methods. The study group consisted of 15 patients (11 men and 4 women) in whom postoperative segmental motor paralysis developed after expansive open-door laminoplasty during a minimum follow-up of 2 years. Their average age at the time of surgery was 56 years. Characteristics of the paralysis, clinical symptoms, recovery rates calculated using pre- and postoperative Japanese Orthopedic Association scores, and radiographic findings including pre- and postoperative magnetic resonance images were analyzed retrospectively and compared with those of 126 patients without segmental paralysis who underwent expansive open-door laminoplasty.Results. The paralysis occurred mainly, but not only, at C5, and eight patients had multievel involvements predominantly in the hinge side, whereas two patients had paralysis on both sides. The paralyis had developed after an average of 4.6 days. Of the 15 patients, 14 reported severe numbness or dysesthesia in their hands before surgery, and their average recovery rate for upper extremity sensory disturbance was lower than for those without paralysis. Postoperative magnetic resonance imaging showed the presence of a T2 high-signal intensity zone in the spinal cord of all the patients. The level of such abnormal signal areas corresponded to the level of paralyzed segments in 10 of the 15 patients. Paralysis resolved completely in 11 patients.Conclusions. Delayed onset of paralysis, dysesthesiain the upper extremities, and the presence of T2 high-signal intensity zones suggest that a certain impairment in the gray matter of the spinal cord may play an important role in the development of postoperative segmental motor paralysis.