Shaffrey C I, Wiggins G C, Piccirilli C B, Young J N, Lovell L R
Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Neurosurg. 1999 Apr;90(2 Suppl):170-7. doi: 10.3171/spi.1999.90.2.0170.
Multilevel anterior cervical decompressive surgery and fusion effectively treats cervical myeloradiculopathy that is caused by severe cervical spinal stenosis, but degenerative changes at adjacent vertebral levels frequently result in long-term morbidity. The authors performed a modified open-door laminoplasty procedure in which allograft bone and titanium miniplates were used to treat cervical myeloradiculopathy in younger patients with congenital canal stenosis while maintaining functional cervical motion segments. Pre- and postoperative magnetic resonance imaging and/or computerized tomography myelography were performed to assess changes in cervical spinal canal dimensions. Pre- and postoperative flexion-extension radiographs were compared to determine the residual motion of the targeted operative segments.
Twenty younger patients (average age 37.7 years) underwent modified open-door laminoplasty for treatment of myelopathy or myeloradiculopathy related to significant cervical spinal stenosis with or without associated central or lateral disc herniation or foraminal stenosis. These surgeries were performed during a 2-year period and follow-up review remains ongoing (average follow-up period 21.6 months). Reconstructive procedures were performed on an average of 4.1 levels (range three-six). Operative time averaged 186 minutes (range 93-229 minutes). Average blood loss was 305 ml (range 100-650 ml). No cases were complicated by neurological deterioration, infection, wound breakdown, graft displacement, or hardware failure. The patients' Nurick Scale grade improved from a preoperative average of 1.8 to a postoperative average of 0.5. Pre- and postoperative sagittal spinal diameter averaged 11.2 mm (8-14 mm) and 16.6 mm (13-19 mm), respectively. The sagittal compression ratio (sagittal/lateral x 100%) increased from 48% pre- to 72% postoperatively. The spinal canal area increased an average of 55% (range 19-127%). In patients in whom pre- and postoperative flexion-extension radiographs were obtained, 72.7% residual neck motion was maintained. No patient developed increased neck or shoulder pain. Neurological symptoms improved in all patients, with total relief of myelopathy in 50% and partial improvement in 50%.
Modified open-door laminoplasty with allograft bone and titanium miniplates effectively treats neurological deficits in younger patients with congenital and spinal stenosis. Although long-term results are unknown, short-term results are good and there is a low incidence of complications.
多节段颈椎前路减压融合术能有效治疗由严重颈椎管狭窄引起的颈脊髓神经根病，但相邻椎体节段的退变改变常导致长期发病。作者实施了一种改良的开门式椎板成形术，术中使用同种异体骨和微型钛板治疗先天性椎管狭窄的年轻患者的颈脊髓神经根病，同时保持颈椎功能运动节段。术前行磁共振成像和/或计算机断层扫描脊髓造影，以评估颈椎管尺寸的变化。比较术前后的屈伸位X线片，以确定目标手术节段的残余活动度。
20例年轻患者（平均年龄37.7岁）接受改良开门式椎板成形术，治疗与严重颈椎管狭窄相关的脊髓病或颈脊髓神经根病，伴或不伴有中央或外侧椎间盘突出或椎间孔狭窄。这些手术在2年期间进行，随访仍在继续（平均随访期21.6个月）。平均在4.1个节段（范围3 - 6个节段）进行重建手术。手术时间平均为186分钟（范围93 - 229分钟）。平均失血量为305毫升（范围100 - 650毫升）。无病例出现神经功能恶化、感染、伤口裂开、植骨移位或内固定失败等并发症。患者的努里克量表分级从术前平均1.8级改善至术后平均0.5级。术前后矢状径平均分别为11.2毫米（8 - 14毫米）和16.6毫米（13 - 19毫米）。矢状压缩率（矢状径/横径×100%）从术前的48%增至术后的72%。椎管面积平均增加55%（范围19% - 127%）。在获得术前后屈伸位X线片的患者中，72.7%的颈部残余活动度得以保持。无患者出现颈部或肩部疼痛加重。所有患者神经症状均有改善，50%的患者脊髓病完全缓解，50%的患者部分改善。
采用同种异体骨和微型钛板的改良开门式椎板成形术能有效治疗先天性和脊柱狭窄年轻患者的神经功能缺损。尽管长期结果尚不清楚，但短期效果良好，并发症发生率低。
