Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H
Orthopaedic Division, Chiba Rosai Hospital, Japan.
Spine (Phila Pa 1976). 1999 Aug 1;24(15):1527-31; discussion 1531-2. doi: 10.1097/00007632-199908010-00005.
A study to measure the shifts of the spinal cords and the effects of decompression laminoplasty in 65 patients with cervical lesions who underwent computed tomographic myelography before and after laminoplasty.
To investigate limitations of the spinal cord posterior shift after laminoplasty and to clarify the optimal decompression areas to obtain effective posterior shifting.
Although several types of laminoplasty have been performed, all procedures share the common purpose of posterior decompression. No previous studies have examined the limitations of posterior decompression or the optimal decompression range.
The distance from the posterior edge of each vertebral body or disc level to the posterior edge of the spinal cord was measured by computed tomographic myelography. After the posterior shift was determined by calculating the difference between pre- and postsurgical distances, the relations between posterior shift and neck alignment, clinical results, and the areas of decompression were analyzed.
The spinal cord shift ranged from a maximum of 6.6 mm to a minimum of 0 mm. Clinically, spinal cord shifts greater than 3 mm were associated with good clinical outcomes. Upward or downward advanced laminoplasty was related to larger spinal cord shifts at the upper or lower cervical spine.
A mean spinal cord shift of > 3 mm was associated with good clinical outcomes after laminoplasty. In cases with compressive lesions at the upper or lower cervical spine, extension of decompression one level above or one level below likely results in a greater posterior spinal cord shift at these lesions.
一项针对65例颈椎病变患者的研究，测量其脊髓移位情况以及椎板成形术减压的效果，这些患者在椎板成形术前后均接受了计算机断层脊髓造影。
探讨椎板成形术后脊髓后移的局限性，并明确获得有效后移的最佳减压区域。
尽管已经开展了多种类型的椎板成形术，但所有手术都有后减压这一共同目的。此前尚无研究探讨后减压的局限性或最佳减压范围。
通过计算机断层脊髓造影测量每个椎体或椎间盘水平后缘至脊髓后缘的距离。在通过计算手术前后距离的差值确定后移情况后，分析后移与颈部对线、临床结果以及减压区域之间的关系。
脊髓移位范围最大为6.6毫米，最小为0毫米。临床上，脊髓移位大于3毫米与良好的临床结果相关。向上或向下的扩大椎板成形术与上颈椎或下颈椎更大的脊髓移位有关。
椎板成形术后平均脊髓移位> 3毫米与良好的临床结果相关。在上颈椎或下颈椎存在压迫性病变的情况下，在病变上方或下方扩大一个节段的减压可能会导致这些病变处脊髓后移更大。
