Roselli R, Pompucci A, Formica F, Restuccia D, Di Lazzaro V, Valeriani M, Scerrati M
Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
J Neurosurg. 2000 Jan;92(1 Suppl):38-43. doi: 10.3171/spi.2000.92.1.0038.
A modified technique of open-door laminoplasty for cervical stenotic myelopathy (CSM) is described, and the role of evoked potential monitoring in selecting patients for surgery and evaluating results is discussed.
Between October 1992 and October 1996, 33 patients with CSM underwent open-door laminoplasty. After surgery, in 27 patients (81.8%) different levels of clinical improvement were demonstrated, and in five of them (15%) full recovery was observed. The Japanese Orthopaedic Association score increased from 5 to 12 (mean 9.8) preoperatively to 8 to 14 (mean 11.6) postoperatively. At 1-year follow up, the N13 cervical response was restored in nine (75%) of 12 patients with isolated presurgical abnormality and in 57.1% of those with combined abnormalities of both N13 and P14 response. Although significant clinical improvement was observed in 82% of the cases, in 24 of 33 patients motor evoked potential abnormalities persisted at least at one explored level.
Of several laminoplasty techniques, the one described here offers some advantages: preservation of biomechanical function of posterior muscular-ligamentous complex, prevention of laminar collapse, smaller degrees in reduction of range of cervical motion, stabilization of the spine with no postoperative malalignment, and maintenance of decompressive effect that avoids recurrent stenosis. Neurophysiological studies sometimes clarified neurological disorders that were only suspected on the basis of history and/or clinical examination, leading to early diagnosis.
描述一种改良的开门式椎板成形术治疗颈椎管狭窄性脊髓病(CSM)的技术,并探讨诱发电位监测在选择手术患者及评估手术效果中的作用。
1992年10月至1996年10月,33例CSM患者接受了开门式椎板成形术。术后,27例患者(81.8%)有不同程度的临床改善,其中5例(15%)完全恢复。日本骨科协会评分术前从5分提高到12分(平均9.8分),术后从8分提高到14分(平均11.6分)。在1年随访时,12例术前孤立性N13颈椎反应异常的患者中有9例(75%)N13颈椎反应恢复,N13和P14反应均异常的患者中有57.1%恢复。虽然82%的病例有显著的临床改善,但33例患者中有24例至少在一个探查水平上运动诱发电位异常持续存在。
在几种椎板成形术技术中,本文所述技术具有一些优点:保留后肌肉韧带复合体的生物力学功能,防止椎板塌陷,颈椎活动度减小程度较小,脊柱稳定无术后畸形,维持减压效果避免复发狭窄。神经生理学研究有时能明确仅根据病史和/或临床检查怀疑的神经功能障碍,从而实现早期诊断。