Jenis Louis G, Banco Steven, Jacquemin John J, Lin Ki-Hon
The Boston Spine Group, Boston, MA 02120, USA.
Spine (Phila Pa 1976). 2004 Apr 1;29(7):763-6. doi: 10.1097/01.brs.0000112070.24165.2e.
Cadaveric human cervical spine anatomic study using posterior lateral mass screw-rod instrumentation to assess foraminal enlargement via distraction techniques.
To determine the role of posterior cervical distraction on foraminal dimensions and to ascertain the impact of this technique on segmental kyphosis.
Management of cervical spondylotic radiculopathy includes removal of offending compressive structures and enlarging the neuroforamen via anterior discectomy with interbody fusion or posterior laminoforaminotomy.
Six human cervical spines were prepared and posterior exposure performed. Lateral mass screws were inserted from C5 to C7 and a longitudinal rod attached. Distraction was applied between the screw heads at 2 mm intervals and accuracy confirmed with digitized calipers. Pre- and postdistraction computed tomography was performed including axial and reformatted images. Foraminal area, height, and width and sagittal alignment and disc heights were evaluated.
The results suggest that minimal posterior distraction of 4 to 6 mm at C5-C6 and C6-C7 may enlarge the neuroforamen by 10 to 18 mm. Foraminal height and width increased minimally from baseline to maximum distraction; however, these measurements did not reach statistical significance at either level. A decrease of segmental lordosis at C5-C6 was noted from baseline to 8 mm of distraction. Statistically significant kyphosis from baseline was present at 6 mm of distraction leading to overall 5.2 +/- 1.4degrees change in alignment. At C6-C7, statistically significant kyphosis was not present until 8 mm of distraction (4.62 +/- 2.23degrees).
This study suggests that posterior cervical instrumented distraction in the setting of foraminal stenosis is a reasonable supplement to direct laminoforaminotomy and nerve root decompression. Distraction leads to minimal segmental kyphosis, allowing this technique to serve as an adjunct for additional foraminal enlargement.
使用后路侧块螺钉-棒器械对尸体人颈椎进行解剖学研究，以通过撑开技术评估椎间孔扩大情况。
确定颈椎后路撑开对椎间孔尺寸的作用，并确定该技术对节段性后凸的影响。
神经根型颈椎病的治疗方法包括切除致压结构以及通过前路椎间盘切除椎间融合术或后路椎板开窗术扩大神经孔。
准备6具人颈椎并进行后路显露。从C5至C7置入侧块螺钉并连接纵向棒。在螺钉头之间以2毫米间隔施加撑开力，并用数字卡尺确认准确性。进行撑开前后的计算机断层扫描，包括轴向和重组图像。评估椎间孔面积、高度、宽度以及矢状位对线和椎间盘高度。
结果表明，在C5-C6和C6-C7处最小4至6毫米的后路撑开可使神经孔扩大10至18毫米。从基线到最大撑开时，椎间孔高度和宽度略有增加；然而，在任何一个水平这些测量值均未达到统计学意义。从基线到8毫米撑开时，C5-C6节段的前凸减小。在6毫米撑开时出现从基线开始的统计学上显著的后凸，导致对线总体改变5.2±1.4度。在C6-C7处，直到8毫米撑开时（4.62±2.23度）才出现统计学上显著的后凸。
本研究表明，在椎间孔狭窄情况下，颈椎后路器械撑开是直接椎板开窗术和神经根减压术的合理补充。撑开导致最小的节段性后凸，使该技术可作为额外扩大椎间孔的辅助手段。
