Kim Phyo, Murata Hidetoshi, Kurokawa Ryu, Takaishi Yoshiyuki, Asakuno Keizo, Kawamoto Toshiki
Department of Neurosurgery, Dokkyo University School of Medicine, Tochighi, Japan.
J Neurosurg Spine. 2007 Sep;7(3):293-304. doi: 10.3171/SPI-07/09/293.
Laminoplasty has been used to expand the cervical spinal canal, based on the belief that reconstruction of the laminae preserves musculoskeletal function. The true efficacy of laminoplasty for maintaining spinal alignment, stability, and flexibility, however, remains to be proven. The authors have developed a new method, myoarchitectonic spinolaminoplasty (MSLP), which preserves all of the nuchal muscles and reconstitutes all of the musculoskeletal couplings to the posterior elements of the vertebrae. The details of this technique are described, and the efficacy of the technique in conserving muscle volume, alignment, and motion, as well as in preventing postoperative musculoskeletal discomfort, is assessed.
The authors' previous midline-splitting laminoplasty procedure, which utilized a hydroxyapatite (HA) implant as a substitute for the spinous process, was improved. Detachment of the muscles is avoided with this new technique by cutting inside the spinous process. The bone-muscle flaps are affixed to the HA spinous process. Radiographs, computed tomography scans, and neurological evaluations obtained at the 1-year follow-up in the groups of consecutive patients assessed immediately prior to and after the modification of the previous technique (the control and the MSLP groups, respectively) were analyzed and compared.
The HA bone constructs became integrated due to osteoconduction. The cross-sectional area of the semispinalis capitis, semispinalis cervicis, and multifidus muscles remained significantly larger in the MSLP group. Slight attenuation in lordosis was observed in the control group, but was prevented in the MSLP group. Range of motion was somewhat restricted in the MSLP group, but the incidence of neck pain and shoulder strain was significantly reduced.
The new MSLP method was effective in preserving the volume and functions of the nuchal musculature and helping to minimize postoperative musculoskeletal complaints.
椎板成形术已被用于扩大颈椎管，基于这样一种信念，即椎板重建可保留肌肉骨骼功能。然而，椎板成形术在维持脊柱排列、稳定性和灵活性方面的真正疗效仍有待证实。作者开发了一种新方法，即肌构筑性椎板成形术（MSLP），该方法保留了所有项部肌肉，并重建了所有与椎骨后部结构的肌肉骨骼连接。本文描述了该技术的细节，并评估了该技术在保留肌肉体积、排列和运动方面的疗效，以及在预防术后肌肉骨骼不适方面的疗效。
作者改进了之前的中线劈开椎板成形术，该手术使用羟基磷灰石（HA）植入物替代棘突。通过在棘突内部切割，这种新技术避免了肌肉的分离。将骨-肌瓣固定在HA棘突上。对在之前技术改进前后立即评估的连续患者组（分别为对照组和MSLP组）在1年随访时获得的X线片、计算机断层扫描和神经学评估进行分析和比较。
由于骨传导作用，HA骨结构实现了融合。MSLP组的头半棘肌、颈半棘肌和多裂肌的横截面积仍显著更大。对照组观察到脊柱前凸略有减弱，但MSLP组预防了这种情况。MSLP组的活动范围有所受限，但颈部疼痛和肩部劳损的发生率显著降低。
新的MSLP方法在保留项部肌肉组织的体积和功能以及帮助减少术后肌肉骨骼不适方面是有效的。
