Lam Fred C, Irwin Beverly J, Poskitt Kenneth J, Steinbok Paul
Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
Childs Nerv Syst. 2009 Jan;25(1):71-6. doi: 10.1007/s00381-008-0694-5. Epub 2008 Aug 14.
The treatment of symptomatic Chiari II malformations typically involves multilevel cervical laminectomies in very young children. These patients are at significant risk of cervical instability. The purpose of this study was to determine the incidence and significance of cervical instability after multilevel cervical laminectomies in a cohort of patients decompressed for Chiari II malformation.
Postoperative dynamic lateral cervical spine radiographs were obtained on pediatric patients who had multilevel cervical laminectomies for symptomatic Chiari II malformations. Postoperative cervical spine instability was determined radiographically using published criteria. Clinical instability and need for cervical fusion were also assessed.
Nine patients met inclusion criteria for the study. Five of the nine patients (56%) showed evidence of radiographic instability of their cervical spines following surgery for their Chiari II malformations, according to the criteria used. No patient showed evidence of clinical instability or required cervical fusion.
Radiographic evidence of cervical spine instability following multilevel cervical laminectomies for Chiari II is common but may be of minimal clinical significance. The reason for the lack of clinical instability in what might be considered high-risk patients is not understood.
有症状的Chiari II型畸形的治疗通常涉及对非常年幼的儿童进行多级颈椎椎板切除术。这些患者存在颈椎不稳定的重大风险。本研究的目的是确定在一组因Chiari II型畸形减压的患者中，多级颈椎椎板切除术后颈椎不稳定的发生率及意义。
对因有症状的Chiari II型畸形接受多级颈椎椎板切除术的儿科患者进行术后颈椎侧位动态X线片检查。使用已发表的标准通过影像学确定术后颈椎不稳定情况。还评估了临床不稳定情况及颈椎融合的必要性。
9名患者符合该研究的纳入标准。根据所使用的标准，9名患者中有5名（56%）在接受Chiari II型畸形手术后显示出颈椎影像学不稳定的证据。没有患者显示出临床不稳定的证据或需要颈椎融合。
Chiari II型畸形多级颈椎椎板切除术后颈椎不稳定的影像学证据很常见，但临床意义可能极小。对于这些可能被视为高危患者却缺乏临床不稳定的原因尚不清楚。
