Otani Koji, Sato Katsuhiko, Yabuki Shoji, Iwabuchi Masumi, Kikuchi Shinichi
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan.
Spine (Phila Pa 1976). 2009 Feb 1;34(3):268-73. doi: 10.1097/BRS.0b013e318195b27a.
STUDY DESIGN: A comparative study regarding the clinical outcome of the 2-different surgical procedures for patients with cervical spondylotic myelopathy (CSM). OBJECTIVES: To describe the anatomic basis of a segmental partial laminectomy (SPL) for the treatment of cervical spondylotic myelopathy and to compare the clinical outcome with traditional C3 to C7 expansive open-door laminoplasty (ELAP). SUMMARY OF BACKGROUND DATA: Laminoplasty has been widely accepted for the treatment of CSM. However, some disadvantages have also been recognized. To resolve these problems, a SPL was performed. No previous studies have been reported regarding this surgical procedure. METHODS: A total of 13 human cadavers were studied to analyze the spinal cord compression of cervical spondylosis. Twenty-six patients who underwent a SPL and 13 age- and gender-matched patients who underwent traditional C3-C7 ELAP were analyzed for their Japanese Orthopedic Association score, axial neck pain, and radiographic parameters (lordotic angle and ROM of cervical spine). RESULTS: Based on cadaver studies, compression of the spinal cord was present in the articular segment, but not in the intraosseous segment. The removal of the ligamentum flavum and the superior edge of the lower lamina was sufficient for minimum posterior decompression of the cervical spinal cord.In comparison with the ELAP, the patients who underwent an SPL showed a similar recovery of the Japanese Orthopedic Association score, but the maintenance of the sagittal alignment and the range of motion were better after the SPL and postoperative neck and/or shoulder complaints also seemed to be reduced. CONCLUSION: A SPL, may therefore, be a useful and effective surgical procedure for cervical spondylotic myelopathy.
研究设计:一项关于两种不同手术方法治疗脊髓型颈椎病(CSM)患者临床疗效的对比研究。 目的:描述节段性部分椎板切除术(SPL)治疗脊髓型颈椎病的解剖学基础,并将其临床疗效与传统的C3至C7扩大开门式椎板成形术(ELAP)进行比较。 背景资料总结:椎板成形术已被广泛用于治疗脊髓型颈椎病。然而,也认识到了一些缺点。为了解决这些问题,实施了节段性部分椎板切除术。此前尚无关于该手术方法的研究报道。 方法:共研究了13具人体尸体以分析颈椎病的脊髓压迫情况。对26例行节段性部分椎板切除术的患者以及13例年龄和性别匹配的行传统C3 - C7扩大开门式椎板成形术的患者进行日本骨科协会评分、颈部轴向疼痛及影像学参数(颈椎前凸角和活动度)分析。 结果:基于尸体研究,脊髓压迫出现在关节段,而非骨内段。切除黄韧带和下位椎板上缘足以实现颈椎脊髓的最小后路减压。与扩大开门式椎板成形术相比,行节段性部分椎板切除术的患者日本骨科协会评分恢复情况相似,但节段性部分椎板切除术后矢状位对线和活动度的维持更好,且术后颈部和/或肩部不适似乎也有所减轻。 结论:因此,节段性部分椎板切除术可能是治疗脊髓型颈椎病的一种有用且有效的手术方法。
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