Shiozaki Takashi, Otsuka Hironori, Nakata Yoshihiro, Yokoyama Toru, Takeuchi Kazunari, Ono Atsushi, Numasawa Takuya, Wada Kanichiro, Toh Satoshi
Department of Orthopaedic Surgery, Akita Social Insurance Hospital, Noshiro, Akita, Japan.
Spine (Phila Pa 1976). 2009 Feb 1;34(3):274-9. doi: 10.1097/BRS.0b013e318194e275.
STUDY DESIGN: A prospective study in 19 patients after cervical laminoplasty, using magnetic resonance imaging. OBJECTIVE: To evaluate the value of spinal cord shift at 24 hours after cervical laminoplasty. SUMMARY OF BACKGROUND DATA: Postoperative C5 palsy is a noticeable complication within 1 week after cervical laminoplasty. The root tethering due to the posterior shift of the spinal cord after laminoplasty was reported as one of the causes of C5 palsy. However, the spinal cord shift after surgery within 1 week is unknown. METHODS: The posterior shift of the spinal cord was measured in 19 consecutive patients on magnetic resonance images at 24 hours and 2 weeks after cervical laminoplasty. RESULTS: The mean posterior shift of the spinal cord at 24 hours was 2.8 mm, with the maximum at the C5 level, decreasing to 1.9 mm at 2 weeks. The posterior shift of the spinal cord at C5 was correlated with the amount of the dura mater at C4, C5, and C6 levels. In a patient with right C5 palsy, posterior shift at C5 level was 5.5 mm, decreasing to 3.0 mm at 2 weeks after surgery. The posterior shift of the spinal cord was not correlated with the sagittal alignment. CONCLUSION: The posterior shift of the spinal cord at 24 hours had a tendency to shift more posteriorly than that observed at 2 weeks after cervical laminoplasty. C5 palsy may be prevented if the expansion of dura mater, which is strongly correlated with the posterior shift, can be controlled.
研究设计：一项对19例颈椎板成形术后患者进行的前瞻性研究，采用磁共振成像。 目的：评估颈椎板成形术后24小时脊髓移位的价值。 背景资料总结：术后C5麻痹是颈椎板成形术后1周内值得注意的并发症。据报道，椎板成形术后脊髓后移导致的神经根束缚是C5麻痹的原因之一。然而，术后1周内脊髓的移位情况尚不清楚。 方法：在19例连续患者中，于颈椎板成形术后24小时和2周时通过磁共振成像测量脊髓的后移情况。 结果：脊髓在24小时时的平均后移为2.8毫米，在C5水平最大，2周时降至1.9毫米。C5水平脊髓的后移与C4、C5和C6水平硬脑膜的量相关。在1例右侧C5麻痹患者中，C5水平的后移为5.5毫米，术后2周降至3.0毫米。脊髓的后移与矢状位对线无关。 结论：颈椎板成形术后24小时脊髓的后移比术后2周时观察到的后移更倾向于向后移位。如果能控制与后移密切相关的硬脑膜扩张，可能预防C5麻痹。
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