Department of Neurological Surgery, University of California, San Francisco, California, USA.
Neurosurg Focus. 2011 Oct;31(4):E12. doi: 10.3171/2011.8.FOCUS11156.
Both anterior cervical corpectomy and fusion (ACCF) and laminoplasty are effective treatments for selected cases of cervical stenosis. Postoperative C-5 palsies may occur with either anterior or posterior decompressive procedures; however, a direct comparison of C-5 palsy rates between the 2 approaches is not present in the literature. The authors sought to compare the C-5 palsy rate of ACCF versus laminoplasty.
The authors conducted a retrospective review of 31 ACCF (at C-4 or C-5) and 31 instrumented laminoplasty cases performed to treat cervical stenosis. The demographics of the groups were similar except for age (ACCF group mean age 53 years vs laminoplasty group mean age 62 years, p = 0.002). The mean number of levels treated was greater in the laminoplasty cohort (3.87 levels) than in the ACCF cohort (2.74 levels, p < 0.001). The mean preoperative Nurick grade of the laminoplasty cohort (2.61) was higher than the mean preoperative Nurick grade of the ACCF cohort (1.10, p < 0.001).
The overall clinical follow-up rate was 100%. The mean overall clinical follow-up was 15 months. There were no significant differences in the estimated blood loss or length of stay between the 2 groups (p > 0.05). There was no statistical difference between the complication or reoperation rates between the 2 groups (p = 0.184 and p = 0.238). There were 2 C-5 nerve root pareses in each group. Three of the 4 patients recovered full deltoid function, and the fourth patient recovered nearly full deltoid function at final follow-up. There was no statistical difference in the rate of deltoid paresis (6.5%) between the 2 groups (p = 1).
Both ACCF and laminoplasty are effective treatments for patients with cervical stenosis. The authors found no difference in the rate of deltoid paresis between ACCF and laminoplasty to treat cervical stenosis.
颈椎管狭窄症的治疗选择包括前路颈椎椎体次全切融合术（ACCF）和单开门椎管扩大成形术。颈椎前路或后路减压术后都可能发生 C5 神经根麻痹；但文献中尚无这两种术式 C5 神经根麻痹发生率的直接比较。作者旨在比较 ACCF 与单开门椎管扩大成形术治疗颈椎管狭窄症的 C5 神经根麻痹发生率。
作者回顾性分析了 31 例接受 ACCF（C4 或 C5）和 31 例接受颈椎管狭窄症后路单开门椎管扩大成形术治疗的患者。除年龄外，两组患者的一般资料相似（ACCF 组平均年龄 53 岁，单开门椎管扩大成形术组平均年龄 62 岁，p=0.002）。单开门椎管扩大成形术组治疗的节段数明显多于 ACCF 组（3.87 个 vs 2.74 个，p<0.001）。单开门椎管扩大成形术组术前 Nurick 分级（2.61）高于 ACCF 组（1.10，p<0.001）。
两组患者的总体临床随访率均为 100%。平均总体临床随访时间为 15 个月。两组患者的失血量和住院时间差异无统计学意义（p>0.05）。两组患者的并发症或再次手术率差异无统计学意义（p=0.184 和 p=0.238）。每组各有 2 例 C5 神经根麻痹。4 例患者中有 3 例三角肌功能完全恢复，第 4 例患者在最终随访时三角肌功能基本完全恢复。两组三角肌麻痹发生率（6.5%）差异无统计学意义（p=1）。
ACCF 和单开门椎管扩大成形术均是治疗颈椎管狭窄症的有效方法。作者发现，这两种术式治疗颈椎管狭窄症的三角肌麻痹发生率无差异。
