Schulz C, Kunz U, Mauer U M, Mathieu R
Abteilung Neurochirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
Orthopade. 2014 Jun;43(6):568-74. doi: 10.1007/s00132-014-2309-z.
Hypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option.
This article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14 months, minimum 12 months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs.
There were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged.
The clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.
项韧带肥厚是颈椎管中央狭窄的原因之一。不进行固定和融合的选择性减压技术可能是一种足够的替代手术治疗选择。
本文介绍了一项对17例接受颈椎板及内侧关节部分选择性减压和咬除治疗患者的观察性研究结果。比较术前和术后（平均随访期为14个月，最短12个月）的日本骨科协会（JOA）评分、颈部疼痛残疾指数（NPDI）以及视觉模拟量表（VAS）评估的手臂和颈部疼痛情况。使用术前和术后的磁共振成像（MRI）测量狭窄程度的减轻和相邻节段疾病的程度。使用Cobb法在站立位平片上确定节段性和区域性前凸以及活动范围。
无并发症发生，无需翻修手术。所有临床参数均显著改善。狭窄得到显著减压，MRI未观察到脊髓病进展。矢状面参数和相邻节段退变程度保持不变。
这种非融合技术的临床和影像学结果令人信服。因此，选择性减压是椎板切除术和融合术以及椎板成形术的一种替代方法。
