Healy Andrew T, Lubelski Daniel, West James L, Mageswaran Prasath, Colbrunn Robb, Mroz Thomas E
Department of Neurological Surgery.
Cleveland Clinic Lerner College of Medicine, and.
J Neurosurg Spine. 2016 May;24(5):746-51. doi: 10.3171/2015.7.SPINE15229. Epub 2016 Jan 22.
OBJECTIVE Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). METHODS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. Ligamentous integrity was preserved and specimens were tested utilizing force control in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the native state, and following 1) C3-7 ODL, 2) ODL with terminal ISL resection, 3) ODL with C3-7 spinous process resection, and 4) C3-7 laminectomy. Range of motion (ROM) was measured across C2-T1, "global," and at the segmental level. RESULTS Compared with ODL, sectioning the terminal ISLs resulted in global ROM increases by 7.9% in FE, 2.4% in LB, and 5.6% in AR (p > 0.05), whereas laminectomy increased global ROM by 36.0% in FE (p = 0.002) and a 26.3% increase in AR ROM (p = 0.01). When considering segmental ROM, resection of the terminal ISLs increased ROM in FE by 36.5% at C2-3 (p = 0.019) and 25.4% at C7-T1 (p > 0.05). Segmental increases following C3-7 spinous process resection averaged less than 3% per level, compared with up to 40% increases in ROM per level after laminectomy. CONCLUSIONS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL.
目的 颈椎开门式椎板成形术（ODL）旨在减压脊髓、维持活动度并预防椎板切除术后后凸畸形。许多传统的椎板成形术技术会破坏后部韧带结构，最显著的是C7 - T1棘上韧带和棘间肌复合体（棘突间和棘上韧带[ISLs]）。方法 使用8具人类颈椎尸体标本（C2 - T1）来研究不同程度后部结构破坏的ODL术后颈椎下部的运动学情况。保留韧带完整性，在自然状态下以及在以下情况后对标本进行测试：1）C3 - 7 ODL；2）终末ISL切除的ODL；3）C3 - 7棘突切除的ODL；4）C3 - 7椎板切除术。在C2 - T1、“整体”以及节段水平测量活动度（ROM）。结果 与ODL相比，切断终末ISLs导致整体ROM在屈伸（FE）时增加7.9%，在侧弯（LB）时增加2.4%，在轴向旋转（AR）时增加5.6%（p > 0.05），而椎板切除术使整体ROM在FE时增加36.0%（p = 0.002），在AR时增加26.3%（p = 0.01）。考虑节段ROM时，终末ISLs切除使C2 - 3节段在FE时ROM增加36.5%（p = 0.019），在C7 - T1节段增加25.4%（p > 0.05）。C3 - 7棘突切除后节段增加平均每节段小于3%，而椎板切除术后每节段ROM增加可达40%。结论 椎板切除术导致整体颈椎ROM增加最大。C2 - 3和C7 - T1节段的ISLs切除使这些特定节段的节段ROM增加到与椎板切除术使每个颈椎节段ROM增加相似的程度。这种节段ROM可能导致疼痛或术后畸形，并突出了ODL终末部位ISLs的重要性。
