Srivastava Niraj Kumar, Singh Sunita, Chauhan Shishu Pal Singh, Gopal Nitya Nand
Department of Surgery, M.L.N. Medical College, Allahabad, Affiliated with King George Medical University, Lucknow, Uttar Pradesh, India.
Asian J Neurosurg. 2016 Jul-Sep;11(3):206-13. doi: 10.4103/1793-5482.145089.
The aim of this study was to discuss the technique of midsagittal splitting laminoplasty and to compare its short-term follow-up results with laminectomy in cases of compressive cervical spinal cord myelopathy.
Exclusion criteria were as follows: Intramedullary compressive lesions, kyphotic cervical spine, previous spinal surgeries, and defective anterior vertebral column. Twenty patients (10 each of laminoplasty and laminectomy groups) were prospectively studied from 2005 to 2008. After clinico-radiological assessment, laminoplasty or laminectomy was performed in patients aged <50 years and >50 years, respectively. The laminoplasty was performed by splitting the excised lamina in midline up to the tip of spinous process. Follow-up was done by neurosurgical cervical spine scoring, Nurick's grading, and the final outcome was determined by Odom's criteria.
The mean operative time and blood loss in laminoplasty and laminectomy was 100 ± 0.87 (range 90-140 min), 80 ± 0.67 (range 75-100 min) P = 0.04; and 65 ± 0.07 (range 60-90 ml) and 68 ± 0.61 (range 65-80 ml) P = 0.09, respectively. There were no intraoperative accidents, and no postoperative neurological deterioration/recurrence of symptoms. One patient who underwent laminectomy alone developed progressive kyphosis of the spine, whereas one having rheumatoid arthritis and long symptom duration didn't improve. 85% (17/20 patients) had sustained excellent to fair outcome (improvement by at least one Nurick's grade).
The technique used by us was simple, effective, and inexpensive. There was no minimal postoperative morbidity, although long-term results are awaited.
本研究旨在探讨经矢状位劈开椎板成形术技术，并将其在压迫性颈脊髓病患者中的短期随访结果与椎板切除术进行比较。
排除标准如下：髓内压迫性病变、颈椎后凸、既往脊柱手术史以及椎体前柱缺损。2005年至2008年对20例患者（椎板成形术组和椎板切除术组各10例）进行前瞻性研究。经临床放射学评估后，分别对年龄<50岁和>50岁的患者实施椎板成形术或椎板切除术。椎板成形术通过在中线将切除的椎板劈开直至棘突尖端来进行。通过神经外科颈椎评分、努里克分级进行随访，并根据奥多姆标准确定最终结果。
椎板成形术和椎板切除术的平均手术时间和失血量分别为100±0.87（范围90 - 140分钟）、80±0.67（范围75 - 100分钟），P = 0.04；以及65±0.07（范围60 - 90毫升）和68±0.61（范围65 - 80毫升），P = 0.09。术中无意外情况，术后无神经功能恶化/症状复发。仅接受椎板切除术的1例患者出现脊柱进行性后凸，而1例患有类风湿关节炎且症状持续时间长的患者未见改善。85%（17/20例患者）获得了持续的良好至中等结果（至少改善一个努里克分级）。
我们所采用的技术简单、有效且成本低廉。尽管尚待长期结果，但术后并发症极少。
