Piazza Matthew, McShane Brendan J, Ramayya Ashwin G, Sullivan Patricia Zadnik, Ali Zarina S, Marcotte Paul J, Welch William C, Ozturk Ali K
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2018 Feb;110:e362-e366. doi: 10.1016/j.wneu.2017.11.017. Epub 2017 Nov 11.
Cervical spondylitic myelopathy is a degenerative condition resulting from chronic spinal cord compression and a leading cause of nontraumatic spinal cord dysfunction. The chief surgical goal in the management of cervical spondylitic myelopathy is adequate spinal cord decompression with or without fusion to slow or prevent further neurologic decline. We conducted a radiographic analysis of canal parameters preoperatively and postoperatively for patients undergoing either anterior or posterior cervical decompression.
Preoperative and postoperative radiographic analysis was performed using midsagittal and axial magnetic resonance imaging at the level of the disc space for 37 patients who underwent anterior or posterior cervical decompression. Statistical comparisons between anterior and posterior groups were performed using independent t test and Mann-Whitney U test where appropriate.
Both postoperative anteroposterior canal diameter and posterior cerebrospinal fluid (CSF) space were greater in patients undergoing posterior decompression (P = 0.011 and P < 0.001, respectively), although postoperative anterior CSF space was comparable between both groups. Both anterior and posterior approaches to decompression resulted in a statistically significant improvement in anteroposterior diameter, anterior CSF space, and posterior CSF space (P < 0.001). Posterior decompression yielded significantly greater change in anteroposterior diameter and posterior CSF space compared with the anterior approach (P < 0.001).
In this quantitative radiographic study, we found that although both posterior cervical laminectomy and anterior cervical discectomy yielded significant decompression, laminectomy yielded a greater degree of decompression of the posterior CSF space.
脊髓型颈椎病是一种由慢性脊髓压迫导致的退行性疾病，是非创伤性脊髓功能障碍的主要原因。脊髓型颈椎病治疗的主要手术目标是充分减压脊髓，可选择融合或不融合手术，以减缓或防止神经功能进一步衰退。我们对接受颈椎前路或后路减压手术的患者术前和术后的椎管参数进行了影像学分析。
对37例接受颈椎前路或后路减压手术的患者，在椎间盘间隙水平进行矢状面和轴位磁共振成像，进行术前和术后影像学分析。在适当情况下，使用独立t检验和曼-惠特尼U检验对前后路手术组进行统计学比较。
后路减压患者术后的前后径和后脑脊液（CSF）间隙均较大（分别为P = 0.011和P < 0.001），尽管两组术后前CSF间隙相当。前后路减压手术均使前后径、前CSF间隙和后CSF间隙有统计学意义的改善（P < 0.001）。与前路手术相比，后路减压术后前后径和后CSF间隙的变化明显更大（P < 0.001）。
在这项定量影像学研究中，我们发现尽管颈椎后路椎板切除术和颈椎前路椎间盘切除术均能产生显著减压效果，但椎板切除术对后CSF间隙的减压程度更大。
