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颈椎椎板切除术和融合术的护理综述

Nursing review of cervical laminectomy and fusion.

作者信息

Epstein Nancy E

机构信息

Chief of Neurosurgical Spine/Education, NYU Winthrop Hospital, Mineola, New York, USA.

出版信息

Surg Neurol Int. 2017 Dec 11;8:300. doi: 10.4103/sni.sni_243_17. eCollection 2017.

DOI:10.4103/sni.sni_243_17
PMID:29296286
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5742911/
Abstract

BACKGROUND

Cervical radiiculopathy/nerve root compression, myelopathy/cord compression are variously attributed to stenosis/narrowing of the spinal canal [anterior/posterior (AP) to less than 10 mm is defined as absolute stenosis, and 13 mm as relative stenosis]. Additional pathology includes disc herniations, ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL). Patients, typically over 60 years of age, may present with severe myeloradicular syndromes requiring multilevel laminectomies and posterior instrumented fusions.

METHODS

Patients typically first undergo magnetic resonance imaging (MRI) studies of the cervical spine that best demonstrate soft tissue pathology; spinal cord and/or nerve root compression in three dimensions (AP/coronal (front/back), lateral (side), and axial (cross section)). Computed tomography (CT) studies better define ossification/calcific changes contributing to stenosis, including OPLL and/or OYL.

RESULTS

If there is multilevel cervical pathology and an adequately preserved cervical lordosis (curvature with the neck), a cervical laminectomy may provide adequate cord/root decompression. Performed under intraoperative monitoring, the laminae (bones cover the back of the cervical spine), spinous processes (midline bony protuberant structures), and OYL may be directly removed. Posterior fusions, utilizing varying instrumentation/constructs may prevent reversal of the lordosis (kyphosis: curve angled forward) and re-tethering of the spinal cord.

CONCLUSIONS

Patients with myeloradiculopathy (cord/root compression) and multilevel cervical stenosis attributed to disc herniations, OPLL, and/or OYL with an adequate lordosis may require multilevel laminectomy and an instrumented fusion.

摘要

背景

颈椎神经根病/神经根受压、脊髓病/脊髓受压的病因多样，包括椎管狭窄[前后径（AP）小于10mm定义为绝对狭窄，13mm为相对狭窄]。其他病理情况包括椎间盘突出、后纵韧带骨化（OPLL）和黄韧带骨化（OYL）。患者通常年龄超过60岁，可能出现严重的脊髓神经根综合征，需要进行多节段椎板切除术和后路器械融合术。

方法

患者通常首先接受颈椎磁共振成像（MRI）检查，该检查能最佳地显示软组织病变；在三个维度（前后/冠状面（前后）、侧面、横断面）观察脊髓和/或神经根受压情况。计算机断层扫描（CT）检查能更好地明确导致狭窄的骨化/钙化改变，包括OPLL和/或OYL。

结果

如果存在多节段颈椎病变且颈椎前凸（颈部的曲度）保存良好，颈椎椎板切除术可能提供足够的脊髓/神经根减压。在术中监测下进行手术，可直接切除椎板（覆盖颈椎后部的骨头）、棘突（中线骨性突出结构）和OYL。利用不同的器械/结构进行后路融合术可防止前凸消失（后凸：向前成角的曲度）和脊髓重新受压。

结论

患有脊髓神经根病（脊髓/神经根受压）且因椎间盘突出、OPLL和/或OYL导致多节段颈椎狭窄且前凸良好的患者，可能需要进行多节段椎板切除术和器械融合术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/7622c17b19c4/SNI-8-300-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/022dbc902a3c/SNI-8-300-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/0882813bde1d/SNI-8-300-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/a4994e328753/SNI-8-300-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/5756f4f51f10/SNI-8-300-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/a9c07910115f/SNI-8-300-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/eb636ce6440b/SNI-8-300-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/9c0026f981a2/SNI-8-300-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/7622c17b19c4/SNI-8-300-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/022dbc902a3c/SNI-8-300-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/0882813bde1d/SNI-8-300-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/a4994e328753/SNI-8-300-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/5756f4f51f10/SNI-8-300-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/a9c07910115f/SNI-8-300-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/eb636ce6440b/SNI-8-300-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/9c0026f981a2/SNI-8-300-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cb9/5742911/7622c17b19c4/SNI-8-300-g008.jpg

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