Kothe R, Schmeiser G, Papavero L
Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.
Oper Orthop Traumatol. 2018 Feb;30(1):3-12. doi: 10.1007/s00064-017-0527-3. Epub 2018 Jan 12.
Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach.
Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis.
Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement of C2 or C7.
Unilateral subaxial approach with detachment of muscles only on one side. The ipsilateral laminae C6 to C3 are cut at the laminofacet junction and opened up. The loss of resistance is usually due to a greenstick fracture in the proximity of the contralateral laminofacet junction. The opened laminae are fixed with Z‑shaped thin titanium plates. If necessary, the laminoplasty can be combined with a unilateral fixation and fusion by the same approach.
Early mobilization 4-6 h postoperatively. No orthosis necessary.
A total of 131 patients (77 men, mean age 67 years) with a multilevel cervical spondylotic myelopathy (CSM) underwent surgery using a posterior approach. In 52 patients (40%), a unilateral approach was performed (laminoplasty: n = 30; laminoplasty/fusion: n = 22). In this group, the mean operation time was less compared with two other techniques (unilateral approach: 110 min; laminectomy/fusion: 150 min; 360° approach: 210 min). The postoperative European myelopathy score (EMS) improved from 12.8 to 15.2. The overall complication rate was 17% (unilateral approach: 9%; laminectomy/fusion: 18%; 360° approach: 27%).
通过微创单侧入路对下颈椎椎管狭窄进行多节段后路减压。
多节段下颈椎椎管狭窄所致的退变性颈椎脊髓病。
颈椎后凸或不稳定、椎间孔狭窄所致双侧神经根病、C2或C7受累。
采用单侧下颈椎入路，仅在一侧分离肌肉。在椎板关节突交界处切断并打开同侧C6至C3椎板。阻力消失通常是由于对侧椎板关节突交界处附近的青枝骨折。打开的椎板用Z形薄钛板固定。如有必要，椎板成形术可通过相同入路与单侧固定融合术联合进行。
术后4 - 6小时尽早活动。无需支具。
共有131例（77例男性，平均年龄67岁）多节段颈椎病性脊髓病（CSM）患者接受了后路手术。52例患者（40%）采用了单侧入路（椎板成形术：n = 30；椎板成形术/融合术：n = 22）。与其他两种技术相比，该组平均手术时间更短（单侧入路：110分钟；椎板切除术/融合术：150分钟；360°入路：210分钟）。术后欧洲脊髓病评分（EMS）从12.8提高到15.2。总体并发症发生率为17%（单侧入路：9%；椎板切除术/融合术：18%；360°入路：27%）。
