Ross Miner N, Ross Donald A
Department of Neurological Surgery, Oregon Health and Science University.
Section of Neurological Surgery, Operative Care Division, Portland Veterans Medical Center, Portland, OR.
Clin Spine Surg. 2018 Oct;31(8):331-338. doi: 10.1097/BSD.0000000000000683.
Cervical spondylotic myelopathy is a common cause of neurological disability, especially in aging populations. There are several approaches to decompress the cervical spinal cord, including anterior cervical discectomy and fusion, corpectomy and fusion, arthroplasty, posterior cervical laminectomy with or without fusion, and laminoplasty. Less well described is minimally invasive cervical laminectomy. The authors report their technique and results for minimally invasive cervical laminectomy.
The authors describe in detail their surgical technique and results of 30 consecutive cases. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) myelopathy scores were recorded.
In total, 30 cases were included. Mean age was 69 years (range, 57-89 y). Twelve procedures were at C3-4, 4 at C4-5, 5 at C5-6, 4 at C7-T1, 3 at C3-4 and C4-5, 1 at C4-5 and C5-6, and 1 at C5-6 and C6-7. Mean preoperative mJOA score was 12.1 (range, 4-15). Average length of surgery was 142 minutes. Mean follow-up was 27 months (range, 3-64 mo). At 3 months, mean postoperative mJOA score was 14.0 (range, 5-17). Mean mJOA improvement of 1.9 was statistically significant (P<0.001). Seventeen patients had magnetic resonance imaging (MRI) available at 3 months postoperatively (5 patients had no MRI, 3 patients had MRI contraindications, and 5 are pending). No MRI findings led to further surgery. There were no durotomies and no wound infections. A single patient had an unexplained new neurological deficit that resolved over 6 months.
Minimally invasive laminectomy for cervical myelopathy is safe and effective and may be an underutilized procedure.
脊髓型颈椎病是导致神经功能障碍的常见原因，在老年人群中尤为常见。有多种方法可用于减压颈椎脊髓，包括前路颈椎间盘切除融合术、椎体次全切除融合术、人工关节置换术、后路颈椎椎板切除术（有无融合）以及椎板成形术。关于微创颈椎椎板切除术的描述较少。作者报告了他们进行微创颈椎椎板切除术的技术和结果。
作者详细描述了他们连续30例病例的手术技术和结果。记录术前和术后改良日本骨科协会（mJOA）脊髓病评分。
共纳入30例病例。平均年龄为69岁（范围57 - 89岁）。手术部位为C₃ - ₄节段12例，C₄ - ₅节段4例，C₅ - ₆节段5例，C₇ - T₁节段4例，C₃ - ₄和C₄ - ₅节段3例，C₄ - ₅和C₅ - ₆节段1例，C₅ - ₆和C₆ - ₇节段1例。术前平均mJOA评分为12.1（范围4 - 15）分。平均手术时长为142分钟。平均随访时间为27个月（范围3 - 64个月）。术后3个月时，平均mJOA评分为14.0（范围5 - 17）分。平均mJOA改善1.9分，差异具有统计学意义（P < 0.001）。17例患者术后3个月进行了磁共振成像（MRI）检查（5例未进行MRI检查，3例有MRI检查禁忌证，5例正在等待检查）。没有MRI检查结果导致进一步手术。没有发生硬脊膜切开和伤口感染。1例患者出现不明原因的新神经功能缺损，6个月后恢复。
微创椎板切除术治疗颈椎脊髓病安全有效，可能是一种未得到充分利用的手术方法。
