Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan.
Eur Spine J. 2018 Nov;27(11):2763-2771. doi: 10.1007/s00586-018-5752-4. Epub 2018 Sep 7.
PURPOSE: The first purpose of this study is to confirm whether the spinal cord and the surrounding tissues can be visualized clearly after laminoplasty using percutaneous ultrasonography. And second purpose is to evaluate the changes in the status of the spinal cord over time. METHODS: Fifty patients who underwent cervical laminoplasty with suture anchors were evaluated using intraoperative ultrasonography and postoperative (1 week, 2 weeks, 3 months, 6 months, and 1 year) percutaneous ultrasonography. We classified the decompression status of the spinal cord into three grades and the pattern of the spinal cord pulsation into six categories. Clinical outcomes were evaluated using the Japanese Orthopaedic Association Score for cervical myelopathy, and the recovery rate was calculated. RESULTS: In all cases and all periods, we could observe the status of the spinal cord using percutaneous ultrasonography after cervical laminoplasty. The decompression status of the spinal cord improved until 3 months postoperatively, and the clinical outcomes improved up to 6 months postoperatively. Although the pulsation pattern of the spinal cord varied in each individual and in each period, spinal pulsation itself was observed in all cases and all periods, except one, when an epidural hematoma caused quadriplegia and a revision surgery was needed. Decompression status and pulsation pattern of the spinal cord were not associated with clinical outcomes as far as pulsation was observed. CONCLUSIONS: Percutaneous ultrasonography was very useful method to evaluate the postoperative status of the spinal cord, particularly in the diagnosis of the postoperative epidural hematoma. These slides can be retrieved under Electronic Supplementary Material.
目的:本研究的首要目的是确认经皮超声检查能否清晰显示椎板切开术后脊髓及周围组织。其次目的是评估脊髓状况随时间的变化。
方法:对 50 例行缝合锚钉颈椎椎板切开术的患者进行术中超声和术后(1 周、2 周、3 个月、6 个月和 1 年)经皮超声检查。我们将脊髓减压状态分为 3 个等级,脊髓搏动模式分为 6 个类别。使用日本骨科协会颈椎脊髓病评分评估临床结果,并计算恢复率。
结果:在所有病例和所有时期,我们都可以通过经皮超声观察颈椎椎板切开术后脊髓的状况。脊髓减压状态在术后 3 个月内改善,临床结果在术后 6 个月内改善。虽然脊髓搏动模式在每个个体和每个时期都有所不同,但除了一例因硬膜外血肿导致四肢瘫痪需要再次手术的病例外,所有病例和所有时期都可以观察到脊髓搏动。只要观察到搏动,脊髓减压状态和搏动模式与临床结果无关。
结论:经皮超声是评估脊髓术后状况的非常有用的方法,特别是在诊断术后硬膜外血肿方面。这些幻灯片可以在电子补充材料中检索到。
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