Dziedzic Tomasz A, Balasa Artur, Bielecki Mateusz, Przepiórka Łukasz, Kunert Przemysław, Marchel Andrzej
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
World Neurosurg. 2019 Feb;122:e455-e460. doi: 10.1016/j.wneu.2018.10.070. Epub 2018 Oct 19.
The main concern with the posterior approach is the risk of postoperative segmental instability. The most commonly cited rule is that removal of the medial half of the articular facet provides adequate surgical exposure and has no effect on stability. The aim of this study was to define the areas of the articular processes in the cervical spine that can be safely removed.
Computed tomography scans of 50 cervical spines were analyzed. Measurements were analyzed for bone removal assuming the standard technique of posterior laminoforaminotomy. The width of the facet was measured at the level of the widest dimension. The height of the articular process was taken from the bottom (in the case of inferior process) or top (in the case of superior process) of the process.
The mean width of the articular process ranged from 11.8 ± 1.5 mm (range, 8.3-15.7 mm) at the C2-C3 level to 14.6 ± 1.7 mm at the C6-C7 level. At the cervicothoracic junction (C7-T1 level), the mean width decreased to 14.0 ± 1.7 mm. The mean value for both sides when the inferior articular process was measured at all levels was 5.0 ± 1.4 mm (range, 4.5-5.8 mm). The mean height of the superior articular process was 7.7 ± 1.5 mm (range, 6.8-8.3 mm).
Based on our findings, our "5-5-7 mm rule" corresponds to the amount of bone removal for each step of the laminoforaminotomy.
后路手术主要关注的问题是术后节段性不稳定的风险。最常引用的规则是，切除关节突内侧一半可提供足够的手术暴露且对稳定性无影响。本研究的目的是确定颈椎关节突可安全切除的区域。
分析了50例颈椎的计算机断层扫描。假设采用标准的后路椎板切开椎间孔扩大术技术，对骨切除量进行了测量分析。在关节突最宽处测量其宽度。关节突的高度取自关节突底部（下关节突情况）或顶部（上关节突情况）。
关节突的平均宽度在C2-C3水平为11.8±1.5mm（范围8.3-15.7mm），至C6-C7水平为14.6±1.7mm。在颈胸交界处（C7-T1水平），平均宽度降至14.0±1.7mm。在所有水平测量下关节突时，两侧的平均值为5.0±1.4mm（范围4.5-5.8mm）。上关节突的平均高度为7.7±1.5mm（范围6.8-8.3mm）。
根据我们的研究结果，我们的“5-5-7mm规则”对应于椎板切开椎间孔扩大术每一步的骨切除量。
