Li Yuwei, Yan Xiaoyun, Cui Wei, Zhang Yonghui, Li Cheng
Department of Orthopedics, Luohe Central Hospital of Orthopedics, No. 54, People's Road, Luohe City, 462000, Henan Province, China.
BMC Musculoskelet Disord. 2019 May 1;20(1):181. doi: 10.1186/s12891-019-2554-8.
The effects of dural release on extended laminoplasty for the treatment of multi-level cervical myelopathy were explored and discussed.
Patients, who underwent extended laminoplasty combined with dural release for the treatment of multi-level cervical myelopathy (35 cases, group A), were compared with patients who underwent simple extended laminoplasty (38 cases, group B). The JOA score, improvement rate, VAS score, distance of retroposition of the spinal cord, cervical lordosis were compared between the two groups.
Dural laceration occurred to five patients during surgery, three in group A and two in group B; cerebrospinal fluid leakage occurred to five patients, three in group A and two in group B. All patients were followed up for 10 to 48 months (mean 20.3 months). JOA scores and VAS scores in the last follow up period were significantly improved in the two groups than preoperative scores (p < 0.05). The improvement rate and JOA scores in group A were significantly higher than group B, while VAS scores in group A were significantly lower than group B (p < 0.05). There were no significant differences in cervical lordosis in the two groups in the last follow up (p > 0.05), and the distance of retroposition of the spinal cord in group A was higher than B (p < 0.05). No shut-up of the 'door' of vertebral lamina occurred in the period of follow-up.
Dural release on extended laminoplasty can achieve retroposition of the spinal cord for multi-level cervical myelopathy, which is more effective than simple extended laminoplasty.
探讨并讨论硬脊膜松解术在扩大椎板成形术治疗多节段颈椎病中的作用。
将接受扩大椎板成形术联合硬脊膜松解术治疗多节段颈椎病的患者（35例，A组）与接受单纯扩大椎板成形术的患者（38例，B组）进行比较。比较两组患者的日本骨科学会（JOA）评分、改善率、视觉模拟评分（VAS）、脊髓后移距离、颈椎前凸。
手术中有5例患者发生硬脊膜撕裂，A组3例，B组2例；5例患者发生脑脊液漏，A组3例，B组2例。所有患者均随访10至48个月（平均20.3个月）。两组患者末次随访时的JOA评分和VAS评分均较术前显著改善（p<0.05）。A组的改善率和JOA评分显著高于B组，而A组的VAS评分显著低于B组（p<0.05）。两组患者末次随访时的颈椎前凸无显著差异（p>0.05），A组的脊髓后移距离高于B组（p<0.05）。随访期间未发生椎板“门”关闭。
扩大椎板成形术中的硬脊膜松解术可使多节段颈椎病患者的脊髓后移，比单纯扩大椎板成形术更有效。
