Hirabayashi Shigeru
Department of Orthopaedic Surgery, Teikyo University Hospital, Tokyo, Japan.
Spine Surg Relat Res. 2018 Feb 28;2(2):154-158. doi: 10.22603/ssrr.2017-0061. eCollection 2018.
Double-door laminoplasty (DDL) of the cervical spine (Kurokawa's method) was developed as one of posterior decompression surgical methods in the late 1970s and after then has been modified by adding various procedures such as the posterior muscle handling and the use of artificial spacers. There are three principles of DDL: First, to decompress the cervical spinal cord by central splitting of the spinous processes and laminae, preserving those lengths as much as possible and widening the spinal canal space symmetrically. Second, to maintain the widened spinal canal space steadily by fixing spacers made of hydroxyapatite the contour is almost the same as the widened space. Third, to re-suture the semispinalis muscles to the C2 spinous process to restore the strength of the posterior cervical muscles.
The important technical points in performing osteotomy are as follows: At each vertebra, osteotomy is performed from the caudal side and gradually proceeds to the cranial side because there is a space between the lamina and the dura mater at the caudal side and the osteotomy can be safely made. The surgeon must pay attention to the changes in color of the osteotomy site from red of cancellous bone, to white of the inner cortex, and finally to yellow of the yellow ligament and extradural fat tissue. Attention must be paid to the changes in sound and tactile sensation delivered from the air-drill when completing osteotomy of the inner cortex of lamina. By moving an air-drill slowly, tactile sensation can be more sensitive. During osteotomy, the process must be checked frequently by touching the inner cortex of the lamina with a probe.
At present, DDL is a useful surgical method for cervical myelopathy at multiple level lesions.
颈椎双开门椎板成形术（黑川法）是20世纪70年代后期开发的一种后路减压手术方法，此后通过添加各种手术步骤进行了改良，如后路肌肉处理和使用人工间隔物。双开门椎板成形术有三个原则：第一，通过棘突和椎板的中央劈开减压颈脊髓，尽可能保留其长度并对称地扩大椎管空间。第二，通过固定由羟基磷灰石制成的间隔物来稳定维持扩大的椎管空间，其轮廓与扩大的空间几乎相同。第三，将半棘肌重新缝合到C2棘突以恢复颈后肌肉的强度。
进行截骨术的重要技术要点如下：在每个椎体，截骨术从尾侧开始，逐渐向头侧进行，因为尾侧椎板和硬脑膜之间有空间，可以安全地进行截骨术。外科医生必须注意截骨部位颜色的变化，从松质骨的红色，到内皮质的白色，最后到黄韧带和硬膜外脂肪组织的黄色。在完成椎板内皮质截骨术时，必须注意气钻传递的声音和触感变化。通过缓慢移动气钻，触感会更灵敏。在截骨过程中，必须经常用探针触摸椎板的内皮质来检查进展情况。
目前，双开门椎板成形术是治疗多节段病变型颈椎病的一种有效手术方法。
