Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China.
The Third Affiliated Hospital of Southern Medical University, No. 183 West of Zhongshan Road, Guangzhou, 510630, People's Republic of China.
Eur Spine J. 2020 May;29(5):1167-1174. doi: 10.1007/s00586-020-06369-9. Epub 2020 Mar 24.
To investigate the relationship between different types of laminectomy extension and spinal cord injury subsequent to acute spinal shorting after 3-column osteotomy in living goat model.
A total of 18 healthy goats were selected, and a procedure of bivertebral column resections and total laminectomy of T13 and L1 was completed followed by different laminectomy extensions under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into three groups according to types of subsequent laminectomy extension. In the first group (enlarged resection of upper lamina group), laminectomy extension was performed on 10 mm caudal to T12; in the second group (equidistant enlarged resection of upper and lower lamina group), laminectomy extension was performed on 5 mm caudal to T12 and 5 mm cranial to L2 simultaneously; and in the third group (enlarged resection of lower lamina group), laminectomy extension was performed on 10 mm cranial to L2. The SSEP measured after vertebral resection was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. Spinal column was gradually shortened until the SSEP monitoring just did not show a positive result. The shortened distance (ΔH) and the changed angle of the spinal cord buckling (Δα) were measured in each group. Neurologic function was recorded by the Tarlov scores at 2 days after the surgery.
The safe shortening distances of three groups were 38.6 ± 1.2 mm, 41.5 ± 0.7 mm, 43.7 ± 0.8 mm, respectively; the corresponding changed angles of the spinal cord buckling were 62.8 ± 6.9°, 82.8 ± 7.5°, and 98.5 ± 7.0°. Significant differences of ΔH and Δα were found among the three groups by LSD multiple comparison test (P < 0.05). Strong correlation between ΔH and Δα was shown in each group by Pearson's correlation test.
Different laminectomy extensions after 3-column osteotomy have different effects on the prevention of SCI caused by acute spinal shortening. The enlarged resection of lower lamina is superior to equidistant enlarged resection of upper and lower laminas which is superior to enlarged resection of upper lamina in preventing SCI. These slides can be retrieved under Electronic Supplementary Material.
在活体山羊模型中，研究三柱截骨术后急性脊柱缩短后不同类型椎板切除延伸与脊髓损伤的关系。
选择 18 只健康山羊，在体感诱发电位（SSEP）监测下完成双椎体切除和 T13 和 L1 的全椎板切除，然后根据随后的椎板切除延伸类型分为三组。在第一组（上椎板扩大切除组），在 T12 尾侧进行 10mm 的椎板切除延伸；在第二组（上、下椎板等距扩大切除组），在 T12 尾侧和 L2 头侧同时进行 5mm 的椎板切除延伸；在第三组（下椎板扩大切除组），在 L2 头侧进行 10mm 的椎板切除延伸。椎体切除后测量的 SSEP 作为基线，与基线峰值潜伏期相比，SSEP 振幅降低 50%或延迟 10%，则视为阳性结果，提示脊髓损伤。脊柱逐渐缩短，直到 SSEP 监测结果不再显示阳性结果。在每组中测量缩短距离（ΔH）和脊髓弯曲角度的变化（Δα）。术后 2 天，通过 Tarlov 评分记录神经功能。
三组的安全缩短距离分别为 38.6±1.2mm、41.5±0.7mm、43.7±0.8mm，相应的脊髓弯曲角度分别为 62.8±6.9°、82.8±7.5°和 98.5±7.0°。LSD 多重比较检验发现三组间ΔH 和Δα差异有统计学意义（P<0.05）。Pearson 相关检验显示，每组中ΔH 和Δα 之间存在很强的相关性。
三柱截骨术后不同的椎板切除延伸对预防急性脊柱缩短引起的 SCI 有不同的效果。下椎板扩大切除优于上、下椎板等距扩大切除，上椎板扩大切除优于下椎板扩大切除。这些幻灯片可以在电子补充材料中检索到。
