University Spine Centre, Department of Orthopaedic Surgery, National University Hospital, Singapore, National University Health System, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Spine (Phila Pa 1976). 2020 Oct 1;45(19):E1256-E1263. doi: 10.1097/BRS.0000000000003546.
Retrospective case series to investigate the result of a new C3 dome-hybrid open-door laminoplasty technique.
This study reports the design and feasibility of a new hybrid laminoplasty technique aimed to reduce the complications of the conventional laminoplasty, with the incorporation of C3 dome-osteotomy, an open-door C4-6 instrumented laminoplasty and C7 cephalad dome-osteotomy.
Recent findings showed that the preservation of the dorsal muscles attached at either C2 or C7 cervical spine reduced the complications of C3-C7 open-door laminoplasty.
A retrospective review of consecutive patients who underwent the C3 dome-hybrid laminoplasty technique by a single surgeon with at least 2 years follow-up was performed. The surgical technique was described in detail. Clinical and radiological outcome data were analyzed.
Twenty six patients with cervical cord compression who underwent C3 dome-hybrid laminoplasty were recruited. The mean postoperative follow-up was 45.6 ± 24.7 (24-101) months. Significant improvements were observed in the preoperative to postoperative mean Japanese Orthopaedic Association (JOA) score (13→15, P < 0.001), Nurick grade (2.3→1.2, P < 0.001), neck disability index (NDI) (23→11, P = 0.011), 36-item short form survey (SF-36) physical component score (40→46, P = 0.027), and neck visual analogue scale (VAS) (3.1→0.3, P < 0.001). There was no significant loss in cervical lordosis from 12° preoperatively to 8° at final follow-up. Postoperative cervical range of motion (ROM) was preserved at 85% and 78% of the preoperative ROM at 2 years and at final follow-up, respectively. When comparing the first 10 patients with the next 16 patients, there was a reduction in mean operation time from 252 ± 75 to 208 ± 7 minutes, mean blood loss from 359 ± 326 to 211 ± 177 mL, and median hospital stay from 7 days (interquartile range [IQR]: 34) to 5 days (IQR: 6).At final follow-up, no patients had revision surgery, spinal infection, C5 palsy, symptomatic cervical kyphosis, or axial neck pain.
The new C3 dome-hybrid laminoplasty technique is safe, feasible, and reproducible with good clinical outcomes. This technique may be considered as an alternative to traditional laminoplasty for patients with C3-C7 multi-level myelopathic disease.
回顾性病例系列研究，旨在调查一种新的 C3 穹顶-杂交式开门椎板成形术的结果。
本研究报告了一种新的混合式椎板成形术的设计和可行性，旨在减少传统椎板成形术的并发症，同时采用 C3 穹顶切开术、C4-6 器械性开门椎板成形术和 C7 颅顶穹顶切开术。
最近的研究结果表明，保留附着在颈椎 C2 或 C7 上的背侧肌肉可减少 C3-C7 开门式椎板成形术的并发症。
对由一名外科医生进行的 C3 穹顶杂交式椎板成形术的连续患者进行回顾性分析，至少随访 2 年。详细描述了手术技术。分析了临床和影像学结果数据。
共招募了 26 例因颈髓受压而行 C3 穹顶杂交式椎板成形术的患者。平均术后随访时间为 45.6±24.7（24-101）个月。术前至术后平均日本骨科协会（JOA）评分（13→15，P＜0.001）、Nurick 分级（2.3→1.2，P＜0.001）、颈部残疾指数（NDI）（23→11，P=0.011）、36 项简明健康调查量表（SF-36）生理成分评分（40→46，P=0.027）和颈部视觉模拟评分（VAS）（3.1→0.3，P＜0.001）均有显著改善。术后颈椎前凸丢失，从术前的 12°降至末次随访时的 8°，但无显著差异。术后颈椎活动度（ROM）在 2 年和末次随访时分别保持在术前 ROM 的 85%和 78%。与前 10 例患者相比，后 16 例患者的平均手术时间从 252±75 分钟缩短至 208±7 分钟，平均失血量从 359±326 毫升减少至 211±177 毫升，中位住院时间从 7 天（四分位距 [IQR]：34）缩短至 5 天（IQR：6）。末次随访时，无患者行翻修手术、脊髓感染、C5 瘫痪、有症状的颈椎后凸畸形或轴向颈部疼痛。
新的 C3 穹顶杂交式椎板成形术安全、可行且可重复，临床效果良好。对于 C3-C7 多节段脊髓病患者，该技术可作为传统椎板成形术的替代方法。
3 级。
