Pan Qiangqiang, Zhang Zhenhui, Zhu Yanyu, Jiang Wentao, Su Kai, Liu Peilin, Kang Yongsheng, Shao Zhe, Mei Wei, Wang Qingde
Henan University, KaiFeng, 475004, China.
Department of Spinal Surgery, Zheng Zhou Orthopaedics Hospital, Zhengzhou, China.
Asian J Surg. 2023 Feb;46(2):723-729. doi: 10.1016/j.asjsur.2022.06.118. Epub 2022 Jul 6.
Spinal cord injury is a common occurrence during spinal surgery. In this study, we proposed a zoning laminectomy, which could reduce the incidence of nerve injury. We also discussed the safety and clinical efficacy of the zoning laminectomy for thoracic ossification of the ligamentum flavum (TOLF).
Forty-five patients with TOLF who underwent zoning laminectomy from October 2016 to February 2020 were included in the retrospective analysis. The Japan Orthopedic Association (JOA) score was used to evaluate clinical outcomes. Meanwhile, the occurrence of complications was recorded.
All 45 patients underwent the operation successfully, and the mean follow-up period was 25.3 months, the mean operation time was 160.2 min, the average blood loss was 474.2 ml, and the average hospital time was 8.0 days. At the final evaluation, the JOA score was significantly higher than the preoperative JOA score (P < 0.001) and the overall recovery rate of the JOA score averaged 69.6%. Seventeen patients were graded as excellent, twenty-six as good, and two as fair. The complications included dural tears in nine patients (20.0%), cerebrospinal fluid leakage in seven patients (15.6%), deep infection in one patient (2.2%), and epidural hematoma in one patient (2.2%). All patients recovered well after treatment. Besides, there was no neurological deterioration and thoracic kyphosis occurred.
Zoning laminectomy adopts a phased resection from "safe zone" to "danger zone" and defines the safe removal range of the lamina, which reduces the risks of spinal cord injury caused by instrument manipulation. Therefore, it is a safe and effective surgical option.
脊髓损伤是脊柱手术中的常见情况。在本研究中，我们提出了一种分区椎板切除术，该方法可降低神经损伤的发生率。我们还探讨了分区椎板切除术治疗胸段黄韧带骨化症（TOLF）的安全性和临床疗效。
回顾性分析2016年10月至2020年2月期间接受分区椎板切除术的45例TOLF患者。采用日本骨科协会（JOA）评分评估临床疗效。同时，记录并发症的发生情况。
45例患者均手术成功，平均随访时间为25.3个月，平均手术时间为160.2分钟，平均出血量为474.2毫升，平均住院时间为8.0天。末次评估时，JOA评分显著高于术前JOA评分（P < 0.001），JOA评分总体恢复率平均为69.6%。17例患者评定为优，26例为良，2例为可。并发症包括9例硬膜撕裂（20.0%）、7例脑脊液漏（15.6%）、1例深部感染（2.2%）和1例硬膜外血肿（2.2%）。所有患者经治疗后恢复良好。此外，未发生神经功能恶化及胸椎后凸畸形。
分区椎板切除术采用从“安全区”到“危险区”的分期切除方式，明确了椎板的安全切除范围，降低了器械操作导致脊髓损伤的风险。因此，它是一种安全有效的手术选择。
