Huang Xinyi, Liu Daming, Yang Yipeng, Qiu Haiyang, Ma Zhensheng, Lei Wei, Zhang Yang
Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, China.
Front Surg. 2023 Mar 3;10:1078138. doi: 10.3389/fsurg.2023.1078138. eCollection 2023.
Cervical laminoplasty is a posterior-based surgical decompression technique for the treatment of multilevel cervical spondylotic myelopathy (CSM) that may improve the preservation of cervical mobility, spinal canal structure, and natural lordosis. Although this procedure is considered to be comparatively safe, with fewer complications than those seen with laminectomy, several postoperative problems have been noted, including axial neck pain, C5 nerve palsy, and failed resolution of radiculopathy. Hence, various modifications have been made to improve the safety and effectiveness of this technique. Here, we report the case of a 74-year-old man with multilevel CSM who underwent posterior cervical laminoplasty in the C3-C7 segments using a novel surgical technique, termed alternating-side cervical laminoplasty. Preoperative and postoperative assessments, including visual analog scale, modified Japanese Orthopaedic Association, neck disability index scores, and imaging data, were collected and analyzed. The results of a 5-year follow-up indicated that the patient recovered well, with no development of axial neck pain. This is the first report of this modified open-door laminoplasty, which we propose may be a better surgical option for preventing postoperative axial neck pain in patients with multilevel CSM. Additionally, opening the laminae on the alternating sides during laminoplasty could provide a flexible approach to complete decompression on different radiculopathy sides.
颈椎椎板成形术是一种基于后路的手术减压技术，用于治疗多节段脊髓型颈椎病（CSM），该技术可能有助于更好地保留颈椎活动度、椎管结构和自然生理前凸。尽管该手术被认为相对安全，并发症比椎板切除术少，但仍有一些术后问题被注意到，包括颈部轴性疼痛、C5神经麻痹和神经根病缓解不佳。因此，人们进行了各种改良以提高该技术的安全性和有效性。在此，我们报告一例74岁多节段CSM男性患者，采用一种名为交替侧颈椎椎板成形术的新型手术技术，在C3 - C7节段进行了后路颈椎椎板成形术。收集并分析了术前和术后评估结果，包括视觉模拟量表、改良日本骨科协会评分、颈部功能障碍指数评分以及影像学数据。5年随访结果表明患者恢复良好，未出现颈部轴性疼痛。这是关于这种改良开门式椎板成形术的首次报告，我们认为该技术可能是预防多节段CSM患者术后颈部轴性疼痛的更好手术选择。此外，在椎板成形术期间交替侧打开椎板可为不同神经根病侧的完全减压提供一种灵活的方法。
