Solou Mary, Politis Anastasios A, Ydreos Ιoannis, Papadopoulos Evangelos K, Banos Stamatios, Savvanis Georgios, Gavra Maria M, Boviatsis Efstathios J, Stavrinou Lampis C
Department of Neurosurgery and Neurotraumatology, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens Medical School, Athens, Greece.
Department of CT and MRI Imaging, "Agia Sofia" Children's Hospital, Athens, Greece.
Front Neurol. 2023 Sep 15;14:1220598. doi: 10.3389/fneur.2023.1220598. eCollection 2023.
Spinal cord injury (SCI) can be caused by a variety of factors and its severity can range from a mild concussion to a complete severing of the spinal cord. Τreatment depends on the type and severity of injury, the patient's age and overall health. Reduction of dislocated or fractured vertebrae via closed manipulation or surgical procedures, fixation and removal of bony fragments and debris that compromise the spinal canal are indicated for decompression of the spinal cord and stabilization of the spine. However, when there is no obvious traumatic obstruction of spinal canal, the question arises as to whether laminectomy is needed to be performed to improve neurological outcome.
A literature review covering all indexed studies published between 2013 and 2023 was performed using keywords to identify the patient group of interest (spinal cord injury, SCI, spinal cord trauma, cervical, thoracic, lumbar, thoracolumbar),central cord syndrome (CCS) and the interventions (laminectomy, laminoplasty, decompression, duroplasty).
This review includes6 observational studies investigating the outcome of posterior spinal decompression in patients suffering from spinal cord injury without traumatic spinal cord stenosis. Most patients already had degenerative stenosis. From a total of 202, 151 patients (74.7%) improved neurologically by at least one grade at ASIA scale, after being treated with either laminectomy, laminoplasty, duroplasty or a combination of these techniques.
Early decompression in SCI patients remains a reasonable practice option and can be performed safely, but no specific evidence supports the use of laminectomy alone. There is emerging evidence that intended durotomy followed by extended meningoplasty may improve the neurological outcome in patients suffering from SCI when meta-traumatic edema is apparent. However, the lack of high-quality evidence and results support the need for further research.
脊髓损伤（SCI）可由多种因素引起，其严重程度从轻度脑震荡到脊髓完全离断不等。治疗取决于损伤的类型和严重程度、患者的年龄及整体健康状况。通过闭合手法或外科手术复位脱位或骨折的椎体，固定并清除压迫椎管的骨碎片和碎屑，以实现脊髓减压和脊柱稳定。然而，当椎管无明显创伤性梗阻时，是否需要进行椎板切除术以改善神经功能结局就成了问题。
使用关键词对2013年至2023年间发表的所有索引研究进行文献综述，以确定感兴趣的患者群体（脊髓损伤、SCI、脊髓创伤、颈椎、胸椎、腰椎、胸腰段）、中央脊髓综合征（CCS）以及干预措施（椎板切除术、椎板成形术、减压、硬脊膜成形术）。
本综述纳入了6项观察性研究，调查了无创伤性脊髓狭窄的脊髓损伤患者后路脊髓减压的结局。大多数患者已有退行性狭窄。在接受椎板切除术、椎板成形术、硬脊膜成形术或这些技术联合治疗后，总共202例患者中有151例（74.7%）在亚洲脊髓损伤神经学分类标准（ASIA）量表上神经功能至少改善了一个等级。
脊髓损伤患者早期减压仍是一种合理的治疗选择，且可安全进行，但尚无具体证据支持单独使用椎板切除术。有新证据表明，在存在明显创伤后水肿的脊髓损伤患者中，有意进行硬脊膜切开术并延长硬脊膜成形术可能会改善神经功能结局。然而，缺乏高质量证据和结果支持进一步研究的必要性。
