Mittal Amol, Mishra Rakesh, Patel Hrishikesh, Shetty Abhishek, Shrivastava Adesh
Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Cureus. 2024 Jun 14;16(6):e62359. doi: 10.7759/cureus.62359. eCollection 2024 Jun.
The posterior ligamentous complex plays a pivotal role in spinal stability during complex movements, especially at the cervical vertebral level. Its disruption leads to the development of post-laminectomy kyphosis. The present case emphasizes the challenges in managing post-laminectomy kyphosis, restoring spinal alignment, and the importance of the posterior tension band as a spine stabilizer. A 19-year-old male underwent C2-C5 laminectomy for cervical C3 neurofibroma at an outside hospital. The patient remained stable for five months and then developed cervical kyphosis, leading to myelopathy. Clinical examination revealed significant neurological deficits, including spasticity, clonus, loss of hand dexterity, and sensory abnormalities. Imaging revealed C3 retrolisthesis with severe cervical kyphosis, cord compression, and myelomalacia. The management involved cervical traction with gradual increments in the weight and correction of the cervical sagittal balance. Principles of kyphotic deformity correction were applied, and C2 pedicle with C3-C5 lateral mass fixation was performed. The patient's modified Japanese Orthopaedic Association score improved from 10 to 16 at six months' follow-up. Post-laminectomy, the disruption of the posterior ligamentous complex increases the range of motion, particularly in the cervical spine, leading to instability and kyphosis. Surgical interventions such as laminoplasty, laminotomy, and laminectomy with posterior cervical fusion aim to mitigate the risk of kyphosis, with techniques such as bone-to-bone ligament-preserving laminoplasty and ultrasonic bone scalpel showing promise in further reducing the risk of kyphosis. The key determinant for the prevention of kyphosis is the integrity of the posterior ligamentous complex. The management of cervical kyphosis includes appropriate pre-operative planning, which includes the evaluation of cervical and spinopelvic parameters. For a posterior spinal approach, one may choose to consider laminotomy, laminoplasty, or laminectomy along with posterior cervical fusion.
后韧带复合体在复杂运动过程中，尤其是在颈椎水平，对脊柱稳定性起着关键作用。其破坏会导致椎板切除术后后凸畸形的发生。本病例强调了处理椎板切除术后后凸畸形、恢复脊柱排列的挑战，以及后张力带作为脊柱稳定器的重要性。一名19岁男性在外院因颈椎C3神经纤维瘤接受了C2 - C5椎板切除术。患者术后五个月情况稳定，随后出现颈椎后凸畸形，并导致脊髓病。临床检查发现明显的神经功能缺损，包括痉挛、阵挛、手部灵活性丧失和感觉异常。影像学检查显示C3椎体向后滑脱，伴有严重的颈椎后凸畸形、脊髓受压和脊髓软化。治疗措施包括颈椎牵引，逐渐增加重量并纠正颈椎矢状面平衡。应用了后凸畸形矫正原则，并进行了C2椎弓根与C3 - C5侧块固定。在六个月的随访中，患者的改良日本骨科协会评分从10分提高到了16分。椎板切除术后，后韧带复合体的破坏会增加活动范围，尤其是在颈椎，导致不稳定和后凸畸形。诸如椎板成形术、椎板切开术以及颈椎后路融合椎板切除术等手术干预旨在降低后凸畸形的风险，像骨对骨保留韧带的椎板成形术和超声骨刀等技术在进一步降低后凸畸形风险方面显示出前景。预防后凸畸形的关键决定因素是后韧带复合体的完整性。颈椎后凸畸形的治疗包括适当的术前规划，其中包括对颈椎和脊柱骨盆参数的评估。对于后路脊柱手术，可选择考虑椎板切开术、椎板成形术或椎板切除术以及颈椎后路融合术。
