Abduljabbar Omar Ahmed
Department of Surgery, College of Medicine, Hawler Medical University, Erbil, IRQ.
Cureus. 2024 Nov 5;16(11):e73034. doi: 10.7759/cureus.73034. eCollection 2024 Nov.
The stenosis of the cervical canal due to spondylotic changes is one of the common causes of spinal cord compression. Without adequate treatment, it results in progressive neurological deterioration. However, despite the wide acceptance of newer techniques, such as laminoplasty and laminectomy with fusion, in most situations, especially in resource-constraint situations, the role of laminectomy alone is pertinent. The following study reviews the effectiveness and safety of laminectomy alone in patients with cervical spondylotic myelopathy.
A retrospective cohort study was conducted at Par Private Hospital, Erbil, including 46 patients diagnosed with cervical canal stenosis. All patients underwent laminectomy without fusion or laminoplasty, and postoperative outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and radiographic evaluations of cervical alignment. The relationship between preoperative and postoperative cervical alignment, kyphosis progression, and clinical outcomes was analyzed.
Most patients showed significant neurological improvement in accordance with the improvement of scores of both mJOA and NDI. Among them, radiographic kyphosis progression occurred in 40% of patients, which was not associated with clinical deterioration. This showed a remarkable correlation between preoperative cervical alignment and postoperative outcomes, with R² = 0.733 and p < 0.001. No major complications like C5 palsy or wound infection were recorded throughout the follow-up period.
Laminectomy alone constitutes a proper and safe surgical alternative for cervical canal stenosis, especially in resource-poor countries. Although kyphosis progression occurred in some cases, there was no clinical impairment. Careful selection of patients by preoperative alignment is important for favorable outcomes. Comparing laminectomy alone with other techniques in longer follow-up will provide the final result in larger, multi-institutional groups.
颈椎病性改变导致的颈椎管狭窄是脊髓受压的常见原因之一。若未得到充分治疗，会导致神经功能逐渐恶化。然而，尽管诸如椎板成形术和融合性椎板切除术等新技术已被广泛接受，但在大多数情况下，尤其是在资源有限的情况下，单纯椎板切除术仍具有重要意义。以下研究回顾了单纯椎板切除术治疗脊髓型颈椎病患者的有效性和安全性。
在埃尔比勒的帕尔私立医院进行了一项回顾性队列研究，纳入46例诊断为颈椎管狭窄的患者。所有患者均接受了无融合或椎板成形术的椎板切除术，并使用改良日本骨科学会（mJOA）评分、颈部残疾指数（NDI）以及颈椎对线的影像学评估来评估术后结果。分析术前和术后颈椎对线、后凸畸形进展与临床结果之间的关系。
大多数患者的神经功能根据mJOA和NDI评分的改善而有显著改善。其中，40%的患者出现影像学后凸畸形进展，这与临床恶化无关。这表明术前颈椎对线与术后结果之间存在显著相关性，R² = 0.733，p < 0.001。在整个随访期间未记录到如C5麻痹或伤口感染等重大并发症。
单纯椎板切除术是颈椎管狭窄一种合适且安全的手术选择，尤其在资源匮乏的国家。尽管在某些情况下出现了后凸畸形进展，但并未造成临床损害。通过术前对线仔细选择患者对于获得良好结果很重要。在更长时间的随访中，将单纯椎板切除术与其他技术进行比较，将在更大的多机构群体中得出最终结果。
