Bayley J C, Yoo J U, Kruger D M, Schlegel J
Department of Orthopaedic Surgery, University of Massachusetts Medical Center, Worcester, USA.
Spine (Phila Pa 1976). 1995 Apr 1;20(7):771-5. doi: 10.1097/00007632-199504000-00005.
This study analyzed the effects of distraction via strut graft insertion on the canal dimensions in spondylotic human cadaver cervical spines. Transverse and anteroposterior diameters and cross-sectional areas were measured by transverse computed tomography imaging before and after distraction without direct decompression.
This experiment was designed to address whether distraction across the disc space without direct canal decompression can improve the space available for the cord.
Smith-Robinson anterior discectomy and fusion have been shown to improve clinical symptoms of radiculopathy and myelopathy even in the absence of direct decompression. This has been postulated to be the result of gradual resorption of intruding osteophytes. However, the immediate effects of indirect distraction alone have not been previously investigated.
Four cadaver spines from elderly donors were harvested intact. The transverse diameter, anteroposterior diameter, and cross-sectional area of the spinal canal were measured before and after discectomy and distraction via insertion of fibular strut graft by digitization of contiguous computed tomography scan slices.
The spinal canal dimensions before distraction were found to vary in a sinusoidal pattern around the disc space, with the maximum measurements located at the pedicle and the minimum measurements at the spondylotic ridge above or below the disc space. Distraction via strut graft insertion significantly increased the anteroposterior diameter and cross-sectional area, but had a negligible effect on transverse diameter.
Anterior discectomy and distraction with a strut graft can significantly improve the space available for the cord in cervical spondylosis. Osteophyte debridement, which risks iatrogenic injury to the cord, may not always be necessary for improving clinical radiculopathy and myelopathy.
本研究分析了通过植入支撑移植物进行撑开对颈椎病患者尸体颈椎管尺寸的影响。在未进行直接减压的撑开前后，通过横向计算机断层扫描成像测量横径、前后径和横截面积。
本实验旨在探讨在不进行直接椎管减压的情况下，跨越椎间盘间隙进行撑开是否能增加脊髓的可用空间。
Smith-Robinson前路椎间盘切除融合术已被证明即使在未进行直接减压的情况下也能改善神经根病和脊髓病的临床症状。据推测，这是由于侵入性骨赘逐渐吸收的结果。然而，此前尚未研究单纯间接撑开的即时效果。
完整获取4具老年供体的尸体颈椎。通过对连续计算机断层扫描切片进行数字化处理，测量椎间盘切除及通过植入腓骨支撑移植物进行撑开前后的椎管横径、前后径和横截面积。
发现撑开前椎管尺寸在椎间盘间隙周围呈正弦模式变化，最大测量值位于椎弓根处，最小测量值位于椎间盘间隙上方或下方的骨赘嵴处。通过植入支撑移植物进行撑开显著增加了前后径和横截面积，但对横径的影响可忽略不计。
前路椎间盘切除及支撑移植物撑开可显著增加颈椎病患者脊髓的可用空间。对于改善临床神经根病和脊髓病，有导致医源性脊髓损伤风险的骨赘清除术可能并非总是必要的。
