Sasai K, Saito T, Akagi S, Watanabe H
Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan.
Nihon Seikeigeka Gakkai Zasshi. 1995 Dec;69(12):1237-47.
We have retrospectively determined the preoperative risk factors in cervical radiculopathy after laminoplasty for cervical myelopathy using preoperative neuroradiographical findings and electrophysiological studies. Of the 67 patients who underwent laminoplasty, 10 patients (14.9%) postoperatively showed cervical radioculopathy. The preoperative radiographical findings had included cervical lordosis, intraspinal cord centering, and anterior protrusion of the apex of the superior articular process. Needle electromyography, somatosensory evoked potentials (SEPs), sensory nerve action potentials (SNAP) were preoperatively examined in 42 cases. There was no relationship between the postoperative radiculopathy and the preoperative radiographical findings. Six (100%) of 6 cases preoperatively diagnosed as C5 radiculopathy (postganglionic type) with Erb-P 14 interpeak latency of dermatomal SEPs and SNAP, developed postoperative C5 radiculopathy. One (25%) of 4 cases preoperatively diagnosed as C6 radiculopathy developed postoperative C6 radiculopathy. No case preoperatively diagnosed as C7 or C8 radiculopathy developed postoperative radiculopathy. This study suggested that an important risk factor for postoperative radiculopathy was subclinical C5 radiculopathy (postganglionic type) that could be preoperatively evaluated using electrophysiological studies.
我们利用术前神经影像学检查结果和电生理研究，回顾性地确定了颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病后发生神经根型颈椎病的术前危险因素。在接受颈椎后路单开门椎管扩大成形术的67例患者中，10例（14.9%）术后出现颈神经根病。术前影像学检查结果包括颈椎生理前凸、脊髓在椎管内居中以及上位关节突顶点向前突出。对42例患者术前进行了针极肌电图、体感诱发电位（SEP）和感觉神经动作电位（SNAP）检查。术后神经根病与术前影像学检查结果之间无相关性。术前诊断为C5神经根病（节后型）且皮节SEP和SNAP的Erb-P 14峰间潜伏期异常的6例患者中，6例（100%）术后发生C5神经根病。术前诊断为C6神经根病的4例患者中，1例（25%）术后发生C6神经根病。术前诊断为C7或C8神经根病的患者术后均未发生神经根病。本研究提示，术后神经根病的一个重要危险因素是术前可通过电生理研究评估的亚临床C5神经根病（节后型）。
