McLaughlin M R, Wahlig J B, Pollack I F
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Spine (Phila Pa 1976). 1997 Mar 15;22(6):613-7. doi: 10.1097/00007632-199703150-00007.
In this retrospective study, a 5-year series of a pediatric population undergoing Chiari decompressions is reviewed.
To review the experience with children treated with suboccipital craniectomy and uni- or multilevel cervical laminectomy for Chiari malformation, to determine the incidence of kyphosis and to identify factors predictive of cervical instability.
Upper cervical laminectomy in the pediatric population has a significant risk of postoperative kyphosis. To decrease the incidence of this complication, a concerted effort was made to avoid violation of the facet joint during cervical laminectomy.
Thirty-two patients (mean age 4.9 years, range 1 day to 18 years) had surgical decompression of Chiari I or II malformations throughout a 5-year period (1989-1994). Radiographs and operative records were analyzed to determine the number of cervical levels decompressed and extent of laminectomy.
Mean follow-up was 3.7 years (range 9 months to 7 years). Only one patient had clinical and radiographic evidence of kyphosis and required C2-C3 fusion. Two others had radiographic signs of mild cervical kyphosis but remained asymptomatic. These three patients had two-level complete laminectomies. Twenty-nine patients had no clinical or radiographic evidence of cervical instability. A mean of three cervical levels were decompressed (range 0-4), including partial laminectomies, complete laminectomies, and one osteoplastic laminotomy to drain a lower cervical syrinx. The overall frequency of kyphosis in this series (9%) was substantially lower than in previous reports. Although the number of cervical levels decompressed did not correlate with cervical instability, the one patient with clinical instability had inadvertent violation of the facet joint, suggesting that overaggressive laminectomy may be a critical factor that predisposes patients to postoperative kyphosis.
Cervical kyphosis after Chiari decompression is a recognized complication of cervical laminectomy in children, the frequency of which may be decreased by careful attention to operative technique.
在这项回顾性研究中，对一组接受Chiari减压术的儿科患者进行了为期5年的回顾。
回顾枕下颅骨切除术和单节段或多节段颈椎椎板切除术治疗Chiari畸形患儿的经验，确定脊柱后凸的发生率，并确定预测颈椎不稳定的因素。
儿科患者的上颈椎椎板切除术有显著的术后脊柱后凸风险。为降低该并发症的发生率，在颈椎椎板切除术中一致努力避免侵犯小关节。
在5年期间（1989 - 1994年），32例患者（平均年龄4.9岁，范围1天至18岁）接受了Chiari I或II畸形的手术减压。分析X线片和手术记录以确定减压的颈椎节段数量和椎板切除范围。
平均随访3.7年（范围9个月至7年）。只有1例患者有脊柱后凸的临床和影像学证据，需要进行C2 - C3融合。另外2例有轻度颈椎后凸的影像学表现，但无症状。这3例患者均接受了双节段全椎板切除术。29例患者无颈椎不稳定的临床或影像学证据。平均减压3个颈椎节段（范围0 - 4个），包括部分椎板切除术、全椎板切除术和1例用于引流下颈椎空洞的骨成形性椎板切开术。本系列中脊柱后凸的总体发生率（9%）显著低于既往报道。虽然减压的颈椎节段数量与颈椎不稳定无关，但1例有临床不稳定的患者术中意外侵犯了小关节，提示过度激进的椎板切除术可能是使患者易发生术后脊柱后凸的关键因素。
Chiari减压术后颈椎后凸是儿童颈椎椎板切除术公认的并发症，通过仔细关注手术技术可降低其发生率。
