Uematsu Y, Tokuhashi Y, Matsuzaki H
Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.
Spine (Phila Pa 1976). 1998 Oct 1;23(19):2057-62. doi: 10.1097/00007632-199810010-00004.
The risk factors of patients with and without radiculopathy after laminoplasty of the cervical spine were compared retrospectively.
To study the association between risk variables and postlaminoplastic radiculopathy to clarify the pathogenesis of radiculopathy and to devise preventive measures.
Radiculopathy after cervical laminoplasty on the expanded side has been attributed mainly to traumatic surgical techniques, whereas radiculopathy on the hinged side has been attributed to traction, tethering, or kinking of the nerve root that has resulted from posterior shift of the spinal cord from the preoperative position. There is still much divergence of opinion concerning the risk factors for the outbreak as well as the prevention.
Of 365 patients who had undergone laminoplasty, 20 patients (5.5%) developed postoperative radiculopathy. Using data from postoperative computed tomography scans and other sources, these patients were compared with 211 patients with no radiculopathy, who had undergone laminoplasty during the same period, to identify risk factors related to patient characteristics and surgical techniques.
Of various risk factors studied, the narrowest level of the spinal canal, preoperative symptomatic severity, flatness of the spinal cord assessed by computed tomography myelography at C4-C5, cervical curvature, anterior protrusion of the superior articular process as assessed by computed tomography scan, laterality of the osteophytes, and ossification of the posterior longitudinal ligament could not significantly discriminate between patients with and without postoperative radiculopathy. The angle of lamina as measured by using computed tomography scans obtained after expansion in the patients with radiculopathy was greater than 68 degrees on the opened and hinged sides and was significantly greater than the angle in patients without radiculopathy (P < 0.05). The incidence of radiculopathy on both the opened and hinged sides was significantly higher in patients in whom the bony gutter had been cut on the lateral side of the medial aspect of the zygapophyseal joint.
Any one of patients' characteristics could not be correlated with postoperative cervical radiculopathy in this study. To prevent postoperative radiculopathy, it may be important during surgery to place the bony gutter on the medial side of the zygapophyseal joint and to keep the slope of the opened lamina within 60 degrees.
对颈椎椎板成形术后出现和未出现神经根病的患者的危险因素进行回顾性比较。
研究风险变量与椎板成形术后神经根病之间的关联，以阐明神经根病的发病机制并制定预防措施。
颈椎椎板成形术后扩大侧的神经根病主要归因于创伤性手术技术，而铰链侧的神经根病则归因于脊髓从术前位置向后移位导致神经根的牵拉、束缚或扭结。关于其发病的危险因素以及预防措施仍存在很大的意见分歧。
在365例行椎板成形术的患者中，20例（5.5%）出现术后神经根病。利用术后计算机断层扫描（CT）扫描及其他来源的数据，将这些患者与同期行椎板成形术且未出现神经根病的211例患者进行比较，以确定与患者特征和手术技术相关的危险因素。
在所研究的各种危险因素中，椎管最狭窄节段、术前症状严重程度、通过颈椎CT脊髓造影评估的C4-C5节段脊髓扁平度、颈椎曲度、通过CT扫描评估的上关节突前凸、骨赘的侧方位置以及后纵韧带骨化，均不能显著区分术后出现和未出现神经根病的患者。神经根病患者在撑开后通过CT扫描测量的椎板角度，在开放侧和铰链侧均大于68度，且显著大于未出现神经根病患者的角度（P<0.05）。在关节突关节内侧缘外侧切断骨槽的患者中，开放侧和铰链侧神经根病的发生率均显著更高。
本研究中患者的任何一项特征均与术后颈椎神经根病无关。为预防术后神经根病，手术中可能重要的是将骨槽置于关节突关节内侧，并使开放椎板的倾斜度保持在60度以内。
