Ishida Y, Ohmori K, Suzuki K, Inoue H
Department of Orthopaedic and Spinal Surgery, Nagoya Daini Red Cross Hospital, Japan.
Neurosurgery. 1999 Jan;44(1):91-5; discussion 95-6. doi: 10.1097/00006123-199901000-00051.
The goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgery.
Radiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent suspension laminotomy.
The dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decompression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P<0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in OPLL cases. The laminotomy width was more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. There were four OPLL cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 25% of the preoperative spinal canal area over three or more segments.
The following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in OPLL cases and laminotomy width of more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. However, in cases of extensive OPLL, sufficient decompression could not be obtained through posterior enlargement of the spinal canal.
本研究的目的是确立椎板成形术中颈椎脊髓充分减压的标准。
对63例脊髓型颈椎病(CSM)患者和31例颈椎后纵韧带骨化症(OPLL)患者进行了影像学检查和神经功能评估,这些患者均接受了悬吊式椎板切开术。
将计算机断层脊髓造影中的硬脊膜形态与36例对照受试者确立的硬脊膜形态临界值进行比较评估。94例患者中有76例被判定实现了充分减压。充分减压患者的神经功能改善明显优于减压不充分的患者(P<0.01)。在大多数CSM充分减压病例中,术后椎管矢状径大于14mm,OPLL病例中大于17mm。在CSM和OPLL病例中,椎板切开宽度均超过椎管横径的70%。有4例OPLL患者术后椎管充分扩大但硬脊膜减压不充分。在这些病例中,骨化的后纵韧带在三个或更多节段上持续占据术前椎管面积的25%以上。
在椎板成形手术中,以下情况被认为对脊髓充分减压至关重要:CSM病例术后椎管矢状径大于14mm,OPLL病例大于17mm,且CSM和OPLL病例的椎板切开宽度均超过椎管横径的70%。然而,在广泛OPLL的病例中,通过后路扩大椎管无法实现充分减压。