| Long-Term Outcome of Laminoplasty for Cervical Myelopathy Due to Disc Herniation
椎板成形术治疗脊髓型颈椎病的长期临床效果
Spine 2005;30(7):756-759
Study Design.
A retrospective study was conducted.
Objective.
To compare the long-term outcomes after laminoplasty and anterior spinal fusion (ASF) for cervical myelopathy secondary to disc herniation.
Summary of Background Data.
There have been no
reports of long-term comparative studies of laminoplastyand ASF for cervical myelopathy due to disc herniation.
Methods.
Of 21 patients who underwent ASF only between 1984 and 1987, 15 were followed up. Of 22 patients who underwent laminoplasty only between 1987 and 1994, 18 were followed up. There were no significant differences in preoperative prognostic factors between the 2 groups. Average follow-up was 15 years in the ASF group and 10 years in the laminoplasty group. Neurologic and radiologic results were examined.
Results. Laminoplasty and ASF provided equal neurologic improvement. In the ASF group, additional surgery was required for bone graft complications in 2 patients and for adjacent spondylosis in 1. In the laminoplasty group, one patient had C5 palsy, and intractable axial pain developed in 5 patients after surgery, but no patientsneeded additional surgery.
Conclusions.
Because the 2 procedures provided the same neurologic improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with laminoplasty for determining the best technique. Therefore, because our
present surgical strategy for cervical myelopathy due to disc herniation, laminoplasty is the procedure of choice except for a patient with single level disc herniation without developmental canal stenosis, who is considered to be a good candidate for ASF
摘要
【设计及目的】：研究设计：采用回顾性的研究方法。
[目的]：比较椎板成形术和前路脊柱融合术（ASF）治疗椎间盘突出所致脊髓型颈椎病术后的长期临床效果。
【背景资料】：目前尚没有关于对椎板成形术和前路脊柱融合术治疗椎间盘突出所致脊髓型颈椎病术后长期临床效果进行比较研究的文献报道。
【方法】： 1984年-1987年间仅有21例患者行前路脊柱融合术治疗，其中15例得到随访； 1987年-1994年间仅有22例患者行椎板成形术治疗，其中18例得到随访。术前两组病例的预后因素没有明显的差别。ASF组平均随访时间为15年，椎板成形术组平均随访时间为10年。患者的神经症状得到检查和影像学结果得到评价。
【结果】：椎板成形术和ASF对于改善神经症状的效果是相同的。在ASF组中，2例患者由于植骨并发症需再次手术，1例患者因颈椎退行性改变而需再次手术。在椎板成形术组，1例患者术后出现C5麻痹，5例患者术后出现难治性颈旋转痛，没有患者需再次手术。
【结论】：由于两种术式对于改善神经症状的效果相同，所以必须通过权衡骨移植并发症和与椎板成形术相关的慢性颈痛的情况，选择最佳的手术方式。因此，按照目前我们治疗椎间盘突出所致脊髓型颈椎病的手术策略，椎板成形术是应选择的方法，而对于单一水平的椎间盘突出并不伴有发育性椎管狭窄的脊髓型颈椎病患者，适宜采用ASF方法治疗。
个人评价：椎板成形术是日本学者首创的治疗颈椎病的有效手术方法，但是，由于考虑到这种手术会导致颈椎稳定性的下降且术后容易造成颈神经根的牵扯性损伤，人们开始运用融合的方法治疗颈椎病，但融合同样会造成一些并发症且在治疗上也有限制即对椎管狭窄及多节段的颈椎椎间盘突出的治疗有难度。本文作者通过比较这两种手术，得出结论认为两种术式对于改善神经症状的效果相同，椎板成形术在治疗颈椎病上是合适的方法，但对于单一水平的椎间盘突出并不伴有发育性椎管狭窄的脊髓型颈椎病患者，更合适的治疗方法是前路脊柱融合术。 | 
发表于 05-11-7 13:30
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