椎板棘突翻转回植和双侧神经根管扩大术治疗颈椎管狭窄

Lamina repair and replacement and bilateral laminaplasty for treatment of spinal stenosis

目的探讨椎板切开后部分椎管后壁缺损及固定等难题,防止椎板移位及再关门。方法用微型风动摆锯沿关节突内侧切开两侧椎板,将椎板、棘突和黄韧带复合体整块取下。再行两侧神经根管内口扩大术及脊髓前外侧减压术。然后将椎板、棘突和黄韧带复合体翻转回植。结果3例病人术后3个月和半年复查X线片和CT显示:椎板骨性融合,颈椎活动度好。平均随访31月,临床症状无复发。结论通过侧翻棘突椎板黄韧带复合体可以增加椎管的矢状径。侧翻后椎管后壁覆盖充分,有效保护脊髓,防止术后的瘢痕再压迫。两侧骨性融合后可以增加脊柱后柱的支持作用,从而增加脊柱后方的稳定性,维持正常的颈椎前凸,防止由于椎板广泛切除后所产生的鹅颈畸形。

Objective On the basis of bilateral laminaplasty, with the safer and effective method to achieve laminaplasty and resolve the problems including posterior wall defect in vertebral canal and fixation after laminectomy to prevent replacement of vertabral lamina. Methods By a small high-speed saw, the medial edges of the articular processes were cut and the compound with bilamina, spinous process and ligamentum flavum were taken away. The compound was turned and embedded after enlarging the keyhole and removing of posterolateral herniations. Results 3 patients averagely followed up for 31 months were detected at 3 and 6 months by X-ray and CT, lamina osteal fusion and good cervical motion was observed and without symptom recrudescence. Conclusions The laminaplasty with turning and embedding the compound of the bilamina, spinous process and the ligamentum flavum is proved helpful in enlarging the sagittal span of cervical canal, protecting spine availably, avoiding the oppression of the scar, increasing the stability of the posterior column, maintaining cervical lordotic curves and avoiding the“goose neck” abnormality.