颈后旁正中小切口显微神经根减压治疗神经根型颈椎病

Microsurgical cervical nerve root decompression via posterior cervical paramedian mini-open approach for cervical spondylotic radiculopathy

目的总结颈后旁正中小切口神经根减压治疗神经根型颈椎病的经验。方法回顾性分析34例神经根型颈椎病病人的手术经验。术前JOA评分11。14分，平均（12．5±0．9）分。采用半坐位33例，健侧卧位1例；经颈后旁正中小切口，显微镜下采用磨钻行神经根管扩大成形术。结果术后无并发症发生，病人3d出院；疼痛消失30例，明显减轻4例。对32例随访3～14个月，平均6．5个月：22例上肢肌力减退病人中，上肢肌力改善19例。术后3个月JOA评分15～17分，平均（15．9±0．8）分；与术前比较，t=-17．951，P〈0．05。结论采用颈后旁正中小切口神经根减压术可有效治疗神经根型颈椎病，避免因广泛剥离颈后部肌肉导致的术后颈肩部轴性疼痛，及颈椎前路手术进行椎体融合引起的并发症。

Objective To review the experience with microsurgical cervical nerve root decompression via posterior cervical paramedian mini-open approach for cervical spondylotic radiculopathy. Methods The clinical data of 34 patients diagnosed as having cervical S spondylotic radiculopathy conformed by clinical manifestation and imagery studies were analyzed retrospectively. The JOA score before operation was 11-14, average 12.5 ±0.9. Semi-sitting position was adopted in 33 patients, and healthy side lying position in 1. Posterior cervical paramedian mini-incision was adopted, and nerve root canal ptasty was performed under a microscope. Results Patients were all discharged in 3 days after operation. Pain disappeared in 30 patients, and alleviated in 4. Thirty-two patients were followed up for 3-14 （average 6.5） months. Among 22 patients suffered decrease in muscle strength of upper extremities, the muscle strength improved in 19. JOA score by 3 months after operation was 15-17, average 15.9±0.8, in the 32 follow-up patients; compared with the preoperative scores, t=-17.951, P〈0.05. Conclusion Microsurgical cervical nerve root decompression via posterior cervical paramedian mini-open approach can effectively treat cervical spondylotic radiculopathy, and avoid the axial pain due to the extensive stripping of the muscles and the complications that related to the anterior vertebral fusion.