颈椎后路手术中双侧椎间孔切开预防C_5神经根麻痹

Preventing C_5 palsy after cervical posterior surgery by bilateral partial foraminotomy

目的评价双侧C4,5节段椎间孔切开对颈椎后路手术发生C5神经根麻痹的预防作用。方法2003～2007年,共75例患者行后路全椎板切除减压内固定术,男42例,女33例,平均年龄为57岁。其中单纯全椎板切除减压41例(A组),全椎板切除并C4,5双侧椎间孔切开34例(B组),分析A、B 2组患者的临床资料和影像学特点。结果平均随访19个月,75例患者中有5例(6.67%)出现了C5神经根麻痹症状,A组患者4例(发生率为9.76%),B组1例,发生C5神经根麻痹的概率(2.94%)远低于A组患者(P<0.05)。末次随访时,4例患者症状完全缓解,1例(A组)肌力恢复至4级。结论C4,5节段双侧的椎间孔切开扩大,能够在一定程度上预防C5神经根麻痹的发生。

Objective To evaluate the effectiveness of bilateral C4.5 partial foraminotomy for preventing C5 palsy after cervical decompression surgery. Methods Form 2003 to 2007, a total of 75 cases （42 males, 33 females） with the mean age of 57 years （range 49 -69 years） that underwent cervical laminectomy, posterior decompression, and internal fixation were reviewed. Forty-one of them received posterior laminectomy, decompression, internal fixation （ group A ）, while other 34 patients underwent laminectomy, internal fixation, and bilateral partial foraminotomy at C4,5 level （group B）. Clinic and radiographic parameters were collected to assess the prophylaxis procedure of C5 palsy. Results Average follow-up was 19 months. C5 palsy occurred in 5 cases （6, 67% ）of all the 75 patients. Four cases were in group A （9, 76% ）, and 1 was in group B （ 2.94% ）. The incidence of C5 palsy in group B was significantly lower than that in group A （ P 〈 0.05 ）. At the last follow-up, 4 patients had a good prognosis for neurologic and functional recovery and except 1 （ in group A） still with a muscle test of grade 4. Conclusion Bilateral C4.5 partial foraminotomy is effective for preventing C5 palsy.