颈椎板开窗根管扩大治疗脊髓神经根型颈椎病

Exploring the treatment effect of cervicolspondylotic radiculopathy by cervical lamina fenestration and nerve root canal enlargement

目的探讨应用颈椎板开窗根管扩大治疗脊髓神经根型颈椎病的手术方法与效果。方法自1999-03-2009-09采用颈椎板开窗与神经根管扩大治疗脊髓神经根型颈椎病25例,并通过JOA评分、疼痛程度评价(VAS)与影像学检查,评价手术疗效。结果本组25例均获随访。时间3个月～6年10个月,平均2年3个月。颈椎曲度变直7例中有4例恢复正常序列,脊髓膨隆良好。术前JOA评分5～15(11.67±2.63)分、疼痛VAS评分6～10(8.22±1.17)分,术后分别为8～17(14.44±2.23)分与0～7(1.67±2.40)分,手术前后比较均有显著性差异(P<0.05)。结论该方法通过有限的颈椎板开窗,为神经孔的扩大、椎间盘或脊髓侧前方骨赘切除,提供了有效的手术操作空间,同时保留了椎板、棘突、韧带等颈椎后方结构复合体,维持了颈椎的稳定。

Objective To explore the treatment effect of cervicospondylotic radiculopathy by cervical lamina fenestration and nerve root canal enlargement.Methods 25 patients with cervicospondylotic radiculopathy were treated by cervical lamina fenestration and nerve root canal enlarge-ment between March 1999 and September 2009.The clinical effect was evaluated by JOA score,vi-sual analog scale scores（VAS） and imageology.Results All patients were followed up for 3 to 82 months with average 27 months.Four cases in 7 patients with straight cervical curvature restored the normal order of cervical vertebra with good spinal cord bulging.The postoperation JOA score 8~17（14.44±2.23）and VAS score 0~7（1.67±2.40）were significantly smaller than preoperation JOA score 5-15 score（11.67±2.63）and VAS score 6~10（8.22±1.17）respectively（P0.05）.Conclusion The method offers the operative spare for enlargement of neural foramen and osteophytes removal of lateral anterior intervertebral disc or spinal cord through limited cervical lamina fenestration with preservation of the posterior cervical ligamentous complex such as vertebral lamina spinous process and ligament to improve the cervical vertebrae stability.