颈椎术后神经根麻痹的原因分析

Analysis of the pathogenesis of postoperative cervical nerve root palsy

目的:通过分析8例颈椎术后发生神经根麻痹患者的临床及影像学资料,探讨颈椎术后神经根麻痹产生的原因。方法:回顾性分析接受手术治疗的颈椎病及颈椎后纵韧带骨化症患者术前、术后MRI观察脊髓高信号的变化情况及脊髓后移的程度。结果:发生神经根麻痹的8例患者中,术前伴有神经根麻痹现象的患者2例,术后神经根麻痹的侧别与术前一致;神经根麻痹均为单侧发生,其中左侧3例,右侧5例;术前5例患者存在脊髓高信号,术后1例患者高信号的范围扩大,余4例患者未见明显变化。术后1年随访时,6例患者均获得Ⅱ级以上的肌力改善。结论:颈椎术后神经根麻痹的发生与术前脊髓高信号、术后脊髓后移引起的栓系效应以及术前是否存在轻度的神经根麻痹有关,重视术前对脊髓功能评估对于预测术后神经根麻痹的发生具有重要的参考意义。

Objective：To explore the causes of postoperative cervical nerve root palsy through analysis of 8 patients＇ clinical and radiographic data, who experienced postoperative cervical nerve root palsy. Methods：The preoperative and postoperative MRI of the patients with cervical spondylosis and ossification of posterior longitudinal ligament who received cervical surgery were retrospective-ly analyzed. High signal changes and the spinal back drift backwards were observed. Results：In the 8 patients with cervical nerve root palsy, 2 cases had the nerve root palsy phenomenon before the surgery, and it was in the same side before and after the surgery;nerve root palsy was unilateral, 3 cases on the left side, 5 cases on the right side. 5 patients had preoperative spinal high signal change, 1 patient came across enlarge of high signal scope and 4 patients did not have obvious change. At 1-year follow-up after the surgery, the improvement of muscle strength of 6 patients came to II level. Conclusions： Cervical nerve root palsy is associated with preoperative spinal cord high signal change, tethering effect caused by postoperative spinal cord drift backwards and preoperative mild nerve root palsy. Therefore, emphasis on the evaluation of preoperative nervous function may be of important reference to predict the occurrence of postoperative nerve root palsy.