前路增高植骨后颈神经根管形态学改变

Morphological change of cervical spinal neuroforamen after anterior incremental interbody bone grafting

目的 评估前路增高植骨后C3～ 4和C5～ 6神经根管形态改变。方法 取老年颈椎标本 10具。摄颈椎正、侧、双斜位X线片 ,然后进行CT平扫 ,三维重建C3～ 4、C5～ 6神经根管。所有标本均进行颈前路椎间盘摘除术 ,取同标本胸椎椎体植骨 ,增高植骨 2 5mm。手术节段为C3～ 4和C5～ 6各 10个。术后在与术前同等条件下重建颈椎相关神经根管。实验统计数据包括 :颈椎椎间盘前方高度、后方高度 ;神经根管高度 ;神经根管内口、外口面积、周径。结果 手术后C3～ 4神经根管增高 11 2 % ,C5～ 6神经根管增高 7 8% ;C3～ 4神经根管内口面积增加 2 2 5 %、外口面积增加 2 3 3% ,C5～ 6神经根管内口面积增加 18 2 %、外口面积增加 2 5 % ;C3～ 4神经根管周径内口增大 11%、外口增大 12 4 % ,C5～ 6神经根管周径内口增大 10 9% ,外口增大 17%。结论 在亚临床水平进行颈椎前路椎间盘摘除并增高植骨 2 5mm ,有效地增加了双侧颈神经根管的高度以及内、外口的面积和周径 ,该术式能使相应神经根管得到扩张。

Objective To investigate the morphological change of dimension in neuroforamen in C 3～4 and C 5～6 after anterior incremental interbody bone grafting. Methods Ten cadaver cervical spine were obtained. All spine had spondylopathy appearance at X rays. X rays in posterior anterior, lateral, 45 oblique position and CT figure reconstruction of neuroforamen at each side of C 3～4 , C 5～6 were performed before and after ACDF by turns. Anterior incremental 2 5 mm grafting based on ACDF was applied at C 3～4 and C 5～6 in 10 degenerative cadaver cervical spines. Re performed radio technique figure was analyzed the same as pre operation. Data of statistics included anterior and posterior height of disc space, height of neuroforamen, area and circumference of internal and external os of neuroforamen.Results After grafting 20 segments, the height of neuroforamen increased by 11.2% at C 3～4 and 7 8% at C 5～6 The neuroforaminal areas significantly increased 22 5% at internal os and 23 3% at external os for C 3～4 , 18 2% at internal os and 25% at external os for C 5～6 ; The neuroforaminal circumferences significantly increased 11% at internal os and 12 4% at external os for C 3～4 , 10 9% at internal os and 17% at external os for C 5～6 . Conclusion The incremental grafting can significantly enlarge neuroforaminal height, areas and circumference of internal & external os, providing adequate space for the nerve root and improving neuroforaminal stenosis. As a result, the procedure can be applied to the patients with myeloradiculopathy.