显微镜辅助椎板椎间孔切开术治疗神经根型颈椎病

Microscopy-assisted posterior laminoforaminotomy for cervical spondylotic radiculopathy

[目的]探讨显微镜辅助微创椎板椎间孔切开术治疗神经根型颈椎病的疗效。[方法]回顾性分析2016年11月~2019年3月本院手术治疗的单节段神经根型颈椎病患者58例。其中30例采用显微镜辅助椎板椎间孔切开术(MAPLF组),28例采用颈前路经椎间隙减压植骨融合内固定术(ACDF组),比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,除ACDF组1例患者出现短暂一侧肢体麻木,所有患者均无严重并发症。两组患者在手术时间及出血量的差异无统计学意义(P>0.05),MAPLF组在手术切口长度、术后住院天数方面显著优于ACDF组(P<0.05)。在13~48个月的随访过程中,两组患者疼痛缓解,功能改善。末次随访时两组患者的VAS和NDI评分均较术前显著减少(P<0.05);末次随访时MAPLF组的VAS和NDI评分均小于ACDF组,尽管差异无统计学意义(P>0.05)。末次随访时,依据改良Odom’s评价标准,临床结果优良率MAPLF组为86.67%(26/30),ACDF组为85.71%(24/28),差异无统计学意义(P>0.05)。影像方面,MAPLF组术后椎间孔处压迫得到了充分解除,颈神经根减压彻底。术后动力位X线片显示MAPLF组手术节段无失稳征象。[结论]采用显微镜辅助椎板椎间孔切开术治疗神经根型颈椎病与传统的ACDF相比,具有微创、保留节段活动功能,且不影响原有节段稳定性的优点。

[Objective] To explore the clinical outcomes of microscopy-assisted posterior laminoforaminotomy(MAPLF) for treating cervical spondylotic radiculopathy. [Methods] A retrospective analysis was performed on 58 patients who underwent surgical treatment for cervical spondylotic radiculopathy in our hospital from November 2016 to March 2019. Among them, 30 patients received MAPLF, while the remaining 28 patients had anterior cervical discectomy fusion(ACDF) performed. The perioperative, follow-up and radiographic data were compared between the two groups. [Results] All the patients in both groups had surgical procedures performed smoothly without serious complications except 1 patient who had temporary paraesthesia in the affected limb in the ACDF group. Although there were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05), the MAPLF proved significantly superior to the ACDF group regarding incision length and hospital stay(P<0.05). As time went in the follow-up period lasted for 13~48 months, the patients in both groups got pain relief and functional improvement. The VAS and NDI scores significantly decreased in both groups at the latest follow up compared those before operation(P<0.05). The MAPLF groups had less VAS and NDI score than the ACDF group at the latest follow-up regardless no statistical significances between them(P>0.05). Based on Odom’s criteria, the excellent and good rate of clinical consequences was of 86.67%(26/30) in the MAPLF group, whereas 85.71%(24/28) in the ACDF group, which was not statistically significant(P>0.05). In term of radiographic assessment, the patients in the MAPLF group got complete decompression of nerve root no MRI and CT images, and no signs of segmental instability on dynamic lateral X-ray films after operation. [Conclusion] The microscopy-assisted posterior laminoforaminotomy has advantages of minimizing surgical invasion, preserving segmental motion and stability over the conventional anterior cervical discectomy fusion for cervical spondylotic radiculopathy.