颈椎单开门椎板成形术是否椎间孔切开的比较

Comparison of unilateral open-door laminoplasty with or without foraminotomy for cervical radiculomyelopathy

[目的]比较单开门椎板成形术中采用与不采用椎间孔切开的临床结果。[方法] 2015年1月~2019年6月,对68例混合型颈椎病患者行后路单开门椎板成形术,其中,早期的38例行单纯单开门成形术(非切开组),后期的30例行单开门成形联合椎间孔切开术(切开组)。比较两组患者围手术期、随访与影像资料。[结果]两组患者均顺利手术,术中无血管、神经损伤。早期并发症方面,切开组30例中,仅1例(3.33%)出现术后脑脊液漏;非切开组38例中,7例(18.42%)出现肩背轴性疼痛症状,6例出现(15.79%) C5神经根病,两组间差异有统计学意义(P<0.05)。随时间推移,两组患者的颈痛和上肢痛VAS评分均显著下降(P<0.05),而JOA评分均显著增加(P<0.05)。术后各时间点切开组的上肢痛VAS评分均显著优于非切开组(P<0.05)。影像方面,末次随访时两组患者椎管矢状径均较术前显著增加(P<0.05);未次随访时切开组神经根管直径较术前显著增加(P<0.05)。[结论]椎间孔切开可有效减少单开门椎板成形术后C5神经根麻痹,改善根性症状。

[Objective] To compare the clinical outcomes to unilateral open-door laminoplasty with or without foraminotomy for cervical radiculomyelopathy. [Method] From January 2015 to June 2019, 68 patients received unilateral open-door laminoplasty for cervical radiculomyelopathy. Of them, 38 patients earlier received the laminoplasty without foraminotomy(the non-foraminotomy group), while the remaining 30 patients latter underwent the laminoplasty combined with foraminotomy(the foraminotomy group). The perioperative, follow-up and imaging data were compared between two groups. [Results] The patients in both groups were successfully operated on without vascular and nerve damage during the operation. In terms of early complications after operation, only one(3.33%) of the 30 patients in the foraminotomy group got cerebrospinal fluid leakage;however, 7(18.42%) had axial pain on the shoulder and upper back, 6(15.79%) suffered from C5 palsy among the 38 patients in the non-foraminotomy group;the difference between the two groups was statistically significant(P<0.05).The VAS scores of neck pain and upper limb pain decreased significantly(P<0.05), while the JOA scores increased significantly over time in both groups(P<0.05). The foraminotomy group proved significantly superior to the non-foraminoplasty in the VAS scores of upper limb pain at all time points after surgery(P<0.05). In terms of imaging, the sagittal diameter of the spinal canal at the latest follow-up significantly increased in both groups compared with that before the operation(P<0.05). In addition, the diameter of the nerve root canal in foraminotomy group significantly increased at the last follow-up in contrast with that before operation(P<0.05). [Conclusion] Foraminotomy does effectively reduce the occurrence of C5 palsy secondary to open-door laminoplasty, and improve relief of radicular symptom of cervical radiculomyelopathy.