颈椎后路单开门术中预防性行C4、5椎间孔扩大对术后发生C5神经根麻痹综合征的影响

Effect of prophylactic C foraminal dilatation in posterior cervical open-door surgery on postoperative C nerve root palsy syndrome

目的探讨颈椎后路单开门手术中预防性行C4、5椎间孔扩大对术后发生C5神经根麻痹综合征的影响。方法回顾分析2016年3月—2019年3月收治且符合选择标准的脊髓型颈椎病(颈脊髓受压节段≥3个)患者临床资料,其中40例采用颈椎后路单开门术中预防性行C4、5椎间孔扩大治疗(观察组),40例行单纯颈椎后路单开门手术治疗(对照组)。两组患者性别、年龄、病程、脊髓症状Nurick分级及术前C4、5椎间孔大小、日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者术后发生C5神经根麻痹综合征情况,包括发生率、发生麻痹时间、恢复时间、脊髓漂移程度,术前及术后12个月采用VAS、JOA评分评价疼痛及功能改善情况。结果术后两组患者切口均Ⅰ期愈合,无脑脊液漏等术后早期并发症发生。两组患者均获随访,随访时间12~23个月,平均17.97个月。术后观察组8例(右侧3例、左侧5例)、对照组2例(均为右侧)发生C5神经根麻痹综合征,两组发生率(20%vs. 5%)差异有统计学意义(χ^(2)=4.114,P=0.043)。除观察组1例于术后5 d发生C5神经根麻痹综合征,其余患者均为术后1 d发生;观察组和对照组恢复时间分别为(3.87±2.85)个月和(2.50±0.70)个月,组间差异无统计学意义(t=–0.649,P=0.104)。两组术后12个月颈椎JOA评分和VAS评分均较术前显著改善,差异有统计学意义(P<0.05);组间比较术后12个月与术前颈椎JOA评分和VAS评分差值,以及脊髓漂移程度,差异均无统计学意义(P>0.05)。结论预防性行C4、5椎间孔扩大并不能有效预防及减少术后C5神经根麻痹综合征的发生,相反可能增加其发生概率,临床应用该术式需谨慎。

Objective To investigate the effect of prophylactic C4, 5 foraminal dilatation in posterior cervical opendoor surgery on postoperative C5 nerve root palsy syndrome. Methods The clinical data of patients with cervical spondylotic myelopathy(cervical spinal cord compression segments were more than 3) who met the selection criteria between March 2016 and March 2019 were retrospectively analyzed. Among them, 40 patients underwent prophylactic C4,5 foraminal dilatation in posterior cervical open-door surgery(observation group) and 40 patients underwent simple posterior cervical open-door surgery(control group). There was no significant difference between the two groups(P>0.05)in gender, age, disease duration, Nurick grade of spinal cord symptoms, and preoperative diameter of C4, 5 intervertebral foramen, Japanese Orthopaedic Association(JOA) score, and visual analogue scale(VAS) score. The occurrence of C5 nerve root paralysis syndrome was recorded and compared between the two groups, including incidence, paralysis time,recovery time, and spinal cord drift. VAS and JOA scores were used to evaluate the improvement of pain and function before operation and at 12 months after operation. Results The incisions of the two groups healed by first intention, and there was no early postoperative complications such as cerebrospinal fluid leakage. Patients of both groups were followed up 12-23 months, with an average of 17.97 months. C5 nerve root paralysis syndrome occurred in 8 cases in the observation group(3 cases on the right and 5 cases on the left) and 2 cases in the control group(both on the right). There was significant difference of the incidence(20% vs. 5%) between the two groups(χ^(2)=4.114, P=0.043). Except for 1 case in the observation group who developed C5 nerve root palsy syndrome at 5 days after operation, the rest patients all developed at 1 day after operation;the recovery time of the observation group and the control group were(3.87±2.85)months and(2.50±0.70) months respectively, showing no significant difference between the two groups(t=–0.649,P=0.104). At 12 months after operation, the JOA score and VAS score of cervical spine in the two groups significantly improved when compared with those before operation(P<0.05);there was no significant difference in the difference of the cervical spine JOA score and VAS score between at 12 months after operation and before operation and the degree of spinal cord drift between the two groups(P>0.05). Conclusion Prophylactic C4, 5 foraminal dilatation can not effectively prevent and reduce the occurrence of postoperative C5 root palsy, on the contrary, it may increase its incidence, so the clinical application of this procedure requires caution.