内窥镜下微创颈椎管成形治疗脊髓线Ⅲ型颈椎病可明显改善颈椎曲度

Cervical microendoscopic laminoplasty remarkably improves cervical curvature in the treatment of the spinal cord line type Ⅲ cervical spondylotic myelopathy

背景:大部分颈椎曲度变直或反弓的脊髓型颈椎病属于脊髓线分型Ⅲ型脊髓型颈椎病,既往文献报道颈椎后路单开门椎管成形术对于颈椎反弓的脊髓型颈椎病有满意的减压效果,但内镜下微创颈椎管成形术对脊髓线Ⅲ型脊髓型颈椎病的减压效果目前尚未见报道。目的:分析内镜下微创颈椎管成形对脊髓线Ⅲ型脊髓型颈椎病减压效果及特点。方法:回顾性分析2013年2月至2021年2月在郑州大学第一附属医院接受手术治疗的脊髓线Ⅲ脊髓型颈椎病患者40例,男性13例,女性27例,平均年龄51.6岁,平均病程16.2个月,平均随访时间18.3个月,共有脊髓线Ⅲ型突出颈椎间盘55个。应用PACS软件测量患者术前、末次随访颈椎MRI各项参数,比较患者术前、术后颈椎突出椎间盘体积、颈椎Cobb角及改良脊髓前方压迫程度评分。结果与结论:(1)所有节段的脊髓线Ⅲ型脊髓型颈椎病均获得满意减压效果,患者改良脊髓前方压迫程度评分末次随访较术前减小(P <0.05);患者突出椎间盘体积末次随访较术前减小(P <0.05);患者末次随访颈椎Cobb角增大,颈椎曲度明显改善(P <0.05);(2)结果说明,内镜下微创颈椎管成形术式对脊髓线Ⅲ型脊髓型颈椎病具有直接减压与间接减压作用,能诱导突出颈椎间盘发生广泛的突出椎间盘自然吸收现象并增加颈椎前凸曲度,可减少或避免脊髓线Ⅲ型脊髓型颈椎病患者前路切除突出的颈椎间盘,为临床治疗脊髓线Ⅲ型脊髓型颈椎病提供新的依据及策略。

BACKGROUND:Most cervical spondylotic myelopathy with ce rvical curvature straight or cervical kyphosis are spinal cord line type Ⅲ ce rvical spondylotic myelopathy.Previous studies have reported that cervical expansive open-door laminoplasty could get satisfied decompression effect of cervical spondylotic myelopathy with curvature straight or cervical kyphosis,while there is no repo rt about the spinal co rd line type Ⅲ cervical spondylotic myelopathy decompression effect of cervical microendoscopic laminoplasty.OBJECTIVE:To analyze the decompression effect and characte ricstics of cervical mic roendoscopic laminoplasty on spinal cord line type Ⅲ ce rvical spondylotic myelopathy.METHODS:Totally 40 spinal cord line type Ⅲ cervical spondylotic myelopathy patients(13 males,27 females,average age of 51.6 years,average disease duration of 16.2 months,average follow-up time of 18.3 months,55 spinal cord line type Ⅲ cervical herniated discs) who underwent ce rvical microendoscopic laminoplasty in the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2021 were retrospectively analyzed.PACS software was utilized to measure the pre-operative and last follow-up cervical magnetic resonance imaging index of the patients.The pre-operative and last follow-up herniated discs volume,cervical Cobb angle and the improved ante rior spinal co rd compression degree score were compared.RESULTS AND CONCLUSION:(1) All the spinal cord line type Ⅲ cervical spondylotic myelopathy obtained satisfied decompression effect.The pre-operative improved anterior spinal cord compression degree score was lower than that at last follow-up(P <0.05).The pre-operative herniated discs volume was smaller than that at the last follow-up(P <0.05).The cervical Cobb angle increased and ce rvical curvature was significantly improved(P <0.05).(2) The res ults suggested that cervical microendoscopic laminoplasty which had both direct and indirect decompression effect could induce cervical herniated discs to get extensive resorption of herniated nucleus pulposus phenomenon and increase cervical lordosis.The ce rvical microendoscopic laminoplasty can avoid or reduce anterior discectomy in spinal co rd line type Ⅲ cervical spondylotic myelopathy patients and provide new strategy and basis for clinical treatment of spinal cord line type Ⅲ cervical spondylotic myelopathy.