Hemilaminectomy with Contralateral Sublaminar for Decompression Multilevel Cervical Spondylotic Myelopathy

使用單側椎板切除術合併對側椎板下減壓術治療多節頸椎退化性病變

林建邦(Chien-Pang Lin) ； 楊椒喬(Jiao-Chiao Yang) ； 莊美芳(Mei-Fang Chuang) ； 陳俊賢(Jun-Yeen Chan) ； 張坤權(Kun-Chuan Chang)

《Formosan Journal of Surgery》 38卷3期 (2005/06) Pp. 119-126

https://doi.org/10.29833/FJS.200506.0003

摘要

對於多節頸椎退化性病變的治療，目前有多種手術方式，本文在探討單側椎板切除合併對側椎板下減壓術治療多節頸椎退化性病變的外科手術結果。我們追蹤了15位病人，因多節頸椎退化性病變而接受單側椎板切除術合併對側椎板下減壓術，追蹤時間平均為24個月。在Nurick功能性計分上，病人平均由術前的2.8分進步為1.8分，在臨床症狀是也分別有50%到80%的病人有改善，影像學上頸髓的直徑和面積均有顯著的改善。因而，我們認為單側椎板切除合併對側椎板下減壓術對於多節頸椎退化性病變而言，是一安全且有效的手術方式，並可提供為開刀的另一選擇。

並列摘要

Objective: Cervical hemilaminectomy with contralateral sublaminar decompression for multilevel cervical myelopathy is reported with surgical results.
Methods: A retrospective study was performed for 15 patients with multilevel cervical myelopathy who underwent cervical hemilaminectomy with contralateral sublaminar decompression at Cathay Medical Center in Taiwan between January 2001 and April 2003. All had undergone magnetic resonance imaging (MRI) scans preoperatively. All underwent MRI scans 6 months after the operation. The duration of follow-up ranged from 12 to 35 months (mean, 24 months). The radiological results were evaluated by the Pavlov ratio at the narrowest level. The clinical results were measured by the Nurick score.
Results: The average duration of symptoms was 15 months (range, 6 months to 4 years). The mean operative levels are 4.6 (range, 3-5). The Nurick Functional Disability Score improved from 2.8 (range, 1-5) preoperatively to 1.8 (range 0-4) postoperatively. Improved muscle power of upper extremities was reported in 20%, and improvement in spastic gait, in 13%. Eleven patients (73%) showed improvement in symptoms of numbness and paresthesia. The average sagittal expansion improved from an average of 50% (range, 30-60%) to 70% (range, 55-80%). The average sagittal diameter improved from an average of 12.5 millimeters (range, 9.5-15 millimeters) to 15.5 millimeters (range, 14-19 millimeters). The mean increase in canal area at the narrowest level was 50% (range, 25-75%). Cervical hemilaminectomy with contralateral sublaminar decompression provided good surgical results in 60% of patients with minimal morbidities 3 months after the operation and 80% of patients at 12 months of follow-up or longer. Spinal stability was well maintained in all patients.
Conclusions: Cervical hemilaminectomy with contralateral sublaminar decompression is a safe and effective procedure and can be performed in patients with multilevel cervical spondylotic myelopathy.

並列關鍵字

multilevel cervical myelopathy ； hemilaminectomy ； sublaminar decompression