颈椎后路单开门椎管扩大成形术后二次手术的原因和手术策略

Etiology and surgical strategies of reoperation after cervical laminoplasty

中文关键词:  颈椎后路椎管扩大成形术  二次手术  后纵韧带骨化症

英文关键词:Cervical laminoplasty  Reoperation  Ossification of posterior longitudinal ligament

中文摘要:

  【摘要】 目的：分析颈椎后路单开门椎管扩大成形术后二次手术的原因和手术策略。方法：回顾性分析2006年5月~2016年4月颈椎后路单开门椎管扩大成形术后于我院行二次手术的病例，根据影像学和临床表现分析二次手术原因，采用mJOA评分评价二次手术的疗效。结果：共有43例二次手术患者纳入本研究，手术距前次手术时间为2～204个月（47.8±51.4个月）。二次手术原因包括：（1）技术相关因素9例，其中椎板回弹或部分关门7例，椎板内陷刺激神经根或脊髓2例；（2）单纯后路手术减压不充分16例，其中前方致压物较大合并颈椎管狭窄15例，后凸合并颈椎管狭窄1例；（3）疾病进展18例，其中OPLL进展14例，椎间盘突出或骨赘增生4例。前方致压物较大且以软性压迫为主、局限性后纵韧带骨化进展、后凸的病例采用前方入路二次手术；椎板回弹或部分关门、椎板内陷刺激神经根或脊髓、巨大后纵韧带骨化前方入路切除困难病例采用后方入路二次手术。采用前路二次手术者28例，后路二次手术者14例，后路联合前路二次手术者1例。二次手术前mJOA评分为5.5～16分（11.6±2.8分），二次手术后3个月随访时mJOA评分为8～17分（13.7±2.1分），mJOA评分改善率为0～100%[（36.6±25.2）%]。结论：颈椎后路单开门椎管扩大成形术后二次手术的原因包括技术相关因素、手术减压不充分和疾病进展；根据患者具体情况个体化选择前路或/和后路手术充分减压可取得较好的疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the etiology and surgical strategies of reoperation after cervical laminoplasty. Methods: All the patients who received reoperation in our center from May 2006 to April 2016 after cervical laminoplasty were retrospectively evaluated, and to analyze radiographic parameters, clinical data and mJOA scores. Results: Forty-three patients were included in this study, and the interval between the two surgeries was 2-204 months(47.8±51.4 months). The etiology of reoperation included: (1)technique related reasons, 7 cases of lamina closure, 2 cases of nerve root or spinal cord compression due to hinge fracture; (2)inadequate decompression, 15 cases of large anterior compression, 1 case of cervical kyphosis; (3)disease progression, 14 cases of progressive ossification of posterior longitudinal ligament, 4 cases of herniated disc or osteophyte. Patients with large anterior soft compression, localized ossification of posterior longitudinal ligament or kyphosis were treated with anterior approach. Patients with lamina closure, nerve root or spinal cord compression due to hinge fracture or large ossification of posterior longitudinal ligament were treated with posterior approach. There were 28 cases of anterior approach and 14 cases of posterior approach, 1 case of combined approach. The mJOA score before the reoperation was 5.5-16(11.6±2.8), which increased to 8-17(13.7±2.1) at 3 months of follow-up. The rate of mJOA score improvement was 0-100%[（36.6±25.2）%]. Conclusions: The etiology of reoperation after cervical laminoplasty includes technique related reasons, inadequate decompression and disease progression. Personalized anterior or/and posterior approach reoperations with sufficient decompression guarantee fine clinical results.