多节段脊髓型颈椎病后路椎管扩大成形术后椎间盘突出的短期变化

Short-term disc herniation change after posterior laminoplasty in multilevel cervical spondylotic myelopathy patients

中文关键词:  脊髓型颈椎病  椎管扩大成形术  椎间盘突出

英文关键词:Cervical spondylotic myelopathy  Laminoplasty  Disc herniation

中文摘要:

  【摘要】 目的：观察多节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者颈后路椎管扩大成形术后3个月时椎间盘突出程度的变化。方法：收集2017年1月～2019年9月在我院行颈后路椎管扩大成形术的多节段CSM患者的临床资料，排除伴后纵韧带骨化患者，共纳入67例患者，男44例，女23例；年龄31～78岁（56.5±9.9岁）。在术前及术后3个月的颈椎矢状面MRI T1加权像上测量各节段颈椎椎间盘突出的大小，术前椎间盘突出≥2.0mm定义为较大椎间盘突出；术后3个月时突出大小较术前变化≤0.5mm定义为无明显变化，＞0.5mm定义缩小或增大，统计缩小、无明显变化和增大的椎间盘数，采用配对样本t检验及非参数检验比较手术前后较大椎间盘突出大小。结果：共测量335个椎间盘，术前314个椎间盘存在突出，C2/3 57个，C3/4 64个，C4/5 66个，C5/6 65个，C6/7 62个；中位突出大小为2.09（1.43，2.69）mm。其中163个突出≥2.0mm，C2/3 9个，C3/4 42个，C4/5 38个，C5/6 41个，C6/7 33个。术后3个月时313个椎间盘存在突出，中位突出大小为1.97（1.35，2.76）mm。314个术前存在突出的椎间盘中，83个（26.4%）椎间盘突出较术前缩小，175个（55.7%）无明显变化，56个（17.8%）增大。其中163个术前突出≥2.0mm的椎间盘术后3个月时54个（33.1%）椎间盘突出缩小，86个（52.8%）无明显变化，23个（14.1%）增大；C2/3、C3/4、C4/5、C5/6、C6/7较大椎间盘突出缩小、无明显变化和增大的患者分别为2、5、14、19、14例，5、28、20、19、14例和2、9、4、3、5例，其中C2/3、C3/4节段椎间盘突出大小与术前比较无显著性差异（P>0.05），C4/5、C5/6、C6/7节段椎间盘突出大小与术前比较有显著性缩小（P<0.05）。3例（4.5%）患者因椎间盘突出较大或术后突出增大，症状缓解不明显而行二期颈前路手术。结论：多节段CSM患者行颈后路椎管扩大成形术后3个月内较大椎间盘突出程度可发生变化，约1/3的椎间盘突出可发生缩小，多见于C4/5、C5/6、C6/7节段；椎间盘突出增大的发生率较低。

英文摘要:

  【Abstract】 Objectives: To observe the size changes of disc herniation at 3 months after posterior cervical laminoplasty in patients with multilevel cervical spondylotic myelopathy(CSM). Methods: Clinical data of patients with multilevel CSM who underwent posterior laminoplasty in our hospital from January 2017 to September 2019 were collected and patients with posterior longitudinal ligament ossification were excluded. A total of 67 patients were included, consisting of 44 males and 23 females, and the age ranged from 31 to 78 years(56.5±9.9 years). The sizes of cervical disc herniation at each level were measured on sagittal MRI T1-weighted images before surgery and at 3 months after surgery, and the disc herniation≥2.0mm before surgery was defined as a large disc herniation. The herniation size change between postoperative 3 months and preoperation≤0.5mm was defined as no significant change, and >0.5mm was defined as regression or progression. The incidence of regression, no significant change or progression was calculated. Paired sample t test and nonparametric test were used to compare the size changes of large disc herniation before and after surgery. Results: A total of 314 intervertebral discs were herniated before surgery among the 335 measured, which fell into 57 at C2/3, 64 at C3/4, 66 at C4/5, 65 at C5/6, and 62 at C6/7, and the median herniation size was 2.09(1.43, 2.69)mm. Among them, 163 herniation≥2.0mm, including 9 at C2/3, 42 at C3/4, 38 at C4/5, 41 at C5/6 and 33 at C6/7. At 3 months after surgery, there were 313 herniations with median size of 1.97(1.35, 2.76)mm. Among the 314 discs with preoperative herniation, 83(26.4%) herniations regressed, 175(55.7%) had no significant change, and 56(17.8%) progressed. Among the 163 discs with preoperative herniation≥2.0mm, 54(33.1%) regressed, 86(52.8%) had no significant change, and 23(14.1%) progressed at postoperative 3 months. Of the large disc herniations at C2/3, C3/4, C4/5, C5/6 and C6/7, the numbers were 2, 5, 14, 19 and 14 of regression, 5, 28, 20, 19 and 14 of no significant change, and 2, 9, 4, 3 and 5 of progression, respectively. The postoperative disc herniation sizes at C2/3 and C3/4 were not significantly different from those before operation(P>0.05), while the herniation sizes regressed significantly at C4/5, C5/6 and C6/7(P<0.05). Three patients(4.5%) underwent secondary anterior cervical surgery due to large disc herniation or herniation progression after surgery with no obvious relief of symptoms. Conclusions: The size of large disc herniation could change at 3 months after posterior cervical laminoplasty in multilevel CSM patients. About 1/3 of the herniated discs may regress, mostly at C4/5, C5/6, and C6/7 segments, while the incidence of disc progression is low.