Twenty cases of myelopathy secondary to cervical spondylosis had been treated by anterior expansive decompression and interbody iliac bone graft. Follow-up for 8 to 42 months, the therapeutic results were satisfactory without any obvious complications. The techniques of fenestration and bone graft were introduced. The advantages of this operation were discussed.
Objective To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. Methods A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T1-6 in 4 cases and T7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. Results The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients’ symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores (P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months (P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. ConclusionThe floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
目的：對平山病的臨床特點、電生理、影像學、預后以及發病機制進行分析。方法：以“平山病”或“上肢肌萎縮”為主題詞，以中國數字期刊總庫和中華醫學會數字化期刊為數據庫，共檢索167篇文獻，剔除重復報道以及病例資料不全的文獻，對22篇國內雜志發表及我院診治的病例共192例患者的臨床資料進行分析。結果：192例患者，男∶女=6.7∶1，起病年齡平均18.6歲。隱匿起病，表現多以一側上肢遠端肌肉無力伴肌萎縮，右側多見，77.6%患者有伸指顫動，81.3%有寒冷麻痹。全部患者患肢肌電圖運動單位電位時限延長，95.8%對側上肢遠端肌電圖出現類似的改變。頸部自然位MRI 44.3%發現低位頸髓萎縮，屈曲位均發現頸髓前移，硬脊膜后壁前移，硬脊膜外間歇增寬。病情在3~4年后處于穩定狀態，部分患者經頸托治療病情好轉。結論：平山病是一種少見的良性自限性疾病，好發于青少年，主要表現上肢遠端不對稱肌萎縮，早期佩戴頸托可以阻止病情進展。