Abstract:

BACKGROUND: Spinal cord compression from the front of the heavy, oppressive, a long segment of cervical disease, before the direct lateral approach to the spinal cord decompression, the exact effect of surgery, but surgery risks are great, difficult and posterior approach is commonly used in clinic. Few reports have addressed anterior open door expansive laminoplasty of cervical vertebrae.
OBJECTIVE: To design the method of anterior open door decompression of cervical vertebrae and to explore anatomical basis of the procedure.
METHODS: Totally 100 vertebrae of 20 dried human cervical spines between the C3 and C7 were measured with caliper to get the following parameter: distance between the tip of uncinate process (UP) and medial wall of transverse foramina, interuncinate process distance, sagittal diameter of vertebral body. Three formalin preserved human cadaveric cervical spines were chosen for simulated operation and observed by the seneation10 CT scan (Siemens, Germany) respectively. The vertebral bodies were partially removed until posterior wall of the vertebral body was fully exposed. The posterior wall surrounding the ossification was removed at three sides. Then the posterior wall of cervical vertebrae was grooved slowly and separated from the underlying spinal dura mater with the assistance of the lift-hook designed by ourselves and the posterior wall and posterior longitudinal ligament were removed. The posterior wall was fixed with suture silk on unoperated side of the vertebrae if it was adhered with posterior longitudinal ligament too serious to separate.
RESULTS AND CONCLUSION: The simulated operation on cadaveric spines was performed successfully and bone window decompression was shown well on spiral CT scan. Distance between the tip of UP and transverse foramina, interuncinate process distance and sagittal diameter of vertebral body increased gradually at each segmental level between C3 and C7. The data were (3.0±0.2) to (3.9±0.5) mm, (20.2±1.9) to (26.3±1.7) mm and (14.2±1.3) to (17.4±1.9) mm respectively. Results have suggested that anterior-lateral hemiexpansive open door decompression of cervical vertebrae is a safe, feasible and effective treatment for serious compression from the front of cervical spinal cord such as ossification of posterior longitudinal ligament, hyperosteogeny and ossification of intervertebral disc.