Anatomic Research And The Clinical Study Of Flavectomy Of Cervical

Part 1 Anatomic Research of the Ligamenta Flava for Flavectomy of CervicalObjectiveTo observe and measure the ligamenta flava in cervical vertebrae and its adjacent relationship provid the anatomic basis to the flavectomy of cervical.Methods20 cervical vertebral specimens and 2 human cadavers (1 male and 1 female) were investigated. We measured and described the enthesis and courser of the ligamenta flava in cervical vertebrae. We measured:vertical dimension between the upper and lower lamina of vertebra at the median line; vertical dimension of ligamenta flava in cervical vertebrae; vertical distance from the upper attachment of ligamenta flava to the lower edge of vertebral lamina; sagittal and transverse diameters of vertebral canal.ResultsThe origin and course of ligamenta flava in cervical vertebra are relative stabilizing. There is no significant difference between two sides in statistics. The vertical distance from the upper to lower lamina is broad in the middle and is narrow at both sides. The distance between C7 and T1 is the longest and the distance is 5.29±0.25mm, the distance between C2 and C3 is the shortest and the distance is 2.97±0.30. Vertical distance of the ligamenta flava in cervical vertebra gradually increases from C2-3 to C7～T1.Vertical distance of the upper and the lower attachment of ligamenta flava gradually increases from the upper to lower. The sagittal diameter of atlas is 19.45±0.87mm, the longest of all and the sagittal diameter of C6 is 12.55±0.75mm, the shortest of all. The transverse diameter of axis is 20.16±0.33mm, the longest and the C6's is 16.25±1.60mm, the shortest.Conclusion 1. The distance between the upper and lower lamina is about 2.97±0.30～5.29±0.25mm, it is safe and feasible to ablate the ligamenta flava through this region.2. The dissection of a part of the upper edge of lamina of vertebra can provide a safe path to dissect the ligamenta flava.3. Detachment of the upper attachment of ligamenta flava should be used in flavectomy of cervical.Part 2:Analysis on Treatment of Cervical Spinal Stenosis with Flavectomy of CervicalObjectiveTo investigate and compare the clinical efficacy of flavectomy of cervical and unilateral expansive laminplasty in the treatment of cervical spinal stenosis.Methods50 patients suffering from cervical spinal stenosis caused by obvious reasons, including flaval ligament hypertrophy 25 cases; ossification of the posterior longitudinal ligament (OPLL) 10 cases; cervical disk herniation 15 cases were treated in QingDao Municipal hospital from June 1999 to June 2009. Flavectomy of cervical was used in 25 cases; unilateral expansive open-door laminoplasty was used in 25 cases. The spinal function recovery or improvement rates were analyzed by Japanese Orthopedic Association (JOA) score system.ResultsThe follow-up period of the 50 cases ranged from 2 to 5 years with an average of 2 years. Recovery or improvement of spinal function was found in most patients, and all the patients had no restenosis at their operation site of cervical canal stenosis. The results were evaluated with JOA score system; the average improvement rate of flavectomy of cervical and unilateral expansive open-door laminoplasty was 84.6% and 84.3% separately. There was no obvious difference in spinal function recovery in the treatment of flavectomy of cervical and unilateral expansive open-door laminoplasty (P>0.05) by statistics analysis. The total average improvement rate was 84.4%by JOA score system, so flavectomy of cervical and unilateral expansive open-door laminoplasty are both effective methods for treating cervical spinal stenosis. Conclusion1. Cervical flavectomy could relieve compression to spinal cord and nerves caused by the flaval ligament hypertrophy without damaging the normal integrality of bony canal, thus avoiding the complication of axial symptoms and so on often encountered in open-door laminoplasty cervical laminoplasty.2. Unilateral expansive open-door laminoplasty can expand sagittal diameter of intraspinal canal, relieve spinal pressure thoroughly and can affect the steadiness of cervical vertebra.3. Both cervical flavectomy and unilateral expansive open-door laminoplasty have their own strong points and shortcomings, no difference in spinal function improvement was found (P>0.05), it's difficult to say which one is better. Cervical vertebral flavectomy can be used to cure cervical spinal stenosis mainly caused by compression of ligamenta flava. Cervical spinal stenosis mainly caused by hyperostosis of vertebral body or OPLL can be treated by expansive laminoplasty.