三维体积法定量评价单开门颈椎管成形与保守治疗突出椎间盘的体积变化.

BACKGROUND: Open-door laminoplasty is the most commonly used posterior cervical decompression surgery. The volume change of cervical herniated disc has always been a hot topic. It has been reported the phenomenon of resorption of herniated nucleus pulposus after open-door laminoplasty. However, most of these observations are qualitative studies. There is no literature on the quantitative observation of postoperative cervical herniated disc volume by threedimensional volume method. OBJECTIVE: To compare and analyze the changes of cervical herniated disc volume after open-door laminoplasty and conservative treatment. METHODS: The data of 61 patients who underwent open-door laminoplasty and 63 patients who received conservative treatment in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from 2014 to 2020 were collected retrospectively. Three-dimensional volume method was used to measure the cervical herniated disc volume of the two groups at the first time before treatment and the last follow-up after treatment. The consistency of the measurement results was tested and the changes were analyzed. The interval between two measurements of all patients was at least 3 months. The absorption ratio and absorption rate, re-protrusion ratio and re-protrusion rate of cervical herniated disc were used as the measurement results. When the absorption rate of herniated cervical intervertebral disc was greater than 5.00% (or the re-protrusion rate was less than -5.00%), it is considered that the cervical herniated disc experienced absorption (or re-herniation). RESULTS AND CONCLUSION: (1) Changes in cervical herniated disc volume in the open-door group: There were 176 cervical herniated discs in 61 patients. Among them, 96 cervical herniated discs were absorbed; the absorption ratio was 54.6% (96/176), and the absorption rate was 5.0%-55.2%. In addition, 46 cervical herniated discs were re-protruded; the ratio of re-protrusion was 26.1% (46/176), and the re-protrusion rate was -5.9% to -77.9%. There was no change in the volume of the other 34 cervical herniated discs. According to the Odom criteria, the results were excellent in 17 cases and good in 28 cases, and the excellent and good rate was 73.8% (45/61). (2) Changes in cervical herniated disc volume in the conservative treatment group: There were 171 cervical herniated discs in 63 patients. Among them, 55 cervical herniated discs were absorbed; the absorption ratio was 32.2% (55/171), and the absorption rate was 5.3%-50.7%. Another 83 cervical herniated discs were re-protruded, with a re-protrusion ratio of 48.5% (83/171), and a re-protrusion rate of -5.4% to -219.8%. There was no change in the volume of the other 33 cervical herniated discs. According to the Odom criteria, the results were excellent in 12 cases and good in 21 cases, and the excellent and good rate was 52.4% (33/63). (3) Three-dimensional volume measurement was an accurate method to observe cervical herniated disc (ICC=0.818). In the open-door group, 6 patients showed varying degrees of re-protrusion of all cervical herniated discs; 13 patients showed resorption of herniated nucleus pulposus; 6 patients showed volume unchanged, and the remaining 36 patients showed the coexistence of those three phenomena. In the conservative treatment group, 32 patients showed varying degrees of re-protrusion in all cervical herniated discs; 5 patients showed resorption of herniated nucleus pulposus; and 7 patients showed volume unchanged, the remaining 19 patients showed the coexistence of the three phenomena. (4) It is concluded that three-dimensional volume method is an accurate and reliable method to observe the changes of cervical herniated disc volume after open-door laminoplasty. Half of the cervical herniated disc after open-door laminoplasty showed slight reduction, which was easy to be ignored, and a few showed moderate and severe re-protrusion, which may lead to further progression of symptoms, indicating that open-door laminoplasty is an effective surgical intervention, but there is a risk of cervical herniated disc re-protrusion, which needs to be further improved. [ABSTRACT FROM AUTHOR]