3D外视镜辅助前路颈椎间盘切除融合术治疗脊髓型颈椎病的疗效

目的 探讨3D外视镜辅助前路颈椎间盘切除融合术（ACDF）治疗脊髓型颈椎病的效果。方法 回顾性分析2019年1~6月3D外视镜辅助ACDF治疗的15例脊髓型颈椎病的临床资料。术后随访12~16个月,平均（14.40±1.45）个月,采用日本骨科协会（JOA）评分评估神经功能。结果 所有病人均在3D外视镜辅助下顺利完成手术,手术时间90~160 min,平均（111.33±17.88）min;术中出血量10~100 ml,平均（44.67±28.50）ml。末次随访JOA评分[（14.27±1.03）分]较术前[（9.60±1.68）分]明显增加（P<0.05）。神经功能改善率在50%~80%,平均（63.41±9.54）%;其中优3例,良12例,优良率为100%。所有病人均未出现手术相关并发症。结论 3D外视镜辅助ACDF治疗脊髓型颈椎病,能够提供良好的放大和照明效果,是一种安全、有效的治疗方法。     

Bioresorbable anterior cervical plate device for multi-level degenerative disc disease: case report with 8-year follow-up

Anterior cervical decompression and fusion is most successful when bone graft is combined with stabilizing instrumentation. The use of bioresorbable anterior cervical plates has been reported recently instead of the traditional titanium plate. We report a novel application of a bioresorbable plate in the management of a 69-year-old Caucasian female with multi-level, long-standing cervical spondylotic myelopathy. The patient previously had a failed anterior fusion with allograft and titanium instrumentation, and due to worsening symptoms, she underwent a revision anterior fusion using a bioresorbable cervical plate and a fibular allograft, in conjunction with posterior fusion with metal instrumentation. Successful fusion is visualized on CT imaging at 8-year follow-up. To our knowledge this is the first report of long-term follow-up showing successful fusion with this technology.     

Diabetes and cervical myelopathy

Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis.     

Cervical spondylotic myelopathy and radiculopathy

A review of the extensive literature on cervical spondylotic myelopathy and radiculopathy shows that the clinical picture and pathology are well defined, and the complex pathogenetic mechanisms are better understood. With recent advances in investigative procedures: computed tomography, magnetic resonance imaging and somatosensory evoked potentials, the diagnosis can be more accurate and the assessment more complete. Careful selection of patients for the appropriate treatment modality (conservative, anterior or posterior surgery) is crucial to the success in management.     

The relationship between cervical lordosis and Nurick scores in patients undergoing circumferential vs. posterior alone cervical decompression,instrumentation and fusion for treatment of cervical spondylotic myelopathy

The loss of regional cervical sagittal alignment and the progressive development of cervical kyphosis is a factor in the advancement of myelopathy. Adequate decompression of the spinal canal along with reestablishment of cervical lordosis are desired objective with regard to the surgical treatment of patients with cervical spondylotic myelopathy. A retrospective chart review was conducted in which patients who underwent either a combined anterior/posterior instrumentation and decompression or a posterior alone instrumentation and decompression for the treatment of CSM at our institution were identified. Any patient undergoing operative intervention for trauma, infection or tumors were excluded. Similarly, patients undergoing posterior instrumentation with constructs extending beyond the level of C2–C7 were similarly excluded from this study. A total of 67 patients met the inclusion criteria for this study. A total of 32 patients underwent posterior alone surgery and the remaining 35 underwent combined anterior/posterior procedure. Radiographic evaluation of patient’s preoperative and postoperative cervical lordosis as measured by the C2–C7 Cobb angle was performed. Each patient’s preoperative and postoperative functional disability as enumerated by the Nurick score was also recorded. Statistical analysis was conducted to determine if there was a significant relationship between improvement in cervical lordosis and improvement in patient’s clinical outcomes as enumerated by the Nurick Score in patients undergoing posterior alone versus combined anterior/posterior decompression, instrumentation and fusion of the cervical spine.     

Bilateral C5 motor paralysis following anterior cervical surgery--a case report

Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. Bilateral C5 nerve root deficits were noticed in the immediate postoperative period, and treated non-operatively. A postoperative magnetic resonance imaging (MRI) scan showed an increase in cervical lordosis accompanied by a posterior shifting of the spinal cord. Potential mechanisms of nerve root injury in this situation are discussed, and the literature on postoperative C5 root deficits is reviewed. The patient returned to his preoperative occupation as an operating room nurse 6 months following surgery, with complete neurologic recovery occurring over an 11-month period. C5 deficits following anterior cervical surgery occur more frequently than generally assumed. Improved lordosis and longitudinal lengthening of the cervical spinal column in multilevel anterior decompression and interbody fusion can paradoxically result in a traction injury to the spinal cord and C5 nerve roots.     

显微外科治疗脊髓型颈椎病的临床研究

目的评价脊髓型颈椎病前入路显微手术减压及内固定的疗效。方法对38例脊髓型颈椎病患者采用经颈前入路显微手术减压,12例取自体髂骨、26例用钛质网笼行植骨及钢板内固定。根据日本骨科协会(JOA)评分对神经功能恢复进行评价,并观察植骨融合率、融合节段椎间高度、颈椎生理曲度维持以及内植入物情况。结果随访32例,随访时间3~24个月,平均18个月,JOA评分由术前平均10.1分提高到术后平均14.8分,平均改善率为86%。32例单节段和两节段病变者以及6例三节段病变者术后3个月内形成骨性融合,融合率为100%;全部病例术后椎间高度和生理曲度维持满意;全部植入物无脱落或移位。结论采用显微手术方式,术野照明良好,经显微镜放大后解剖层次清晰,能准确识别各种病理损害,不但能使脊髓减压彻底而且能增加手术的安全性。     

寰枕畸形伴发脊髓型颈椎病患者一期手术治疗的临床效果评价

目的 根据寰枕畸形伴发脊髓型颈椎病患者的不同临床特征、影像学特点采取不同手术方式组合对颈脊髓进行减压,并评价探讨其疗效和预后.方法 北京大学第三医院自2002年1月至2007年7月共收治22例寰枕畸形伴发脊髓型颈椎病患者,在了解患者首发症状及病程演变情况后,以日本矫形外科学会(JOA)评分系统对手术前后体征进行分析比较,常规行X片、CT、MRI等影像学检查.一期以不同术式组合(枕颈减压、枕大池成形3例,枕颁减压、枕大池成形和空洞穿刺引流1例,枕颈减压、单开门椎管扩大成形5例,枕颈减压、局限性单侧椎板切除减压1例,枕颈减压、钛板内固定1例,枕颈减压+颈前路间盘摘除、植骨、钛板内固定1例,枕颈减压、枕大池成形+单开门椎管扩大成形3例,枕颈减压、枕大池成形+局限性单侧椎板切除减压4例,枕颈减压、枕大池成形和空洞穿刺引流+局限性单侧椎板切除减压3例)对两种病变造成的颈脊髓等神经系统压迫进行允分减压.术后全部患者均随访调查,并以改善、稳定、进展时患者术后中期状况进行评价.结果 术后效果优6例(手术前后JOA分值差≥2),好13例(JOA分值差=1),一般3例(JOA分值差为0).随访2～48月,进一步改善20例,稳定2例.结论 根据不同临床表现、体征和影像学特点,采取不同术式组合一期手术治疗寰枕畸形伴发脊髓型颈椎病可获良好的治疗效果.     

Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients.

Recently the debate over the management of cervical spondylotic myelopathy (CSM) has regained interest; more specifically whether treatment should be operative versus non-operative, raising the question about the real effectiveness of surgery in influencing the natural history of this pathology and about the choice of the most appropriate approach (anterior vs. posterior). The authors report a retrospective review of 70 consecutive patients who underwent elective anterior cervical corpectomy and fusion with iliac crest autograft or titanium mesh and placement of an anterior cervical plate for the treatment of CSM. The patients underwent pre-and postoperative evaluation, including history, and physical and neurological examination. Patients were also evaluated pre-and postoperatively using a modified version of the Japanese Orthopedics Association Scale (mJOA), which provides a fine semi-quantitative graded evaluation of overall function. Upon discharge home, patients were followed for an average of 42 months (range, 12-63 months). Following an anterior cervical decompression of the spinal cord, 94.2% of patients improved their functional status and 5.8% were unchanged; the mean preoperative mJOA score of all patients was 12.2, the postoperative was 15.4 and the amelioration was also documented by neurophysiological studies which showed an increase in amplitude and decrease in latency of somatosensory evoked potentials and motor evoked potential in 47 patients (67%). Older age and longer duration of preoperative symptoms both were not associated with a lower postoperative mJOA score (p < 0.47, p < 0.29, respectively). Single versus multiple level decompression was not predictive of a lower postoperative mJOA score (p < 0.18). Preoperative spinal cord low signal intensity changes on T1-weighted MRI were related to a lower postoperative mJOA score (p < 0.05), whereas spinal cord high-signal intensity changes on T2-weighted MRI were related to a higher postoperative mJOA score (p < 0.01); finally a lower preoperative mJOA score was highly predictive of a lower postoperative mJOA score (p < 0.0005). Anterior cervical corpectomy and fusion for CSM appears to be an effective procedure with a more favorable neurological improvement when compared to posterior decompressive laminectomy, minimally invasive procedures or non-surgical treatment. It is also a safe procedure even in the elderly population, with low morbidity and the potential for permanent spinal cord decompression and excellent bone stability.     

脊髓型颈椎病病人经颅磁电刺激运动诱发电位的对比研究

目的探讨磁电刺激运动诱发电位（ＭＥＰ）在脊髓型颈椎病（ＣＳＭ）的应用价值，并对其临床相关性进行分析。方法采用经颅磁、电刺激对３０例脊髓型颈椎病病人以及年龄性别等相配匹的３０名健康成人分别于外展小指肌、肱二头肌及下肢展短肌表面进行ＭＥＰ的检测。结果全部病人的ＭＥＰ都出现异常，表现为潜伏期、中枢传导时间（ＣＭＣＴ）延长，时限增宽，波辐降低或不能引出。磁刺激ＭＥＰ的ＣＭＣＴ和皮层刺激潜伏期与脊髓型颈椎病临床日本整形外科协会（ＪＯＡ）评分间有密切相关性，能较好地反映ＣＳＭ病人的病情。结论ＭＥＰ在检测ＣＳＭ病人运动功能方面具有定量评价作用。与电刺激相比，磁刺激ＭＥＰ能更好地反映ＣＳＭ病人的病情。     

颈前路侧前方减压术治疗根型颈椎病的临床研究

目的 总结颈前路侧前方显微减压术治疗神经根型颈椎病的临床经验。方法 借助显微镜和高速磨钻对79例根型颈椎病患者行颈前路侧前方显微椎间盘摘除减压术，采用Cage或钛网自体骨融合后并使用钉板系统固定；术中同时采用体感诱发电位（SEP）进行监护。结果 79例病人术后临床症状明显好转，无严重并发症发生，无症状加重或术后复发者。随访5-48个月，影像学资料证实：神经根减压充分，融骨良好，内固定钛板位置准确。结论 颈前路侧前方显微减压术治疗神经根型颈椎病，手术创伤小，成功率高。     

前路显微外科手术治疗多节段颈椎病

目的探讨单一或多个椎体广泛切除,显微外科手术减压,颈椎植骨融合,钛钢板颈椎固定手术治疗多节段颈椎病的疗效.方法根据临床表现及神经影像学资料选择24例脊髓型颈椎病患者,采用Caspar颈椎手术器械及新型植骨融合固定技术实施手术,于显微镜下切除病变的颈椎椎间盘、椎体和后纵韧带,高速气动磨钻磨除患椎骨赘,以自体髂骨或骨水泥行植骨融合、钛钢板固定.结果根据Nurick神经功能评价标准,术后92%(22例)的患者神经功能不同程度改善,8%(2例)的患者症状无改变,无一例症状加重.结论应用颈椎前入路显微外科手术治疗来自颈脊髓前方压迫的多节段颈椎病患者(包括症状严重者),减压彻底,固定稳定,安全可行,多数患者疗效满意.     

颈前路显微减压治疗脊髓型颈椎病(附54例报告)

目的探讨脊髓型颈椎病的手术治疗方式和早期疗效。方法54例脊髓型颈椎病患者,前路显微镜下手术减压及椎间植骨融合颈前路钛钢板内固定术50例,前路脊柱内镜下手术减压及椎间植骨融合颈前路钛钢板内固定术2例,前路显微镜下减压后椎间植Bryan人工椎关节盘2例。结果随访进行6～48个月(平均25个月),症状明显缓解,脊髓功能明显改善者52例,占96.3%。52例植骨者术后6个月植骨融合率100%。2例Bryan人工椎关节盘植入者,术后6个月及1年X线平片随访显示:颈椎过曲、过伸运动及生理曲度良好,与自体椎体融合良好。术后症状与术前比较无明显缓解但无加重者2例。结论对脊髓型颈椎病,前路手术不同方式各有其适应证,应根据临床表现、体征、影像学特征早期诊断和尽早手术,进行仔细的显微操作技术,可以更加充分减压并减少对脊髓的损伤,取得更加良好的治疗效果。     

颈后旁正中小切口显微神经根减压治疗神经根型颈椎病

目的总结颈后旁正中小切口神经根减压治疗神经根型颈椎病的经验。方法回顾性分析34例神经根型颈椎病病人的手术经验。术前JOA评分11。14分,平均（12．5±0．9）分。采用半坐位33例,健侧卧位1例;经颈后旁正中小切口,显微镜下采用磨钻行神经根管扩大成形术。结果术后无并发症发生,病人3d出院;疼痛消失30例,明显减轻4例。对32例随访3～14个月,平均6．5个月：22例上肢肌力减退病人中,上肢肌力改善19例。术后3个月JOA评分15～17分,平均（15．9±0．8）分;与术前比较,t=-17．951,P〈0．05。结论采用颈后旁正中小切口神经根减压术可有效治疗神经根型颈椎病,避免因广泛剥离颈后部肌肉导致的术后颈肩部轴性疼痛,及颈椎前路手术进行椎体融合引起的并发症。     

Tract pain because of cervical spondylotic myelopathy: A case series

Spinal cord compression may lead to pain that is sometimes directed to areas far below the compression level. In certain cases, it may present as sciatica pain, knee pain or low back pain (LBP). These types of pain are called tract pain or funicular pain. Tract pain because of cervical spondylotic myelopathy (CSM) may lead to delays in the diagnosis and treatment of CSM in some cases, and sometimes unnecessary medical and surgical treatments. This study evaluated the results of four patients who presented to the outpatient clinic with complaints of LBP accompanying CSM findings. This study aims to present the improvement in low back pain as a result of anterior cervical microdiscectomy and cage procedure in four patients who presented with tract pain because of CSM, which is a rare condition.     

脊髓型颈椎病的前路显微外科治疗策略

目的总结脊髓型颈椎病的前路显微手术治疗方式和疗效。方法回顾性分析85例脊髓型颈椎病的手术经验。均经前路行手术治疗,其中显微镜下手术减压+椎间植骨融合+钛钢板内固定59例,内镜下手术减压+椎间植骨融合+钛钢板内固定2例,显微镜下减压+Bryan人工椎间盘植入24例。结果术后随访3～52个月,平均23个月;脊髓功能明显改善82例,占96.5%,稳定3例,占3.5%。24例Bryan人工椎间盘植入病人术后随访X-线平片显示:颈椎过曲、过伸运动及生理曲度良好,与自体椎体融合良好。结论对中央型或神经根型椎间盘突出病人经前路行显微减压术,减压更加充分,并可减少对脊髓的损伤;椎间植入人工椎间盘可保留部分脊柱运动功能,取得更好的治疗效果。     

Transcranial magnetic stimulation in patients with cervical spondylotic myelopathy: Clinical and radiological correlations

Motor evoked potentials (MEPs) were studied in 28 patients with cervical spondylotic myelopathy. MEPs after cortical stimulation were abnormal in 27 patients, the responses in the leg muscles being affected the most often. Clinically asymptomatic motor lesions were detected in 7 patients (25%). The central motor conduction time (CMCT) for the abductor digiti minimi muscles correlated significantly with the clinical disability, whereas the radiological findings did not correlate with the clinical and neurophysiological parameters. In 9 patients MEPs were also recorded in the biceps muscles. The 7 patients with an abnormal CMCT for the biceps muscles had the most severe stenosis at the C-4–C-5 level or higher. The 2 patients with normal MEPs of the biceps muscles both had a stenosis at the C-5–C-6 level. The results of this study suggest that MEPs are useful for detecting spinal cord dysfunction and for localizing the level of the lesion. Some recommendations regarding the possible use of MEPs in the clinical evaluation of patients with cervical spondylotic myelopathy are given. © 1994 John Wiley & Sons, Inc.     

颈前入路手术治疗脊髓型颈椎病疗效分析

目的 探讨脊髓型颈椎病（CSM）早期诊断、手术指征、手术技巧等对颈前人路手术效果的影响。方法 对75例CSM病人行颈前人路手术脊髓减压及椎间植骨融合术，所有病人都经静态及动态Hoffmann征或（和）Lhermitte征检查。结果 所有病人都经随访，手术优良率87．7％，其中静态Hoffmann征阳性者手术优良率为81．1％，早期仅为动态Hoffmann征或（和）Lhermitte征阳性者手术优良率为93．1％。结论 早期诊断、早期前路手术治疗CSM，特别是在仅为动态Hoffmann征或（和）Lhermitte征阳性时，彻底去除致压物能显著提高手术效果。     

Bryan人工颈椎间盘置换治疗脊髓型颈椎病8例

回顾性分析2007-05/2008-07南通大学第二附属医院脊柱外科和上海长征医院骨科收治的脊髓型颈椎病患者8例,男2例,女6例;年龄36~58岁,病程8~24个月;病变节段：均为单节段,C4~5 5例,C5~6 3例。全部患者均采用Bryan人工颈椎间盘置换,置换后3个月行JOA评分,摄置换节段前屈后伸位、左右侧屈位X射线平片,观察假体置入后的稳定性及置换颈椎节段的活动度。结果显示置换过程中和置换后未出现神经和血管损伤的并发症,平均置换时间135 min。8例患者均进行门诊随访,随访时间3~13个月,所有患者置换后症状明显缓解。JOA评分由置换前平均8.9分(6~12分)增加到置换后第3个月平均15.2分(12~17分)。置换后3个月置换节段前屈后伸活动范围平均5.3°(4.3°~6.1°);左右侧屈活动范围分别为平均3.4°(2.8°~4.3°)和3.5°(2.9°~4.3°)。假体无偏移或下沉。末次随访未发现置换节段异位骨化、假体松动、下沉或颈椎生理曲度的改变。提示Bryan人工椎间盘置换治疗脊髓型颈椎病近期临床效果良好,能维持颈椎正常的活动范围和生理曲度。     

脊髓型颈椎病合并胸椎管狭窄症的诊断与治疗

目的：探讨脊髓型颈椎病合并胸椎管狭窄症的诊断与治疗。方法：回顾性分析4例脊髓型颈椎病合并胸椎管狭窄症的诊断与治疗。其中2例先行颈椎减压和稳定手术，后行胸椎板切除减压术；1例颈、胸椎同时行减压；1例先行胸椎板切除减压术，后行颈椎板成形术。结果：神经病学损害完全恢复2例，明显改善2例。结论：脊髓型颈椎病合并胸椎管狭窄症手术治疗可取得良好的效果。