不同椎间植入物内固定方式治疗长节段颈椎后纵韧带骨化症的比较

背景：颈椎长节段后纵韧带骨化症的治疗方法目前各界尚存争议,无指导性的标准方案。 目的：对比分析不同路径椎间植入物内固定治疗长节段颈椎后纵韧带骨化症的效果。 方法：随访35例长节段颈椎后纵韧带骨化症伴重度脊髓型颈椎病患者,前路内固定组10例患者采用颈前路椎体次全切、骨化灶切除或部分切除、椎间植骨融合内固定;后路内固定组16例患者采用颈后路单开门减压椎管成形、椎体侧块内固定;后路无内固定组9例患者采用后路单开门减压椎管成形。 结果与结论：患者均获随访,随访时间为6~24个月。治疗后12个月JOA评分改善率前路内固定组、后路内固定组、后路无内固定组分别为79.59%,83.01%及60.35%。治疗后前路内固定组1例患者并发脑脊液漏;后路无内固定组3例患者治疗后症状改善不明显;后路内固定组治疗效果好,无并发症。表明后路椎管成形经椎弓根钉内固定治疗长节段颈椎后纵韧带骨化症具有减压完全、安全有效、长期效果佳的特点,是治疗该病的一种较好方法。     

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.     

不同手术方式治疗多节段脊髓型颈椎病的疗效观察

目的探讨不同手术方式对多节段脊髓型颈椎病的治疗效果。方法选取因多节段脊髓型颈椎病在我院行首次颈椎后路手术的84例患者为研究对象。根据手术方式的不同分为3组,A组行颈椎后路单开门椎管扩大椎板成形术,B组行颈椎后路全椎板切除术,C组行颈椎后路全椎板切除侧块螺钉内固定术,比较3种手术方式患者术前、术后JOA评分、VAS评分,分析颈椎后路3种手术方式对多节段脊髓型颈椎病的临床疗效。结果 3组术后3个月、末次随访JOA评分与术前相比,差异均有统计学意义(P0.05);术后3个月神经功能改善组间比较,差异均无统计学意义(P0.05);末次随访神经功能改善组间比较,差异均有统计学意义(P0.05)。3组术后3个月、末次随访VAS评分与术前相比,差异均有统计学意义(P0.05);术后3个月VAS评分组间相比,差异均无统计学意义(P0.05);末次随访VAS评分组间相比,差异均有统计学意义(P0.05)。结论颈椎后路单开门椎管扩大椎板成形术、颈椎后路全椎板切除术、颈椎后路全椎板切除侧块螺钉内固定术等3种术式治疗多节段脊髓型颈椎病短期预后较好,但颈椎后路全椎板切除侧块螺钉内固定术在远期改善患者神经功能、降低颈肩痛的发生风险方面具有显著优势,是颈椎后路治疗多节段脊髓型颈椎病理想的手术方式。     

联合单节段零切迹椎间融合器治疗三节段脊髓型颈椎病技术

目的 对比颈前路联合应用单节段零切迹椎间融合器与常规锁定钛板治疗三节段脊髓型颈椎病的临床疗效。方法 回顾性分析18例采用颈前路椎间盘切除减压融合术(ACDF)+双节段锁定钛板固定系统+单节段零切迹椎间融合固定系统(联合组)和20例采用常规颈前路ACDF+三节段锁定钛板固定系统(常规组)患者的临床资料。分析两组患者术前、术后各指标及术后随访。结果 联合组在手术时间、术中出血量、术后邻近节段退变率方面均明显优于常规组(均P 0. 001)。两组患者术前及术后各随访时间点的VAS、JOA评分及颈椎Cobb角比较,差异均无统计学意义(均P 0. 05)。末次随访时根据改良Macnab疗效评定标准,常规组优12例、良5例、可3例,优良率为85%;联合组优11例、良4例、可3例,优良率为83. 3%。末次随访时两组间Ⅰ级融合率比较,差异无统计学意义(P0. 05)。结论 颈前路联合零切迹椎间融合器治疗三节段脊髓型颈椎病可以取得与常规锁定钛板一样的疗效,但在缩短手术时间、减少术中出血量、降低邻近节段退变率以及降低手术难度方面具有优势。     

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。     

颈椎前路钢板置入内固定并减压植骨治疗脊髓型颈椎病118例

背景: 目前应用前路减压内固定方法治疗脊髓型颈椎病得到了普遍认可,但大宗病例的临床报告并不常见。 目的：探讨颈椎前路减压植骨结合锁定钛板内固定治疗脊髓型颈椎病的疗效。 方法：回顾性分析了2001-01/2007-08于黄冈市中心医院骨科行前路椎体次全切减压、取髂骨植骨或钛网植骨结合前路锁定钛板固定术治疗的118例脊髓型颈椎病患者。根据术前、术后即刻及术后随访颈椎标准侧位X射线片,测量融合节段前凸Cobb角、融合节段椎体前缘高度及后缘高度,并评估植骨融合情况;JOA标准评价神经功能。 结果与结论：随访期间(6~32个月,平均19个月)3例出现钛网轻度沉陷,所有病例无内固定断裂、松动,末次随访骨融合率为100%。与术前比较,术后即刻及末次随访时患者的JOA评分明显增高(P < 0.05),术后末次随访优良率为86.2%;术后Cobb角、融合节段椎体前缘高度及后缘高度值也较术前明显改善(P < 0.05)。说明前路次全切减压植骨锁定钛板内固定治疗脊髓型颈椎病,既能彻底减压又能有效矫正颈椎畸形,坚固骨融合重建稳定,临床效果满意。     

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.     

颈椎前入路手术治疗脊髓型颈椎病的临床研究

目的 探讨经颈椎前入路手术治疗脊髓型颈椎病的方法,总结临床经验.方法 63例脊髓型颈椎病患者,于体感诱发电位监测下施行颈椎前入路椎间盘切除、椎体次全切除并椎体问融合、钛板内固定术.根据日本整形外科协会(JOA)评分及影像学改善程度,评价于术疗效.结果 63例患者手术后临床症状均明显改善,无一例发生出血、瘫痪、脑脊液漏及内冈定松脱、断裂等严重并发症.手术后3 d和1个月JOA评分分别为(14.86±0.69)分和(15.27±0.63)分,均较手术前[(8.25±0.92)分]明显增加(P<0.01).影像学显示减压充分,椎体间融合良好,内同定位置准确.结论 经颈椎前入路施行椎间盘切除、椎体次全切除并椎体间融合、钛板内固定术治疗脊髓型颈椎病,手术风险小,成功率高,疗效满意.     

比较纳米羟基磷灰石/聚酰胺66人工椎体与自体髂骨在颈椎前路减压融合中的应用

摘要 背景：目前用于颈椎前路重建的材料较多,如自体髂骨、同种异体骨、钛网等,但各种材料均存在一定的不足。纳米羟基磷灰石/聚酰胺66人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。 目的：评估纳米羟基磷灰石/聚酰胺66人工椎体应用于颈椎前路减压融合治疗脊髓型颈椎病的临床效果,并与自体髂骨进行对比。 方法：2009-01/2010-03对40例脊髓型颈椎病患者行颈前路椎体次全切减压融合钛板内固定。22例行纳米羟基磷灰石/聚酰胺66人工椎体植骨,18例行自体髂骨块植骨,采用JOA评分法评价神经功能的恢复情况,测量Cobb角评价融合节段曲度以及融合节段椎体前缘、后缘高度。 结果与结论：患者均获得 6~14个月随访,JOA评分较治疗前明显改善。人工椎体组及自体髂骨组融合节段后缘高度和前凸Cobb角治疗后3个月与治疗后即刻差值、治疗后6个月与治疗后3个月差值差异均有显著性意义(P < 0.01)。根据融合标准,治疗后6个月两组融合情况差异无显著性意义(P > 0.05)。提示纳米羟基磷灰石/聚酰胺66人工椎体作为颈椎前路植骨材料,融合率同自体髂骨相似,可以有效保持颈椎生理曲度及椎间高度,长期效果有待进一步观察。 关键词：纳米羟基磷灰石/聚酰胺;颈椎病;自体髂骨;前路植骨融合;Cobb角 doi:10.3969/j.issn.1673-8225.2011.12.026     

椎管内外哑铃型肿瘤的手术治疗（附16例分析）

目的探讨椎管内外哑铃型肿瘤的手术治疗策略。方法回顾性分析16例椎管内外沟通性肿瘤的手术治疗经验。3例为已行全椎板切除手术的复发性肿瘤,其他病人均采用半椎板切除或开窗手术。对肿瘤侵犯椎体和受累超过2个节段以上的病例,在切除肿瘤的同时。行相应节段椎体固定融合手术。结果显微镜下均全切除,行椎体固定融合手术3例。术后神经功能症状均明显改善。随访0．5～3．5年,平均2．2年,未见肿瘤复发和术后脊柱畸形。结论椎管内外沟通性肿瘤在颈段较为多见,胸、腰段次之。一次手术全切除较困难．肿瘤全切除后疗效好。对肿瘤侵犯椎体和受累超过2个节段以上的病例应行椎体固定融合术,以维持脊柱稳定。     

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.     

Use of an integrated anterior cervical plate and cage device (PCB) in cervical anterior fusion

The aim of this study is to evaluate an integrated cage and plate device (the plate cage Benezech, PCB) filled with autogenous bone in anterior cervical discectomy and fusion. The fused segment height, lordosis, and fusion were assessed by postoperative radiographic examination at different intervals. Patients were evaluated using Odom’s criteria and the Short Form (SF)-36 Health Survey questionnaire. The mean follow-up duration was 4.1 years. Fusion was achieved in 90.0%, 96.0% and 100% of patients at 3 months, 6 months and at final visit, respectively. The fused segment height and lordosis were restored and maintained. Cage subsidence (3 mm) occurred at one level and settling was observed at three levels. An excellent-to-good result was achieved in 81.8% of patients. The data from the SF-36 questionnaire revealed significant postoperative improvement (p < 0.01) except for social function and mental health. This study suggests that patients instrumented with PCB can obtain good radiographic and clinical results and that PCB is a safe and effective device in cervical anterior fusion.     

Hybrid Surgery of Multilevel Cervical Degenerative Disc Disease : Review of Literature and Clinical Results

Objective

In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD).

Methods

Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed.

Results

Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed.

Conclusion

Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.     

Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis

Pseudarthrosis occurs after approximately 2–20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3–151) months after ACDF. Median age at index surgery was 51 (range: 33–67) years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0–10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p = 0.013), had more frequent preoperative neurological deficits (p = 0.064), and lower baseline VAS scores (p = 0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2–14) months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p = 0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.     

Modified Robinson-Smith procedure for the treatment of cervical radiculopathy

In the present study, a modified Robinson-Smith procedure was used surgery for cervical radiculopathy in 52 patients. Thirty-one one-level and 21 two-level operations were performed. All patients were followed up between 1 and 3 years (mean 23 months) after surgery with a clinical evaluation by an independent investigator including a radiological examination. In 26 patients the postoperative result was classified as excellent, in 23 the result was good, in 2 satisfactory, while one patient was unchanged compared to the preoperative examination. No patient developed worsening of symptoms after surgery. Of 18 patients with duration of symptoms of more than 4 years, 16 demonstrated markedly improvement. No permanent postoperative complications were seen. A modified Robinson-Smith procedure appears to be safe and reliable and can be recommended in surgery for cervical radiculopathy.     

Outpatient anterior cervical discectomy and fusion: A meta-analysis

Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Data from studies meeting inclusion criteria (minimum of 25 patients, control group of inpatient ACDF patients, non-duplicative data source) was then categorized and assimilated for analysis. Seven studies met inclusion criteria, encompassing a 21-year timespan. Each provided Oxford Center for Evidence-Based Medicine Level 3 evidence. The studies yielded a total of 2448 outpatient ACDF patients; only 125 (5.1%) originated from studies published prior to 2011. Single-level surgery occurred in 63.8% of patients, with 0.5% extending beyond two-level fusions. The overall complication rate was 1.8% (mean follow-up of 141.2 days); only 2% of patients required readmission. In conclusion, outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2–5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.     

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries.     

Cervical Disc Herniation as a Cause of Brown-S��quard Syndrome

The possible causes of Brown-Séquard Syndrome (BSS) have been frequently observed with spinal trauma and extramedullary spinal tumors, but the cervical disc herniation to cause BSS is rare. The authors present five cases of patients who were diagnosed with BSS resulting from cervical disc herniation, and the results of the literature in view of their distinctive symptoms and clinical outcomes. Postoperatively, the patients showed complete or almost complete recovery from their motor and sensory deficits. On the basis of our cases, it is important to diagnose it early by cervical magnetic resonance imaging, especially in the absence of the typical symptoms of cervical disc herniation or other obvious etiology of extremity numbness. Immediate surgical treatment is also essential for a favorable functional neurological recovery.     

Safety of anterior cervical discectomy and fusion using titanium-coated polyetheretherketone stand-alone cages: Multicenter prospective study of incidence of cage subsidence

This multicenter prospective study investigated cage subsidence in anterior cervical discectomy and fusion (ACDF) using titanium-coated polyetheretherketone (PEEK) stand-alone cages. This study recruited patients who underwent 1- or 2-level ACDF using titanium-coated PEEK stand-alone cages for cervical disc disease. Patients with acute trauma or past cervical spine operations were excluded. Sixty-two cages in 42 patients were eligible for analysis. Minimum follow-up was 6 months after ACDF. Significant cage subsidence was recognized in 11 of 62 cages (17.7%). Cage subsidence was predominantly moderate (14.5%), with severe subsidence found in only 2 cages (3.2%). The slowest occurrence of cage subsidence was 6 months after surgery, in 4 of 11 cages. Frequency of cage subsidence did not differ significantly between patients <65 and ≥65 years old. Patients with and without cage subsidence both demonstrated significant improvement of neurological function. Cage subsidence resulted in aggravation of local angle, but finally did not affect C2-7 angle or cervical tilt angle. Severe cage subsidence was found in only 3.2% of patients within 6 months after ACDF. Cage subsidence aggravated local angle, but finally did not affect C2-7 angle or cervical tilt angle. One- or 2-level ACDF using titanium-coated PEEK stand-alone cages appears safe and justified, even in elderly patients.     

前路椎间盘摘除合并cage融合固定术治疗颈椎病的临床研究

目的　总结颈前入路显微椎间盘摘除术合并人工椎间融合器 (cage)融合固定术治疗颈椎病的临床经验。方法　借助显微镜和高速磨钻对 38例颈椎病患者进行颈前入路显微椎间盘摘除术 ,采用cage融合后并使用钛板系统固定 ;术中同时采用体感诱发电位 (SEP)进行监护。结果　 38例病人术后均无发生严重的并发症 ;随访 8～2 4个月 ,影像学资料证实 :脊髓和神经根减压明显 ,cage融骨良好 ,内固定钛板位置准确 ;术后JOA评分均恢复至 15分以上 ,无症状恶化或复发者。结论　前路椎间盘摘除合并cage融合固定术治疗颈椎病 ,手术创伤小 ,无供区并发症 ,术后恢复快 ,手术成功率高。