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.

Anterior approach microsurgery in multisegmental cervical spondylosis

Objective Anterior surgical approach, single or multisegmental extensive spondylectomy, vertebral body replacement combined with microsurgical decompression and anterior osteosynthesis with titanium steel plate in the multisegmental cervial spondylosis were studied. Methods According to the clinical symptoms of advanced cervical myelopathy and the neuroradiologic images of multisegmental cervical spondylosis of the patients, 24 cases were selected and operated with the Caspar cervical spine instrumentation system, the recently developed bony fusion and osteosynthetic techniques and the microsurgical skills. Results The pre - and postoperative neurological features of the patients were evaluated by the Nurick grading system of cervical spondylotic myelopathy. Improvements in varying degrees was found in 22 of the 24 patients(91% ) postoperatively. Two patients (8 % ) were unchanged and none of the patients became worse. Conclusion The techniques was found successfully in multisegmental cervical spondylosis, with the relevant compressive abnormality locating anterior to the spinal cord and even advanced cases. It can be performed in a safe and effective manner in the patients with satisfactory effects. The decompression and fixation with subsequent significant relief of pre - operative clinical symptoms and signs can be obtained in most patients.