经皮全内镜下颈后路椎间盘切除术治疗神经根型颈椎病的短期临床疗效

目的 探讨经皮全内镜下颈后路椎间盘切除术（PPECD）治疗单节段神经根型颈椎病（CSR）的安全性和短期疗效。方法 回顾性分析2020年1月至2021年12月于我院行PPECD治疗单节段CSR者28例,评估其手术前后的疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）颈椎评分及颈椎功能障碍指数（NDI）,以及末次随访（术后12个月）的改良MacNab疗效评价优良率。结果 术中未出现神经根损伤、硬膜囊撕裂,术后无感染、血肿形成等并发症,无病人因复发行翻修手术。28例病人随访时间为（16.7±2.9）个月（12~23个月）。术后及各随访时间的VAS评分、NDI均较术前降低,JOA颈椎评分较术前升高,差异有统计学意义（P＜0.05）。末次随访时MacNab评分优良率为96.4％（优20例、良7例、可1例）。结论 在把握严格适应证的情况下,PPECD是治疗CSR的一种安全、有效的微创手术方式,可作为传统前路颈椎间盘切除融合术的替代术式。     

改良TESSYS技术治疗老年腰椎管狭窄症

目的探讨改良TESSYS技术治疗老年腰椎管狭窄的效果。方法回顾性分析2016年1月～2018年9月在我院行可视化椎间孔成形并保留后纵韧带的改良TESSYS技术治疗37例老年性腰椎管狭窄的临床资料,记录手术时间、术中出血量,术前、术后3天、术后3个月、术后6个月疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、日本骨科协会(Japanese Orthopedic Association,JOA)评分及末次随访MacNab标准的疗效。结果手术时间(107.1±9.5)min,术中出血量(22.0±5.2)ml。37例随访12～24个月,中位数18个月。疼痛VAS评分术后3天[(0.89±0.74)分]较术前[(7.32±1.27)分]明显降低(P=0.000),术后3个月[(0.22±0.42)分]继续降低(P=0.000),术后6个月[(0.19±0.40)分]与术后3个月无明显差异(P=0.711)。JOA评分和ODI术后3个月[(21.70±2.46)分、(15.51±4.41)%]较术前[(11.97±2.54)分、(74.29±7.95)%]明显改善(P=0.000),术后6个月[(23.86±1.84)分、(9.54±3.14)%]继续改善(P=0.000)。末次随访MacNab标准优34例,良2例,可1例,优良率97.3%(36/37)。结论改良TESSYS技术治疗老年性腰椎管狭窄症具有良好的疗效。     

影响神经根型颈椎病人工颈椎间盘置换术疗效的相关因素分析

目的:探讨影响神经根型颈椎病(cervical spondylotic radiculopathy,CSR)人工颈椎间盘置换术(cervical total disc replacement,CTDR)疗效的因素。方法:回顾性研究2012年5月~2014年5月长征医院骨科收治的接受CTDR的CSR患者45例,随访6个月~2年(1.4±0.5年)。满足以下条件为显效组:(1)末次随访颈部伤残指数(neck disability index,NDI)评分改善(术前NDI评分-末次随访NDI评分)15分;(2)术后末次随访手术节段未出现神经根受损;(3)未出现手术失败及二次手术;(4)随访复查颈椎正侧位、动力位及左右侧屈X线片未见人工椎间盘移位、活动受限及假体相关问题。不满足以上任意一条者为无显效组。比较两组间背景资料及主观变量,分析其手术效果的影响因素,背景资料包括性别、年龄、病程、吸烟史、肌电图确诊神经根受损、受压神经根所支配的肌肉肌力、手术节段数量、术前颈椎活动度(ROM)、手术时间及术中出血量,主观变量包括疼痛视觉模拟评分(visual analogue score,VAS)及NDI。结果:显效组34例,无显效组11例。两组间年龄、病程、吸烟史、肌电图确诊神经根受损例数、术前肌力、术前VAS及NDI评分差异均有统计学意义(P0.05),两组间性别比、术前颈椎ROM、手术节段数量、手术时间、术中出血量比较均无统计学差异(P0.05)。结论:患者年龄、病程、吸烟史、肌电图确诊神经根受损、术前肌力、术前VAS及NDI评分可能与CSR患者CTDR的疗效有关。     

后路经皮内窥镜下颈椎间盘切除术治疗神经根型颈椎病的临床应用

目的 :评价后路经皮内窥镜下颈椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD)治疗神经根型颈椎病的临床应用价值。方法:2013年1月~2016年10月,共有43例单节段神经根型颈椎病患者入选,随机分入两个手术组并获得至少1年随访。其中采用颈前路减压椎间植骨融合内固定术(anterior cervical decompression and fusion,ACDF)治疗23例,随访时间23.1±5.9个月;采用PPECD治疗20例,随访时间25.6±8.3个月。比较两组患者的手术时间、术后住院天数、住院费用、术前及术后各随访点(1d、1周、1个月、3个月、1年)的上肢疼痛VAS评分、创口疼痛VAS评分,术前及术后1年颈椎前凸Cobb角、颈椎活动度、颈椎功能障碍指数(neck disability index,NDI)评分、轴性症状发生率、重返工作岗位时间等情况,记录术后并发症情况,并在术后1年随访时进行Macnab临床疗效评价。结果:两组平均手术时间无显著性差异(P0.05),术后1d时ACDF组及PPECD组的上肢疼痛VAS评分分别为1.13±1.78分、1.02±2.24分,两组间无显著性差异(P0.05),且较术前的7.13±1.25分、7.28±1.30分均有显著改善(P0.05);术后1d时PPECD组的创口疼痛VAS评分为1.91±0.58分,显著小于ACDF组的3.87±1.19分(P0.05),但术后1周后随访两组间无显著性差异(P0.05)。此外,PPECD组在平均术后住院天数、住院费用、重返工作岗位时间等方面均显著小于ACDF组(P0.05)。ACDF组和PPECD组术后1年时颈椎前凸Cobb角分别为13.7°±6.9°和8.2°±4.8°,较术前的4.3°±11.3°、4.7°±8.9°均有显著增大(P0.05),且ACDF组的平均增幅显著大于PPECD组(P0.05)。术后1年时PPECD组的颈椎活动度同术前无显著性差异(P0.05),但ACDF组较术前显著减小(P0.05)。术后1年时NDI评分、轴性症状发生率及Macnab临床疗效评价优良率方面两组间无显著性差异(P0.05)。结论:PPECD治疗神经根型颈椎病的临床疗效与ACDF相当,但前者手术创伤更小,术后恢复更快,费用更少,可作为临床治疗的术式选择。     

Mobi-C人工颈椎间盘临床应用初步报告

目的探讨采用Mobi-C人工颈椎间盘假体在颈椎前路椎间盘切除减压、人工椎间盘置换术(artificial disc replacement,ADR)中的临床应用价值。方法 2009年1月-6月,收治符合颈椎间盘置换指征的颈椎退行性疾病患者20例。其中男8例,女12例;年龄29～54岁,平均45.2岁。颈椎间盘突出症13例,神经根型颈椎病7例。病程4d～5年,平均1.2年。病变节段:C3、41例,C4、52例,C5、67例,C6、75例,C4、5合并C5、62例,C5、6合并C6、73例。术前常规行颈椎正侧位、动力位X线片及MRI检查。均行经前路椎间盘切除减压、Mobi-C人工颈椎间盘假体ADR,共植入Mobi-C人工颈椎间盘假体25枚。所有患者术后定期摄X线片测量置换节段活动度(range of motion,ROM);采用北京大学第三医院40分(COA)评分系统评价患者术前及末次随访时的颈脊髓功能;采用颈椎残障功能量表(NDI)评分及疼痛视觉模拟评分(VAS)评价患者生活质量。结果所有患者术后切口均Ⅰ期愈合,术中、术后未出现手术相关并发症。20例均获随访,随访时间14～18个月,平均16.5个月。术前及末次随访时置换节段ROM比较差异无统计学意义(t=0.808,P=0.440)。随访期内未见异位骨化。术前及末次随访时COA评分分别为(32.10±2.96)分和(38.20±1.14)分,差异有统计学意义(t=9.278,P=0.000);末次随访时改善率为77.2%±5.4%。术前及末次随访时VAS评分分别为(5.10±1.29)分和(3.20±1.23)分,差异有统计学意义(t=10.585,P=0.000);NDI评分分别为(39.20±3.80)分和(29.40±4.55)分,差异有统计学意义(t=16.039,P=0.000)。结论在合理选择适应证的前提下,采用Mobi-C人工颈椎间盘假体行ADR治疗退行性颈椎疾患,近期临床疗效满意。     

脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄

目的探讨局麻下脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄的疗效。方法局部麻醉下经椎间孔入路,从背侧和腹侧减压受压神经根。术后症状改善采用下肢痛视觉疼痛模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估,手术疗效采用改良MacNab标准评估。结果术中1例硬膜撕裂,术后出现随体位变化的疼痛不适感,3周后症状改善。12例侧凸腰椎冠状面Cobb角39.3°±6.8°。12例随访(19.4±3.4)月。下肢痛VAS评分从术前(6.5±1.2)分,改善为末次随访(1.2±0.9)分(P=0.000)。ODI从术前(67.5±6.1)%,改善为末次随访(29.0±6.6)%(P=0.000)。末次随访改良MacNab标准优良率为83.3%(10/12)。结论高龄退变性腰椎侧凸合并神经根管狭窄的处理需要考虑患者自身条件,局麻脊柱内镜下减压能够有效缓解神经压迫症状,改善生活质量,是一种可供选择且安全有效的方法。     

颈椎人工间盘置换与前路减压融合术治疗单节段颈椎间盘突出症的疗效

目的:探讨Mobi-C颈椎人工间盘置换(cervical artificial disc replacement,CADR)与传统颈椎前路减压融合术(anterior cervical decompression and fusion,ACDF)治疗颈椎间盘突出症的临床疗效。方法:对2009年6月至2012年6月收治的27例单节段颈椎间盘突出症患者进行回顾性分析,男18例,女9例,年龄30~62岁,平均46.7岁。其中12例采用CADR治疗(CADR组),15例采用ACDF治疗(ACDF组)。所有患者有颈肩部及上肢疼痛麻木,病程1~13个月,平均2.4个月。术前、术后1周、末次随访时均进行全面的临床评价和生活质量问卷调查。应用Odom标准评价术后疗效,采用视觉模拟疼痛量表(VAS)记录疼痛级别,用颈椎功能障碍指数(NDI)和健康状况调查问卷SF-36对患者生活质量进行综合评定。结果:27例患者无神经血管并发症发生,均获得随访,平均随访时间16个月(6~30个月)。术后1周CADR组优10例,良2例,ACDF组优5例,良10例,两组疗效差异有统计学意义(χ2=6.75,P=0.019);末次随访时CADR组优10例,良2例,ACDF组优12例,良3例,两组疗效差异无统计学意义(χ2=0.049,P=1.000)。术后1周及末次随访时两组患者的上肢VAS评分均明显缓解(P<0.05)。术后1周:CADR组颈部VAS评分由术前的3.58±0.79下降至0.58±0.51(P<0.05),NDI指数由术前的(23.42±6.36)分下降至(5.42±1.68)分(P<0.05),而ACDF组下降不明显。末次随访时:两组患者的颈部VAS评分、NDI指数及SF-36生活质量与术前比较均有明显改善(P<0.05)。结论:Mobi-C CADR保留了减压节段的运动,允许患者迅速恢复正常的活动,术后早期即可显示明显疗效,且疗效稳定维持,患者的生活质量明显提高。     

椎间孔镜技术治疗腰椎间盘突出症2年以上随访的疗效

目的探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症2年以上随访的疗效。方法2013年12月~2015年12月对80例腰椎间盘突出症行经皮穿刺椎间孔镜下腰椎间盘切除术并随访2年以上,比较患者术前后腰腿痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、病变节段椎体活动域、病变节段椎间隙高度,采用改良MacNab标准评价疗效。结果80例随访24~35个月(平均28.5月),术前腰痛VAS评分中位数6(1~9)分,显著高于术后3个月3(1~5)分和末次随访时1(0~3)分(P<0.05);术前腿痛VAS评分中位数6(1~9)分,显著高于术后3个月2(0~6)分和末次随访时1(0~3)分(P<0.05);ODI术前(70.8±4.6)%,显著高于术后3个月(16.6±1.6)%和末次随访时(9.9±1.2)%(P均=0.000);病变节段椎体活动域(过伸位角度+过屈位角度),术前L 4~5节段椎体间角度活动域为9.62°±0.78°,显著低于术后3个月9.91°±0.72°(P=0.037),但与末次随访9.91°±0.61°无统计学差异(P=0.058);L 5~S 1节段椎体间角度活动域术前、术后3个月和末次随访分别为10.78°±1.27°、10.84°±1.43°和°,10.92°±0.97°,术前后比较差异无显著性(F=0.260,P=0.771);病变节段椎间隙高度术前(6.52±1.12)mm,与术后3个月(6.38±0.93)mm和末次随访(6.42±1.29)mm无统计学差异(F=0.329,P=0.720)。按改良MacNab标准,末次随访患者术后优良率95.0%(76/80)。结论经皮椎间孔镜治疗腰椎间盘突出症创伤小,恢复快,能明显缓解症状,中期临床疗效可靠。     

自锁双锚定融合器治疗颈椎病早期疗效

目的探讨应用自锁式双锚定融合器(ROI-C)行前路颈椎椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗颈椎病的早期疗效。方法选择2011年12月—2013年4月采用ROI-C行ACDF治疗的37例(64个节段)颈椎病病例,记录手术情况和术后并发症,统计分析术前和术后各随访时间点的颈椎功能障碍指数(neck disability index,NDI)、日本骨科学会(Japanese Orthopaedic Association,JOA)评分、椎间隙高度和颈椎整体曲度,观察植骨融合情况。结果所有手术顺利完成。术后随访25~40个月,平均32个月。NDI术前(21.6±9.4)%,末次随访时为(10.9±11.2)%,差异具有统计学意义(P0.01)。JOA评分术前(6.2±2.9)分,末次随访时为(12.9±1.6)分,差异具有统计学意义(P0.01)。JOA评分评价优良率达91.9%(34/37)。椎间隙高度术前(5.1±1.8)mm,末次随访时为(7.8±0.7)mm,差异具有统计学意义(P0.01)。颈椎整体曲度术前5.2°±7.1°,末次随访时为9.2°±13.1°,差异具有统计学意义(P0.01)。4例患者术后并发轻度吞咽困难,术后1周至3个月症状自行消失;1例出现声音嘶哑,术后2周症状自行消失。术后6个月随访,X线或CT检查证实64个节段均获骨性融合。结论 ACDF中使用自锁式双锚定融合器可以恢复颈椎椎间隙高度,重建颈椎生理曲度,为颈椎提供即刻稳定性,植骨融合率高,早期临床疗效满意。     

经皮后路全内镜下锁孔术与颈前路椎间盘切除融合术治疗神经根型颈椎病的短期疗效

目的 对比分析经皮后路全内镜下锁孔术和开放颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion, ACDF)治疗神经根型颈椎病(cervical radiculopathy, CR)短期疗效，探讨CR治疗方案的选择。方法 回顾性分析2019年4月至2021年4月北京电力医院手术治疗的52例CR患者资料，采用经皮后路全内镜下锁孔手术治疗25例(内镜组),其中男14例，女11例，平均年龄(46.61±9.23)岁；采用ACDF治疗27例(融合组),其中男14例，女13例，平均年龄(52.32±9.05)岁。行疼痛视觉模拟评分(visual analogue scale, VAS)、日本骨科协会(Japanese orthopaedic association, JOA)颈椎评分及颈椎功能障碍指数(neck disability index, NDI)评估；末次随访时测定颈椎生理曲度；同时采用改良MacNab疗效评定标准评估手术疗效。结果 两组均顺利完成手术，内镜组手术时间(73.23±7.61) min,融合组手术时间(75.28±8.4...     

Morphology of Herniated Disc as a Predictor for Outcomes of Posterior Percutaneous Full‐endoscopic Cervical Discectomy in Treating Cervical Spondylotic Radiculopathy

ObjectiveTo quantitively characterize the morphology of cervical disc herniation (CDH) causing cervical spondylotic radiculopathy (CSR) and investigate whether the morphological features of CDH are associated with clinical outcomes in CSR patients treated by posterior percutaneous full‐endoscopic cervical discectomy (PPECD).MethodsThis is a single‐center retrospective study. Eighty‐seven PPECD‐treated patients meeting the inclusion criteria were included between May 2017 and May 2019. Based on preoperative T2‐weighted magnetic resonance imaging (MRI), we designed and measured six morphological parameters of CDH for all patients to reflect its relative position to cervical spinal cord and protruding degree: DC‐SC distance from the center of disc (DC) and the center of spinal cord (SC); DC‐DP distance from the center of cervical disc (DC) to the peak of herniation (DP); internal diameter of the disc; axial length of CDH; central angle of CDH formed by central axes of CDH and spinal cord; the modified index of CDH. We recorded general information, neck disability index (NDI) scores, visual analog scale (VAS) scores of neck and arm of all patients preoperatively and postoperatively at 1‐year follow‐up. The association of preoperative general variables and morphological parameters with clinical outcomes were explored by utilizing logistic regression and receiver operating characteristic curve (ROC) analysis.ResultsThe preoperative neck‐VAS, arm‐VAS, and NDI were significantly decreased after PPECD and remained at a low value at follow‐up. In regards to the morphological parameters of CDH, the mean value of DC‐SC distance, DC‐DP distance, internal diameter of the disc, axial length of CDH, central angle of CDH, and modified index of CDH were 1.61 ± 0.30 cm, 1.66 ± 0.32cm, 1.04 ± 0.21 cm, 0.63 ± 0.19cm, 39.38° ± 11.94°, and 0.39 ± 0.24, respectively. For patients grouped by difference in the recovery rate of NDI and arm‐VAS (excellent improved group, EI; and limited improved group, LI), there were no differences in the age, gender, surgical segments, and morphological parameters, except for the central angle of CDH. According to binary logistic regression analysis, only the preoperative central angle of CDH was significantly associated with postoperative NDI recovery (odds ratio: 0.873; 95% confidence interval: 0.819–0.931, P = 0.002). ROC analysis showed the optimal cut‐off value of the central angle of CDH for predicting the postoperative improvement of functional outcomes is 33.788°.ConclusionPreoperative morphology of CDH is related to the outcomes of CSR patients after PPECD. Patients with a large central angle of CDH (>33.788°) have more likelihood of ameliorating neurological symptoms of CSR. There is the potential to select the central angle of CDH as a predictor for outcomes of PPECD in treating CSR.     

颈椎前路椎间盘切除融合术后颈长肌、颈伸肌变化与临床疗效的相关性

目的:评估颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）后颈长肌、颈伸肌的容积变化,以及其与临床疗效的相关性。方法:回顾性分析2013年1月至2018年12月接受单节段ACDF手术治疗的脊髓型颈椎病患者57例,随访时间为（23.0±4.8）个月（范围...     

Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine

The object of this study is to review the early clinical results and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN), together with its effect on maintaining sagittal alignment of the functional spinal unit (FSU) and overall sagittal balance of the cervical spine for the treatment of single-level or two-level symptomatic disc disease. Forty-seven patients with symptomatic single or two-level cervical disc disease who received the Bryan Cervical Artificial Disc were reviewed prospectively. A total of 55 Bryan disc were placed in 47 patients. A single-level procedure was performed in 39 patients and a two-level procedure in the other eight. Radiographic and clinical assessments were made preoperatively and at 1.5, 3, 6, 9, 12, and 18 and up to 33 months postoperatively. Mean follow-up duration was 24 months, ranging from 13 to 33 months. Periods were categorized as early follow up (1.5–3 months) and late follow up (6–33 months). The visual analogue scale (VAS), neck disability index(NDI), Odom’s criteria were used to assess pain and clinical outcomes. Static and dynamic radiographs were measured by hand and computer to determine the range of motion (ROM), the angle of the functional segmental unit (FSU), and the overall cervical alignment (C2–7 Cobb angle). With all of these data, we evaluated the change of the preoperative lordosis (or kyphosis) of the FSU and Overall sagittal balance of the cervical spine during the follow-up period. There was a statistically significant improvement in the VAS score from 7.0 ± 2.6 to 2.0 ± 1.5 (paired-t test, P = 0.000), and in the NDI from 21.5 ± 5.5 to 4.5 ± 3.9 (paired-t test P = 0.000). All of the patients were satisfied with the surgical results by Odom’s criteria. The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level. Only 36% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis following surgery. However, the overall sagittal alignment of the cervical spine was preserved in 86% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 13% of patients during the late follow-up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 33% of the patients postoperatively. Clinical results are encouraging, with significant improvement seen in the Bryan Cervical Artificial disc. The Bryan disc preserves motion of the FSU. Although the preoperative lordosis (or kyphosis) of the FSU could not always be maintained during the follow-up period, the overall sagittal balance of the cervical spine was usually preserved.     

Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy

ObjectiveTo describe the rationale and application of triggered EMG (T‐EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM).MethodsThis study was a retrospective cohort control study. The clinical data of 74 patients with single‐segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM‐assisted PPECD with triggered EMG (T‐EMG group), while 39 were subjected to IOM‐assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale.ResultsOperations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow‐up. No significant difference was found in preoperative baseline data between the T‐EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T‐EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T‐EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post‐operation (T‐EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow‐up (T‐EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T‐EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1‐month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow‐up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T‐EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T‐EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow‐up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T‐EMG group and IOM group, respectively.ConclusionsTriggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.     

零切迹自稳型颈椎融合器治疗双节段脊髓型颈椎病的中期临床疗效

目的评价应用零切迹自稳型颈椎融合器(ROI-C)行颈前路椎间盘切除融合术(ACDF)治疗双节段脊髓型颈椎病的中期临床疗效。方法 2012年3月—2014年3月,本院采用ROI-C行ACDF治疗的双节段脊髓型颈椎病患者22例,男16例,女6例;年龄45~76岁,平均58.1岁;C3/C4/C5 3例,C4/C5/C6 11例,C5/C6/C7 5例,C6/C7/T1 1例,C5/C6及C7/T1 1例,C3/C4及C5/C6 1例。采用疼痛视觉模拟量表(VAS)评分评价颈部疼痛程度,日本骨科学会(JOA)评分评价神经功能,Mac Nab标准评价疗效优良率。颈椎侧位X线片测量颈椎生理曲度和融合节段椎间高度,过伸过屈位X线片评价融合相邻节段的椎间活动度(ROM),并对术前及随访时数据进行比较。结果所有手术顺利完成。所有患者随访29~53个月,平均35.3个月。术后3个月VAS和JOA评分均较术前明显改善,差异有统计学意义(P0.05);末次随访时VAS评分和JOA评分较术后3个月进一步改善,且差异有统计学意义(P0.05)。术后3个月颈椎曲度和融合节段椎间隙高度均较术前明显改善,差异有统计学意义(P0.05);末次随访时与术后3个月时相比,差异无统计学意义(P0.05),颈椎曲度和融合节段椎间隙高度维持良好。末次随访时融合器沉陷率为11.4%。术后3个月相邻节段ROM较术前增加,差异有统计学意义(P0.05);末次随访时相邻节段ROM较术后3个月进一步增加,且差异有统计学意义(P0.05)。末次随访时有1例融合上位相邻节段发生椎间隙不稳,但无临床症状。根据Mac Nab标准,疗效优良率为90.9%。随访中未发生术后颈部轴性疼痛、融合器松动等其他并发症。结论应用ROI-C行ACDF治疗双节段脊髓型颈椎病中期随访临床疗效可靠,颈椎生理曲度和融合椎间高度得以有效维持。     

Clinical Outcomes of Open-Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi-Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Objectives

The prevalence of multi-level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS-TCISCI) is low, and the optimal surgical approach remains unclear. Open-door laminoplasty combined with bilateral lateral mass screw fixation (ODL-BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS-TCISCI has not been well-established. This study aims to assess the clinical value of ODL-BLMSF against MCSS-TCISCI.

Methods

We retrospectively analyzed 20 cases of MCSS-TCISCI treated with ODL-BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2-C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t-test was utilized for statistical analysis.

Results

All included patients were followed up for an average period of 26.5 months (range: 24–30 months) after ODL-BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 ± 0.1 preoperatively to 1.13 ± 0.1 and 1.12 ± 0.04 at 6 months postoperatively and at the last follow-up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 ± 2.6 before surgery to 11.65 ± 4.3 and 12.1 ± 4.3 at 6 months postoperatively and at the last follow-up (t = 9.6, −9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 ± 1.3 (preoperative) to 1.65 ± 1.22 and 1.5 ± 1.2 (6 months postoperatively and at last follow-up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 ± 4.3 preoperatively to 13.2 ± 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 ± 8.6 at the final follow-up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 ± 1.5 preoperatively to 1.5 ± 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 ± 0.7 at the final follow-up (t = 10.356, p < 0.001).

Conclusion

ODL-BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS-TCISCI.     

高压氧环境下颈椎牵引治疗神经根型颈椎病

目的评估高压氧环境下颈椎牵引治疗神经根型颈椎病的临床疗效。方法将2013年6月至2013年12月于广州市番禺区南村医院门诊就诊的78例神经根型颈椎病患者随机分为两组,治疗组（n=39）采用高压氧环境下颈椎牵引治疗,对照组（n=39）单纯行颈椎牵引治疗。根据中医病证诊断疗效标准评价1个疗程后的治疗效果,同时采用视觉模拟量表（VAS）评分判定患者疼痛症状的缓解程度,依据颈椎功能障碍指数（NDI）观察颈椎功能障碍的改善情况。对两组中临床疗效评估为治愈的患者进行为期6个月的随访,了解其复发情况。结果 1个疗程结束后对照组总有效率80%（31/39）,治疗组总有效率97%（38/39）,两组比较,差异有统计学意义（P〈0.05）;两组治疗1个疗程后VAS评分、NDI均较治疗前明显改善,治疗组治疗后VAS评分、NDI均优于对照组（P〈0.05）;6个月随访时对照组复发率为2/11,治疗组复发率为10%（2/21）,两组比较,差异无统计学意义（P〉0.05）。结论高压氧环境有助于提高牵引治疗神经根型颈椎病的近期临床疗效。     

DISCOVER人工颈椎间盘置换在颈椎病治疗中的初期疗效观察

目的 探讨应用DISCOVER人工颈椎间盘置换治疗颈椎病的短期临床疗效.方法 采用DISCOVER人工颈椎间盘置换术治疗颈椎病患者12例,其中脊髓型8例,神经根型4例.统计并分析患者术前和术后1、6个月及末次随访时颈椎运动范围、置换节段活动度、相邻节段活动度进行影像学评估,术前及末次随访时NDI脊髓功能评分及颈部疼痛及...     

颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析

目的:探讨颈前路手术治疗4个节段脊髓型颈椎病的中期临床效果及其并发症分析。方法:回顾性分析2013年9月~2016年10月,行颈椎前路手术治疗的4个节段脊髓型颈椎病31例患者资料,男18例,女13例,年龄54~74岁,平均58.1±4.9岁,对所有患者进行随访,采用疼痛视觉模拟评分(visual analogue scale,VAS)评估颈肩肢体疼痛情况,日本骨科协会(Japanese Orthopedic Association,JOA)评分评估患者神经功能恢复情况,行颈椎正侧位及过伸过屈位X线片,观察钛网等内固定情况,测量C2~C7颈椎椎体高度和颈椎生理曲度,评估植骨融合情况。并记录患者手术相关并发症。结果:27例患者获得随访,随访时间为35~72个月,平均52.7±3.6个月。末次随访时VAS为1.6±0.6分,低于术前的7.2±1.5分,差异有统计学意义(P<0.001)。末次随访JOA评分为16.1±4.2分,高于术前的8.8±3.7分,差异有统计学意义(P<0.001)。至末次随访时,患者颈椎椎体高度及颈椎曲度较术前均有明显改善,差异有统计学意义(P<0.001)。所有患者均获得骨性融合,27例患者共出现19例次并发症,脑脊液漏3例,一过性吞咽困难2例,轴性症状1例,C5神经根麻痹2例,邻近节段退变6例,钛网下沉2例,内固定松动、移位2例,螺钉断裂1例。结论:颈前路手术治疗脊髓前方受压为主的4个节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,其中期疗效满意。     

Cervical kinematics and radiological changes after Discover artificial disc replacement versus fusion

Background contextThe cervical disc arthroplasty has emerged as a promising alternative to the anterior cervical discectomy and fusion (ACDF) in patients with radiculopathy or myelopathy with disc degeneration disease. The advantages of this technique have been reported to preserve the cervical mobility and possibly reduce the adjacent segment degeneration. However, no studies have compared the clinical outcomes and radiological results in patients treated with Discover artificial disc replacement to those observed in matched group of patients that have undergone ACDF.PurposeWe conducted this clinical study to compare the cervical kinematics and radiographic adjacent-level changes after Discover artificial disc replacement with ACDF.Study designAnalysis and evaluation of data acquired in a comparative clinical study.Patient sampleThe number of patients in the Discover and ACDF group were 149 and 196, respectively.Outcome measuresThe Neck Disability Index (NDI) and visual analog scale (VAS) pain score were evaluated. The range of movement (ROM) by the shell angle, the functional segment unit and global angles were measured, and the postoperative radiological changes at adjacents levels were observed.MethodsA total of 149 patients with symptomatic single or two-level cervical degenerative diseases received the Discover cervical artificial disc replacement from November 2008 to February 2010. During the same period, there were a total of 196 patients undergoing one or two-level ACDF. The average follow-up periods of the Discover disc group and ACDF group were 22.1 months and 22.5 months, respectively. Before surgery, patients were evaluated using static and dynamic cervical spine radiographs in addition to computerized tomography and magnetic resonance imaging. Static and dynamic cervical spine radiographs were obtained after surgery and then at 3- and 6-month follow-up. Then, the subsequent follow-up examinations were performed at every 6-month interval. The clinical results in terms of NDI and VAS scores, the parameters of cervical kinematics, postoperative radiological changes at adjacent levels, and complications in the two groups were statistically analyzed and compared. No funding was received for this study, and the authors report no potential conflict of interest–associated biases in the text.ResultsAlthough the clinical improvements in terms of NDI and VAS scores were achieved in both the Discover and ACDF group, no significant difference was found between the two groups for both single- (VAS p=.13, NDI p=.49) and double-level surgeries (VAS p=.28, NDI p=.21). Significant differences of cervcial kinematics occurred between the Discover and the ACDF group for both the single- and double-level surgeries at the operative segments (p<.001). Except the upper adjacent levels for the single-level Discover and ACDF groups (p=.33), significant increases in adjacent segment motion were observed in the ACDF group compared with the minimal ROM changes in adjacent segment motion noted in the Discover group, and the differences between the two groups for both single and double-level procedures were statistically significant (p<.05). There were significant differences in the postoperative radiological changes at adjacent levels between the Discover and ACDF groups for the single-level surgery (p<.001, χ²=18.18) and the double-level surgery (p=.007, χ²=7.2). No significant difference of complications was found between the Discover and ACDF groups in both single (p=.25, χ²=1.32) and double-level cases (p=.4, χ²=0.69).ConclusionsThe adjacent segment ROM and the incidence of radiographic adjacent-level changes in patients undergoing ACDF were higher than those undergoing Discover artificial disc replacement. The cervical mobility was relatively well maintained in the Discover group compared with the ACDF group, and the Discover cervical disc arthroplasty can be an effective alternative to the fusion technique.