不离断后纵韧带的前路椎体－骨化物复合体可控前移融合术治疗颈椎多节段后纵韧带骨化症的疗效

【摘要】 目的：评估不离断后纵韧带颈椎前路椎体－骨化物复合体可控前移融合术（anterior controllable antedisplacement and fusion,ACAF）治疗颈椎多节段后纵韧带骨化症（ossification of the posterior longitudinal ligament,OPLL）的手术疗效。方法：回顾性分析2017年10月~2019年11月在我院行ACAF治疗的多节段颈椎OPLL患者73例,其中采用不离断后纵韧带的ACAF治疗的42例纳入非离断组（男32例,女10例,年龄55.8±9.7岁,随访时间2.4±0.4年）,采用离断后纵韧带的ACAF治疗的31例纳入离断组（男25例,女6例,年龄56.7±11.4岁,随访时间2.3±0.3年）。记录两组患者的手术时间、出血量、住院时间和手术相关并发症。在术前和术后12个月的颈椎CT上测量椎管占位率、前移距离（术后椎管前后径-术前椎管前后径）、减压宽度、椎管前后径,评估手术减压情况;在术后7d和12个月的颈椎正侧位、动力位X线片和CT上观察棘突间隙活动变化、融合器内外骨桥形成以及椎体间总高度,评估术后骨融合程度。术前和末次随访时对患者进行JOA评分并计算JOA改善率,评估神经功能恢复情况。结果：非离断组手术时间212.9±33.8min,出血量489.8±199.0ml,住院时间7.2±2.0d;离断组手术时间257.4±33.2min,出血量598.9±241.3ml,住院时间8.9±3.2d,两组间差异有统计学意义（P＜0.05）。术前、术后12个月的椎管占位率、减压宽度、前移距离和椎管前后径,两组间差异无统计学意义（P＞0.05）。非离断组术后12个月的骨融合率明显高于离断组[棘突间隙活动（92.9% vs 74.2%）,融合器内外骨桥（88.1% vs 61.3%）],差异有统计学意义（P＜0.05）。非离断组的总并发症发生率（9.5%）显著低于离断组（32.2%）,差异有统计学意义（P＜0.05）。末次随访时JOA评分和神经功能改善率,两组间差异无统计学意义（P＞0.05）。结论：与离断后纵韧带相比,不离断后纵韧带的ACAF能够在保证减压效果的情况下,有效降低手术难度,减少手术时间、出血量和并发症,促进术后康复和骨融合。     

前路椎体骨化物复合体可控前移技术治疗颈椎后纵韧带骨化症的脊髓原位减压效果

目的:观察颈椎前路椎体骨化物复合体可控前移(anterior controllable antedisplacement fusion,ACAF)技术治疗颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的脊髓原位减压效果。方法:回顾分析2017年6月~2018年12月我院收治的78例OPLL患者的人口学信息、影像资料以及术后指标(年龄、性别、症状持续时间、椎管侵占率和骨化累及椎体数量)。其中采用ACAF治疗42例,单开门椎管扩大椎板成形术(简称单开门椎板成形术open-door laminoplasty,LAM)治疗36例,平均随访时间21.7±4.0(12~30)个月。比较两组患者术前及末次随访时的JOA评分、脊髓面积、Cobb角、Kang′s分级以及C5神经麻痹、脑脊液漏、吞咽困难等并发症情况。结果:末次随访时,ACAF组与LAM组相比,在JOA评分(14.17±0.81分vs 13.81±1.12分,P<0.05)、脊髓面积(74.12±4.48mm^2 vs 70.36±5.60mm^2,P<0.05)、Cobb角(20.07°±1.28°vs 9.99°±0.65°,P<0.05)和Kang′s分级(0.93±1.40 vs 2.00±0.89,P<0.05)方面具有优势。对比ACAF组与LAM组的术后并发症,两组间C5神经麻痹(4.8%vs 11.1%)、脑脊液漏(2.4%vs 2.8%)、吞咽困难(9.5%vs 0%)无统计学差异。ACAF组2例出现C5神经麻痹的患者未能顺利完成原位减压。结论:ACAF手术可通过恢复椎管容积和形态实现脊髓原位减压,减压效果良好。在恢复颈椎曲度和脊髓位置形态方面,ACAF较LAM为优。     

前路椎体骨化物复合体前移融合术治疗颈椎后纵韧带骨化症

目的评估颈椎前路椎体骨化物复合体前移融合术(ACAF)对颈椎后纵韧带骨化症(OPLL)椎管横截面积及椎管矢状径的改善情况。方法 2017年5月—2017年8月,本院采用ACAF治疗颈椎OPLL患者13例,术前、术后采用日本骨科学会(JOA)评分评估患者神经功能情况,采用视觉模拟量表(VAS)评分评估患者疼痛程度;术前、术后在颈椎侧位X线片上测量颈椎椎管矢状径,在横断面CT上测量骨化物横截面积和椎管横截面积,并计算椎管狭窄率。结果所有患者手术顺利完成。所有患者随访3~6个月,神经功能均得到不同程度恢复。末次随访时,JOA和VAS评分均较术前有所改善,椎管矢状径和椎管横截面积均较术前增加,椎管狭窄率较术前降低,差异均有统计学意义(P0.05)。结论 ACAF治疗颈椎OPLL安全有效,可扩大椎管矢状径,增大椎管横截面积,降低椎管狭窄率,使患者神经症状明显改善,短期疗效满意。     

前路椎体骨化物复合体前移融合术治疗颈椎后纵韧带骨化症的荟萃分析

颈椎后纵韧带骨化症（OPLL）是指因颈椎的后纵韧带发生骨化，压迫脊髓和神经而导致肢体的感觉和运动障碍及内脏植物神经功能紊乱，其发生率在东亚人群中较高，为1.0% ~ 4.6%^[1-3]。颈椎OPLL的手术治疗方式主要有前路、后路及前后联合入路，虽临床疗效满意，但术后脑脊液漏、内固定失败、C5神经根麻痹等并发症发生率较高。前路椎体骨化物复合体前移融合术（ACAF）是由上海长征医院史建刚团队^[4]于2017年率先提出的一种治疗颈椎OPLL的新型手术方式。为探讨ACAF的有效性和安全性，本研究对采用ACAF治疗OPLL的临床文献进行荟萃分析，对比ACAF手术前后颈肩部及患肢疼痛程度、临床功能改善情况、影像学改变（C_2~7 Cobb角、椎管面积、椎管侵占率、椎管脊髓和椎管矢状径）等，总结ACAF的手术并发症发生率，以评价ACAF的临床应用价值。     

椎体钉道强化技术在颈椎前路椎体－骨化物复合体前移融合术治疗颈椎后纵带骨化症中的应用

颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament,OPLL）是由韧带组织异位骨化引起颈椎管狭窄,从而导致脊髓和神经根压迫的一种颈椎退变性疾病,常需手术治疗以解除其对脊髓和神经根的压迫。颈椎前路椎体－后纵韧带骨化物复合体前移融合术（anterior controllable anteriodisplacement and fusion,ACAF）是一种新的治疗颈椎OPLL的前路手术方式,其可在不直接切除骨化物的基础上,通过将颈椎椎体及骨化物作为一个复合体整体前移,达到脊髓和神经根直接减压的效果。与颈椎前路椎间盘切除减压植骨融合术（anterior cervical discectomy and fusion,ACDF）和颈椎前路椎体次全切除融合术（anterior cervical corpectomy and fusion,ACCF）治疗颈椎OPLL不同的是,ACAF技术术中需要对椎体骨化复合物进行提拉前移操作以实现对脊髓的减压和椎管容积的恢复。目标椎体骨强度是ACAF术中提拉操作是否成功的一个重要影响因素,因此相对ACDF和ACCF而言,ACAF技术对颈椎椎体有着更高的骨质强度要求。椎体存在低骨量或骨质疏松是ACAF术中提拉失败的原因之一。椎体强化术是脊柱外科固定手术中应对骨质疏松症的一种安全有效的方法,本研究采用椎体强化术联合ACAF治疗OPLL合并颈椎骨质疏松的患者,取得了较为满意的临床疗效,报道如下。     

前路或后路手术治疗颈椎后纵韧带骨化症的中期疗效观察

目的:观察颈椎前路椎体次全切减压融合术(ACCF)和颈椎后路单开门椎管扩大成形术在治疗颈椎后纵韧带骨化症(OPLL)的中期临床疗效和影像学改善情况。方法:2010年1月~2012年12月我院收治33例颈椎OPLL患者,男17例,女16例;年龄41~78岁(58.6±8.8岁)。其中16例骨化块累及2个节段及以内者通过ACCF切除骨化块减压(A组);17例骨化块累及2个节段以上、前路切除有困难者采用后路单开门椎管扩大成形术(B组)。所有患者术前、术后3个月、1年、2年、3年和末次随访时进行JOA评分。通过配对样本t检验分析两组患者术前、术后和末次时的JOA评分、颈椎曲度及椎管狭窄率的变化情况。结果:A组1例术后发生吞咽困难;B组1例发生脑脊液漏,1例发生切口感染。均经对症处理后痊愈。A组随访48.56±8.02个月,B组随访52.59±8.88个月。两组患者术后JOA评分均较术前有显著性改善(P0.05);术后和末次随访时颈椎曲度较术前无明显差异(P0.05);A组末次随访骨化块面积明显大于术后(P0.05),B组末次随访骨化块面积较术后无明显差异(P0.05)。结论:对于颈椎OPLL,ACCF和后路单开门椎管成形术均为有效且安全的术式,中期随访疗效满意。前者通过切除或"漂浮"骨化块达到有效减压;后者能够扩大椎管缓解脊髓压迫,中期随访椎管狭窄率维持稳定。     

后路手术治疗颈椎后纵韧带骨化症的疗效分析

【摘要】 目的 分析后路椎板切除融合固定术治疗颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament, OPLL）的疗效及并发症,并探讨二者的影响因素。 方法 2003年4月~2009年12月,采用后路椎板切除融合固定术治疗颈椎OPLL患者54例。采用日本骨科学会(Japanese Orthopedic Association, JOA)神经功能评分评价患者术前、术后神经功能,将患者分为疗效良好和疗效不佳2个组。分析患者年龄、性别、症状持续时间、术前JOA评分、是否合并糖尿病、颈椎曲度、椎管狭窄率、骨化物范围、骨化物分型、是否有脊髓高信号对患者手术疗效及并发症的影响。 结果 随访1~6年,平均3.3年。患者神经功能JOA评分从术前9.2±1.3分增加至术后14.2±0.9分,差异有统计学意义(P＜0.01),神经功能改善率（improvement rate, IR）为（62.4±13.2）%。其中35例患者手术疗效良好(IR≥50%),19例患者疗效不佳(IR＜50%)。术后并发症包括9例神经根麻痹和2例血肿压迫。影像学研究表明手术疗效良好患者术后颈椎曲度明显大于手术疗效不佳患者,差异有统计学意义(P＜0.01),术后神经根麻痹患者的颈椎曲度矫正程度明显大于非麻痹患者,差异有统计学意义(P＜0.05)。 结论 后路椎板切除融合固定术是一种适于治疗严重的多节段颈椎OPLL的手术方式,术中矫正患者颈椎曲度有利于提高手术疗效,但同时可能增加术后神经根麻痹的发生率。     

前路椎体骨化物复合体前移融合术治疗颈椎后纵韧带骨化症的研究进展

颈椎后纵韧带骨化症（OPLL）是颈椎后纵韧带发生异位骨化并不断增生压迫颈脊髓,引起肢体感觉和躯体运动不同程度障碍及脏器植物神经功能紊乱的一种疾病,在中国其发病率约为0.077‰^[1]。虽然颈椎OPLL的传统手术方式已得到了长足的发展和完善,但复杂的长节段颈椎OPLL的术式选择仍然没有明确的定论。近年来,随着对颈椎解剖学研究的深化及手术方法的改进,海军军医大学长征医院史建刚^[2]团队创造性地通过将椎体与骨化的后纵韧带整体向腹侧平移的方式实现对颈椎椎管的可控减压,即颈椎前路椎体骨化物复合体前移融合术（ACAF）。该术式通过磨除部分椎体前柱实现前路直接减压,既可以将椎管内减压转化为直观的椎体前移,又规避了如何处理骨化物粘连的难题,降低了术后并发症的发生率,为颈椎OPLL的治疗带来了新的选择;45例患者ACAF术后平均随访4个月,疗效满意^[3]。近5年的相关文献表明,ACAF在治疗长节段颈椎OPLL导致的颈椎椎管狭窄症方面具有明显的优势,但由于ACAF为新兴术式,在手术适应证、禁忌证方面仍未达成一定共识;在对于不同类型颈椎OPLL患者ACAF是否适用、手术相关并发症及其预防手段方面,仍有较大的讨论空间。     

颈椎前路椎体骨化物化复合体可控前移融合术的关键技术和并发症预防

颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)是由骨化物压迫造成脊髓神经损害的脊柱韧带肥厚性疾病,好发于亚洲人种40岁以上人群,发生率在东亚地区约为1.0%~4.6%[1~3]。手术是目前治疗OPLL的主要方法。1969年,Boni等[4]尝试用多节段椎体次全切除术(multiple subtotal corpectomies)治疗颈椎管狭窄症,后来该术式演变为颈前路椎体次全切除术(anterior cervical corpectomy and fusion,ACCF),成为前路治疗OPLL的主要方法。1977年,Hirabayashi[5]提出单开门椎管扩大椎板成形手术,后经不断改良,最终作为后路治疗OPLL的主要术式得到广泛应用。传统前后路手术各有所长,总体而言,前路减压效果确切,但手术难度大,硬膜和脊髓损伤的风险较高;后路手术安全性好、操作简单,但减压有赖于脊髓向后漂移,不能实现直接减压[6、7]。近年来,史建刚等[8~10]采用颈椎前路椎体骨化物复合体可控前移融合术(anterior controllable antedisplacement and fusion surgery,ACAF)治疗OPLL。该术式通过将颈椎骨化物及其前方椎体一并向腹侧提拉,在实现脊髓前方直接减压的同时规避了直接切除骨化物的相关风险和并发症,临床随访疗效满意。现将ACAF的操作流程进行贯序介绍,并对确保减压充分的关键技术进行阐释。     

两种不同术式治疗合并颈椎后纵韧带骨化的重度脊髓型颈椎病疗效分析

目的探讨前路、后-前联合入路两种不同术式治疗合并颈椎后纵韧带骨化(Ossificationof posterior longitudinal ligament,OPLL)的重度脊髓型颈椎病的适应证及临床疗效。方法对38例合并颈椎OPLL的重度脊髓型颈椎病患者分别行颈椎前路手术(A组,22例)和后-前联合入路手术(B组,16例)。比较两组患者椎管狭窄率、骨化节段及脊髓压迫率的差异,并根据术前及术后随访时的JOA评分,评价两组患者的神经功能恢复情况。结果所有病例随访12～30个月,平均20个月,术中未出现脊髓、椎动脉损伤等严重并发症,两组脊髓功能均获不同程度改善。A组JOA评分从术前平均(7.9+2.1)分提高至术后1年平均(13.1+1.7)分,平均改善率为(65.9+5.2)%;B组JOA评分从术前平均(6.8+1.6)分提高至术后1年平均(13.9+0.9)分,平均改善率为(69.8+4.5)%,对比两组患者疗效无统计学差异(P>0.05)。结论采用前路或后-前联合入路治疗合并颈椎OPLL的重度脊髓型颈椎病,均取得彻底的椎管减压和良好的临床疗效,根据脊髓受压程度、影像学资料、骨化范围及患者全身情况合理选择恰当的手术入路是手术成功的关键。     

Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis

The purpose of this article is to compare the outcomes of three different anterior approaches for three-level cervical spondylosis. The records of 120 patients who underwent anterior approaches because of three-level cervical spondylosis between 2006 and 2008 were reviewed. Based on the type of surgery, the patients were divided into three groups: Group 1 was three-level anterior cervical discectomy and fusion (ACDF); Group 2 anterior cervical hybrid decompression and fusion (ACHDF, combination of ACDF and ACCF); and Group 3 two-level anterior cervical corpectomy and fusion (ACCF). The clinical outcomes including blood loss, operation time, complications, Japanese Orthopedic Association (JOA) scores, C2–C7 angle, segmental angle, and fusion rate were compared. There were no significant differences in JOA improvement and fusion rate among three groups. However, in terms of segmental angle and C2–C7 angle improvement, Group 2 was superior to Group 3 and inferior to Group 1 (all P < 0.01). Group 2 was less in operation time than Group 3 (P < 0.01) and more than Group 1 (P < 0.01). Group 3 had more blood loss than Group 1 and Group 2 (all P < 0.01) and had higher complication rate than Group 1 (P < 0.05). No significant differences in blood loss and complication rate were observed between Group 1 and Group 2 (P > 0.05). ACDF was superior in most outcomes to ACCF and ACHDF. If the compressive pathology could be resolved by discectomy, ACDF should be the treatment of choice. ACHDF was an ideal alternative procedure to ACDF if retro-vertebral pathology existed. ACCF was the last choice considered.     

颈椎前路X形椎体次全切除融合内固定术治疗双节段颈椎病的疗效分析

目的：探讨颈椎前路X形椎体次全切除融合内固定术（anterior cervical X-shape-corpectomy and fusion,ACXF）治疗双节段颈椎病的临床疗效。方法：回顾性分析2019年1月～2020年12月间在我院骨科行ACXF治疗的双节段颈椎病患者的临床资料,并与同期行颈椎前路椎体次全切除融合固定术（anterior cervical corpectomy and fusion,ACCF）治疗的双节段颈椎病患者进行比较。收集两组患者的基线信息、手术时间、出血量及住院时间,术前和术后即刻、3个月、6个月及1年时行日本骨科学会（Japanese Orthopaedic Association,JOA）评分、疼痛视觉模拟评分（visual analogue scale,VAS）,术前和术后3个月、术后6个月及术后1年行颈椎功能障碍指数（neck disability index,NDI）评估;测量ACXF组术中前方截骨距离以及两组患者术前和术后不同随访时间点的颈椎整体曲度、手术节段脊柱功能单位（functional spine unit,FSU）活动度及高度、后方减...     

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Purpose

We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).

Methods

A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.

Results

Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.

Conclusions

Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.     

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom’s criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara’s index at 1 year. Group 1 had a mean age 46.2 years (range 35–60 years). Group 2 had a mean age 50.1 years (range 35–70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.     

ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病

目的探讨颈前路椎体次全切除减压融合术(ACCF)联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析自2016-05—2017-07采用ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗的30例多节段脊髓型颈椎病,比较术前、术后1周及末次随访时JOA评分、颈椎Cobb角、椎间隙高度。结果30例均顺利完成手术并获得完整随访,随访时间平均21.6个月,切口均一期愈合,植骨均骨性愈合,无内固定松动、移位、断裂、伤口感染、声音嘶哑及神经功能加重等并发症。术后1例出现脑脊液漏,2例出现吞咽不适,非手术治疗后均治愈。术后1周与末次随访时JOA评分、颈椎Cobb角、椎间隙高度较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时根据JOA评分改善率评定综合疗效:优12例,良14例,可4例。结论ACCF联合颈前路减压zerop椎间植骨融合内固定术治疗多节段脊髓型颈椎病安全可靠,能够有效地恢复椎间隙高度和颈椎生理曲度。     

磁共振对脊髓型颈椎病前路减压及融合术后评价

目的：研究脊髓型颈椎病前路减压及融合术后的MRI表现与临床意义,评价术后MRI表现及其与术后疗效的关系。方法：回顾性分析58例脊髓型颈椎病患者对照术前与术后MRI图像与临床资料,观察颈椎磁共振影像表现与临床疗效间的关系。结果：前路减压术中植骨MRI信号强度根据手术时间由低逐渐向等信号转变,而纯钛钢板均为无信号影,术前仅表现出骨赘和椎间盘突出者其术后功能改善好,而术后功能不佳者术前MRI特征表现为脊髓T2WI高信号,融合平面与融合相邻椎间层面出现不同程度的脊髓受压。结论：MRI可根据信号变化反映前路植骨融合状况,并通过术后MRI不同表现为评价脊髓型颈椎病前路术后的功能变化提供了影像学基础。     

三种颈前路融合术后颈椎前柱高度和Cobb角比较

目的比较3种不同植入物的颈前路椎间盘切除、椎间融合术(anterior cervical discectomy and fusion,ACDF)后颈椎前柱高度和Cobb角的情况.方法 1998年1月～2003年1月,随机选择行ACDF的神经根型颈椎病和脊髓型颈椎病患者共60例,其中男41例,女19例.年龄36～68 岁,平均57岁.病程1～36个月,平均6.2个月.按植入物类型分为自体骨(A组)、自体骨 交锁钢板内固定(B组)及Syncage-C(C组)各20例.术前,术后7 d、3个月及最后1次随访(2年以上)摄X线片,评估3组患者融合节段的颈椎前柱高度、Cobb角及功能恢复情况.结果术后患者均获随访2～7年.未保留终板的A、B组,较保留终板的C组,其融合节段的颈椎前柱高度和Cobb角丢失更明显.术后12例植骨块塌陷、3例植骨块移位和10例颈椎姿势异常,主要发生在A、B组.A、B及C组骨性融合分别为17、19及20例,功能评估示A、B、C组的优良率分别为75%、85%及90%.结论为更好维持颈椎前柱高度和生理曲度,须强调保留椎体终板、重视植骨技术、术前仔细评估患者的骨质疏松程度和必要时选用颈前路交锁钢板固定和/或Syncage-C融合.     

Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature

A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evaculate her bladder and control her micturition. Anal tone and sensation were intact. A self-catheterisation regime was instituted with a diagnosis of parasympathetic nerve injury during the anterior spinal fusion. After a period of 3 months, the patient regained control of urination. We report this case to highlight the importance of protecting the parasympathetic presacral nerve during L5-S1 anterior interbody fusion, as injury to this nerve affects urinary evacuation.     

Efficacy of combined anteroposterior fusion with no plate versus anterior fusion alone with cage and plate for multilevel degenerative cervical disease

Background contextMany studies have reported that anterior fusion alone has high rates of complications, such as pseudoarthrosis, graft subsidence, and graft dislodgement, with multisegmental constructs. No previous studies have compared the outcomes of combined anteroposterior fusion with no plate and anterior fusion alone with a cage and plate.PurposeTo compare the efficacy of combined anteroposterior fusion with that of anterior fusion alone for the treatment of multisegmental degenerative cervical disorder.Study designRetrospective study.Patient sampleSixty-two consecutive patients who underwent anterior fusion alone with a cage and plate or combined anteroposterior fusion with no plate for multisegmental (three or more segments) degenerative cervical disease.Outcome measureRadiological and clinical outcome measures.MethodsPatients in group A (n=36) underwent anterior fusion with a cage and plate construct (AFA); patients in group B (n=26) underwent combined anterior fusion with a cage and posterior fusion with a rod/screw construct (CAPF). The degree and maintenance of the correction angle, fusion rates, and adjacent level degeneration were assessed with radiographs. Clinical outcomes were assessed with a visual analog scale (VAS) and Neck Disability Index (NDI) scores, operative time, blood loss, and rates of complications.ResultsThe mean correction angle did not differ significantly between groups, but the loss of correction at final follow-up was greater in group A than group B (p=.001). Compared with group B, group A had a higher incidence of pseudarthrosis (p=.035), cage subsidence (p=.005), hardware-related complications (p=.032), and dysphagia (p=.012). The mean VAS score for arm pain and the mean NDI score were better for group B than group A (p=.0461, .0360), but the mean VAS score for posterior neck pain was better for group A than group B (p=.0352). Group B had greater blood loss and a longer operative time than group A (blood loss: p=.037; operative time: p=.0001).ConclusionsAlthough combined anterior/posterior fusion is associated with a longer operative time and greater blood loss than anterior fusion alone, the combined approach provides better maintenance of sagittal alignment, a higher rate of fusion, a lower incidence of cage subsidence and adjacent level disease, and better VAS and NDI scores.     

Correlation of spinal canal post-traumatic encroachment and neurological deficit in burst fractures of the lower cervical spine (C3–7)

Summary Burst fractures of the lower cervical spine (C3–7) are often associated with severe neurological injury. During the last 5 years (1987–1992) we operated on 11 patients who had sustained burst fractures together with neurological deficit. The operations were performed through an anterior approach. The burst vertebra was excised, and the defect was filled with bone graft. Implants (plates and screws) were used in 10 cases. The preoperative examination was conducted by computed tomography and revealed that in 4 patients with complete tetraplegia (Frankel grade A) there was more than 50% spinal canal narrowing, whilst in the remaining 7 patients, with various levels of incomplete tetraplegia, there was less than 50% spinal canal narrowing, resulting in considerable improvement. The above results support the hypothesis that a correlation exists between the magnitude of the spinal canal encroachment, the initial neurological deficit and the final outcome.