颈椎间盘置换与融合术后发生相邻节段退变的对比分析

目的综合分析颈椎间盘置换术(Cervical intervertebral disc replacement)后发生相邻节段退变情况。方法自2013-01-2016-07,选取本院收治的126例接受颈椎间盘置换术患者临床资料,按照不同的手术方法分为置换组与融合组各63例。置换组应用颈椎间盘置换术,融合组应用前路颈椎间盘切除融合术。对比两组患者术后相邻节段退变情况、手术前后JOA脊髓功能评分。结果 (1)术前,置换组和融合组患者JOA评分比较无统计学意义(P0.05);术后,两组JOA评分显著高于手术前(P0.05),但两组对比无统计学差异(P0.05);(2)术后随访1年,置换组发生相邻节段退变率为9.52%(6/63),融合组为25.40%(16/63),置换组显著低于融合组(P0.05)。结论颈椎间盘置换术能够有效治疗颈椎病患者,与此同时,能够在一定程度上降低相邻节段退变率。     

前路减压植骨融合术与颈椎间盘置换手术对颈椎相邻节段退变的影响

目的探讨颈椎间盘置换手术与前路减压植骨融合术(anterior cervical decompression and fusion,ACDF)对颈椎相邻节段退变的影响。方法回顾性分析2015年4月～2017年4月于本院接受治疗的94例颈椎病患者,依据其手术情况分为两组:观察组47例均采用颈椎间盘置换术治疗,对照组47例均采用ACDF手术治疗,对比两组患者的手术疗效,以及术后相邻节段退变情况。结果两组术后NDI、JOA评分均有显著改善,但组间对比无统计学差异(P0.05)。术后24个月,观察组相邻节段退变率为17.0%,显著低于对照组的31.9%,具有统计学差异(P0.05)。两组于术后随访期间,均未发生假体松动、假体移位以及钢板断裂等并发症。结论两种术式均可取得显著疗效,但颈椎间盘置换手术可显著减轻术后颈椎相邻节段的退变程度。     

双节段BRYAN人工颈间盘置换的中期疗效分析

[目的]观察相邻双节段BRYAN人工颈椎间盘置换术治疗相邻节段颈椎病的临床疗效与影像学结果.[方法]回顾2006年1月～ 2009年2月在本院行相邻双节段BRYAN人工颈椎间盘置换术并获得随访的颈椎病患者19例.术前及术后1周,术后3、6、12、24、36个月进行JOA评分、NDI评分及颈痛VAS评分,评估手术临床疗效;术前及术后3、6、12、24、36个月通过颈椎动力位X线片评定置换节段、上下相邻节段和C2-7颈椎活动度;术后12、24、36个月,通过X线椎间盘退变评分系统评估手术相邻节段退变.[结果]所有患者术后神经症状均明显好转,各随访点JOA评分、NDI评分、颈痛VAS评分较术前显著改善,差异有统计学意义(P＜0.05),3个月后各随访时点两两比较差异无统计学意义(P＞0.05).两置换节段活动度术后各随访点与术前比较差异有统计学意义(P＜0.05);3个月后随访,上下相邻节段活动度与术前相比略减小,C2-7活动度较术前略增加,差异无统计学意义(P＞0.05).至末次随访时,手术未导致相邻节段椎间盘退变加剧,无严重并发症发生.[结论]BRYAN人工颈椎间盘置换治疗相邻双节段颈椎间盘退变性疾病临床疗效良好,不仅保留了颈椎的运动学特性,防止置换节段与相邻节段退变,而且术后近中期无严重并发症.     

ACDF联合ACRFA治疗多节段颈椎间盘突出症的疗效

[目的]研究采用颈前路减压植骨融合联合颈椎间盘微创消融术治疗多节段颈椎间盘突出症的远期疗效。[方法]选取2007年1月~2011年1月本院脊柱微创中心收治的多节段颈椎病变患者96例,根据手术适应证进行手术治疗,术后进行美国脊髓损伤协会(ASIA)评分、疼痛视觉模拟(VAS)评分、日本矫形外科协会(JOA)脊髓功能评分,随访。[结果]93例患者获得随访,平均随访时间60个月,术后ASIA、VAS和JOS评分均明显改善(P0.05),差异具有统计学意义。[结论]颈前路减压融合术联合椎间盘微创消融术治疗多节段颈椎间盘突出症减少了融合节段,降低了相邻节段间盘的退变率及不稳率,临床效果好,术后远期效果优良。     

人工颈椎间盘置换对邻近节段椎间盘的保护作用

[目的]探讨Bryan人工颈椎间盘置换治疗颈椎病和颈椎间盘突出症的临床疗效及对邻近节段椎间盘的保护作用。[方法]回顾分析2004年以来本科收治的254例颈椎病及颈椎间盘突出症患者。117例施行了Bryan人工椎间盘置换术,其中男性55例,女性62例;年龄33~65岁,平均46.6岁,89例行单节段人工椎间盘置换术,6例行双节段人工椎间盘置换术,22例行1节段人工椎间盘置换术和1节段椎间盘切除植骨融合术。137例行颈椎前路减压融合术,其中男性74例,女性63例;年龄29~81岁,平均47.8岁。术后评定患者神经功能恢复情况,测量邻近节段活动度的大小,并进行邻近节段颈椎间盘退变情况的X线评估。[结果]两组患者术后随访时间为6~60个月,平均26.4个月。两组患者术后神经功能均有明显改善,JOA评分平均较术前提高5.6分,平均改善率为62.9%,有效率为100%,两组间无统计学差异(P0.05)。测量邻近节段椎间隙活动度的结果显示融合组较非融合组变化明显,具有统计学意义(P0.05)。椎间盘退变的X线评估结果显示,融合组邻近节段颈椎间盘退变的发生率和严重程度明显高于非融合组,具有统计学意义(P0.05)。[结论]Bryan人工颈椎间盘置换治疗颈椎病和颈椎间盘突出症具有良好的疗效,较传统前路减压融合术,可以较好发挥其对邻近节段椎间盘的保护作用。     

Bryan人工颈椎间盘置换术的中期随访结果分析

目的 观察Bryan人工颈椎间盘置换术后临床和影像学结果以及相邻节段退变的情况.方法 回顾性分析术后随访时间超过2年的26例单节段置换患者的临床资料,临床效果采用JOA和Odom评分进行评定.采用x线片观察手术节段活动度和椎旁骨化.采用X线片和MRI观察对比相邻节段退变情况.术前X线片示置换节段的活动度为2°～12°,平均为6.9°.结果 (1)临床结果:18例脊髓型颈椎病患者随访时JOA评分平均16分,平均改善率84%,8例神经根型颈椎病患者随访时临床症状全部消失.Odom分级:优秀15例,良好7例,一般4例.(2)X线片:术后置换节段的活动度为1°～14°,平均7.8°;7例出现假体周围异位骨化,仅1例假体运动消失,其余6例平均活动度为5.3°.相邻节段椎间隙高度术后无明显变化.(3)MRI T2加权像:根据Pfirrmann椎间盘退变分级方法,相邻节段椎间盘的分级术后无明显加重表现;相邻节段黄韧带肥厚对椎管的侵占率术后无明显加重;但是上下相邻椎间盘侵占率均略有增加.结论 Bryan人工颈椎间盘置换术保留了置换节段的运动性,避免了相邻节段的加速退变,2年以上随访效果优良.     

颈椎融合结合人工颈椎间盘置换术治疗三节段颈椎病

目的 分析单椎体次全切颈椎融合结合相邻节段人工颈椎间盘置换(CADR)治疗三节段颈椎病的临床疗效及影像学结果.方法 回顾性分析自2008年6月～2011年3月采用经颈前路单椎体次全切除,钛网植骨融合带锁钛板内固定(ACCF),结合相邻单节段椎间盘切除Modi-c人工颈椎间盘置换手术(CADR)治疗19例三节段颈椎病.结果 本组平均随访26.5个月(12～36个月),融合节段均得到骨性融合.术前JOA评分(9.6±1.7)分,末次随访为(14.4±1.1)分(P＜0.05),末次随访JOA评分平均改善率为70.1％.术前VAS评分(7.1±1.1)分,术后(1.0±0.7)分(P＜0.05);术前NDI(40.4±3.7)分,末次随访降至(9.3±2.2)分(P＜0.05).人工颈椎间盘置换节段术前活动度为(16.0±3.3)°,末次随访时(15.6±3.1)°(P＞0.05).结论 采用人工颈椎间盘置换结合颈椎融合术治疗三节段颈椎病,有效可行,减压彻底,保留了部分手术节段的运动功能,减少术后相邻节段出现退变的可能.     

单节段人工椎间盘置换治疗颈椎病的中长期疗效

目的:评价单节段颈椎人工椎间盘置换(cervical disc arthroplasty,CDA)对颈椎病的中长期治疗效果。方法:2003年12月～2005年12月采用前瞻、随机、对照研究单节段Bryan假体CDA与传统前路颈椎减压融合(ACDF)手术治疗颈椎病的疗效,所有患者均按统一的纳入、排除标准进入临床研究,共80例,随机分为两组,并进行均衡性检验,一组进行CDA手术,另一组进行ACDF手术,术后经1d、3个月、6个月、1年、2年、5年及2012年6月的末次随访。其中CDA组32例、ACDF组35例完成了随访,应用动力位X线片观察置换间隙活动度,采用McAfee异位骨化分级方法评定颈椎间盘置换术后异位骨化情况,在MRI T2加权像上采用Miyaza-ki颈椎间盘退变分级方法评定两组相邻节段椎间盘退变情况,采用颈椎活动障碍指数(NDI)和疼痛视觉模拟评分(VAS)评价术后症状改善程度。结果:本组病例随访7.2~9.6年,平均8.8年。CDA组假体位置良好,无塌陷或移位发生,末次随访时矢状面假体置换间隙活动度1.20°~8.20°,平均6.35°±1.45°;32例患者中8例(25%)置换间隙发生异位骨化,其中2例(6.25%)置换节段丧失活动度;翻修3例,1例因头侧邻近间隙退变、颈椎间盘突出压迫脊髓;2例因头侧跳跃间隙后方骨赘压迫脊髓;末次随访时置换间隙相邻的其他63个节段中22个椎间盘退变分级加重1级,8个加重2级,但无相关临床症状出现。ACDF组融合率100%,翻修3例,2例因头侧邻近间隙退变、存在神经症状;1例因尾侧邻近间隙退变,压迫脊髓;其余67个相邻节段中34个椎间盘退变分级加重1级,15个加重2级,但均无相关临床症状出现。末次随访时CDA组的NDI、颈部VAS及上肢VAS评分分别为16.83±3.12、1.17±0.41及1.96±0.51分,ACDF组分别为17.21±3.53、1.23±0.35及1.86±0.62分,较术前均显著改善,但两组间比较无显著性差异(P>0.05)。结论:颈椎人工椎间盘置换术与ACDF手术治疗单节段颈椎病的中长期临床疗效间无显著性差异,颈椎人工椎间盘置换节段术后中长期可以保持一定活动度,相邻节段椎间盘退变情况好于ACDF组,可以作为单节段颈椎病的手术选择方式。     

人工颈椎间盘置换与颈前路融合术治疗脊髓型颈椎病3年随访结果报道

[目的]比较人工颈椎间盘置换与颈前路减压植骨融合术治疗脊髓型颈椎病的3年随访结果。[方法]回顾性分析2004年11月²009年3月在本院接受手术治疗,并完成3年随访的65例脊髓型颈椎病患者。31例行人工颈椎间盘置换术,其中单节段置换26例,双节段置换5例,13例14个节段应用Bryan假体,18例22个节段应用Prestige LP假体,34例行颈前路减压植骨融合术,其中单节段融合28例,椎体次全切双节段融合6例。分别在术前,术后1周,术后12、24及36个月对患者进行SF-36生活质量量表、JOA评分、NDI评分、Nurick分级的评估,术后36个月采用Odom’s标准评价临床效果;在各随访时点采用颈椎正侧位X线片观察置入物的稳定性,并采用动力位X线片测量手术节段屈伸活动度;同时记录患者术中、术后并发症及二次手术的发生情况。[结果]两组患者的JOA评分、Nurick分级术后各随访时点较术前比较均有明显改善(P<0.05),两组之间差异无统计学意义(P>0.05),两组患者SF-36躯体评分及心理评分、NDI评分术后各随访时点较术前有明显改善(P<0.05),两组间比较,置换组优于融合组(P<0.05)。术后各随访时点置换组手术节段屈伸活动度维持在术前水平(P>0.05),而融合组手术节段屈伸活动度较术前明显下降(P<0.05)。置换组中2例患者发生假体前移,2例发生轻度异位骨化,1例因脑脊液漏接受二次手术。融合组中1例患者发生了假关节形成,6例存在供骨区的疼痛,3例因邻近节段退变接受二次手术。[结论]人工颈椎间盘置换术与颈前路减压植骨融合术治疗脊髓型颈椎病3年随访疗效均满意,且前者保留了手术节段运动功能,减少了融合导致的多种并发症。     

颈椎前路减压人工颈椎间盘置换术与融合术治疗单节段颈椎间盘突出症的短期疗效比较

背景：颈前路椎间盘切除植骨融合术（ACDF）能够为有症状的颈椎病患者提供较好的治疗效果,但颈椎融合可导致相邻节段椎间盘内部应力增加,加速邻近节段椎间盘的退变。颈椎人工椎间盘置换术（ACDR）作为最具代表性的颈椎前路非融合技术,为颈椎间盘突出症的治疗提供了另外一种外科手段。目的：比较ACDR和ACDF治疗单节段颈椎间盘突出症的临床效果。方法：2009年1月至2012年2月,61例单节段颈椎间盘突出症患者接受Discover人工颈椎间盘置换手术（置换组,26例）或ACDF手术（融合组,35例）。分别在术前,术后1周,术后3、6、12及24个月对患者进行疼痛视觉模拟评分（VAS）、日本矫形外科协会（JOA）评分及影像学评估,同时记录患者并发症及二次手术情况。结果：最终,52例患者（融合组29例,置换组23例）获得平均15.3个月（12-24个月）随访。两组患者术后各随访时间点的颈痛、上肢痛VAS和JOA评分,较术前均有改善（P〈0.05）,但两组间无显著统计学差异（P〉0.05）。置换组术后手术节段及邻近节段屈伸活动度与术前比较无统计学差异（P〉0.05）。融合组融合成功率为90.5%。置换组中2例患者术后6个月时假体有〈3 mm的前移,l例术后发生脑脊液漏。融合组中1例患者发生邻椎病并接受二次手术治疗。结论：单节段Discover人工颈椎间盘置换术和ACDF均可明显缓解颈椎间盘突出症患者的症状。间盘置换还能减少手术邻近节段代偿活动度的增加,有望预防相邻节段退变的发生。     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

【摘要】 目的：探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法：2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位：C5/6 4例,C6/7 5例,C7/T1 3例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分（7~10分）,末次随访时为1.4±0.2分（0~3分）,两者比较有显著性差异（P<0.05）;术前NDI为26.4±1.3分（22~31分）,末次随访时为4.2±0.6分（3~8分）,两者比较有显著性差异（P<0.05）,改善率为84.1%;术前病变水平椎间盘高度为5.4±0.7mm（4.2~6.1mm）,末次随访时为4.9±0.7mm（3.6~5.8mm）,两者比较无显著性差异（P>0.05）。术后满意度为100%。结论：微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响。方法回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DCI治疗(DCI组)。记录并比较2组患者手术时间、术中出血量,术前及术后1年日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、手术节段Cobb角、C2~7颈椎曲度、邻近椎体高度及颈椎各运动方向(前屈后伸、左右侧曲、左右旋转)的ROM。结果所有手术顺利完成。2组术中出血量比较,差异无统计学意义(P>0.05)。DCI组手术时间比ACDF组短,差异有统计学意义(P<0.05)。2组患者术后1年JOA评分、VAS评分和邻近椎体高度均较术前改善,差异有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。术后1年ACDF组C2~7颈椎曲度、手术节段Cobb角均较术前有所丢失,DCI组无明显丢失,组间比较,差异有统计学意义(P<0.05)。术后1年2组前屈后伸、左右侧曲ROM与术前比较均未出现明显变化,差异无统计学意义(P>0.05)。术后1年2组左右旋转ROM出现了相近程度的受限,与术前比较,差异有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。结论ACDF与DCI治疗单节段CDH均可获得满意的临床效果,虽然ACDF术后影像学资料显示有生理曲度的丢失,但颈椎ROM维持良好,并不影响患者的生活质量。     

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented. METHODS: A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique. RESULTS: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later. CONCLUSION: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。