经皮内镜下颈椎后路循椎弓根360°神经根减压术

[目的]介绍经皮内镜下颈椎后路循椎弓根360°神经根减压治疗伴椎间孔骨性狭窄的神经根型颈椎病技术及初步临床效果。[方法] 2017年5月～2020年1月对38例伴椎间孔骨性狭窄的神经根型颈椎病患者采用经皮内镜下颈椎后路循椎弓根360°神经根减压术。术前确定病变节段与程度,克氏针锚定后置入软组织扩张器,显露"V"点后,沿上下椎弓根內缘向外切除侧块关节至椎弓根外缘,清理神经根周围粘连组织,必要时在工作导管保护下以磨钻磨除增生钩椎关节,对神经根进行360°减压。[结果] 38例患者手术均顺利完成,平均手术时间67 min,术中未出现神经、硬膜损伤等并发症。术后患者颈肩和上肢疼痛症状均显著缓解。术后随访影像学显示所有患者目标减压区域均实现彻底减压,术后CT测量侧块关节切除率均50%,无节段失稳表现。[结论]经皮内镜下颈椎后路循椎弓根360°神经根减压术,减压区域沿上下位椎弓根从椎间孔的内口到外口,可在内镜直视下明确减压边界,减压准确快速,可安全有效治疗伴椎间孔骨性狭窄的神经根型颈椎病。     

METRx椎间盘镜下颈椎后路椎间孔切开减压术疗效研究

目的 探讨METRx椎间盘镜下颈椎后路椎间孔切开减压术对神经根型颈椎病及颈椎间盘突出症的治疗效果.方法 METRx椎间盘镜下颈椎后路椎间孔切开减压术治疗9例神经根型颈椎病及2例颈椎间盘突出症.结果 本组11例患者术后MRI检查显示突出椎间盘及神经根压迫消失.随访3个月后JOA脊髓功能评分和VAS评分,与术前比较差异有统计学意义(P<0.05).结论 METRx椎间盘镜下颈椎后路椎间孔切开减压术手术创伤小,术后恢复快,临床疗效优良.     

显微内镜下颈椎后路椎间孔切开减压术的疗效探讨

目的探讨显微内镜下颈椎后路椎间孔切开减压术治疗神经根型颈椎病及颈椎间盘突出症的临床疗效。方法2004年2月-2007年6月,于显微内镜下行颈椎后路椎间孔切开减压术24例。男16例,女8例;年龄42～68岁,平均59岁。其中神经根型颈椎病16例,颈椎间盘突出症8例。病变节段:C4、58例,C5、612例,C6、74例。病程6～15个月。影像学检查显示8例颈椎间盘突出症中软性突出物6例、硬性突出物2例;神经根型颈椎病的受压因素主要为黄韧带肥厚、钩椎关节增生及关节突关节位置异常。根据日本骨科协会(JOA)脊髓功能评分法评定为(12.60±1.52)分。结果手术时间90～120min,平均100min;术中出血量100～150mL,平均120mL。1例全麻手术患者术中为切除钙化的突出髓核组织造成神经根牵拉伤,术后采用甲泼尼龙冲击治疗后3个月神经根功能恢复;其余患者术后神经根疼痛症状明显改善19例,减轻4例。术后影像学检查显示手术部位减压彻底。24例均获随访,随访时间24～36个月,平均28个月。X线片及CT检查示椎间高度无明显丢失,生理曲度正常。术后24个月根据JOA脊髓功能评分法评定为(16.10±0.29)分,与术前比较差异有统计学意义(P0.01)。结论显微内镜下颈椎后路椎间孔切开减压术可通过小切口快捷进入术区,减少了组织损伤,避免了椎间高度丢失,临床疗效优良。     

后路全内镜下椎间孔环形减压治疗伴骨椎间孔狭窄的神经根型颈椎病

神经根型颈椎病常合并因钩突和关节突增生导致的骨性椎间孔狭窄,同时伴有软性椎间盘突出,压迫神经根,从而出现上肢放射性疼痛或麻木、肌力减退等神经根性损害表现。对于合并骨性颈椎间孔狭窄的神经根型颈椎病患者,目前手术方式的选择仍有一定争议,颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）的目的在于从前方减压、椎间植骨融合的同时能一定程度撑开椎间隙的高度,增大椎间孔的面积,从而达到间接减压的目的,但椎间融合牺牲了椎间活动度,加速了邻近节段退变。近年来,后路椎间孔切开术是治疗颈椎间孔狭窄的常见手术方式,但同时解决椎间孔前方和后方骨性压迫的技术鲜有报道。2017年5月～2018年7月云南省德宏州中医医院骨科采用全内镜下椎间孔环形减压技术治疗13例伴骨性颈椎间孔狭窄的神经根型颈椎病患者,报告如下。     

骨科：脊柱

前路手术治疗神经根型颈椎病12例报告；寰枢椎椎弓根钉板固定融合治疗寰枢关节脱位；不同外科术式治疗多节段脊髓型颈椎病的疗效评价；闭合性椎动脉损伤的临床诊断和治疗；颈椎前后路联合手术治疗颈椎管狭窄并颈椎损伤……[编者按]     

颈椎开门钢板内固定治疗脊髓型颈椎病12例

脊髓型颈椎病是一种临床常见病,对于多节段颈椎间盘突出、颈椎管狭窄及多节段后纵韧带骨化患者,通常采用后路或前后路联合减压手术;后路椎板成形术常采用单开门成形术.传统的单开门术采用悬吊固定、或加用侧块钢板固定,但是随着病例的增多及随访时间延长,出现了术后再次关门、悬吊牵拉引起轴性疼痛、侧块钢板限制手术节段椎间活动度等并发症发生严重影响了临床疗效.我科自2009年4月至2011年4月采用颈椎开门钢板(centerpieceTM微型钢板,美敦力公司生产)治疗12例脊髓型颈椎病,疗效满意,现报道如下.     

内镜下经后路颈椎椎板开窗髓核摘除术

内镜下经后路颈椎椎板开窗髓核除术从传统的侧后入路颈椎间盘手术发展而来，可避免后路手术需要提供足够视野的长切口和广泛剥离脊柱旁肌肉组织的弊端，同时可以切除突出的椎间盘和增生的骨赘，解除神经根受压。本就近几年脊柱内镜在治疗颈椎间盘突出症及神经根型颈椎病方面的进展作一综述。     

单侧双通道内镜技术治疗神经根型颈椎病的早期临床疗效

颈前路减压植骨融合术（anterior cervical decompression and fusion,ACDF）是治疗神经根型颈椎病的常用术式。但椎间融合使脊柱节段生物力学发生改变,加速临近节段退变。传统的颈后路开窗减压髓核摘除术不需要融合手术节段,但需要广泛剥离软组织,出血较多、易导致颈椎不稳及轴性疼痛等并发症。随着微创技术的发展,应用脊柱内镜技术治疗神经根型颈椎病为骨科医生提供了更多选择。单侧双通道内镜技术（unilateral biportal endoscopy,UBE）使用观察和操作2个通道,观察通道放置内镜的同时具备冲洗功能,操作通道则用于手术器械操作。相对于传统颈椎后路手术,该技术具有创伤小、出血少、恢复快等优势。但目前应用UBE技术治疗神经根型颈椎病的报道相对较少。2021年3月～2021年11月,我们应用UBE技术治疗9例神经根型颈椎病患者,取得了较好的临床疗效,报道如下。     

颈椎后路椎板减压侧块内固定与单开门椎管扩大成形术治疗多节段脊髓型颈椎病的疗效比较

目的比较颈椎后路椎板减压侧块内固定与单开门椎管扩大成形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2016-01—2018-01诊治的110例多节段脊髓型颈椎病,55例采用单开门椎管扩大成形术治疗(观察组),55例采用颈椎后路椎板减压侧块内固定治疗(对照组)。比较2组术后出现C5神经根麻痹数,比较2组术后3、6、9、12个月JOA评分以及术后12个月伤椎Cobb角、CCI指数。结果 110例均顺利完成手术并获得12个月以上的随访,观察组术后出现C5神经根麻痹数较对照组少,差异有统计学意义(P0.05),2组术后3、6、9、12个月JOA评分比较差异无统计学意义(P0.05),2组术后12个月伤椎Cobb角、CCI指数比较差异无统计学意义(P0.05)。结论颈椎后路椎板减压侧块内固定术和单开门椎管扩大成形术治疗多节段脊髓型颈椎病均可有效保护神经功能、矫正伤椎Cobb角、促进颈椎曲度恢复,但单开门椎管扩大成形术可有效减少术后C5神经根麻痹的发生。     

两种颈后路术式治疗多节段脊髓型颈椎病术后C_5神经根麻痹分析

目的回顾分析两种颈后路手术术后C5神经根麻痹的发生与预后。方法回顾性分析自200-08-2011-01期间行手术治疗并获得随访的166例脊髓型颈椎病患者的临床资料,单纯行颈椎后路单开门椎管扩大成形术84例(A组):其中多节段椎间盘突出脊髓型颈椎病37例,发育性椎管狭窄28例,后纵韧带骨化19例。同期行颈椎后路全椎板切除、椎间孔扩大减压联合侧块螺钉内固定术82例(B组):其中多节段椎间盘突出脊髓型颈椎病39例,发育性椎管狭窄24例,后纵韧带骨化19例。记录术后C5神经根麻痹的发生情况,其诊断标准为:在无脊髓原有症状加重的情况下,颈椎管减压术后出现三角肌和/或肱二头肌肌力下降,伴或不伴肩部感觉减退或消失。结果两组术后神经功能改善率方面组间比较差异无统计学意义(P0.05)。两组术后颈椎曲度改变率以及术后C5神经麻痹发生率方面组间比较差异有统计学意义(P0.05)。结论颈椎后路全椎板切除联合侧块螺钉内固定术中,对椎间孔的减压降低了术后C5神经根麻痹的发生率。     

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.     

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。     

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.     

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.     

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.     

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。     

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。     

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.