显著椎间盘退变的脊髓型颈椎病的方式选择

目的：探讨椎间盘显著退变与脊髓型颈椎病节段性不稳的关系及其对手术方式选择的意义。方法：回顾性分析42例椎间盘显著退变的脊髓型颈椎病的术前动态X片和MRI，了解颈椎不稳和脊髓压迫的相关因素，随访观察前路和后路手术的治疗效果。结果：显著退变椎间盘的上方相邻椎体不稳率71.4％，明显狭窄椎间隙及上方相邻椎间隙处常存在明显的脊髓压迫。前路减压植骨融合固定术或后路双开门椎板成形术的神经功能恢复率分别为60．8％和57．1％，优良率分别为88．5％和81．3％。结论：显著退变椎间盘的上方相邻椎体有失稳倾向，脊髓压迫存在静态和动态压迫因素，手术应采用前路多节段减压融合固定或后路椎板扩大成形术。

Surgical Treatment of Cervical Spondylotic Myelopathy with Severe Disc Degeneration

Objective:To investigate the relationship between severe disc degeneration and segmental instability in cervical spondylotic myelopathy (CSM) and its significance for the surgical treatment strategy. Methods:The preoperative dynamic radiographs and MRI of 42 patients of CSM with severe disc degeneration were reviewed retrospectively. The related factors of cervical instability and spinal cord compression were analyzed. The outcomes of anterior cervical decompression and fusion (AC-DF) and expansive laminoplasty (ELAP) were evaluated. Results:Segmental instability was found in 71.4% of the upper adjacent vertebral bodies above the severe degenerative disc. Obvious spinal cord compression was found at the intervertebral space of disc degeneration and upper adjacent disc space. The recovery rate of ACDF and ELAP was 60. 8% and 57.1%,respectively. ACDF and ELAP acquired excellent or good result in 88. 5% and 81. 3% of patients at final follow-up respectively . Conclusion:The upper adjacent vertebral body of severe disc degeneration has the tendency of segmental instability. There are static and dynamic factors in spinal cord compression.Multisegmental ACDF or expansive laminoplasty (ELAP) should be used for surgical treatment.