颈椎病前路减压术后再手术

目的探讨颈椎病颈椎前路减压术后再手术的原因、术式选择及效果。方法颈椎病前路减压术后再手术者29例,其中脊髓型颈椎病19例,神经根型颈椎病2例,混合型颈椎病8例。均再次经颈前入路去除残留致压物、移位植骨块及内固定物,并植骨融合固定。根据患者症状和体征及再手术所见,结合颈椎X线和MR检查,分析再手术原因,并观察再手术的临床效果。结果再手术的原因有初次手术减压不彻底11例,植骨移位压迫4例,cage植入后再压迫4例,钢板螺钉松脱2例,相邻节段病变8例。全部病例随访6～29个月,平均11个月。再次减压固定后23例获得骨性愈合,6例延迟愈合。再手术后6个月脊髓型和混合型颈椎病神经功能恢复率分别为52.4%和46.7%。神经根型完全恢复。结论再手术的主要原因为残留或新形成的脊髓和神经根受压,彻底减压和重建施术节段的稳定是获得满意疗效的保证。

Revision surgery in the patients with cervical spondylosis after anterior decompression

Objective To study the causes, technique, selection and results of revision surgery in the patients with cervical spondylosis after anterior decompression. Methods Twenty nine patients with cervical spondylosis were treated with revision surgery after anterior decompression. Among them, there were 19 patients with cervical myelopathy, 8 with combination of myelopathy and radiculopathy, and 2 with radiculopathy only. The procedures included removal of the residual compressive elements, migrated bone grafts and implants, and refusion with bone graft and internal fixation. Depending on the clinical symptoms and findings of physical examination, X ray films and MRI were used to analyze the causes and the results of the revision surgery. Results There were 11 patients with incomplete initial decompression, 4 patients with the migration of the bone graft, 4 patients with new neural compression after cages interbody fusion, 2 patients with loose and migration of the plates and 8 patients with the degenerative changes in adjacent segments. Solid fusion in 23 cases and delayed fusion in 6 cases were observed during follow up. The neural recovering rate after the revision surgery was 52.4% in the patients with cervical myelopathy and 46.7% in the patients with combination of myelopathy and radiculopathy. Conclusion The main causes for the reoperation after anterior decompression were residual or newly formed neural compression. The complete decompression and segmental stabilization in the cervical revision surgery was essential for obtaining the good results.