颈椎后路一次性手术治疗颈椎管狭窄合并颈椎间盘突出

目的探讨颈椎管狭窄合并颈椎间突出一次性后路减压和髓核摘除的手术方法以及手术时应注意的问题。方法 :经颈椎后路摘除椎间盘 38例。局麻、俯卧位 ,颈椎后路单开门椎管扩大成形后 ,以病变间隙为中心 ,纵行切开硬脊膜 ,根据需要切断病变侧 2～ 3条齿状韧带 ,将脊髓轻轻向中线牵拉 ,摘除突出的髓核。结果 :38例中 35例获得平均 3年 2个月 (6个月～ 7年 10个月 )的随访 ,优 2 1例 ,良 11例 ,有效 3例 ,避免前、后路 2次手术 ,效果满意 ,但应选择好手术适应证 ,手术操作时应注意对脊髓和神经根的牵拉以及对齿状韧带与神经根的辨认等问题。

POSTERIOR APPROACH FOR CERVICAL DISC HERNIATION WITH CERVICAL SPINAL CANAL STENOSIS

Objective:To investigate the posterior approach method for cervical disc herniation with cervical spinal canal stenosis and some questions to be considered during the operations. Method:Thirty-eight patients who had the cervical disc herniation with cervical spinal canal stenosis were treated by the cervical posterior approach.The local anaesthesia was used in all the patients.After the laminoplasty of single opening,the herniated discs were removed.Results:Of the 38 patients,35 were followed up for an average of three years and two months(six months to seven years and ten months).The results of twenty-one patients were excellent and that of eleven patients were good.The excellent and good rate was 91.4% (35/38).Conclusions:The cervical disc herniation is usually associated with cervical spinal canal stenosis.With the posterior approach,the stenosis and the herniated disc can be cured by one-stage operation.So the traditional treatment with two-stage operations of the anterior and the posterior approach can be avoided.Though the results got in this surgical treatment were satisfing,some questions should be considered,such as the selection of indications,the protection of spine and nerve roots and the identification of nerve roots with the tooth-like ligaments.