前路手术治疗多节段脊髓型颈椎病临床疗效分析

目的 探讨多节段脊髓型颈椎病前路减压与重建术的临床疗效。方法对22例多节段脊髓型颈椎病的患者行颈前路减压自体髂骨或钛网以及钛网与椎间融合器（Cage）植骨加颈前钛板内固定术。结果22例术后均获得随访,随访时间为6个月～2a,平均13．5个月。采用日本骨科协会（JOA）评分标准评价,术前JOA评分为（7．23．4±1．06）分,术后为（14．60±2．96）分（P〈0．01）。用骨髓功能改善率（RIS）评定疗效,本组优16例,良4例,可1例,差1例,优良率90．9％。结论颈前路减压植骨内固定术是治疗多节段脊髓型颈椎病的有效方法。     

多节段颈椎病的前路显微外科手术

多节段颈椎病 (ＭＳＣＳ)的外科治疗可通过前路或后路手术来进行。术式包括多节段椎体切除植骨融合术、椎板切除术和椎管成形术。考虑到ＭＳＣＳ病情复杂性超过一个节段和颈椎病的病理生物力学特点 ,一期手术能获得充分的脊髓减压、纠正颈椎过度活动 ,使患者进行性加重的脊髓症状得到良好的即刻和长期缓解。由于在多数患者中与进行性加重的脊髓症状有很大关系的骨性病变位于脊髓前方 ,因此神经外科医生越来越多地采用前路脊髓减压术。显微外科技术应用对于无创根治性减压术有很大帮助 ,而且新型骨连接技术能够增进移植骨的融合。基于此 ,前…     

颈椎前路手术方式的进展

<正>颈椎病的发病率逐年增高,保守治疗无效的患者多寻求手术治疗。颈椎前路手术因其直接接触椎间盘及后方骨赘对脊髓的压迫,常能达到彻底的减压效果,同时保证椎体良好的骨性融合,维持正常的椎间高度和生理曲度,已经成为治疗颈椎病的最常见手术方式。颈椎前路手术方式分为融合性手术与非融合性手术。融合性手术历来被认为是颈椎前路手术方式的金标准,目前常用类型分为:单纯植骨组,自体髂骨植骨内固定组,钛网钛板内固定组,椎间融合器(Cage)和椎体间零切迹     

颈椎前路减压植骨内固定术治疗老年脊髓型颈椎病的疗效

<正>脊髓型颈椎病(CSM)是颈椎退变引起脊髓受压和(或)脊髓供血障碍所导致的脊髓功能障碍性疾病,约占颈椎病总数的10%~15%,是各型颈椎病中的最严重的类型,也是55岁以上人群中脊髓功能障碍的最常见原因〔1〕。脊髓型颈椎病发病率随着年龄的增长逐渐升高。老年患者具有病程长、病情重、并发症多的特点,治疗起来颇为棘手。本文回顾性分析行颈椎前路手术的老年脊髓型颈椎病患者的手术疗效。     

有限性选择性颈椎前路减压融合术治疗老年多节段颈椎病

颈椎病作为一种退变性疾病,随着人均寿命的延长,在老年病人中发病率逐渐增高。老年人颈椎病往往表现出起病隐匿,就医晚,症状重,多节段受累的特点,而且老年病人合并慢性内科疾病的比例非常高,故老年人颈椎病的手术治疗有其独特的规律[1]。现回顾分析本中心有限性选择性颈椎前路减压融合手术治疗老年人多节段颈椎病17例的治疗情况。1资料与方法1.1病例资料1.1.1一般情况：     

颈前路多节段减压原位植骨治疗脊髓型颈椎病

采用自行设计的颈前路多节段减压原位植骨术治疗脊髓型颈椎病患者56例.术后随访40例.疗效满意。该术式的优点为:①脊髓减压充分彻底.植骨融合率高.颈椎稳定性好;②操作简便.手术创伤小.患者痛苦少;③无需自体另行取骨,避免了供骨区反应及后遗症;④近期疗效好,远期疗效稳定。认为该术式对有颈前路手术指征的脊髓型颈椎病患者是一种理想的疗法。     

颈椎前路手术并发症研究进展

颈椎前路手术已成为颈椎手术中的一种常用手术入路,虽然它被公认为相对安全和有效,但因手术所造成的并发症仍是术者和患者不小的挑战。了解这些并发症种类和处理方法有重要意义。本文综述了颈椎前路手术并发症的种类及相关预防和治疗措施。     

颈椎非融合术治疗颈椎病的优势

目前,多数研究认为脊髓型颈椎病手术治疗的最佳时机应在不可逆转的神经功能丧失发生之前。颈椎病传统的手术方式为颈椎前路减压融合术（ACDF）或后路椎管减压术。但该手术融合了脊柱的运动单位,减少了颈椎的活动度,使颈部僵硬;融合增加了临近节段的负荷,使相邻两椎间盘的退变明显加速,数年后可因新的病变需二次手术。而颈椎非融合手术是在去除致病因素后,又保留了颈椎的运动功能。人工椎间盘置换术是非融合手术的代表,其优良的近期疗效已经得到证实,为颈椎病的手术治疗提供了一个新的选择。     

一期后前路联合手术治疗老年颈椎后纵韧带骨化症合并脊髓型颈椎病的疗效

目的 探讨一期后前路联合手术治疗合并脊髓型颈椎病的老年颈椎后纵韧带骨化症的临床疗效.方法 选择2009年3月至2011年3月吉林大学第二医院骨科收治的合并脊髓型颈椎病的老年颈椎后纵韧带骨化症患者17例,一期采用后路双开门椎管扩大成形术和前路髓核摘除椎体次全切骨化物切除钛网植骨钛板内固定术,术后随访3-24个月,采用JOA评分,Nurick分级及X线检查评估疗效.结果 所有患者均得到随访,平均随访时间14.5个月,术后JOA评分从术前的(7.5±1.3)分提高到(15.8±0.7)分(P＜0.05);Nurick分级从术前的(3.2±1.4)级改善到术后的(0.6±1.1)级(P＜0.05);X线检查表明所有病例在术后3个月植骨得到不同程度的融合.结论 一期后前路联合手术是治疗合并脊髓型颈椎病的老年颈椎后纵韧带骨化症的有效方法.     

颈椎前路手术中应用AO锁定型颈椎前路钢板13例临床效果分析

颈椎前路带锁钢板可为植骨提供有效固定,植骨融合率明显提高。1998～2001年,我们在颈椎前路手术中应用AO锁定型颈椎前路钢板13例,效果满意。现报告如下。临床资料：本组13例,男11例,女2例;年龄30～67岁,平均51．6岁。脊髓型颈椎病7例,颈椎椎体骨折、脱位伴截瘫6例（Frankel A级2例,B级1例,C级3例）。单节段融合7例,双节段融合6例。最高节段为C3,最低节段C7。均采用AO锁定型颈前路钢板行内固定术。     

针灸治疗颈椎病远期疗效的系统评价

目的 评价针灸治疗颈椎病的远期疗效.方法 收集针灸治疗颈椎病远期疗效的随机对照试验文献,对符合纳入标准的文献按改良后的Jadad计分表评价其质量,对纳入的试验作系统评价,同时按远期疗效指标的不同进行分层分析.结果 符合纳入标准的文献共11篇,研究对象1 723例患者.Meta分析结果 显示,针灸治疗组与对照组远期疗效痊愈率相比,OR为3.42,95% CI[2.64,4.43],治疗组痊愈率优于对照组,差异有统计学意义(P<0.000 01).针灸治疗组对比对照组复发率,OR为0.45,95%CI[0.23,0.91],治疗组远期疗效优于对照组,差别有统计学意义(P=0.03);其中干预措施仅为单纯针刺的P=0.02,I2=67%,采用随机效应模型检验,其合并OR为0.52,95%CI[0.19,1.44],差别无统计学意义(P=0.21).结论 针灸治疗颈椎病远期疗效优于对照组,但需要高质量、大样本、更规范疗效指标的研究进一步证明.     

颈椎病大鼠模型的建立

目的研究大鼠颈椎病动物模型的建立。方法80只SD大鼠随机分成4组,模型组2组行颈后肌切除术,另2组为对照假手术组。于术后3月、术后6月分别处死模型组和对照组动物各1组,对颈椎间盘进行组织学观察。结果大鼠椎间盘在增龄的过程中逐渐发生退变,椎间盘由外周规则排列的纤维环、中央大的髓核及较完整软骨终板逐渐转变成纤维环出现玻璃样变、断裂,髓核出现皱缩、变小或消失,软骨板变薄、缺损。而模型组退变发生更为严重。结论模型的产生符合颈椎病慢性进展性退变过程。     

Cervical balance and clinical outcomes in cervical spondylotic myelopathy treated by three-level anterior cervical discectomy and fusion and hybrid cervical surgery: A CONSORT-compliant study with minimum follow-up period of 5 years

As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic myelopathy. While studies on cervical alignment between 3-level HS and anterior cervical discectomy and fusion (ACDF) were seldom reported. The effects of cervical imbalance on its related clinical outcomes are yet undetermined as well.Patients with cervical spondylotic myelopathy, who underwent 3-level ACDF or HS, were included to compare cervical alignment parameters after surgery and then explore the relationship between cervical balance and clinical outcomes.Forty-one patients with HS (HS group) and 32 patients who with ACDF (ACDF group) were reviewed from February 2007 to September 2013 with the mean follow-up of 90.3 ± 25.5 (m) and 86.3 ± 28.9 (m), respectively. Cervical alignments parameters including the C2 to C7 cervical lordosis (CL), C2 to C7 sagittal vertical axis, T1 slope. and T1SCL (T1 slope minus CL), and the clinical outcomes like neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were measured and recorded preoperatively (PreOP), intraoperatively, and on the first preoperative day and the last follow-up (FFU). The balance and imbalance groupings were sorted based on the T1SCL: T1SCL≤20°,balance; T1SCL > 20°, imbalance.We found significant improvements (P < .001) in NDI and JOA at intraoperatively and FFU after ACDF and HS, and no difference on cervical alignment and clinical outcomes between the 2 procedures on the basis of intergroup comparisons. By between-subgroups comparisons, however, we found significant differences in CL and T1SCL at PreOP (P < .05). Nonetheless, there was no significant difference on the clinical outcomes between balance and imbalance subgroups at FFU at PreOP (P > .05), indicating that the change of T1SCL was not correlated to NDI and JOA at FFU.Both HS and ACDF groups showed significant clinical improvements after surgery. There was no correlation between cervical balance and clinical symptoms.     

Risk factors associated with dysphagia after anterior surgery in treatment for multilevel cervical disorder with kyphosis

This is a retrospective study. Our aim was to investigate the risk factors related to dysphagia following anterior surgery treating the multilevel cervical disorder with kyphosis based on a subgroup of follow-up time. Finally, a total of 81 patients suffering from the multilevel cervical disorder with kyphosis following anterior surgery from July 2018 to June 2020 were included in our study. Patients with dysphagia were defined as the dysphagia group and without dysphagia as the no-dysphagia (NG) group based on a subgroup of follow-up time (1-week, 1-month, 3-month, 6-month, and 1-year after surgery). Clinical outcomes and radiological data were performed to compare between dysphagia group and NG. In our study, the rate of dysphagia was 67.9%, 44.4%, 34.6%, 25.9%, and 14.8% at 1-week, 1-month, 3-month, 6-month, and 1-year after surgery, respectively. Our findings showed that change of Cobb angle of C2–7 was associated with dysphagia within 3-month after surgery. Furthermore, postoperative Cobb angle of C2–7 was linked to dysphagia within 6-month after surgery. Interestingly, a history of smoking and lower preoperative SWAL-QOL score were found to be risk factors related with dysphagia at any follow-up. In the present study, many factors were found to be related to dysphagia within 3-month after surgery. Notably, a history of smoking and lower preoperative SWAL-QOL score were associated with dysphagia at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffering from dysphagia after anterior surgery in the treatment of multilevel cervical disorder with kyphosis.     

椎前筋膜缝合预防颈椎前路减压融合内固定术后咽部不适感的效果观察

目的探讨椎前筋膜缝合预防颈椎前路减压融合内固定术后咽部不适感的效果。方法选择2012-07~2014-06在该院行手术治疗的颈椎病患者62例,半随机分为实验组和对照组各31例。实验组术中缝合椎前筋膜,对照组术中不缝合椎前筋膜。术后对两组患者咽部不适感及持续时间进行比较分析。结果两组患者术后JOA改善率之间差异无统计学意义(P0.05);实验组术后咽部不适感发生率低于对照组(P0.01),实验组患者咽部不适感持续时间短于对照组(P0.01);两组患者术后其他并发症发生率之间差异无统计学意义(P0.05)。结论椎前筋膜缝合预防颈椎前路术后咽部不适感效果明显。     

应用hybrid术式治疗多节段脊髓型颈椎病的疗效观察

目的探讨hybrid术式治疗多节段脊髓型颈椎病的疗效。方法 2011-04~2013-05对该科收治的多节段颈椎病患者37例行颈椎前路融合与非融合相结合的hybrid术式(A组),记录手术前后JOA、NDI评分、颈椎总活动度及手术节段的邻近节段的活动度,术后随访2.5年,通过与单纯融合组(B组)比较,分析其治疗效果。结果术后2.5年A、B两组患者JOA评分及改良率、NDI评分、轴性症状的构成比、颈椎总活动度、手术前后邻近节段活动度差值相比,差异有统计学意义(P0.05)。结论 hybrid术式能够保留一定节段的活动度,避免邻近节段的过度代偿导致的应力负荷增加,是治疗多个节段脊髓型颈椎病的有效方法。     

Predictive nomogram of cage nonunion after anterior cervical discectomy and fusion: A retrospective study in a spine surgery center

The cage nonunion may cause serious consequences, including recurrent pain, radiculopathy, and kyphotic deformity. The risk factors for nonunion following anterior cervical discectomy and fusion (ACDF) are controversial. The aim of the study is to investigate the risk factors for nonunion in cervical spondylotic cases after ACDF. We enrolled 58 and 692 cases in the nonunion and union group respectively and followed up the cases at least 6 months. Patient demographic information, surgical details, cervical sagittal parameters, and the serum vitamin D level were collected. A logistic regression was performed to determine the independent predictors for nonunion, which were used for establishing a nomogram. In order to estimate the reliability and the net benefit of nomogram, we applied a receiver operating characteristic curve analysis, calibration curves and plotted decision curves. Using the multivariate logistic regression, we found that age (odds ratio [OR] = 1.16, P < .001), smoking (OR = 3.41, P = .001), angle of C2 to C7 (OR = 1.53, P < .001), number of operated levels (2 levels, OR = 0.42, P = .04; 3 levels, OR = 1.32, P = .54), and serum vitamin D (OR = 0.81, P < .001) were all significant predictors of nonunion (Table ​(Table3).3). The area under the curve of the model training cohort and validation cohort was 0.89 and 0.87, respectively. The calibration curves showed that the predicted outcome fitted well to the observed outcome in the training cohort (P = .102,) and validation cohort (P = .125). The decision curves showed the nomogram had more benefits than the All or None scheme if the threshold probability is >10% and <100% in training cohort and validation cohort. We found that age, smoking, angle of C2 to C7, number of operated levels, and serum vitamin D were all significant predictors of nonunion.Table 3Univariate and multivariate logistic regression model for predicting nonunion after ACDF.

Clinical observation of Long chiropractic treatment on patients with neurogenic cervical spondylosis: Study protocol for a randomized controlled trial

Neurogenic cervical spondylosis is the most common type of cervical spondylosis, accounting for approximately 60% percent of the incidence of cervical spondylosis. Cervical spine Long manipulation and sling exercise training (SET) have obtained good therapeutic results in clinical rehabilitation. The aim of this study was to evaluate the effect of Long manipulation combined with SET on neurogenic cervical spondylosis. In this assessor-blind, randomized controlled trial, 90 eligible patients will be randomized into a combination treatment group (Long manipulation combined with SET), a Long manipulation group and a conventional massage group. The visual analogue score, the Neck Disability Index score, and muscle fatigue in the bilateral upper oblique and Musculus sternocleidomastoideus, using mean power frequency and median frequency from the surface electromyography frequency domain index, will be assessed before and after the intervention at 0 and 4 weeks, respectively. Trial registration: Registered in the Chinese Clinical Trial Registration Center with the number ChiCTR2100054978. Registered December 30, 2021.