Combined single‐level subtotal corpectomy and decompression for cervical spondylotic myelopathy treatment

Background: The purpose of this study was to summarize outcomes of patients with refractory multisegmental cervical spondylotic myelopathy (CSM) who were treated by combined single‐level subtotal corpectomy and decompression of the intervertebral space using the anterior approach. Methods: Forty‐five consecutive patients with multisegmental CSM were included; their ages ranged from 37 to 72 years. Seventeen (37.8%) patients had noncontiguous or ‘jumping’ multisegmental CSM and 28 (62.2%) had contiguous multisegmental CSM. The mean preoperative Japanese Orthopedic Association (JOA) score was 8.1 points. All patients underwent combined single‐level decompression of the involved intervertebral space and subtotal corpectomy together with subsequent fusion and internal fixation. An anterior approach was used for all patients. A cage filled with bone graft was inserted and internal fixation was performed after single‐level intervertebral space decompression. Mesh filled with bone graft was inserted and plate internal fixation was performed after subtotal corpectomy. Results: Follow‐up data (average follow‐up, 14 months) were available for all 45 patients; the mean postoperative JOA score was 13.2 points, which was significantly different from the preoperative JOA score. Bony fusion was achieved in all patients based on postoperative radiography, and no pseudoarthrosis was observed during follow‐up. Conclusions: An excellent outcome can be achieved with the combination of single‐level subtotal corpectomy and decompression of the intervertebral space using the anterior approach to treat multisegmental CSM.     

Functional outcome of corpectomy in cervical spondylotic myelopathy

Background:

Cervical spondylotic myelopathy (CSM) is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure.

Materials and Methods:

Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rate was calculated.

Results:

Preoperative patients had a mean Nurick''s grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years).The complications included one case (4.17%) of radiculopathy, two cases (8.33%) of graft displacement, and two cases (8.33%) of screw back out/failure.

Conclusions:

Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.     

两种颈椎前路减压融合术治疗脊髓型颈椎病的临床疗效分析

[目的]回顾性分析比较椎间盘切除减压融合术(ACDF)和椎体次全切除减压融合术(ACCF)在治疗相邻两个节段脊髓型颈椎病的临床疗效及影像学数据.[方法]2005年4月～2007年8月,采用ACDF和ACCF治疗相邻两个节段脊髓型颈椎病156例.临床疗效采用日本骨科学会评分系统(JOA评分)对术前、末次随访的临床疗效进行评价.比较两组患者I临床疗效及手术时间、住院大数、术中失血量、颈椎活动度、颈椎曲度及节段性高度.[结果]两组的临床改善优良率无显著性差异(P＞0.05),ACDF组与ACCF组术中平均出血量及手术时间有显著性差异(P＜0.01),ACCF较ACDF增加,而ACCF组术后的节段性高度及颈椎前凸角较ACDF组明显降低(P＜0.01).[结论]ACDF与ACCF均能达到良好的手术疗效,然而ACDF在减少术中出血量、手术时间,改善和维持术后颈椎前凸角度及节段性高度较ACCF作用明显,但ACDF要求技术较高,有较长的学习曲线.     

颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病

目的探讨颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗脊髓型颈椎病的临床疗效。方法对36例双节段脊髓型颈椎病患者采用颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗。对术前和术后6、12个月的JOA评分进行比较,计算术后6、12个月的神经功能改善率,评价术后植骨融合情况。结果 36例均获随访,时间12~18个月。JOA评分:术前为8.8分±1.0分,术后6个月为12.8分±1.6分,术后12个月为13.2分±1.4分,术后6、12个月与术前比较差异均有统计学意义(P0.01)。改善率:术后6、12个月分别为56.6%±9.8%和57.9%±10.1%。术后3个月31例(86.1%)植骨融合,术后6个月36例全部植骨融合。结论颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病疗效确切。     

Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

Purpose

To document the neurological outcome, spinal alignment and segmental range of movement after oblique cervical corpectomy (OCC) for cervical compressive myelopathy.

Methods

This retrospective study included 109 patients—93 with cervical spondylotic myelopathy and 16 with ossified posterior longitudinal ligament in whom spinal curvature and range of segmental movements were assessed on neutral and dynamic cervical radiographs. Neurological function was measured by Nurick’s grade and modified Japanese Orthopedic Association (JOA) scores. Eighty-eight patients (81%) underwent either a single- or two-level corpectomy; the remaining (19%) undergoing three- or four-level corpectomies. The average duration of follow-up was 30.52 months.

Results

The Nurick’s grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). The mean postoperative segmental angle in the neutral position straightened by 4.7 ± 6.5°. The residual segmental range of movement for a single-level corpectomy was 16.7° (59.7% of the preoperative value), for two-level corpectomy it was 20.0° (67.2%) and for three-level corpectomies it was 22.9° (74.3%). 63% of patients with lordotic spines continued to have lordosis postoperatively while only one became kyphotic without clinical worsening. Four patients with preoperative kyphotic spines showed no change in spine curvature. None developed spinal instability.

Conclusions

The OCC preserves segmental motion in the short-term, however, the tendency towards straightening of the spine, albeit without clinical worsening, warrants serial follow-up imaging to determine whether this motion preservation is long lasting.     

ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病

目的探讨颈前路椎体次全切除减压融合术(ACCF)联合颈前路减压zero-p椎间植骨融合内固定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2016-05—2017-07采用ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗的30例多节段脊髓型颈椎病,比较术前、术后1周及末次随访时JOA评分、颈椎Cobb角、椎间隙高度。结果30例均顺利完成手术并获得完整随访,随访时间平均21.6个月,切口均一期愈合,植骨均骨性愈合,无内固定松动、移位、断裂、伤口感染、声音嘶哑及神经功能加重等并发症。术后1例出现脑脊液漏,2例出现吞咽不适,非手术治疗后均治愈。术后1周与末次随访时JOA评分、颈椎Cobb角、椎间隙高度较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时根据JOA评分改善率评定综合疗效:优12例,良14例,可4例。结论ACCF联合颈前路减压zerop椎间植骨融合内固定术治疗多节段脊髓型颈椎病安全可靠,能够有效地恢复椎间隙高度和颈椎生理曲度。     

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Purpose

We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).

Methods

A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared.

Results

Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups.

Conclusions

Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.     

颈前路椎体次全切除联合椎间隙减压融合治疗多节段脊髓型颈椎病

目的:探讨多节段颈椎病颈前路椎体次全切除联合椎间隙减压融合内固定术的疗效。方法 :对2012年10月至2014年6月行颈椎前路治疗的28例脊髓型颈椎病的临床资料进行回顾性分析,其中男18例,女10例;年龄45~77(60.11±9.37)岁;27例患者病变累及3个节段,1例累及4个节段;术前JOA评分为8.89±1.87,拟融合节段Cobb角为(4.87±4.56)°,颈椎曲度为(11.68±1.25)°,均行颈椎前路椎体次全切除联合椎间隙减压融合内固定术。通过影像学资料测量术后1、12个月时的融合节段Cobb角、颈椎曲度,并采用JOA评分评价疗效。结果:手术时间120~205 min,平均163 min;术中出血量100~300 ml,平均198 ml;术后1例患者出现声音嘶哑,术后3周恢复正常;1例出现饮水呛咳,术后1周恢复正常。28例患者均获得随访,时间12~24(18.46±3.20)个月。术后12个月植骨椎间隙均获骨性愈合,内固定物位置良好。术后1、12个月时融合节段Cobb角与颈椎曲度及JOA评分均较术前明显改善(P0.05)。术后12个月JOA评分改善率为(46.46±20.26)%,手术疗效根据改善率评定:优12例,良14例,好转2例。结论:颈椎前路椎体次全切除联合椎间隙减压融合内固定术治疗多节段颈椎病效果满意。     

脊髓型颈椎病合并Meige综合征2例

病例1：男,43岁。因四肢麻木无力,进行性加重1个月就诊。查体：双侧C4以下痛觉减弱,双上肢肌力为3级,下肢肌力左侧4级、右侧3级。X线检查示：颈椎诸椎体边缘骨质增生,椎体结构及椎间隙显示欠佳。MRI检查示：C3-4、C4-5椎间盘突出。3D—CT检查示：C3-4、C4-5椎间盘局限向后突出,椎后脂肪间隙消失,硬膜囊受压。     

综合疗法治疗非脊髓型颈椎病的临床研究

目的探讨综合疗法治疗非脊髓型颈椎病的临床疗效。方法 210例非脊髓型颈椎病患者分为3组,治疗组70例,行综合疗法（颈椎牵引、推拿、微波、药物、功能锻炼）治疗;对照组70例,行颈椎牵引、电脑中频治疗、功能锻炼;牵引组70例,仅给予颈椎牵引治疗;治疗15天后,采用数字疼痛评分（NRS）、颈部残障指数（NDI）及临床疾病诊断依据治愈好转标准评价临床疗效。结果平均随访8月,三组临床疗效比较,治疗组疗效优于对照组（P〈0.05）,对照组疗效优于牵引组（P〈0.05）,治疗组疗效明显优于牵引组（P〈0.01）。结论对于非脊髓型颈椎病治疗,选择综合疗法疗效明显优于单一疗法,本综合疗法治疗颈椎病安全简便、疗效显著,是颈椎病理想的治疗方法。     

前路椎间盘切除减压融合与椎体次全切除减压融合治疗多节段颈椎病疗效比较

目的比较前路椎间盘减压融合(ACDF)与前路椎体次全切除减压融合(ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间:观察组(128.3±32.4)min,对照组(163.2±43.6)min;术中出血量:观察组(161.4±122.5)ml,对照组(319.2±308.7)ml;以上指标观察组均少于对照组(P0.05)。术后住院时间:观察组(8.1±3.6)d,对照组(9.5±4.2)d;术后6个月时JOA评分:观察组(12.1±2.2)分,对照组(11.7±2.1)分;颈椎总活动度:观察组26.6°±7.3°,对照组30.5°±8.1°;以上指标两组间差异无统计学意义(P0.05)。术后颈椎曲度:观察组23.5°±7.4°,对照组16.1°±7.2°;椎间节段性高度:观察组5.6°±0.4°,对照组4.7°±0.8°;以上指标两组比较差异有统计学意义(P0.05)。结论 ACDF较ACCF手术时间短、术中出血量少、颈椎生理弯曲和椎间节段高度恢复更好。     

脊髓型颈椎病的手术方案选择

脊髓型颈椎病是指由于颈椎退行性改变导致颈髓受压而引起的综合征,常伴脊髓功能异常。手术治疗是解决颈髓受压最确切而有效的手段。该文结合颈椎常见手术的适应证、禁忌证及相关并发症,简要探讨颈椎常见手术的优缺点,以期为临床医师提供参考。     

前路联合术式与后路单开门治疗3节段脊髓型颈椎病的疗效观察

目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。     

Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis

Background

Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP).

Objective

To perform a systematic review and meta-analysis evaluating the results of anterior CORP compared with posterior LAMP for patients with multilevel cervical myelopathy.

Methods

Systematic review and meta-analysis of cohort studies comparing anterior CORP with posterior LAMP for the treatment of multilevel cervical myelopathy due to CSM or OPLL from 1990 to December 2012. An extensive search of literature was performed in Pubmed, Embase, and the Cochrane library. The quality of the studies was assessed according to GRADE. The following outcome measures were extracted: pre- and postoperative Japanese orthopedic association (JOA) score, neurological recovery rate (RR), surgical complications, reoperation rate, operation time and blood loss. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis was conducted according to the mean number of surgical segments.

Results

A total of 12 studies were included in this review, all of which were prospective or retrospective cohort studies with relatively low quality. The results indicated that the mean JOA score system for cervical myelopathy and the neurological RR in the CORP group were superior to those in the LAMP group when the mean surgical segments were <3, but were similar between the two groups in the case of the mean surgical segments equal to 3 or more. There was no statistical difference in the surgical complication rate between the two groups when the mean surgical segments <3, but were significantly higher incidences of surgical complications and complication-related reoperation in the CORP group compared with the LAMP group in the case of the mean surgical segments equal to 3 or more. Besides, the operation time in the CORP group was longer than that in the LAMP group, and the average blood loss was significantly more in the CORP group compared with the LAMP group.

Conclusion

Based on the results above, anterior CORP and fusion is recommended for the treatment of multilevel cervical myelopathy when the involved surgical segments were <3. Given the higher rates of surgical complications and complication-related reoperation and the higher surgical trauma associated with multilevel CORP, however, it is suggested that posterior LAMP may be the preferred method of treatment for multilevel cervical myelopathy when the involved surgical segments were equal to 3 or more. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw a strong conclusion claiming superiority for CORP or LAMP. A well-designed, prospective, randomized controlled trial is necessary to provide objective data on the clinical results of both procedures.     

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

Purpose

To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial follow-up.

Methods

We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan’s system graded anterior osteophyte formation. Neurological function was measured by Nurick’s grade and modified Japanese Orthopedic Association (JOA) scores.

Results

The majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick’s grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). 17 % of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77 % of the whole spine ROM and 62 % of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2° and 10.9°, respectively (p ≤ 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan’s grade showed increase in osteophytosis in more than two-thirds of the patients (p ≤ 0.01). The whole spine range of movement at follow-up significantly correlated with Nathan’s grade.

Conclusions

Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.     

Anterior surgical treatment for cervical spondylotic myelopathy

Cervical spondylotic myelopathy is a disease of the cervical spine causing spinal cord compression secondary to spondylosis or ossification of the posterior longitudinal ligament. Anterior surgical options include anterior cervical discectomy and fusion, cervical corpectomy, and cervical disc arthroplasty. The surgeon must choose the right surgical option to decompress the cord, restore cervical lordosis, and adequately stabilize the spine. Although these surgical procedures are considered to be highly successful, each one is associated with complications. One must exercise great care when performing anterior cervical surgery and discuss with each patient the risks and benefits of the procedures.     

脊髓型颈椎病的非手术治疗

目的阐述早期、中期脊髓型颈椎病(CSM)可首选非手术治疗。方法研究1990年2001年共收治的CSM病人426例,执行严格的诊断、纳入标准,采用颈牵、推拿、药物等综合治疗。结果426例CSM患者的近期疗效的优良率为67．11％,好转率为97．67％,并对其中的169例进行1年至7年11个月的随访,平均随访2年8个月,优良率78．70％,好转率98．22％,在随访患者中有30例治疗前后颈椎MRI对比,显示15例患者颈椎间盘达到部分还纳,其余15例无明显变化,426例CSM患者中未出现1例并发症。结论非手术治疗早、中期CSM安全,有效,患者痛苦小。     

前路跳跃式减压在4节段脊髓型颈椎病临床疗效分析

目的评价前路跳跃式减压植骨融合术治疗4节段脊髓型颈椎病的临床疗效。方法对16例4节段脊髓型颈椎病患者采用跳跃式减压,保留颈5椎体,切除颈4、6椎体的分节段减压。分析手术时间、术中出血量、术后6个月植骨融合率、JOA评分改善率,节段性前突角度。结果所有患者均获随访,平均18个月。手术时间130～260min,平均180min;术中失血约300～800ml,平均650ml;术后颈椎X—RAY提示均恢复颈椎生理曲度,及椎间高度;6个月植骨融合率93．75％。无植骨块脱m或钛笼下沉、钢板螺钉断裂松脱、脑脊液瘘及感染等严重并发症发生。术后3、6个月及术后1年JOA评分为（13．6±1．3）、（13．9±1．1）、（14．O±0．8）分（P〈0．05）,术后3、6个月平均改善率为56．4％、60．2％、61．5％。节段性前突角度术前（9．38＋3．0）,术后（16．22＋1．9）。（P〈0．05）。结论颈椎前路跳跃式减压植骨融合术治疗四节段脊髓型颈椎病是较好的手术方式,具有更多优点。     

Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy

Summary One hundred and fourteen patients were admitted to our department for evaluation of their cervical spondylogenetic symptoms, including local cervical pain, radiculopathy and myelopathy. This retrospective study gives the results, expressed as improved, unchanged or worse, of anterior surgery, posterior surgery and conservative treatment. Local cervical pain improved in about half of the patients, without any difference between the groups. The effect of surgery on radiculopathy was superior to that of conservative treatment, 71 percent and 74 percent respectively, being improved after anterior and posterior surgery, compared to 19 percent in the conservatively treated group. The majority of patients with myelopathy were treated with posterior surgery and 69 percent had improved. The results were not influenced by the patients age or the duration of symtoms. It is argued that the positive effects of surgery on the radiculopathy are due to a segmental stabilisation rather then to decompression. The immediate post-operative improvement of the myelopathy is undoubtedly caused by the decompression while the long-termed improvement cannot with certainty be attributed to the operation.