微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

【摘要】 目的：探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法：2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位：C5/6 4例,C6/7 5例,C7/T1 3例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分（7~10分）,末次随访时为1.4±0.2分（0~3分）,两者比较有显著性差异（P<0.05）;术前NDI为26.4±1.3分（22~31分）,末次随访时为4.2±0.6分（3~8分）,两者比较有显著性差异（P<0.05）,改善率为84.1%;术前病变水平椎间盘高度为5.4±0.7mm（4.2~6.1mm）,末次随访时为4.9±0.7mm（3.6~5.8mm）,两者比较无显著性差异（P>0.05）。术后满意度为100%。结论：微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。     

Anterior cervical microforaminotomy for persistent brachialgia in a patient with multilevel cervical spondylosis; comparing PROMIS with Nurick score for outcome of surgery

Introduction and importanceThe primal instinct of neurosurgeons has been to maintain spinal stability and motion since the beginning of spinal procedures. Conventional anterior approaches without fusion eliminate motion in time as fusion invariably sets in and hampers the vertebral column's normal dynamic physiology.Case presentationWe reported a 60 years old male patient who presented with signs of myelopathy, but his primary complaint was brachialgia. He had myelopathic features for eight years, for which he offered fusion surgery at multiple levels years ago, and he denied it. He was static since then, and the disease did not progress further. For intolerable pain, he agreed to minimally invasive surgery. Therefore, we operated for a right C6 transcorporeal microforaminotomy and removed the inciting disc material.Clinical discussionClinical implication for anterior cervical microforaminotomy for this patient was successful where there was acute disc prolapse in cervical spondylotic myelopathy.ConclusionFinally, functional preservation of the cervical spine in multilevel spondylosis can optimize the fusion. In this case, the report authors have explored the comparison between the PROMIS score and the Nurick score, reporting for the first time.     

Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results

A prospective analysis of the first twenty patients operated for cervical radiculopathy by a new modification of transcorporeal anterior cervical foraminotomy technique. To evaluate early results of a functional disc surgery in which decompression for the cervical radiculopathy is done by drilling a hole in the upper vertebral body and most of the disc tissue is preserved. Earlier approaches to cervical disc surgery either advocated simple discectomy or discectomy with fusion, ultimately leading to loss of motion segment. Posterior foraminotomy does not address the more common anterior lesion. Twenty patients suffering from cervical radiculopathy not responding to conservative treatment were chosen for the new technique. Upper vertebral transcorporeal foraminotomy was performed with the modified technique in all the patients. All the patients experienced immediate/early relief of symptoms. No complications of vertebral artery injury, Horner’s syndrome or recurrent laryngeal nerve palsy were noted. Modified transcorporeal anterior cervical microforaminotomy is an effective treatment for cervical radiculopathy. It avoids unnecessary violation of the disc space and much of the bony stabilizers of the cervical spine. Short-term results of this technique are quite encouraging. Longer-term analysis can help in outlining the true benefits of this technique.     

Outcomes and technical issues of transcorporeal anterior cervical microforaminotomy in patients with cervical brachialgia

IntroductionTranscorporeal anterior cervical microforaminotomy is a motion-preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in the transuncal approach, there is a chance of vertebral artery injury and it also decreases disc height; hence, may alter the motion of that segment.ObjectiveAim is to assess the outcome of surgery and its effectiveness.MethodsA total of 40 patients were observed retrospectively of which 33 were male and 7 were female. A single study of transcorporeal anterior cervical microforaminotomy was analyzed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who were not relieved by conservative treatment over 6–8 weeks in cervical disc prolapse were included in the study. Patients having more than one level of disease, features of myelopathy, or instability were excluded from the study.ResultsAll patients were pain-free postoperatively, although after one to two months 2 out of 40 patients developed brachialgia and required anterior cervical discectomy and fusion.ConclusionTranscorporeal microforaminotomy for brachialgia is a safe and effective approach that is motion preserving and minimally invasive as well.     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review

Introduction  

There is considerable controversy as to which technique is best option for reconstruction after multilevel anterior decompression for cervical spondylosis. The aim of this study was to compare the clinical and radiographic results and complications of anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) in the treatment of multi-level cervical spondylosis.     

Anterior cervical discectomy and fusion for cervical radiculopathy and myelopathy

Anterior cervical discectomy and fusion is indicated for the operative treatment of either cervical radiculopathy orcervical myelopathy. This article discusses the indications for the procedure, as well as the advantages of this approach, compared with foraminotomy, laminectomy, as well as laminoplasty. The operative technique is described in detail, as well as the results and complications.     

Anterior cervical fusion and Caspar plate stabilization for cervical trauma

A technique for anterior cervical iliac graft fusion with standardized, commercially available screw and plate fixation (Caspar plating) has been developed. The step-by-step procedure, as well as the instruments designed to facilitate the procedure, are described in this report. Sixty cases of cervical trauma (fractures, subluxations, ligamentous instability, or a combination of these problems) were treated with Caspar plating. All patients obtained fusion, and stability was achieved immediately after surgery without external stabilization. No unusual surgical complications occurred, and the most dreaded complication of dural penetration by drilling or screw placement was not observed. This report details the neurological presentation, anatomical lesions, surgical therapy, and outcome of these patients. Caspar plating combines the advantage of an anterior surgical approach with immediate postoperative stabilization without external stabilization. This advantage persists even in the presence of posterior ligamentous instability. The technique is an important addition to the surgical treatment of cervical trauma.     

Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy

Background:Noncontiguous cervical spondylotic myelopathy (CSM) is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF) with zero-profile devices for two noncontiguous levels of CSM.Results:The mean followup was 48.59 months (range 24-56 months). The average operative time and blood loss was 105.29 min and 136.47 ml, respectively. The preoperative JOA score was 8.35, which significantly increased to 13.7 at the final followup (P < 0.01). The NDI score was significantly decreased from preoperative 13.06 to postoperative 3.35 (P < 0.01). The operation also provided a significant increase in the cervical lordosis (P < 0.01) from preoperative 10.17° to postoperative 17.06°. The fusion rate was 94.1% at 6 months postoperatively, and 100% at 12 months after surgery. The mean SWAL-QOL score decreased from preoperative 68.06 to immediate postoperatively 65.65 and then increased to 67.65 at final followup. There was a statistically significant difference between preoperative and immediate postoperatively values (P < 0.05), but none between preoperative and at final followup (P > 0.05). Cerebrospinal fluid leak, dysphagia and radiological adjacent segment degeneration occurred in one patient, respectively.Conclusion:The ACDF with zero-profile devices is generally effective and safe in treating two noncontiguous levels of CSM.     

Anterior cervical fusion. A review of thirty-three patients with cervical disc degeneration.

Thirty-three patients who had undergone anterior cervical fusion for degenerative disc disease were reviewed to determine the efficacy of the procedure. Only patients who were available for examination and who had undergone operation at least one year previously were included in the review. Nearly all had had arm pain and three-quarters neck pain. Diminished neck movement and neurological abnormalities in the arms had been frequent findings. Diagnosis from the clinical features and plain radiographs is described. Myelography was not used routinely and discography was not used at all. Indications for operation and surgical technique are described. Results show that pain in the neck and arm was relieved in a high proportion of cases and that the neurological abnormalities often recovered. It is concluded that this operation is safe and has a definite place in the relief of pain from cervical disc degeneration resistant to conservative treatment.     

Anterolateral approach for cervical spinal cord tumors via an anterior microforaminotomy: technical note.

A cervical spinal cord tumor located anteriorly to the spinal cord is conventionally approached through an anterior vertebrectomy followed by bone-graft reconstruction. In order to make a surgical approach minimally invasive, an anterior microforaminotomy technique is used for removal of a tumor located anterior to the spinal cord. When the senior author's experience increased with anterior microforaminotomy for cervical radiculopathy and myelopathy, it was observed that intradural pathology could also be taken care of through the anterior microforaminotomy which did not require bone fusion or postoperative immobilization. For tumor resection, the anterior foraminotomy is made like a flask-shaped hole, with a smaller outer opening similar to that for radiculopathy but incorporating a larger inner opening to accommodate the extent of the tumor in a longitudinal and transverse dimension. The surgical technique is described with two illustrated patients. Postoperatively, the patients did not require a cervical brace. Although their postoperative discomfort was minimal, they were kept in the hospital overnight postoperatively. Spinal stability was well maintained 6 weeks postoperatively. Postoperative imaging of the spine confirmed resection of the tumors. Anterior microforaminotomy is a minimally invasive microsurgical technique which can provide safe and successful removal of tumors located anteriorly to the spinal cord.     

应用颈椎前路动态ABC钢板促进颈椎椎体间融合

目的观察颈椎前路动态ABC钢板促进颈椎椎体间植骨融合的疗效。方法对40例患者（68个节段）行颈椎前路椎间盘摘除、椎体间自体髂骨植骨、ABC钢板内固定术。术后观察ADL评分，颈椎曲度、椎体间融合及融合植骨块下沉情况。结果40例均获随访，时间12—44（22．17±8．33）个月。ADL评分术前2～13（7．92±3．07）分，术后8—17（13．94±2．48）分，改善明显。术后无钢板、螺钉断裂或松动现象发生。39例颈椎生理性前凸获得良好改善，仅1例术后3个月融合椎体邻近节段发生反曲，患者颈部无不适症状。68个融合节段中，67个节段6个月内融合，1个节段延迟至术后12个月时方融合。术后3个月内，单节段融合植骨块下沉平均（1．21±0．54）mm，2节段平均（2．01±0．87）mm，3节段平均（2．97±0．82）mm。3个月后各节段下沉不再明显。结论应用动态ABC钢板可以降低植骨后相关并发症的发生，有效避免静态钢板造成的应力遮挡，从而促进颈椎椎体间的融合。     

Anterior cervical corpectomy

Anterior cervical corpectomy and fusion serves as a powerful surgical technique in the treatment of complex cervical spine pathology including multilevel cervical myelopathy, cervical trauma, cervical infection, and neoplastic disease. Determining the optimal approach for treatment involves assessing the need for spinal cord decompression and restoration of structural stability. A number of factors or measurements have been described to assist in determining the best treatment approach for a given pathology. Similar anterior cervical techniques may be utilized whether performing a single or multilevel corpectomy although supplemental posterior instrumentation and fusion should be considered for multilevel corpectomy cases due to increased failure rates with anterior cervical plating alone. Attention to detail and an appropriate degree of vigilance can help surgeons minimize risk, recognize potential complications, and deliver optimal patient care in these often complex and challenging patients.     

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.     

Anterior cervical decompression and fusion for a single-level cervical disc herniation

Cervical radiculopathy is a clinical diagnosis consisting of sensory and/or motor symptoms in a nerve root distribution of the upper extremity. Operative management is frequently required to relieve symptoms. Anterior cervical decompression and fusion (ACDF) was originally described by Smith and Robinson and has been shown to be a relatively safe treatment approach to the cervical spine. Modern advances have helped to improve outcomes and decrease complications, including the development of bone grafting techniques, cage constructs, and augmentation of grafting with anterior plating systems. Anterior plating serves to increase fusion rates and maintain sagittal alignment. Despite advancements, complications still exist, including dysphagia, dural tear, adjacent segment disease, esophageal perforation, hardware failure, and recurrence of symptoms. We have reviewed the literature and shown that for single-level radiculopathy of a nerve root in the cervical spine, ACDF with plating is a favorable surgical treatment.     

颈前路撑开提拉复位法治疗外伤性颈椎脱位

目的探讨外伤性颈椎脱位的改良复位术式及应用价值。方法对24例外伤性颈椎脱位采用前入路撑开提拉复位并行植骨内固定。采用日本骨科协会评分(JOA)、疼痛视觉模拟评分(VAS)对术前和术后1周、3个月、6个月、12个月、48个月治疗效果进行评定。结果所有患者获得随访3~48个月,术后颈椎脱位矫正率、受损椎体间高度及颈椎稳定性恢复良好、颈椎生理曲度和内固定装置位置良好,植骨融合;脊髓功能恢复情况:B级2例,C级3例,D级10例,E级9例。术后1周~48个月VAS、JOA评分均较术前明显改善,差异有统计学意义(P0.01)。结论前路撑开提拉复位法可早期对颈椎脱位进行有效复位,前路植骨内固定术后并发症少,减少受损神经细胞的死亡,进一步保护了神经功能,术后缩短了神经功能的恢复时间,适合临床推广应用。     

Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine

A retrospective review of the surgical experience in treating 18 patients with osteomyelitis of the cervical spine is reported. The patients ranged in age from 20 to 60 years and all complained of neck pain upon admission. Ten patients had a prior history of intravenous drug abuse, three had previously suffered penetrating injuries of the neck, and one had an extraspinal site of osteomyelitis. Bacteria were isolated in 13 cases and tuberculosis in three. Neurological abnormalities were present in over one-half of the patients, consisting of myelopathy (nine cases) or radiculopathy (four cases). Plain cervical spine films and polytomography demonstrated vertebral and end-plate destruction, spinal instability, and increased paravertebral soft-tissue shadow in all cases. Computerized tomography and, more recently, magnetic resonance imaging have proven helpful in detecting bone involvement and the presence of epidural extension associated with cervical osteomyelitis. The risk of vertebral body collapse, kyphosis, and myelopathy in the osteomyelitic cervical spine has standardized the management of this problem in this institution to consist of skeletal traction, needle aspiration or blood culture for organism identification, anterior cervical debridement, autogenous iliac graft fusion, and intravenous administration of antibiotics. Spinal stability and neurological improvement were achieved in all 18 patients.