颈椎牵引预矫形结合手术矫形治疗重度颈椎后凸畸形

目的 :研究颈椎牵引预矫形结合手术矫形与单纯手术矫形治疗重度颈椎后凸畸形的疗效,探讨重度颈椎后凸畸形的治疗策略。方法:回顾性分析2003年3月~2017年3月,在我院接受手术治疗的大于40°的重度颈椎后凸畸形患者共32例,男24例,女8例。年龄5.9~63.4岁,平均19.5±12.2岁。根据治疗方案是否行牵引预矫形分为牵引组及非牵引组。牵引组26例,其中4例为颅骨牵引,22例为颈椎平衡悬吊牵引,6例先行颈椎松解手术、而后采用牵引预矫形,最后进行颈椎矫形内固定融合手术。非牵引组6例,单纯采用颈椎矫形内固定融合手术。测量及记录所有患者治疗前、矫形手术(前路、后路或前后联合入路矫形融合内固定手术)后出院前(术后2周左右)、末次随访时,以及牵引组患者牵引后(矫形手术前)不同时间点的颈椎后凸节段的后凸角、JOA脊髓功能评分并进行比较。结果 :本组32例后凸角由治疗前73.5°±26.5°矫正至术后16.6°±17.2°,最终矫正率平均(79.8±19.0)%,术后与治疗前存在统计学差异(P0.05)。治疗前JOA评分11.9±4.5分,术后JOA评分15.2±2.9分,有统计学差异(P0.05)。治疗前牵引组的后凸角(77.9°±26.5°)明显大于非牵引组(54.7°±18.2°,P0.05),但是牵引组的手术矫正率(81.7±17.9)%高于非牵引组(73.4±25.8)%,存在统计学差异(P0.05)。采用平衡悬吊牵引的牵引预矫正率(70.3±18.7)%及手术后的最终矫正率(83.8±14.4)%与采用颅骨牵引的相应指标(52.2±21.8)%、(70.4±32.1)%相比,差异无统计学意义(P0.05)。结论 :对于重度颈椎后凸畸形,采用颈椎牵引预矫形,结合前路、后路或者前后联合入路矫形固定融合手术,可以取得良好的矫形效果。     

重度颈椎后凸畸形病人平衡悬吊牵引的护理

目的 总结重度颈椎后凸畸形病人平衡悬吊牵引的护理措施,探讨平衡悬吊牵引的护理经验与体会.方法 回顾性分析2017年3月至2020年7月,术前接受平衡悬吊牵引预矫形的17例重度颈椎后凸畸形病人的临床资料.牵引过程中,对病人采取不良反应的观察与处理、平衡悬吊牵引管理、心理疏导和舒适护理等系统的护理干预措施.观察病人牵引前后...     

多发颈椎不连综合征的影像学特点与外科诊疗策略

【摘要】 目的：分析多发颈椎不连综合征（multilevel cervical disconnection syndrome,MCDS）的影像学特点及外科诊疗策略。方法：2004年3月~2021年6月,我院收治MCDS患者共7例,男性3例,女性4例;年龄5~46岁（中位年龄12岁）。7例MCDS患者中,平均椎体发育不良节段数3.6±1.3个节段,平均椎弓不连节段数5.7±1.5个节段,局部后凸角平均-92.2°±20.2°,C2-7 Cobb角平均-68.6°±31.0°,T1倾斜角（T1 slope,T1S）平均-12.5°±12.5°,后凸顶点位于C4节段1例,C5节段5例,T1节段1例;术前改良日本骨科学会评分（mJOA评分）8.5~14分（平均12.6±2.1分）,其中1例患者伴有吞咽困难。记录患者预矫形方式及手术方式,入院时、预矫形后、术后及末次随访影像学参数,神经功能及并发症。结果：1例术前接受颅骨牵引,3例接受平衡悬吊牵引,3例接受联合牵引,经术前牵引预矫形后,局部后凸角矫正率为60.8%。1例接受手术松解、Halo-vest外固定治疗,1例接受前路矫形内固定手术,1例接受后路矫形固定融合术,4例接受前-后联合手术治疗,手术固定6.0±2.1个节段,2例患者出现术后神经系统并发症,接受翻修手术。术后随访时间6~84个月（41.2±32.0个月）,末次随访局部后凸角平均-27.9°±11.6°,矫正率69.7%,C2-7 Cobb角平均-13.3°±28.4°,T1S平均4.9°±17.9°;术后mJOA评分10.5~17分（15.7±2.3分）,改善率78.3%。对比手术前后临床及影像学指标,mJOA评分、C2-7后凸角、局部后凸角及T1S有统计学差异。结论：MCDS影像学上主要表现为前方椎体发育不良伴多节段椎弓不连,继发严重后凸畸形。治疗策略可采取术前牵引预矫形并前路多节段椎体切除重建、后路长节段固定融合。     

重度僵硬型非角状颈椎后凸畸形的手术治疗

目的探讨重度僵硬型非角状颈椎后凸畸形的手术治疗方法.方法2004年1月～2006年7月对8例重度僵硬型非角状颈椎后凸畸形的患者先行颅环弓牵引7～16 d,平均10d,待后凸畸形矫正率超过30%时,再行后路小关节松解植骨钉棒矫形内固定术.根据人院时、牵引后、术后10d、术后6个月时颈椎的标准侧位X线片,测量后凸Cobb角;以JOA评分评估神经功能改善情况;随访观察治疗效果.结果随访6～36个月,平均19.4个月,所有病例未发生手术相关并发症,均获骨性融合.JOA评分由术前的平均10.3分改善至术后6个月时的14.0分,改善率为55.2%.人院时颈椎平均Cobb角为44.4°,牵引后平均Cobb角为26°.术后10d平均Cobb角为-4.1°,术后6个月随访时平均Cobb角为-3.6°.牵引后Cobb角与人院时相比具有显著性差异(P＜0.05),术后10d时Cobb角与术前相比具有显著性差异(P＜0.05),术后6个月时Cobb角与术后10d比较无统计学差异(P＞0.05).结论先进行规范的颈椎牵引,后行小关节松解植骨钉棒矫形内固定术治疗重度僵硬型非角状颈椎后凸畸形方法可行,疗效满意.     

快速成型技术在重度先天性脊柱畸形矫形手术中的应用

目的：探讨快速成型技术在重度先天性脊柱畸形矫形手术中的应用价值。方法：2005年1月～2007年7月对34例重度先天性脊柱畸形患者进行术前CT扫描、数字化三维重建。将数据导入MEM-300-E熔融挤压快速成型设备构建脊柱模型，直观评估脊柱畸形情况，设计手术方案。其中半椎体畸形22例，椎体分节不全、腰椎严重后凸6例，半椎体合并分节不全等混合畸形6例；胸椎（T2～T10）7例，胸腰段（T1l-L2）18例，腰椎（L3～L5）9例；合并脊髓低位或拴系5例，脊髓空洞和骨性纵裂1例；术前侧凸Cobb角50^o-125^o（平均750）。后凸50^o～110^o（平均78^o）。均采用单纯后路畸形矫正及全节段椎弓根螺钉固定技术，将消毒后的快速成型脊柱模型于术中指导手术进行。术后复查脊柱X线平片及CT三维扫描。并于术后再次进行快速成型构建矫形后脊柱模型。结果：手术时间3．5～7h，平均4．5h；术中失血400～1500ml，平均1100ml；未出现脊髓、神经及血管损伤等并发症。术后三维CT扫描示矫形和内固定效果满意，椎弓根螺钉位置良好。27例42个先天性半椎体切除彻底，术后侧凸Cobb角5^o-25^o（平均16^o），侧凸畸形矫正率为80％～98％，后凸畸形矫正率为100％，生理曲度恢复正常；7例经椎弓根楔形截骨矫正的先天性腰椎后凸畸形患者矫形效果满意，腰椎生理前凸恢复正常。术后随访3～24个月．平均9个月。随访期间矫正率丢失不明显。结论：脊柱快速成型能够直观地反映脊柱畸形情况．可指导术前评估、手术计划制定。对手术矫形和内固定操作具有较好的指导意义。     

特发性颈椎后凸畸形的手术治疗

目的探讨颈前路撑开的矫形方式治疗特发性颈椎后凸畸形的可行性和疗效。方法对12例特发性颈椎后凸畸形患者均采用颈前路椎间盘切除减压、椎间隙植骨融合和前路钛板内固定治疗,其中男性5例,女性7例;年龄18～34岁,平均24.3岁。5例难复性患者术前先行颅骨牵引适当行颈部软组织松解,术中给予颈椎过伸位牵引以帮助恢复正常的颈椎生理曲度。结果手术后患者临床症状、体征明显改善,颈椎后凸畸形矫正效果明显;术后随访表明颈椎矫正度数在随访中没有明显丢失,内固定位置良好无松动。所有患者均未发生与手术有关的并发症。结论颈椎前路手术通过延长颈椎前柱,可矫正颈椎的后凸畸形,明显改善临床症状和体征,是治疗特发性颈椎后凸畸形的可行方法。     

特发性颈椎后凸畸形的手术治疗

目的 :明确颈椎前路手术治疗特发性颈椎后凸畸形的可行性和局限性。方法 :本文对 14例颈椎特发性后凸畸形患者采取手术方法进行治疗 ,所有患者均采用颈椎前路椎间盘切除减压 ,椎间隙植骨和前路钢板内固定。结果 :手术后患者临床体征明显改善 ,颈椎后凸畸形由手术前平均 -15 6°矫正为手术后平均 -6 4° ,矫正效果明显 ;手术后患者的短期随访表明颈椎矫正度数在随访中没有丢失。结论 :前路手术 ,延长颈椎前柱能够矫正颈椎的后凸畸形 ,改善临床症状和体征     

后路楔形截骨矫形治疗重度结核性胸腰椎后凸或侧后凸畸形

目的评价后路楔形截骨矫形治疗重度胸腰椎结核性后凸或侧后凸畸形的疗效和安全性。方法结核性重度胸腰椎后凸或侧后凸畸形14例，男10例，女4例；年龄17-62岁，平均29．8岁。畸形位于胸椎8例，胸腰段5例，腰椎1例；累及2椎1例，3-5椎11例，5椎以上2例。12例合并神经损害，5例为Frankel C级，7例为D级。均行后路楔形截骨、多棒顺序矫形固定融合术。术前、术后及随访时摄站立位全脊柱X线片，测量矢状面、冠状面胸椎后凸、腰椎前凸Cobb角及躯干矢状偏移距离，记录脊柱融合固定节段和融合情况。结果均获随访15-74个月，平均31．9个月。融合固定节段为8-16个椎体，平均11-3个。矢状面Cobb角由术前平均108．2^o矫正至32．1^o，矫正率70-3％。冠状面Cobb角由术前平均14．4^o矫正至2．0^o。胸椎后凸由术前平均14．9^o矫正至17．9^o，平均矫正38．6^o。腰椎前凸由术前平均66．0^o矫正至36．6^o，平均矫正30-3^o。躯干矢状偏移距离由术前平均-15．4mm矫正至-0．6mm，平均矫正21．2mm。术后神经功能均获改善，平均提高1级。围手术期主要并发症包括胃肠功能障碍2例，术中椎板骨折2例，胸膜破损4例，二次手术4例。结论对重度胸腰椎结核性后凸或侧后凸畸形采用后路楔形截骨矫形及内固定是较为安全、有效的方法。融合范围选择和截骨矫形技术是成功的关键。     

青少年脊柱侧凸的后路CDH Legacy矫形内固定技术与疗效

[目的]探讨脊柱侧凸后路CDH Legacy在脊柱侧凸后路矫形中的应用及其矫形效果。[方法]2003年7～8月，共有9例患者接受后路CDH Legacy矫形内固定加植骨融合手术，其中女7例，男2例；年龄11～18岁，平均13．5岁。病因学分类：青少年特发性脊柱侧凸（AIS）7例，先天性脊柱侧凸（CS）1例，神经纤维瘤病伴脊柱侧凸（NFI）1例。术前Cobb＇s角48^o～68^o，平均54^o。7例AIS和1例CS患者直接行一期后路CDH Legacy矫形内固定术，另1例NFI因Risser为0，先行一期前路骨骺阻滞再行二期后路CDH Legacy矫形固定。[结果]本组无死亡、感染，无神经系统并发症。未发生术中骨折及脊膜胸膜损伤。1例并发肠系膜上动脉综合征，给予禁食等保守治疗后症状缓解。手术时间210～300min，平均260min；出血量300～1000ml，平均700ml。术后Cobb’s角平均20^o，矫正率63％。本组随访20～30个月，平均23个月，随访1年时均获得骨性融合，无额状面或矢状面失偿，纠正丢失4^o，纠正丢失率7．4％。[结论]CDH Legacy在矫形效果与以往第3代内固定系统无明显差异，有操作简便、内固定牢固和选择多样性的特点。     

重度颈椎后凸畸形的手术治疗

目的回顾性分析颈椎后凸畸形的外科治疗策略及临床疗效。方法1998至2005年间，16例重度颈椎后凸畸形（Cobb角平均为36^o）的患者接受手术治疗，颈椎后路椎板切除术后10例（7例多节段脊髓型颈椎病，3例脊髓型颈椎病合并后纵韧带骨化），青少年神经纤维瘤病合并后凸畸形2例，颈椎严重退变性后凸畸形2例，颈前路术后塌陷1例以及颈椎感染后畸形1例。手术策略分别为前路矫形与前后路联合矫形，对于畸形僵硬者辅以后路截骨，术中应用运动诱发电位（MEP）监测。术后通过影像学评估及JOA评分对手术效果进行评价。结果全部患者均得到随访，平均随访2．5年（2．0-5．8年）。影像学随访显示在术后1年均获得骨性融合，JOA评分由术前（10．5±1．8）分改善至术后（15．8±2．4）分（P〈0．01），末次随访（15．1±1、7）分。2例患者术后颈部疼痛加重，1例术后出现肩部疼痛，经对症保守治疗后症状均有所缓解；1例切口血肿，经过应用止血药、穿刺抽吸后好转，2周后血肿吸收。术后5例患者神经症状完全缓解，9例有不同程度地改善，2例与术前相比无明显变化。术后畸形明显改善，平均Cobb角-1．6^o，末次随访矫形维持较好。结论对于重度颈椎后凸畸形，术前仔细评估、选择恰当的手术策略、术中脊髓监测、较为熟练的外科技术均是获得良好疗效的前提条件，由于疾病本身病理生理改变及手术方式较为复杂，远期疗效有待于进一步观察。     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.     

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.     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩

目的 观察颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩的临床效果.方法 笔者单位1988-2011年收治颈前区烧伤后瘢痕挛缩患者66例.采用颈横动脉颈段皮支皮瓣修复患者颈部瘢痕,包括岛状皮瓣55例(其中9例行预扩张)、非岛状皮瓣11例(其中1例行预扩张).术中先切除、松解患者颈部瘢痕,在锁骨上、下及前胸区设计颈横动脉颈段皮支皮瓣,其轴心血管为颈横动脉在胸锁乳突肌、肩胛舌骨肌交界处穿出的皮动脉.皮瓣后界达斜方肌前缘,外侧界达三角肌中段,内侧界达胸骨中线,下界达乳头下3.0 ～4.0 cm处.术中先切开皮瓣外、下、内缘,锐性分离达锁骨平面后改为钝性剥离,分离到蒂部后,分离深度以皮瓣旋转后可无张力覆盖创面为度.其中预扩张的皮瓣供区直接拉拢缝合,非预扩张皮瓣供区植皮封闭.结果 本组患者中64例术后皮瓣成活良好;2例术后皮瓣下血肿致尖端部分坏死,经补充植皮后治愈;供区均愈合.所有皮瓣色泽、质地与周围组织匹配良好;皮瓣感觉功能术后初期恢复为胸部感觉,6个月后完全恢复为颈部感觉.结论 颈横动脉颈段皮支皮瓣血供恒定,解剖操作相对简便,皮瓣色泽、质地与颈部相近,是修复颈部严重瘢痕挛缩的良好选择.     

经皮髓核成形术与椎间盘切除术治疗退变性颈椎间盘突出症

目的比较经皮髓核成形术与经皮椎间盘切除术治疗退变性颈椎间盘突出症的临床疗效及对颈椎稳定性的影响。方法2002年7月至2004年12月共收治退变性颈椎间盘突出症患者80例,行经皮髓核成形术42例(PCN组),经皮椎间盘切除术38例(PCD组)。回顾性分析两组的临床资料,比较两组在手术时间、临床效果及颈椎稳定性等的差异。结果所有病例随访6~26个月,PCN组平均(12±5)个月;PCD组平均(12±4)个月。两组手术均获成功。两组手术时间有显著差异(t=-21·70,P=0·000);两组手术临床效果(JOA评分)经自身配对t检验显示均有显著性差异(PCN:t=14·05,P=0·000;PCD:t=-14·79,P=0·000),即两组均有效;两组手术临床效果(Williams评分)经Kruskal-Wallis检验无显著差异(z=-0·377,P=0·706,>0·05),即两组临床效果相似。两组手术后均无颈椎不稳病例发生,颈椎稳定性手术前后均无显著差异(P>0·05)。结论经皮髓核成形术与经皮椎间盘切除术治疗颈椎间盘突出症的临床疗效优良,对颈椎稳定性影响小,不会造成颈椎失稳的发生。     

颈椎不稳致交感型颈椎病的诊断和治疗

目的 探讨交感型颈型病的发病机制及有效的治疗方法。方法 回顾了1989-1998年应用颈前路间盘切除加植骨融合术治疗的交感型颈椎病患者18例,分析了患者产及术后颈椎伸、屈侧位X光片。结果 18例患者术前均有颈椎不稳,不稳定节段为1个者6例,2个者9例,3个者3例;颈椎不稳主要发生于C3-C4和C4-C5,偶见于C5-C6和C6-C7。14例患者术前行颈椎高位硬膜外封闭,11例有效;于不稳定节段行颈前路间盘切除加植骨融合术,18例均获随访,平均随访时间为1年9个月,术后有效率为88.9%,结论 颈椎不稳定是交感型颈椎病发病的重要因素。颈椎高位硬膜外封闭具有重要的诊断价值。颈前路间盘切除加植骨融合术是治疗交感型颈椎病的有效方法。     

颈椎自锁PEEK椎间融合器在颈椎病治疗中的应用

目的评价应用颈椎自锁PEEK椎间融合器前路减压治疗颈椎病的疗效。方法应用颈椎自锁PEEK椎间融合器治疗颈椎病患者18例,观察椎间融合器的稳定性和融合情况,采用Borden法测量椎间隙高度、颈椎曲度,对术前和术后JOA评分、椎间隙高度、颈椎曲度等指标进行统计学分析。结果 18例患者均获随访,时间6～42个月,未见严重并发症。术后6个月提示椎间骨性融合。椎间高度:术前为(3.26±0.68)mm,术后1周为(6.03±0.89)mm(P<0.01);术后6个月为(5.89±0.78)mm,与术后1周比较变化不大(P>0.05)。颈椎生理弧度:术前为(2.55±0.48)mm,术后1周为(3.24±0.67)mm(P>0.05);术后6个月为(8.14±1.17)mm,与术后1周比较明显改善(P<0.01)。末次随访根据JOA评分法进行疗效评价:优4例,良9例,可3例,差2例。结论颈椎自锁PEEK椎间融合器可以有效恢复颈椎生理曲度及椎间隙高度,可以获得满意的融合率,改善颈脊髓功能。     

Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation

Background contextAlthough anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments. In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR. However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional motion and coupled movement during motion of one axis.PurposeThe purpose of this study was to compare the clinical parameters and cervical motion by three-dimensional motion analysis between ACDF and ADR and to investigate the ability of ADR to maintain cervical kinematics.Study designThis was a prospective case control study.Patient samplePatients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation.Outcome measuresVisual analog scale (VAS), Korean version of Neck Disability Index (NDI, %), and three-dimensional motion analysis were used.MethodsThe patients were evaluated by VAS and the Korean version of the NDI (%) to assess pain degree and functional status. Cervical motions were assessed by three-dimensional motion analysis in terms of sagittal, coronal, and horizontal planes. Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10–20 system of electroencephalography, C7 spinous process, and both acromions. These evaluations were performed preoperatively and 1 month and 6 months after surgery.ResultsThe ACDF and ADR groups revealed no significant difference in VAS, NDI (%), and cervical range of motion preoperatively. After surgery, both groups showed no significant difference in VAS and NDI (%). In motion analysis, significantly more range of motion was retained in flexion and extension in the ADR group than the ACDF group at 1 month and 6 months. There was no significant difference in lateral tilt and rotation angle. In terms of coupled motion, ADR group exhibited significantly more preserved sagittal plane motion during right and left rotation and also showed significantly more preserved right lateral bending angle during right rotation than ACDF group at 1 month and 6 months. There was no significant difference in other coupled motions.ConclusionThree-dimensional motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes. ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF. ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.