Surgical outcomes of cervical myelopathy in patients with athetoid cerebral palsy

Purpose

Surgical treatment for cervical myelopathy with athetoid cerebral palsy remains unestablished. Instrumented fusion is reported to have good clinical results; however, there are no data of decompression surgery for this pathology in recent years. This study aimed to assess the surgical outcomes of laminoplasty with or without posterior instrumented fusion for cervical myelopathy in patients with athetoid cerebral palsy.

Methods

A multi-centre surgical series of patients with cervical myelopathy and athetoid cerebral palsy were enrolled in this study. All patients showed symptoms and signs suggestive of cervical myelopathy and underwent laminoplasty with or without instrumented fusion. The Japanese Orthopaedic Association (JOA) score, Barthel index (BI), and changes in the C2–C7 sagittal Cobb angle in the lateral plain radiograph were analysed.

Results

There were 25 patients (16 men and 9 women; mean age, 54.4 ± 10.8 years) with cervical myelopathy and athetoid cerebral palsy who underwent surgical treatment. The mean follow-up period was 41.9 ± 35.6 months. Overall, the BI significantly improved after surgery, whereas the JOA score and C2–C7 angle did not improve postoperatively. The recovery rate of the JOA score in the laminoplasty group was significantly higher than that of the fusion group (P = 0.02).

Conclusions

Cervical laminoplasty with or without instrumented fusion for treating cervical myelopathy due to athetoid cerebral palsy is effective in improving activities of daily living. Cervical laminoplasty may be an effective and less invasive surgical method for selective patients, especially for those with small involuntary movements and no remarkable cervical kyphosis nor instability.

     

Surgical treatment of cervical spondylotic radiculomyelopathy with abnormal involuntary neck movements. Report of three cases

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.     

Cervical myelo-radiculopathy in athetoid cerebral palsy

Cervical myelopathy complicating athetoid cerebral palsy has not been adequately highlighted in the literature. We report two cases of patients with athetoid cerebral palsy and long histories of involuntary movements who developed cervical myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the myelo-radiculopathy. The two patients were treated with combined anterior and posterior fusion with satisfactory results. They were bedridden preoperatively but have since started walking with or without a cane. We conclude that combined anterior and posterior fusion is the treatment of choice for severe myelopathy complicating athetoid cerebral palsy.     

What is the best treatment option for cervical spinal cord injury by os odontoideum in a patient with athetoid dystonic cerebral palsy?

Context: Atlantoaxial instability in an athetoid dystonic cerebral palsy patient due to os odentoideum represents a rare cause of high-level cervical spinal cord injury. There is no evidence-based treatment protocol for this injury and a number of reports have debated whether nonsurgical or surgical treatment is the best option.Findings: Here, we report the case of a 32-year-old athetoid dystonic cerebral palsy patient with os odontoideum (OO) causing compressive myelopathy on the C1–2 levels. About two weeks after atlantoaxial fusion, the patient started an intensive rehabilitation program and maintained it for four weeks. He showed neurological and functional improvement at discharge after four weeks of training. There were further improvements in function and symptoms four weeks after discharge.Conclusion: Intensive rehabilitation programs are important for the recovery and good prognosis in spinal cord injury patients. However, rehabilitation of CP patients with spinal cord injury is often neglected. We provided intensive rehabilitation therapy to a patient for a cervical spinal cord injury by OO with athetoid dystonic cerebral palsy and achieved neurological and functional recovery.     

Surgical treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy

There have been several reports on surgical interventions in patients with adult cervical spondylotic myelopathy associated with athetoid cerebral palsy; however, the long-term effectiveness of these interventions has not been demonstrated. We have performed surgical treatments — posterior fusion with wave-shaped rods and anterior interbody fusion with internal fixators — in 20 patients. The present study included 17 of these patients, 16 men and 1 woman, and their mean follow-up period was 8.6 years (range, 5–15.5 years). One year after surgery, walking ability was improved in 14 patients. Pain in the upper extremities and muscle weakness of the deltoid were alleviated in all patients. One patient showed recurrence of myelopathy after 8.5 years' follow-up. Our surgical technique is effective in patients with cervical spondylotic myelopathy secondary to athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixations are not required. Received: July 27, 1999 / Accepted: March 7, 2000     

Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.

BACKGROUND: Patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. METHODS: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: Patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.     

Cervical myelopathy in patients with congenital cervical block vertebrae

Summary Thirty-two patients with congenital cervical block vertebrae are reviewed. Twenty-nine patients had single level fusion, one had two-level fusion, and the remaining two had multilevel fusion. Eighteen patients had cervical myelopathy; five of these had related trauma and 13 had no history of trauma. The five patients who had cervical myelopathy following trauma underwent magnetic resonance imaging (MRI); three of them had abnormalities in the spinal cord at the segment adjacent to fusion. In all five patients the symptoms and signs were attributed to the segment adjacent to fusion. Myelography, computed tomographic myelography and MRI were performed in 11 of the 13 patients with cervical myelopathy without trauma. In 9 of them maximum compression of the spinal cord was not seen at the segment adjacent to fusion. The major factor contributing to cervical myelopathy was associated spinal canal stenosis. Seven patients with cervical myelopathy without history of trauma were treated surgically, six of whom had spinal canal stenosis treated by enlargement of the spinal canal: subtotal corpectomy and arthrodesis was performed in three, and open-door expansive laminoplasty in three. Anterior interbody arthrodesis was performed in one patient without spinal canal stenosis. All recovered from the myelopathy postoperatively. When a trauma occurs, it concentrates stress at the segment adjacent to fusion, resulting in possible spinal cord injury. On the other hand, when there is no trauma, spinal canal stenosis is the principal factor contributing to cervical myelopathy.     

Surgical treatment of cervical spondylotic myelopathy associated with athetoid cerebral palsy

 After a mean follow-up period of 7 years (range 4–17 years), we reviewed the cases of 14 patients who underwent surgical treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy. All of the patients who underwent anterior decompression and arthrodesis showed degeneration and increased range of motion of the adjacent disc despite halo-vest immobilization postoperatively. Laminoplasty is useful in cases in which physiological lordosis is present preoperatively, whereas a case with preoperative kyphotic deformity showed increased neurological symptoms and deterioration of activities of daily living postoperatively due to increased kyphotic deformity and canal stenosis. Anterior decompression and arthrodesis following posterior fusion with lateral mass plating and posterior wiring is a favorable option for patients with highly kyphotic deformity and canal stenosis, as it preserves neurological status and cervical alignment postoperatively. Received: January 18, 2002 / Accepted: June 21, 2002 Acknowledgments. The authors thank Masahiro Kamikozuru, M.D. (Saitama Prefectural Rehabilitation Center), Hirokazu Satoh, M.D. (Saiseikai Kawaguchi General Hospital), Osamu Nakai, M.D. (Kudanzaka Hospital), Michiyuki Fuchioka, M.D. (Saitama Prefectural Rehabilitation Center), and Hiroyuki Yamada, M.D. (Saiseikai Kawaguchi General Hospital) for kindly providing cases and for data collection. Offprint requests to: H. Haro     

Long-term results of double-door laminoplasty for cervical stenotic myelopathy

STUDY DESIGN: A retrospective study of the long-term results from double-door laminoplasty (Kurokawa's method) for patients with myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. OBJECTIVE: To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. SUMMARY OF BACKGROUND DATA: There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic myelopathy. METHODS: In this study, 35 patients with cervical myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120-200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121-218 months) in patients with cervical spondylotic myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. RESULTS: In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic myelopathy, myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic myelopathy resulting from ossification of the yellow ligament in the thoracic spine. CONCLUSIONS: The short-term results of laminoplasty for cervical stenotic myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic myelopathy.     

颈椎病后路减压融合术后颈5神经根麻痹

目的：探讨颈椎病患者后路椎板切除融合术后颈5神经根麻痹的临床表现、特点及发生机制。方法：我院脊柱外科自2003年1月至2006年1月手术治疗102例各类颈椎病患者，术后5例患者合并颈5神经根麻痹，对其临床资料进行回顾性分析研究。结果：本组中5例术后合并颈5神经根麻痹，男4例、女1例，平均年龄64岁，发生牢为4．9％；平均术后2．9天发生。对患者手术前、后的影像学资料进行了分析比较，所有患者均有术后MRI片上1、2像高信号影像，4例麻痹的节段与影像学资料相一致。4例患者基本完全恢复。结论：颈椎病后路减压融合术后可能发生颈5神经根麻痹：术后脊髓灰质区的损伤在该并发症发生中起着重要的作用。     

Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years

The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases.     

颈前路分节段减压融合治疗多节段颈椎病

目的评价颈前路分节段减压植骨融合术治疗多节段颈椎病的临床疗效。方法对24例连续3或4个节段病变的颈椎病患者采用分节段减压融合术治疗。均行术前X线、MR I和术后X线片检查。均于术前及术后3个月进行JOA评分。结果 24例均获随访,时间3~48（28±20）个月。患者功能均有不同程度的改善。无植骨块不愈合、内置物下沉等并发症发生。JOA评分术前平均为（8.20±2.26）分,术后3个月平均为（13.50±1.28）,改善率为60.2%,植骨融合率100%。结论颈椎前路分节段减压融合术具有减压彻底、术后神经功能恢复好、恢复颈椎曲度、融合率高、并发症少等优点。     

颈椎侧块钢板在脊髓型颈椎病治疗中应用

目的 对15例脊髓型颈椎病患者行后入路椎管减压、椎板成型术的同时使用颈椎侧块钢板固定，探讨和分析该手术方法的优点和手术治疗效果。方法 从自2000年3月—2002年12月，对15例脊髓型颈椎病患者(术前颈椎MR显示有三个节段颈椎椎间盘水平病变并有黄韧带增厚突入椎管)，行颈椎后入路双开门椎板成型术加双侧颈椎侧块钢板固定。按JOA评分法评定患者手术前后恢复情况。结果 本组患者男10例，女5例，随访5个月—1年2个月，平均9个月，术后2—7天(平均3．5天)可戴颈围坐起，颈围外固定时间12周，融合时间3—5个月，(平均为3．5个月)，术后JOA评分明显提高，所有病人无术中血管、神经根损伤，无植骨不愈合，无内固定断裂。结论 行颈椎后入路双开门椎板成型术联合应用颈椎侧块钢板固定，从后方扩大椎管容积，对脊髓进行减压，辅助以侧块钢板对减压后的颈椎行即时的稳定的固定，增加后方所植髂骨的融合成功率，大大地减少颈椎术后后突畸形发生和术后卧床并发症的发生率。     

Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004. We identified 53 patients and reviewed their medical records to determine the effectiveness of CCDF for improving myelopathy, pain, and neurological function. Degree of fusion, functional anatomic alignment, and stability were also assessed. Operative morbidity and mortality were measured. The most common causes of cervical myelopathy, instability, or deformity were degenerative disease (57%) and traumatic injury (34%). Approximately one-fifth of patients had a prior fusion performed elsewhere and presented with fusion failure or adjacent-level degeneration. Postoperatively, all patients had stable (22.6%) or improved (77.4%) Nurick grades. The average preoperative and postoperative Nurick grades were 2.1 ± 1.9 and 0.4 ± 0.9, respectively. Pain improved in 85% of patients. All patients had radiographic evidence of fusion at last follow-up. The most common complication was transient dysphagia. Our average clinical follow-up was 27.5 ± 9.5 months. We present an extensive series of patients and demonstrate that cervical myelopathy can successfully be treated with CCDF with minimal operative morbidity. CCDF may provide more extensive decompression of the spinal cord and may be more structurally stable. Concerns regarding operation-associated morbidity should not strongly influence whether CCDF is performed.     

Peri-operative treatment with botulinum A toxin prior to posterior cervical decompression in a case with cervical spondylosis caused by spasmodic torticollis secondary to cerebral palsy

Patients with spasmodic torticollis secondary to athetoid cerebral palsy may develop symptomatic degenerative cervical disc disease or spondylosis. In these cases, peri-operative stabilization of the cervical spine is considered to be difficult and recurrence occurs frequently. We reported a case with cervical spondylosis induced by athetoid cerebral palsy. A 44-year-old female with athetoid cerebral palsy had suffered from secondary spasmodic torticollis. 7 years previously, she had been admitted to our hospital for the first time with complaints of gait disturbance, dysesthesia and hypesthesia in all extremities. CT-myelography and MRI showed disc degeneration and spondylosis at the level of C4/5 and C5/6, compressing the spinal cord. She underwent C5 vertebrectomy and C4-6 anterior fusion. However, due to cervical dystonia, it was difficult for her to wear a Philadelphia collar, so she had to under go complete bed rest for postoperative neck stabilization. Her symptoms improved after the operation. 5 years after the first operation, she complained of gait disturbance and sensory disturbance, again. MRI showed compression of the spinal cord at C2-C4, rostral to the level of the previous surgical area. So we planned the second operation. Prior to the operation, we used botulinum A toxin to reduce the athetoid movement of the neck. And we performed C3-6 expansive laminoplasty and partial laminectomy of C2 and C7 laminae. After the second operation, she was able to wear the Philadelphia collar without trouble and her neurological condition improved again. Botulinum A toxin was very effective to control the spasmodic torticollis peri-operatively in this case with cervical dystonia.     

Dystonic movement disorders and spinal degenerative disease

The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we reviewed the available published data. Epidemiologic studies reveal that degenerative spinal disorders in patients with dystonia and choreoathetosis occur much earlier than in the physiological aging process. Dystonic movement disorders more often affect the spine at higher cervical levels (C(2-5)), in contrast to spinal degeneration with age which manifests more frequently at the middle and lower cervical spine (C(5-7)). Degenerative changes of the cervical spine are more likely to occur on the side where the chin is rotated or tilted to. Various operative approaches for treatment of spinal pathologies have been advocated in patients with dystonic movement disorders. The available data do not allow making firm statements regarding the superiority of one approach over the other. Posterior approaches were first used for decompression, but additional anterior fusion became necessary in many instances. Anterior approaches with or without instrumented fusion yielded more favorable results, but drawbacks are pseudarthrosis and adjacent-level disease. Parallel to the development of posterior fusion techniques, circumferential surgery was suggested to provide a maximum degree of cord decompression and a higher fusion rate. Perioperative local injections of botulinum toxin were used initially to enhance patient comfort with halo immobilization, but they are also applied in patients without external fixation nowadays. Treatment algorithms directed at the underlying movement disorder itself, taking advantage of new techniques of functional neurosurgery, combined with spinal surgery have recently been introduced and show promising results.     

Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy

Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges for the aspiring endoscopic surgeons, the most critical of which is mastering hand–eye coordination. With training in live animal and cadaver surgery, the technical progress has reduced the problem of morbidity following surgery. The authors have performed microendoscopic decompression surgery on more than 2,000 patients for lumbar spinal canal stenosis. Fifty-one patients underwent the posterior decompression surgery using microendoscopy for cervical myelopathy at authors’ institute. The average age was 62.9 years. The criteria for exclusion were cervical myelopathy with tumor, trauma, severe ossification of posterior longitudinal ligament, rheumatoid arthritis, pyogenic spondylitises, destructive spondylo-arthropathies, and other combined spinal lesions. The items evaluated were neurological evaluation, recovery rates; these were calculated following examination using the Hirabayashi’s method with the criteria proposed by the Japanese Orthopaedic Association scoring system (JOA score). The mean follow-up period was 20.3 months. The average of JOA score was 10.1 points at the initial examination and 13.6 points at the final follow-up. The average recovery rate was 52.5%. The recovery rate according to surgical levels was, respectively, 56.5% in one level, 46.3% in two levels and 54.1% in more than three levels. The complications were as follows: one patient sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery, one patient developed an epidural hematoma 3 days after surgery, and two patients had the C5 nerve root palsy after surgery. The epidural hematoma was removed by the microendoscopy. All two C5 palsy improved with conservative therapy, such as a neck collar. These four patients on complications have returned to work at the final follow-up. This observation suggests that the clinical outcomes of microendoscopic surgery for cervical myelopathy were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for cervical myelopathy.     

颈椎减压钛网植骨术后的前路再手术治疗

目的：分析颈椎减压钛网植骨术后疗效不佳的原因,探讨经前路再手术治疗该类患者的临床疗效。方法：自2004年1月至2011年12月,采用经颈前路再次减压手术治疗颈椎钛网植骨术后患者16例,男7例,女9例,年龄46～75岁,平均61岁。脊髓型颈椎病11例,神经根颈椎病2例,混合型颈椎病3例。首次手术至再次手术时间4～12年,平均7年。所有患者首次手术均行前路椎体次切钛网植骨内固定术,钛网植骨节段C3-C52例,C4-C6 8例,C4-C7 2例,C5-C74例,其中C4椎体次切钛网植入＋C5,6椎间盘摘除cage植入1例。患者术后症状好转或消失后再次复发13例;术后症状无明显改善2例;术后症状持续加重1例。所有患者再手术前行颈椎正侧位片、CT、MRI检查,12例患者融合节段的邻近节段退变引起脊髓或神经根的压迫,其中上节段4例,下节段8例;3例患者因减压节段椎体后缘骨赘形成,造成脊髓或神经根受压;1例患者因前路减压不彻底脊髓仍受压。应用日本骨科协会（JOA）评分系统,颈部功能障碍指数（ODI）及Odom分级标准来评价临床效果。结果：全部患者通过前路完成二次手术减压,手术时间80-150min,平均110min;出血量30-200ml,平均160ml。l例患者出现30ml较清引流液,怀疑脑脊液漏,术后第2天拔除引流液管后缝合引流口,10d后拆线切口Ⅰ／甲级愈合。其余患者无饮水呛咳、声音嘶哑、喉头水肿等并发症。16例均获随访,时间12～28个月,平均16个月。JOA评分及ODI指数术后2个月及末次随访与术前比较差异均有统计学意义（P〈0．01）,术后2个月与末次随访比较差异也有统计学意义（P〈0．01）。末次随访JOA评分改善率为（72．9±0．2）％。按照Odom临床效果分级标准：优12例,良3例,可1例。结论：颈椎减压钛网植骨术后,因手术减压不彻底、术后邻近节段的退变或新形成的各种致压因素、内植物引起的各种并发症等需要再次手术,而经前路再手术治疗患者能获得较好的临床疗效。     

颈前路钢板内固定治疗脊髓型颈椎病39例体会

目的观察颈前路钢板在脊髓型颈椎病手术中的作用和疗效。方法对39例脊髓型颈椎病患者行颈前路减压植骨、颈前路钢板内固定术,术后随访观察神经功能恢复情况、植骨融合率及有无植骨并发症。结果术后进行6—18个月（平均10个月）随访。症状明显缓解、脊髓功能明显改善者36例,占90％。术后8个月植骨融合率达到100％。无钢板断裂、螺钉松动、植骨不愈合、椎体高度丢失现象存在。结论应用颈前路减压植骨、颈前路钢板系统内固定术治疗脊髓型颈椎病具有以下优点：可获得术后颈椎即刻稳定,防止植骨块移位,手术时间短,术后无需行石膏固定,能显著提高植骨融合率。     

Retro-odontoid pseudotumor concomitant with proximal adjacent cervical spondylotic myelopathy after multilevel anterior cervical discectomy and fusion

Introduction and importanceAdjacent cervical spondylotic myelopathy (CSM) following anterior cervical discectomy and fusion (ACDF) presenting as a retro-odontoid pseudotumor (ROP) is uncommon. This consequence adversely affects hand function, causes gait imbalance and results in other disabilities for the patient. This report describes the successful surgical treatment of a patient with ROP associated with adjacent CSM following multilevel ACDF of the subaxial cervical vertebrae by performing posterior cervical decompression and fusion.Case presentationA 60-year-old-male presented with progressive, disabling cervical myelopathy. He had undergone ACDF C3-C7 for treatment of CSM 16 years ago and his symptoms had fully resolved. Magnetic resonance imaging (MRI) revealed severe cervical spinal cord compression caused by a retro-odontoid mass at the C1-C2 level with upper adjacent segment disease (ASD) of C1-C3. The patient received C1-C3 posterior cervical spinal fusion by C1 lateral mass C2 and C3 pedicle screw fixation and C1-C3 laminectomy. After the surgery, he was able to ambulate independently and the myelopathic symptoms were significantly improved at the 6 months follow-up.Clinical discussionRetro-odontoid pseudotumor concomitant with proximal ASD following ACDF is a rare occurrence. Both diagnosis and surgical management are challenging.ConclusionsPosterior cervical decompression and fusion of C1-C3 is an effective option for treatment of severe cervical spinal cord compression by a retro-odontoid mass at the C1-C2 level combined with ASD after ACDF.