颈前路经椎间盘显微手术减压治疗神经根型颈椎病

目的探讨颈前路经椎间盘显微手术潜行减压治疗神经根型颈椎病的临床疗效。方法2010年3月至2016年3月,采用颈前路经椎间盘显微手术椎间孔潜行减压治疗的神经根型颈椎病106例,其中男66例,女40例,年龄32~69岁,平均58.32岁。术后定期随访,应用上肢疼痛的视觉模拟评分(VAS评分)与颈椎功能障碍指数评分(NDI评分)对其临床疗效进行评价。计量资料均数的比较采用t检验。结果全部病例无神经根损伤、脊髓损伤、脑脊液漏、伤口感染、椎动脉损伤及食管损伤等并发症发生。106例患者术前上肢疼痛VAS评分为(8.2±0.4)分,术后即刻为(1.5±0.1)分;术前NDI评分为(27.5±1.4)分,术后即刻为(5.4±0.6)分。100例患者获得12~36个月随访,末次随访上肢疼痛VAS评分为(1.2±0.2)分,与术前比较差异有统计学意义(P<0.05);末次随访NDI评分为(3.8±0.5)分,与术前比较差异也有统计学意义(P<0.05)。结论颈前路经椎间盘显微手术椎间孔潜行减压治疗神经根型颈椎病能取得安全满意的疗效,临床效果良好。     

神经根型颈椎病椎间孔内神经根受压的原因分析及减压方式选择

目的:分析神经根型颈椎病患者椎间孔内神经根受压的原因,选择合理的减压方式。方法 :2010年1月~2013年8月,我院共收治神经根型颈椎病患者178例,其中56例为椎间孔内神经根受压所致的单侧神经根型颈椎病,术前VAS评分为8.99±1.01分(7~10分);颈椎功能障碍指数(NDI)为41.15±7.12分(37~49分)。根据术前影像学资料判断椎间孔内神经根受压的原因分为3组:单纯椎间盘压迫,14例(A组);单纯骨性压迫,22例(B组);混合压迫(椎间盘+骨性压迫),20例(C组)。A组切除椎间盘至钩椎关节,适当扩大椎间孔,取出突出髓核;B、C组切除椎间盘至钩椎关节后,将钩突基底部内侧磨平,充分显露钩突后部、上位椎体后下角及钩椎关节间隙,刮除上位椎体后下角及部分增生的钩突。减压后均行椎间植骨内固定。使用Surgimap软件测量患者术前颈椎双斜位X线片上病变节段的双侧椎间孔面积,将健侧与患侧的椎间孔面积进行对比。比较3组患者术前及末次随访时VAS评分和NDI,同时比较3组的手术时间、术中出血量和术后住院时间。结果:3组患者术前健侧椎间孔面积无显著性差异(P0.05),B组和C组的患侧椎间孔面积均较A组明显狭窄(P0.05);B组和C组无显著性差异(P0.05);B组和C组的患侧椎间孔面积均较各自的对侧椎间孔面积明显狭窄(P0.05);而A组患侧椎间孔面积较对侧无明显狭窄(P0.05)。3组患者均顺利完成手术,B、C组与A组相比术中出血量较多,手术时间和术后住院天数较长(P0.05);B组与C组比较无显著性差异(P0.05)。术后3组患者均无神经症状加重、感染及脑脊液漏等并发症发生。56例患者均获得随访,随访时间27.2±8.9个月(12~52个月),3组术前VAS评分和NDI比较无显著性差异(P0.05),末次随访时亦无显著性差异(P0.05);3组末次随访时与术前比较均有显著性差异(P0.05)。结论:术前根据影像学资料分析神经根型颈椎病患者椎间孔内神经根受压的原因,进行针对性的减压手术可取得良好效果。     

颈神经根病致三角肌麻痹的治疗

目的对引起三角肌麻痹的颈神经根病患者进行临床分析。方法1998年5月～2003年11月,收治无脊髓锥体束症状的颈神经根病患者15例,男11例,女4例;年龄34～76岁。病变发生在C3、4间隙1例,C4、5间隙9例,C5、6间隙5例。颈椎间盘突出9例,按照Yamazaki分类,4例为旁内侧型突出,5例为外侧型突出;钩椎关节骨赘形成4例;上关节突增生2例。所有患者均表现为单侧肩部无力,以外展为主,严重者有肌肉萎缩,肩部、肩胛区至前臂有放射性疼痛,部分有感觉迟钝;神经学检查无锥体束症状、无病理反射、无腱反射亢进。术前三角肌麻痹程度为2.40±0.51级,神经根病变程度为7.60±1.45分,MRI测定椎间孔宽度为2.90±0.15mm。13例采用颈椎前路颈椎间盘切除、钩椎关节切除及椎间孔扩大术,术中注意切除突出的椎间盘、增厚的后纵韧带和增生的钩椎关节;2例采用后路部分内侧关节突关节切除,以见到减压后神经根自由活动为准。结果15例获随访16～24个月,平均19.4个月。患者疼痛症状改善最为明显,神经根病变程度为3.34±0.62分,与术前比较差异有统计学意义（P〈0.01）;13例患者的肌肉力量也有较好的恢复,术后三角肌麻痹程度为4.40±0.74级,与术前比较差异有统计学意义（P〈0.01）;MRI上椎间孔宽度测量为4.07±0.16mm,与术前比较差异有统计学意义（P〈0.01）。结论颈神经根病通常伴随颈椎病发生,单独发生不伴有脊髓锥体束症状的颈神经根病少见,常与椎间盘侧方突出、椎体后缘骨赘形成、关节突增生骨化有关,手术切除增生骨赘或突出的椎间盘以解除对神经根的压迫是一种较好的治疗方法。     

腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效分析

【摘要】 目的：评定腰椎人工椎间盘置换术（TDR）治疗腰椎间盘退变性疾病的中长期疗效。方法： 1999年12月~2006年12月应用Charite SB Ⅲ假体进行腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病患者65例,其中随访时间≥5年的患者48例,共52个假体。均在术前和末次随访时进行疼痛VAS评分和Oswestry功能障碍指数（ODI）评定,测量术前及末次随访时手术节段的活动度和椎间隙高度。对上述数据进行统计学分析。结果: 随访时间≥5年但＜10年患者（A组）33例,≥10年者（B组）15例。术前、末次随访时疼痛VAS评分,A组分别为94.0±6.3分、23.0±3.1分,B组分别为92.0±5.8分、21.0±2.2分,每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时ODI,A组分别为（66.0±4.2）%、（12.0±2.9）%,B组分别为（65.0±7.8）%、（9.0±2.8）%,每组末次随访时与术前比较均有统计学差异（P＜0.05）。术前、末次随访时手术节段活动度,A组分别为5.0°±2.3°、6.0°±1.1°,B组分别为4.0°±3.8°、6.0°±2.2°,每组末次随访时与术前比较均无统计学差异（P＞0.05）;末次随访时3例患者手术节段基本丧失活动度（平均为1.2°±0.4°,术后5年1例,术后7年2例）,其余患者保留了2°~10°的活动度,平均为6.5°。48例患者中,出现相邻节段退变4例,其中1例患者术后8年出现腰痛,影像学检查发现手术相邻上位节段椎间盘退变并膨出,行手术治疗;1例患者术后7年手术相邻上位节段椎间隙高度较术前降低＞2mm,2例（术后5年、8年各1例）患者手术相邻上位节段椎体前缘骨赘高度＞3mm。2例出现假体移位（分别于术后5年和6.5年）,3例出现异位骨化（分别于术后6年、7年和9年）,均未出现临床症状。结论：腰椎人工椎间盘置换术治疗腰椎间盘退变性疾病的中长期疗效较为满意。     

METRx椎间盘镜下颈椎后路椎间孔切开减压术疗效研究

目的 探讨METRx椎间盘镜下颈椎后路椎间孔切开减压术对神经根型颈椎病及颈椎间盘突出症的治疗效果.方法 METRx椎间盘镜下颈椎后路椎间孔切开减压术治疗9例神经根型颈椎病及2例颈椎间盘突出症.结果 本组11例患者术后MRI检查显示突出椎间盘及神经根压迫消失.随访3个月后JOA脊髓功能评分和VAS评分,与术前比较差异有统计学意义(P<0.05).结论 METRx椎间盘镜下颈椎后路椎间孔切开减压术手术创伤小,术后恢复快,临床疗效优良.     

改良椎板间隙入路经皮内镜下椎间盘切除术治疗L5/S1椎间盘突出症的疗效观察

【摘要】 目的：探讨改良椎板间隙入路经皮内镜下椎间盘切除术（modified percutaneous endoscopic interlaminar discectomy,MPEID）治疗L5/S1椎间盘突出症的临床疗效。方法：2018年12月~2021年5月我院对123例符合纳入标准的L5/S1椎间盘突出症患者采用MPEID治疗,其中男65例,女58例;年龄16~83岁（44.43±12.67岁）。术前、术后和末次随访时进行疼痛视觉模拟评分（visual analogue scale,VAS）,术前和末次随访时进行Oswestry功能障碍指数（Oswestry disability index,ODI）评定,末次随访时根据改良Macnab标准评定疗效。结果：123例均顺利完成手术,手术时间为45.96±21.87min,术中出血量为5.93±3.15ml。术后出现并发症8例,发生率为6.5%。复发3例,复发率为2.4%。术后随访时间为6~35个月（16.49±7.30个月）。术前、术后及末次随访时腰腿痛VAS评分分别为5.29±1.71、2.89±0.75和0.59±0.72（P<0.05）;术前与末次随访时的ODI分别为（61.14±13.93）%、（7.47±10.46）%,末次随访ODI改善明显（P<0.05）。末次随访改良MacNab标准评定：优100例,良20例,可2例,差1例,优良率97.6％（120／123）。结论：MPEID治疗L5/S1椎间盘突出症能够保留黄韧带,早期临床疗效满意。     

颈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

【摘要】 目的：探讨颈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的疗效。方法：回顾性分析2002年3月～2012年1月采用颈前路椎体次全切除联合椎间隙减压融合内固定术治疗的32例多节段颈椎病患者资料,男20例,女12例;年龄48～76岁,平均52.32±5.73岁。脊髓型颈椎病26例,脊髓型合并神经根型颈椎病6例。病变累及3个节段29例,累及4个节段3例。术前JOA评分为8.07±1.82（5~11）分,颈前柱高度为67.29±2.63（61.98～73.01）mm,颈椎曲度C值为2.86±2.63[（-3.14）～8.42]。均行颈前路混合减压融合内固定术,其中脊髓主要受压节段采用椎体次全切除减压,脊髓次要受压节段行椎间隙减压。观察手术并发症情况及术后1周、6个月、12个月时JOA评分、颈前柱高度与颈椎曲度C值的恢复情况。结果：手术时间90～160min,平均105min;术中出血量100～350ml,平均200ml。术后1例出现饮水呛咳,术后2周恢复正常;2例出现声音嘶哑,经对症处理均于术后1个月内恢复正常。随访12～24个月,平均14.0±3.1个月。术后6～12个月均获骨性愈合,末次随访时无假关节形成和内固定松动或断裂。术后1周、6个月、12个月时颈前柱高度、颈椎曲度C值及JOA评分均较术前明显提高（P<0.05）。术后12个月JOA评分改善率为（68.38±11.07）%,按改善率评定手术疗效,优11例,良17例,好转4例。结论：颈前路椎体次全切除联合椎间隙减压融合内固定术是治疗多节段颈椎病一种安全、有效的方法。     

腰椎融合术后邻近节段椎体压缩性骨折的治疗方式及临床疗效

【摘要】 目的：分析腰椎融合术后邻近节段椎体压缩性骨折（adjacent vertebral compression fracture,AVCF）的特点,并探讨其治疗方式及临床疗效。方法：回顾性分析2013年1月~2019年1月在我中心因腰椎退行性病变行腰椎固定融合术治疗的患者353例,有11例患者发生融合术后AVCF,均为女性,年龄70±7.2岁（61~83岁）,其中T12椎体骨折1例,T12合并L1椎体骨折1例,L1椎体骨折4例,L2椎体骨折2例,L1合并L2椎体骨折1例,L3椎体骨折1例,L3合并T11椎体骨折1例。依据AVCF患者的骨折特点,予以不同的治疗方式,其中3例发现骨折时已趋于愈合或合并其他基础疾病不适合手术,采用抗骨质疏松等保守治疗;3例单纯骨折无严重神经损伤症状,采用局麻下后路经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）;5例骨折合并下肢神经压迫症状,采用后路翻修、椎管减压、向上延长固定术治疗。随访24.5±6.4个月（24~31个月）。术前、术后1周和末次随访时进行腰痛、下肢痛视觉模拟量表（visual analogue scale,VAS）评分和腰椎日本骨科协会（Japanese Orthopaedic Association,JOA）评分,术后定期复查,记录围手术期及随访中并发症发生情况。结果：腰椎融合术后AVCF的发生率为3.1%（11/353）。腰痛VAS评分术前5.2±2.3分,术后1周3.5±1.8分（P＜0.05）,末次随访时3.9±2.0分（P＜0.05）;下肢痛VAS评分术前7.1±2.2分,术后1周3.0±1.6分（P＜0.05）,末次随访时3.7±1.9分（P＜0.05）;腰椎JOA评分术前14.8±5.6分,术后1周21.5±4.2分（P＜0.05）,末次随访时18.7±3.9分（P＜0.05）。末次随访时依据JOA改善率（recovery rate,RR）,优5例,良3例,可2例,差1例,临床疗效满意率72%。共有4例（36%）患者出现5例次并发症,其中1例患者术后出现伤口深部金黄色葡萄球菌感染,给予切开清创灌洗引流,使用敏感抗生素治疗后痊愈;1例患者术后双下肢无力加重,出现尿潴留,术后再次行椎管减压、骨水泥螺钉延长固定,翻修术后患者出现一过性心功能不全,经限盐限水、强心利尿等治疗后痊愈;1例患者术后再次出现椎体压缩骨折,给予PKP骨水泥强化治疗;1例患者术后再次出现AVCF合并椎间盘突出、椎管狭窄,再次翻修延长固定。结论：腰椎融合术后AVCF多发生在胸腰段,以老年女性多见,单纯AVCF不伴神经症状采取PKP治疗,合并椎间盘突出或椎管狭窄的AVCF采取腰椎翻修椎管减压内固定术,手术治疗腰椎融合术后AVCF可取得较好的临床效果。     

胸、腰椎椎体结核病椎置钉短节段内固定的疗效分析

 目的 总结胸、腰椎椎体结核前路一期病灶清除、椎体间植骨融合、病椎置钉短节段内固定的疗效,并探讨其安全性和有效性。方法 2009年6月至2013年11月,行前路一期病灶清除、椎体间植骨融合、病椎置钉短节段内固定治疗胸、腰椎椎体结核患者46例,男25例,女21例;年龄13~69岁,平均39.6岁。病变节段为T6~L4(均≤ 3个节段)。术前Frankel分级：B级3例、C级6例、D级4例、E级33例。术前后凸Cobb角平均为16.34°±3.19°。术前红细胞沉降率为19~81 mm/1 h。术前均行胸、腰椎CT平扫及二维重建,测量残余椎体冠状位及矢状位前、中柱最低有效残留高度,当最低残留有效高度>10 mm时,结合术中测量选择合适的内固定器械行前路病灶清除、植骨融合、病椎置钉内固定。对手术前后Cobb角、视觉模拟评分(visual analogue scale,VAS)、红细胞沉降率、Frankel分级行统计分析,并观察内植物稳定性和植骨融合情况。结果 46例患者随访12~48个月,平均26个月。所有患者结核中毒症状均消失,红细胞沉降率为0~15 mm/1 h。末次随访Frankel分级：D级2例、E级44例。术后1周后凸Cobb角平均为4.16°±2.71°,末次随访平均为4.52°±1.29°;VAS评分由术前(6.85±1.22)分,恢复至术后1周(4.79±0.95)分,末次随访时(2.26±0.93)分;红细胞沉降率由术前(41.25±1.61) mm/1 h,恢复至术后1周(17.36±6.82) mm/1 h,末次随访时(10.67±0.72) mm/1 h。术后6个月植骨融合优44例、良2例。结论 胸、腰椎椎体结核残余椎体有效高度>10 mm时行病椎置钉短节段内固定安全且可靠。     

颈后路椎板减压联合椎间孔切开术治疗混合型颈椎病的疗效观察

目的探讨颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗脊髓合并神经根受压的混合型颈椎病疗效。方法 2010年1月-2012年1月,采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗58例混合型颈椎病患者。男31例,女27例;年龄41~72岁,平均52.7岁。病程3~15年,平均5.4年。术前日本骨科协会(JOA)评分为(7.8±1.3)分,疼痛视觉模拟评分(VAS)为(6.8±1.7)分。椎间盘突出伴黄韧带肥厚37例,椎体后缘骨赘形成11例(骨赘椎管占有率为51.7%±18.1%),颈椎不稳合并椎间盘突出10例。颈椎曲度为(—5.5±12.5)°。螺钉固定节段:C3~7 29例,C4~7 19例,C3~6 10例;共切开椎间孔135个,平均每例2.33个。结果手术时间167~260 min,平均204 min;术中出血量为210~378 m L,平均273 m L。术中无椎动脉、神经根损伤发生。术后1例发生皮下血肿,8例轴性疼痛;均无颈神经根麻痹症状发生。患者均获随访,随访时间2.1~4.3年,平均3.4年。术后2年,JOA评分为(14.1±1.7)分,显著高于术前,比较差异有统计学意义(t=—27.672,P=0.000);JOA评分改善率为68.5%±21.9%。VAS评分为(2.1±1.1)分,较术前显著降低,比较差异有统计学意义(t=15.168,P=0.000)。影像学复查示,1例邻近节段发生退变,但未出现临床症状;随访期间无螺钉松动、无假关节形成。术后5 d及2年颈椎曲度分别为(13.6±5.1)、(13.2±4.8)°,与术前比较差异均有统计学意义(P0.05)。术后2年11例骨赘椎管占有率为36.5%±10.4%,与术前比较差异有统计学意义(t=6.921,P=0.000);随访期间骨赘残余压迫逐渐吸收。结论对脊髓合并神经根受压的混合型颈椎病,采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗可获得满意疗效。术中扩大椎板切除(椎板切除和椎间孔切开)能充分缓解脊髓及神经根受压症状,侧块螺钉内固定在纠正颈椎曲度的同时,可进一步降低脊髓及神经根张力。     

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.     

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.     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的 对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响.方法 回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DC...     

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。     

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented. METHODS: A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique. RESULTS: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later. CONCLUSION: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.     

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.     

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.     

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.