颈前路保留中部椎体的分段减压治疗多节段颈椎病

目的通过比较,评价颈椎前路分段减压、保留中部椎体、钛网植骨长钛板内固定治疗多节段颈椎病的疗效和应用价值。方法采用颈前路长节段减压治疗多节段颈椎病21例,分段减压治疗32例。根据影像学检查评估术后内固定的并发症、植骨融合率、颈椎生理曲度的恢复和重建,根据JOA评分评估神经功能改善率。结果长节段减压组有4例出现内固定并发症,主要为钛网和螺钉的松动脱落;分段减压组未出现并发症。术后6个月长节段减压组有4例钛网植骨未达到骨性融合,分段减压组均达到融合。术前与术后比较Cobb角的改善,分段减压组明显优于长节段减压组(P<0.05)。JOA评分两组无明显差别(P>0.05)。结论采用颈前路保留中部椎体分段减压、钛网植骨长钛板固定、术后外固定保护治疗多节段颈椎病,可有效地进行颈前路融合、改善颈椎生理曲度,促进神经功能恢复。     

单间隙加单节段减压治疗老年多节段颈脊髓伤病

目的探讨颈前路单间隙加单节段减压植骨融合治疗多节段老年性颈脊髓伤病的疗效。方法对13例老年性多节段颈脊髓伤病患者采用前路单间隙加单节椎体次全切除减压植骨内固定治疗,平均随访28个月,评估神经功能恢复、颈椎生理曲度的改善情况。结果 JOA评分术前3～8分,平均5.34分,术后11～15分,平均13.33分,改善率68.5%,颈椎生理曲度亦明显改善。结论前路单间隙加单节段减压手术疗效好,是治疗老年性多节段颈脊髓伤病的较好术式。     

颈椎病前路不同治疗方法疗效比较

目的分析四种颈椎前路融合术的疗效。方法用四种融合方式对241例因颈椎病患者行前路减压。其中单纯髂骨植骨（A组）单节段40例,双节段22例;颈椎前路减压界面固定术（B组）（cervical interbody fusion cage CIFC）单节段40例。双节段21例;植骨融合并颈椎前路钢板内固定（C组）单节段45例,双节段23例;CIFC并前路钢板内固定（D组）单节段35例,双节段15例。术后定期随访及拍摄X线片,观察疗效、椎间高度、颈椎前弯曲度和融合情况。结果平均随访时间3．2年,经过随访,A组融合率为82．1％,B组融合率为96．3％,C组融合率为95．6％。D组融合率为95．4％。终访时。A组平均椎间高度和颈椎前弯曲度较术后早期显著性降低（P〈0.05）,B组、C组和D组则无显著性差异（P〉0.05）。A组与B、C组和D组之间远期疗效均有显著性差异（P〈0.05）,B组与C组和D组之间远期疗效无显著性差异（P〉0.05）。结论单纯髂骨植骨方法简单,但并发症较多。CIFC、颈椎前路钢板植骨融合内固定和CIFC并前路钢板内固定,固定牢固,符合颈椎生物力学特件并管瘫,p沅期疗特好．     

颈椎前路减压cage与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的疗效比较

目的比较颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病的临床疗效及并发症情况。方法纳入自2013-06—2015-06诊治的110例单节段脊髓型颈椎病,采用颈椎前路减压cage椎间植骨融合钛板内固定治疗55例(cage组),采用颈椎前路减压zero-p椎间植骨融合内固定治疗55例(zero-p组)。比较2组手术时间、术中出血量、住院时间,术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度及植骨融合率,术后1周、3个月吞咽困难发生例数。结果所有患者均获得(22.78±3.10)个月随访。2组手术时间、术中出血量、住院时间比较差异无统计学意义(P0.05)。2组术后12个月JOA评分、NDI指数、颈椎曲度、颈椎节段高度、植骨融合率差异无统计学意义(P0.05)。zero-p组术后1周、3个月吞咽困难发生例数少于cage组,差异有统计学意义(P0.05)。结论颈椎前路减压cage椎间植骨融合钛板内固定与zero-p椎间植骨融合内固定治疗单节段脊髓型颈椎病均可取得满意的临床疗效,但zero-p椎间植骨融合内固定术后吞咽困难发生的风险明显较低,其安全性更符合临床需要。     

两种手术方法治疗单节段颈椎病的疗效观察

目的探讨单节段颈椎前路减压后有无必要在椎间融合器(Cage)植入基础上加用钢板固定。方法自2006-08-2010-08对55例实行单节段颈椎前路减压手术的颈椎病患者进行随访。根据手术方式分2组:A组21例行颈椎前路减压单纯Cage植骨,B组34例行颈椎前路减压Cage植骨加钢板内固定。根据手术情况、症状改善情况及影像学资料对两组患者作分析比较。结果手术时间和出血量两组差异无统计学意义(P>0.05),放射性暴露时间两组差异有统计学意义(P<0.05)。术后JOA评分改善率两组差异无统计学意义(P>0.05),术后融合率两组差异有统计学意义(P<0.05)。两组颈椎生理曲度术后明显改善(P<0.01);术后随访1年时颈椎的生理前凸丢失程度两组间有显著性差异(P<0.01)。两组椎间高度术后改善明显(P<0.01);术后随访1年椎间高度丢失程度两组有显著性差异(P<0.01)。结论单节段颈椎前路减压单纯Cage植骨融合和加用钢板固定两种手术方式都是安全、可靠的,加用钢板有助于保持椎间高度及颈椎生理曲度、减少椎间隙塌陷和促进融合。     

颈椎前路单节段减压四种不同融合方式的疗效比较

目的比较颈椎前路单节段减压并不同融合方法治疗脊髓型颈椎病（cervical spondylotic myelopathy,CSM）的临床疗效。方法对168例单节段病变的CSM患者采用前路减压并植骨融合治疗,其中单纯植骨融合42例（A组）、颈椎前路减压界面固定术（cervical interbody fusioncage,CIFC）54例（B组）、植骨融合并颈椎前路钢板内固定40例（C组）、CIFC并前路钢板内固定32例（D组）。术后定期随访并摄X线片,观察疗效、椎间高度、颈椎前弯曲度和融合情况。结果经过随访,A组融合率为83．3％,B组融合率为96．3％,C组融合率为95．0％,D组融合率为96.9％。终访时,A组平均椎间高度和颈椎前弯曲度较术后早期显著降低（P〈0．05）,B组、C组和D组则无显著差异（P〉0．05）。结论脊髓型颈椎病的治疗关键不仅在于充分减压及有效植骨融合,而且不同融合技术对疗效有明显影响。     

颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病的疗效比较

目的比较颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病的临床疗效。方法回顾性分析自2015-03—2018-03诊治的120例单节段颈椎病,60例采用颈前路减压zero-p椎间植骨融合内固定治疗(zero-p组),60例采用颈前路减压cage椎间植骨融合内固定治疗(cage组)。比较2组手术时间、术中出血量、术后出现吞咽困难数,比较2组术后3个月及末次随访时上肢疼痛VAS评分、JOA评分、C_(2～7)颈椎曲度、病椎Cobb角、邻近椎体高度,比较2组末次随访时Eck植骨融合等级。结果 2组均顺利完成手术并获得至少2年的随访。zero-p组手术时间较cage组短,术后出现吞咽困难数较cage组少,差异有统计学意义(P0.05)。2组术中出血量比较差异无统计学意义(P0.05)。术后3个月及末次随访时2组颈部及上肢疼痛VAS评分、JOA评分比较差异无统计学意义(P0.05)。术后3个月2组C_(2～7)颈椎曲度、病椎Cobb角、邻近椎体高度比较差异无统计学意义(P0.05);末次随访时zero-p组C_(2～7)颈椎曲度、病椎Cobb角、邻近椎体高度较cage组小,差异有统计学意义(P0.05)。末次随访时2组Eck植骨融合等级比较差异无统计学意义(P0.05)。结论颈前路减压cage与zero-p椎间植骨融合内固定治疗单节段颈椎病疗效相当,而颈前路减压zero-p椎间植骨融合内固定手术时间较短,术后吞咽困难的发生率较低,但维持椎间高度与颈椎曲度的效果较差。     

颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折

目的评价颈椎前路钛网植骨及带锁钢板固定治疗下颈椎骨折的临床应用价值。方法 2005年5月～2012年12月共收治下颈椎压缩性及爆裂性骨折患者32例,其中颈脊髓损伤患者28例,采用前路减压复位椎体次全切除、钛网植骨及带锁钢板固定方法一期手术治疗。按照Frankel评分系统对神经功能恢复情况进行评价,以X线片测量的Cobb角、"D"值改变评价复位效果、观察融合节段曲度及颈椎生理曲度重建和维持情况。结果不完全脊髓损伤患者Frankel评分恢复平均1级以上。Cobb角、"D"值测量统计表明术前与术后差异有统计学意义(P<0.05),术后即刻与术后随访差异无统计学意义(P>0.05)。结论颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折临床疗效满意,能重建和维持颈椎生理曲度。     

前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病

目的评价前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病(CSM)的临床疗效。方法采用前路手术治疗累及3个节段的CSM患者46例。其中24例行椎体次全切除+单间隙减压植骨融合术(A组);22例行2个椎体次全切除减压植骨融合术(B组)。观察比较两组手术时间、术中出血量、植骨融合率、神经功能改善、颈椎生理曲度恢复情况。结果患者均获得随访,时间15~36个月。手术时间:A组(105±20)min,B组(180±30)min;术中出血量:A组(120±35)ml,B组(210±25)ml;两项指标两组比较差异均有统计学意义(P0.05)。术后3个月植骨融合率:A组为100%,B组为77.3%,差异有统计学意义(P0.05)。神经功能改善优良率:A组为83.3%,B组为81.8%,差异无统计学意义(P0.05)。两组术后颈椎生理曲度均得到明显改善,差异无统计学意义(P0.05)。结论前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段CSM可取得满意的疗效,具有操作相对简单、出血少、手术时间短、植骨融合率高等优点,是减少并发症的安全有效的手术方法。     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

椎体次全切除与椎间隙减压治疗多节段颈椎病的疗效比较

目的 比较椎体次全切除减压植骨融合术(anterior cervical corpectomy with fusion,ACCF)和经椎间隙减压植骨融合术(anterior cervical discectomy with fusion,ACDF)治疗多节段颈椎病的临床疗效及影像学结果.方法 回顾性分析2002年6月～...     

前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效分析

目的回顾性分析前路选择性椎体次全切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效。方法32例多节段脊髓型颈椎病患者均接受前路选择性椎体切除分节段减压植骨融合术,平均年龄为63．4岁。测量术后颈椎矢状呵的活动度;采用日本骨科学会（Japanese Orthopaedie Association,JOA）评分评估功能恢复情况;采用正侧位、动力位X线片评估融合程度。结果所有病例均获得平均25．2个月的有效随访。JOA评分术前为8.3±1．6,术后6个月为12．5±1．6,末次随访时为12．6±1．6,与术前比较差异均有统计学意义（P〈0．05）。末次随访时除1例出现假关节外,其余病例均已达到骨性融合。术前活动度为68．3°±5．8°,术后6个月为43．9°±4．2°,末次随访时为45．9°±4．5°,与术前比较差异均有统计学意义（P〈0．05）。结论前路选择性椎体切除分节段减压植骨融合术因保留中间椎体,并结合应用多组螺钉固定钢板,避免了因为跨多节段植骨内固定而导致的内置物失败。     

Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease

STUDY DESIGN: Clinical and radiologic study evaluating the outcome after anterior corpectomy with iliac bone fusion compared with discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. OBJECTIVES: To investigate the safety and effectiveness of interbody titanium cage with plate fixation in multilevel postdiscectomy fusion. SUMMARY OF BACKGROUND DATA: The operation for segmental multilevel cervical degenerated disc disease remains controversial. Data on safety and efficacy of titanium cages in multilevel postdiscectomy fusion are rarely available. We investigated the safety and effectiveness of interbody fusion cages with plate fixation and compared the clinical and radiographical results between anterior corpectomy and iliac bone fusion with plate fixation and multilevel discectomy and cage fusion with plate fixation. METHODS: Sixty-two patients were treated with either a multilevel discectomy and cage fusion with plate fixation (27 patients, group A) or an anterior corpectomy and iliac graft fusion with plate fixation (35 patients, group B). We evaluated the patients for cervical lordosis, fusion status, and stability 24 months postoperatively on the basis of spine radiographs. The patients' neurologic outcomes were assessed by the Japanese Orthopedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale. RESULTS: Both groups A and B demonstrated a significant increase in the JOA scores (preoperatively 11.1+/-2.1 and 10.4+/-3.5, postoperatively 14.3+/-2.4 and 13.9+/-2.1, respectively) and a significant decrease in the visual analog pain scores (preoperatively 8.5+/-1.1 and 8.7+/-1.5, postoperatively 2.9+/-1.8 and 3.0+/-2.0, respectively). However, there was no significant difference between groups A and B. Both groups A and B showed a significant increase in the cervical lordosis after operation and reached satisfactory fusion rates (96.3% and 91.4%, respectively). Three patients (two 2-level corpectomies and one 3-level corpectomy) had construct failures that required a second operation. Eight of 35 patients who underwent iliac bone fusion had donor site pain. The hospital stay in group A was significantly shorter than that in group B (P=0.022). CONCLUSIONS: Either a multilevel discectomy and cage fusion with plating or a corpectomy and iliac bone fusion with plating provides good clinical results and similar fusion rates for cervical degenerative disc disease. However, absence of donor site complications and construct failures and shorter hospital stay make the multilevel discectomy and cage fusion with plate fixation better than corpectomy and strut graft fusion with plate fixation.     

Treatment of multilevel cervical fusion with cages

BACKGROUND: Multilevel cervical discectomy usually requires plate and screw fixation for maintaining the spinal curvature, and increasing the graft fusion rate. However, the use of plate and screw fixation may cause a few complications, such as screw breakage, screw pullout, esophagus perforation, and cord or nerve root injury. In this study, we try to use cages to replace plate function in multilevel cervical fusion. METHODS: From January 1997 to June 2001, there were 180 consecutive cases of multilevel cervical degenerative disease. We randomized them into three groups: Group A (60 patients) underwent anterior discectomy and polyetheretherketone (PEEK) fusion, Group B (50 patients) underwent anterior discectomy, autogenous iliac crest graft (AICG) fusion and plate fixation, and Group C (70 patients) underwent anterior discectomy and AICG only. X-ray of cervical spine was taken every 3 months until fusion was complete. Spinal curvature was measured by lateral view of X-ray. The functional and working status were evaluated by Prolo scale. Blood loss and operation time were recorded, respectively. RESULTS: The total complication rates were 3.3%, 16%, and 54.3% in Groups A, B, and C respectively. The graft complications were evaluated by radiographic findings (graft collapse, nonunion, or dislodged graft). However, only 37.1% of patients (13/35) with graft complications had clinical symptoms (severe neck pain, radicular pain, or neurologic deficits). The fusion rate was better, and the time to fusion was sooner in Groups A and B than Group C, p < 0.001 (chi(2) test). PEEK cage is statistically better than plating group in total complications, p < 0.05. Graft collapse and nonunion were the major graft complications in Group C (AICG without plating). Screw pullout, and screw breakage were the main causes of plating complication. Blood loss was minimum in Group A, p < 0.05. Spinal lordosis increased by a mean of 4.61 +/- 2.93 mm and 1.68 +/- 5.02 mm in Groups A and B, respectively, but spinal kyphosis increased by a mean of -2.09 +/- 4.77 mm in Group C. Group A had a statistically better Prolo scale than Group C, p < 0.0001. CONCLUSIONS: Both PEEK cage without plating and AICG with plating are good methods for interbody fusion in multilevel cervical degenerative diseases. They increase spinal lordosis and graft fusion rate, and cause fewer surgical complications. However, PEEK cage is preferred in our study for multilevel fusion, because it has the fewest complication rates and the least amount of blood loss.     

颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症

目的探讨颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症的疗效。方法对确诊为颈椎管狭窄症患者62例,采用颈前路椎体次全切除钛网植骨钢板固定,对比手术前后患者的JOA评分,分析术前、术后及随访时的动力位片,观察钛网、钢板的位置及颈椎前凸角的变化。结果获得完整随访的患者42例,术后随访6～48个月（平均24个月）,6～8个月均获得植骨融合。术后颈椎前凸角改善明显,钛网及钢板位置稳定,JOA评分在术后获得较显著提高（P〈0.05）。结论颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症近期疗效肯定,是一种值得推广的术式,但该术式应严格掌握其适应证。     

Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment,cervical lordosis,graft collapse,and adjacent-level ossification

Background contextSingle-level corpectomy and two-level discectomy with anterior cervical plating have been reported to have comparable fusion and complication rates. However, there are few large series that have compared the two for sagittal alignment, cervical lordosis, graft subsidence, and adjacent-level ossification.PurposeTo determine the differences between these two procedures for patients with two-level spondylosis by comparing the pre- and postoperative radiographic data.Study designRetrospective review of prospectively collected data in an academic institution.Patient sampleFifty-two with a single-level corpectomy and 45 with a two-level anterior cervical discectomy and fusion (ACDF).Outcome measuresPre- and postoperative radiographic data for sagittal alignment, cervical lordosis, subsidence, and adjacent-level ossification.MethodsWe retrospectively reviewed the lateral cervical radiographs of patients who had a solid fusion after a single-level cervical corpectomy or a two-level ACDF for the treatment of a degenerative cervical spondylosis by a surgeon at an academic institution. The choice of the operation was dependent on the presence or absence of retrovertebral compression. All patients underwent anterior cervical fusion using fibula strut allograft and variable-angle screw-plate fixation. None had had prior cervical spine surgery. Twenty-five were excluded because of inadequate radiographs and follow-up. There were 52 with a single-level corpectomy and 45 with a two-level ACDF. The following were analyzed: 1) sagittal alignment (modified method of Toyama); 2) cervical lordosis measured by Cobb angles of fusion constructs (fusion Cobb) and C2–C7 (C2–C7 Cobb); 3) graft collapse determined by the subsidence of anterior/posterior body height of fused segments (anterior/posterior subsidence) and the cranial/caudal plate-to-disc distances (cranial/caudal subsidence), and the difference between anterior and posterior body height for the fused levels (anteroposterior [AP] difference); and 4) the severity of ossification at two adjacent levels.ResultsThe mean durations of follow-up were 23.3±6.6 (corpectomy) and 25.7±6.2 (ACDF) months, range 12 to 45 months. There were no significant differences between the two groups in sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Graft subsidence and loss of cervical lordosis occurred significantly more during the first 6 weeks after surgery (all measurements, p<.0001) than after 6 weeks, with no significant difference between the two groups. Posterior and caudal end plate subsidence significantly progressed after 6 weeks in Group 1 (p=.04, p=.02). The final follow-up Cobb angle positively correlated with preoperative and immediate postoperative Cobb angles (r=0.437, p<.0001; r=0.727, p<.0001), caudal subsidence (r=0.270, p=.008), and the final AP difference (r=0.915, p<.0001) but did not correlate with surgery level, preoperative and final sagittal alignments, anterior/posterior subsidence, and cranial subsidence. Anterior/posterior subsidence was significantly more strongly related with caudal subsidence (r=0.607, p<.0001; r=0.424, p<.0001) than cranial (r=0.277, p=.007; r=0.211, p=.040) but did not correlate with pre- and postoperative fusion Cobb, and preoperative and the last sagittal alignments.ConclusionsOur data suggest that the two procedures yield comparable results in terms of sagittal alignment, cervical lordosis, graft subsidence, and adjacent-level ossification. Graft subsidence and loss of cervical lordosis appeared to occur mainly during the first 6 weeks after surgery. Single-level corpectomy and fusion continued to subside at the posterior portion of caudal end plate even after 6 weeks. On the other hand, graft subsidence did not correlate with preoperative and final postoperative sagittal alignments.     

A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion

A single corpectomy and strut grafting has been proposed as an alternative to performing two-level adjacent discectomies with multiple grafts to produce superior fusion rates. The purpose of this study was to compare the clinical and radiographic success of two-level discectomy and fusion with anterior cervical plate fixation compared with a single-level corpectomy. Fifty-two patients were treated with either a two-level adjacent anterior cervical discectomy and fusion with cervical plating, or by a single-level corpectomy and plate. Thirty-two patients had two-level discectomies, whereas 20 had a single corpectomy and a strut graft (average follow-up was 3.6 years). One patient had a pseudarthrosis from a single-level corpectomy and required subsequent surgery to obtain an osseous union. The fusion rates between the two groups was not statistically significant (p = 0.385). The clinical results of the surgeries were similar between the groups based on Odom's criteria. The addition of cervical plates to either two-level discectomies or single-level corpectomies yielded similar fusion and complication rates.     

两种前路减压融合术治疗颈椎间盘突出症的比较

目的对前路颈椎间盘切除减压的碳纤维椎间融合器(cage)植入术与自体髂骨块植骨加钛板固定术治疗单节段颈椎间盘突出症(CDH)进行临床疗效及影像学评估。方法需要手术治疗的单节段CDH患者60例,其中前路减压cage植入术31例,自体髂骨块植骨加钛板固定术29例。术前、术后及随访期间摄X线片,比较两组病例的手术时间、术中出血量、术后并发症、症状改善率、融合时间、融合率、融合节段椎体间高度的维持情况。结果cage植入术较自体髂骨块植骨加钛板固定术手术时间短,出血少(P<0.01)。两组融合节段椎体间高度较术前均明显改善(P<0.01)。两组间症状改善率、融合率无统计学意义(P>0.05)。cage植入术较自体髂骨块植骨加钛板固定术并发症少。结论cage植入术和自体髂骨块植骨加钛板固定术都是前路减压治疗单节段CDH的重要而有效的方法。而cage植入术在减小手术创伤的同时,可以获得同样的临床效果,是治疗单节段CDH理想的术式之一。