Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years.

STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: To compare the long-term outcomes of subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: No study has compared the long-term outcomes between subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy. METHODS: In this study, 23 patients treated with subtotal corpectomy and 24 patients treated with laminoplasty were followed up for 10 to 14 years after surgery. Neurologic recovery, late deterioration, axial pain, radiographic results (degenerative changes at adjacent levels, alignment, and range of motion of the cervical spine), and surgical complications were compared between the two groups. RESULTS: No significant difference in neurologic recovery was found between the two groups 1 and 5 years after surgery, or at the latest follow-up assessment. Neurologic status deteriorated in one patient of the subtotal corpectomy group because of adjacent degeneration, and in one patient of the laminoplasty group because of hyperextension injury. Axial pain was observed in 15% of the corpectomy group and in 40% of the laminoplasty group (P < 0.05). In the corpectomy group, listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, and osteophyte formation at 54% of the lower adjacent levels. In the laminoplasty group, kyphotic deformity developed in one patient (6%) after surgery. In the corpectomy group, the mean vertebral range of motion had decreased from 39.4 degrees to 19.2 degrees (49%) by the final follow-up assessment. In the laminoplasty group, the mean vertebral range of motion had decreased from 40.2 degrees to 11.6 degrees (29%) by the final follow-up assessment. Neurologic complications related to the surgery occurred in two patients (one myelopathy from bone graft dislodgement and one C5 root palsy from bone graft fracture) of the corpectomy group and four patients (C5 root palsy) of the laminoplasty group. All of these patients recovered over time. The corpectomy group needed longer operative time (P < 0.001) and tended to have more blood loss (P = 0.24). Six patients in the corpectomy group needed posterior interspinous wiring because of pseudarthrosis. CONCLUSIONS: Subtotal corpectomy and laminoplasty showed an identical effect from a surgical treatment for multilevel cervical spondylotic myelopathy. These neurologic recoveries usually last more than 10 years. In the subtotal corpectomy group, the disadvantages were longer surgical time, more blood loss, and pseudarthrosis. In the laminoplasty group, axial pain occurred frequently, and the range of motion was reduced severely.     

Cervical alignment and range of motion after laminoplasty: radiographical data from more than 500 cases with cervical spondylotic myelopathy and a review of the literature

STUDY DESIGN.: A large-scale analysis of radiographical results of patients with cervical spondylotic myelopathy and a review of the literature. OBJECTIVE.: To identify changes in sagittal alignment and range of motion (ROM) after cervical laminoplasty. SUMMARY OF BACKGROUND DATA.: Cervical laminoplasty is an effective procedure for decompressing multilevel spinal cord compression. It often induces postoperative complications such as loss of lordotic alignment and restriction of neck motion. Although numerous studies have reported the loss of flexion-extension ROM after laminoplasty, no large-scale study has been reported. METHODS.: Five hundred twenty consecutive patients with cervical spondylotic myelopathy (331 male and 189 female; mean age, 62.2 yr) who underwent modified double-door laminoplasty were enrolled. The average follow-up period was 33.3 months. All patients were allowed to sit up and walk on the first postoperative day using an orthosis, which could be removed within the first 2 weeks, even if long. Early cervical ROM exercises were performed as a part of the rehabilitation schedule. Radiography was performed before surgery and at the final follow-up. Cervical alignment in the neutral and flexion-extension view were measured by the Cobb method at C2-C7. The ROM was assessed by measuring the difference in alignment between flexion and extension. RESULTS.: The mean C2-C7 alignment in the neutral position was 11.9° lordotic preoperatively and 13.6° lordotic postoperatively; the alignment increased by 1.8° in lordosis. The mean total ROM decreased from a preoperative value of 40.1° to 33.5° at the final follow-up, showing a significant difference of 6.6°. The mean total ROM preservation after laminoplasty was 87.9%. CONCLUSION.: Sagittal alignment was slightly changed, with only a 1.8° increase in lordosis. The ROM of the cervical spine was preserved by 87.9%. This preservation of alignment and ROM might be attributable to improvements including early removal of the cervical orthosis, postoperative neck exercises, and some surgical modifications.     

颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床比较

目的分析比较颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床效果。方法回顾2003-09-2009-06收治的50例多节段脊髓型颈椎病患者,其中28例行颈椎后路单开门椎管成形术,作为A组;22例行颈椎后路双开门椎管成形术,作为B组。对两组患者术前及术后2年的JOA评分改善率、轴性症状严重程度、颈椎活动度进行评估比较。结果 JOA评分改善率A组(52.0±21.4)%,B组为(52.7±19.8)%,两组差异无统计学意义(P=0.970>0.05)。A组术后有明显轴性症状患者的比例为42.9%,B组为36.4%,组间比较差异无统计学意义(P=0.642>0.05)。颈椎活动度A组平均丢失3.9°,B组平均丢失3.6°,两组差异无统计学意义(P=0.492>0.05)。结论颈椎后路双开门椎管成形术比单开门椎管成形术的轴性症状发生率及颈椎活动丢失率更低。但两者间的差异无统计学意义。术者可以根据不同的适应证及术者自身的熟练程度来采用不同开门方法。     

颈椎单开门椎管成形术结合微型钛板内固定治疗多节段脊髓型颈椎病

目的：探讨颈椎后路微型钛板内固定结合单开门椎管成形术治疗多节段脊髓型颈椎病的临床效果。方法2008年3月至2011年10月山东大学齐鲁医院沂南分院采用单开门椎管成形术结合微型钛板内固定治疗34例多节段脊髓型颈椎病患者,对患者术前及术后3周、15个月日本骨科学会（JOA）评分、椎管矢状径、轴性症状严重程度、颈椎活动度（ROM）进行评估。结果所有患者获随访10～18个月,平均随访时间13个月。术后3周、15个月JOA评分及椎管矢状径较术前均明显提高（P＜0.05）;术后3周及15个月的JOA评分、椎管矢状径比较,差异无统计学意义（P＞0.05）。颈部轴性疼痛发生率12%。术后ROM较术前有所降低,但差异无统计学意义（P＞0.05）。结论颈椎后路微型钛板内固定结合单开门椎管成形术是治疗多节段脊髓型颈椎病安全有效的方法。     

Long-term results of tension-band laminoplasty for cervical stenotic myelopathy: a ten-year follow-up

We reviewed 75 patients (57 men and 18 women), who had undergone tension-band laminoplasty for cervical spondylotic myelopathy (42 patients) or compression myelopathy due to ossification of the posterior longitudinal ligament (33 patients) and had been followed for more than ten years. Clinical and functional results were estimated using the Japanese Orthopaedic Association score. The rate of recovery and the level of postoperative axial neck pain were also recorded. The pre- and post-operative alignment of the cervical spine (Ishihara curve index indicating lordosis of the cervical spine) and the range of movement (ROM) of the cervical spine were also measured. The mean rate of recovery of the Japanese Orthopaedic Association score at final follow-up was 52.1% (SD 24.6) and significant axial pain was reported by 19 patients (25.3%). Axial pain was reported more frequently in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p = 0.027). A kyphotic deformity was not seen post-operatively in any patient. The mean ROM decreased post-operatively from 32.8° (SD 12.3) to 16.2° (SD 12.3) (p < 0.001). The mean ROM ratio was 46.9% (SD 28.1) for all the patients. The mean ROM ratio was lower in patients with ossification of the posterior longitudinal ligament than in those with cervical spondylotic myelopathy (p < 0.001). Compared to those with cervical spondylotic myelopathy, patients with ossification of the posterior longitudinal ligament had less ROM and more post-operative axial neck pain.     

The Torg--Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population

STUDY DESIGN: A radiologic study to compare the Torg--Pavlov ratios between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. OBJECTIVES: To determine and compare the Torg--Pavlov ratios between the two groups of patients. SUMMARY OF BACKGROUND DATA: Patients with congenital cervical spinal canal stenosis are more likely to develop cervical spondylotic myelopathy. The Torg--Pavlov ratio eliminates errors related to magnification, a problem with determination of spinal canal stenosis from direct measurements of plain cervical spine radiographs. There has only been one other study that directly compares the Torg--Pavlov ratio between patients with cervical spondylotic myelopathy and a normal control population. METHODS: The preoperative plain lateral cervical spine radiographs of 28 patients with cervical spondylotic myelopathy requiring surgical decompression were compared with radiographs of 88 nonspondylotic, nonmyelopathic patients. The Torg--Pavlov ratio was computed for each level from C3 to C7. RESULTS: The study showed that the Torg--Pavlov ratio is significantly smaller (P < 0.001) in myelopathic patients (mean 0.72 +/- 0.08) compared with the control patients (mean 0.95 +/- 0.14). This was so when individual levels and the mean values were compared. Age was also found to be a significant factor (P = 0.002), although lesser in magnitude when compared with the Torg--Pavlov ratio (P = 0.0001). CONCLUSIONS: The Torg--Pavlov ratio is significantly lower in patients with cervical spondylotic myelopathy compared with a nonspondylotic, nonmyelopathic population. It could possibly be used to predict the likelihood of developing cervical spondylotic myelopathy.     

Expansive laminoplasty for myelopathy in ossification of the longitudinal ligament

Laminectomy, which had long been used for treatment of cervical spondylotic myelopathy, including ossification of the longitudinal ligament in the cervical spine, had numerous complications such as postoperative malalignment of the cervical spine and vulnerability of the spinal cord caused by total removal of the posterior structures. In 1977 Hirabayashi devised an open door expansive laminoplasty, which is a relatively easier and safer procedure than laminectomy, that eliminated such problems by preserving the posterior elements. The decompression effect of the expansive laminoplasty against a compressed spinal cord is comparable with that of laminectomy and anterior decompression followed by fusion, whereas the expansive laminoplasty has no structural problems and adverse effects on adjacent disc levels that often are associated with anterior decompression followed by fusion. Average recovery rate of expansive laminoplasty for cervical spondylotic myelopathy has been reported to be approximately 60% (Japanese Orthopaedic Association score) and with long term stability. At present, authors consider all patients with cervical spondylotic myelopathy candidates for expansive laminoplasty except for those having preoperative kyphosis and single level lesion without canal stenosis. Two remaining problems of expansive laminoplasty to be solved are prevention of C5,C6 radicular pain and/or paresis, the most frequent complication that occurs in approximately 5% to 10% of the patients, although most complications resolve spontaneously within 2 years, and correction of nonlordotic alignment to lordosis which are essential for posterior decompression effect of expansive laminoplasty by allowing the spinal cord to shift dorsally.     

颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的病例对照研究

目的 :比较颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的临床疗效。方法:对2009年7月至2012年6月收治的56例多节段脊髓型颈椎病病例进行回顾性分析,男32例,女24例;年龄42~79岁,平均(56.9±12.8)岁,病程2个月~16年,平均(10.6±3.2)年。所有患者术前经影像学检查显示有多节段颈椎间盘突出,并具有脊髓型颈椎病的临床表现。其中34例采用颈椎前路减压分段融合术(前路组),22例采用后路椎管扩大成形术(后路组)。通过影像学资料对两组患者手术前后的病变节段前柱高度和颈椎前曲度进行比较,并采用JOA评分评价手术效果。结果:两组患者无神经血管并发症发生,并获得24~36个月的随访(平均28.6个月)。前路组,术后2周时颈椎病变节段前柱高度较术前明显增高(P0.05),颈椎前曲度较术前明显降低(P0.05)。后路组,术后2周及末次随访时,病变节段前柱高度和颈椎前曲度较术前差异均无统计学意义(P0.05)。两组间在术后2周及末次随访时颈椎前曲度差异有统计学意义(P0.05)。术后两组JOA评分均出现了明显恢复,术后3个月及末次随访时,前路组明显高于后路组(P0.05),且JOA评分改善率前路组也优于后路组(P0.05)。结论:这种分段式前路融合手术可以有效地恢复颈椎前柱高度,并且与颈椎后路椎管扩大成形术相比,可以显著地改善脊髓功能,是治疗多节段脊髓型颈椎病的有效方案。     

影响单开门椎管扩大成形术治疗颈椎病疗效的术后相关因素分析

目的 探讨单开门椎管扩大成形术治疗多节段脊髓型颈椎病术后因素对手术效果的影响.方法 回顾性分析2001年5月至2006年12月接受单开门椎管扩大成形术治疗的多节段脊髓型颈椎病患者.选取JOA改善率>75%(A组38例)和<25%的病例(B组32例)进行分析.对两组患者年龄、性别、病程、术前JOA评分、术前Pavlov比率、术前颈椎活动度、术前颈椎曲度指数、脊髓受压节段数、随访时间等可能影响术后JOA改善率的术前参数行统计学分析,两组只在年龄和术前JOA评分上差异有统计学意义.去除两组中年龄>60岁的病例以及JOA评分<6分的病例.A组剩余24例(A1组),B组18例(B1组).再次对A1组和B1组行以上统计学分析,两组各项参数差异均无统计学意义.对A1和B1两组术后颈椎活动范围及其改变率、术后颈椎曲度指数及其改变率、术后Pavlov比率及椎管扩大率等六项参数进行成组设计t检验,并与JOA改善率进行相关性分析.结果上述六项参数中除两组术后颈椎活动范围差异无统计学意义(P>0.05),其余五项参数差异均有统计学意义(P<0.05).A1组中除术后颈椎活动范围与JOA改善率无相关性,其余指标均与JOA改善率有相关性;B1组中除术后颈椎活动范围及其改变率与JOA改善率无相关性,其余各指标均与JOA改善率有相关性.结论 术后减小颈椎活动范围、维持颈椎前凸及尽量扩大椎管直径有利于神经功能的恢复.     

Is cervical lordosis relevant in laminoplasty?

Background contextLaminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis.PurposeTo identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty.Study designRetrospective cohort study.Patient sampleFrom August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty.Outcome measuresThe clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment.MethodThe effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle.ResultsNo difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results.ConclusionsDespite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.     

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

BACKGROUND:: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion. OBJECTIVE:: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion. METHODS:: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores. RESULTS:: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = -0.43, P < .001 and r = -0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant. CONCLUSION:: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction. ABBREVIATIONS:: CGH, center of gravity of headHRQOL, health-related quality-of-lifeNDI, neck disability indexPCSz, physical composite scoreSVA, sagittal vertical axisVAS, visual analog scale.     

锚定钉在多节段脊髓型颈椎病单开门椎管扩大术中的应用

目的:探讨锚定钉在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病中的临床应用价值。方法:2009年1月～2011年1月,采用颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病25例,男21例,女4例。年龄35～78岁,平均63.5岁。病程1.6～18年,平均3.6年。3节段18例,4节段7例。20例合并发育性或退变性颈椎管狭窄,均有颈脊髓受压症状,JOA评分3～11分,平均6.7±2.2分。均行颈椎单开门椎管扩大术,开门节段均为C3～C7,均采用锚定钉固定,固定节段为C3、C5、C7。结果 :锚定钉均顺利置入,手术时间60～100min,平均75min。术中出血100～500ml,平均200ml,无脊髓损伤、脑脊液漏、硬膜外血肿等并发症发生。1例术后有颈肩部疼痛,给予对症处理2个月后疼痛消失。术后随访0.5～2.5年,平均1.9年,末次随访时JOA评分10～16分,平均13.8±1.4分,与术前比较差异有统计学意义(P<0.01),平均改善率为(68.1±7.5)%,优良率为88%。X线片检查显示颈椎曲度基本正常,椎管中矢状径与椎体中矢状径比值平均为1.2,锚钉无松动,无颈椎不稳及关门。结论:在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病时应用锚定钉固定开窗椎板方法简单可靠,可避免"关门",临床疗效满意。     

分期治疗颈椎黄韧带骨化合并后纵韧带骨化症

目的回顾性分析分期后前路手术治疗颈椎黄韧带骨化(ossification of ligamentum flavum,OLF)合并后纵韧带骨化(ossification of the posterior longitudinal ligament,OPLL)的临床疗效。方法完整随访手术治疗的颈椎OLF合并OPLL患者18例,一期行后路椎板成形术,术后严密观察6~9个月,一期术后症状改善有限,影像学检查发现前方骨化的韧带压迫脊髓,二期行前路椎体次全切除并切除骨化的韧带+植骨内固定术。术前、一期和二期术后行JOA评分并计算恢复率,测量颈椎前凸值,比较术前、术后颈椎前凸值、JOA评分和恢复率。结果椎板成形术后出现不全瘫痪症状加重者1例,C5神经根麻痹症状1例,脑脊液漏3例;二期前路手术后出现脑脊液漏2例,神经根麻痹2例,保守治疗后痊愈。平均随访时间26.3个月,术前JOA评分(7.2±1.3)分,颈椎前凸值(5.7±4.1)°;一期术后JOA评分(12.6±3.8)分,改善率为(51.6±19.3)%,颈椎前凸值(9.3±3.8)°;二期术后JOA评分(14.8±1.6)分,改善率为(72.7±13.4)%,颈椎前凸值(15.5±3.2)°。JOA评分、改善率以及颈椎前凸值在一期、二期术后与术前相比差异均有统计学意义,P0.05。结论分期后前路手术治疗可明显改善OLF合并OPLL患者术后JOA评分、恢复率和颈椎前凸值,是治疗OLF合并OPLL的一种良好方式。     

Laminoplasty versus skip laminectomy for the treatment of multilevel cervical spondylotic myelopathy: a systematic review

Introduction

Laminoplasty and skip laminectomy are two specific posterior surgical approaches for multilevel cervical spondylotic myelopathy. The objective of this study was to perform a systematic review comparing the clinical results and complications of laminoplasty and skip laminectomy in the treatment of multilevel cervical spondylotic myelopathy.

Materials and methods

We reviewed and analyzed papers published from January 1969 to December 2012 through the Mediline, Embase, Cochrane review library, and other databases regarding the comparison between laminoplasty and skip laminectomy for multilevel cervical spondylotic myelopathy.

Results

One randomized controlled trial and three non-randomized controlled trials were included in this systematic review. In three studies, the preoperative and postoperative JOA score was similar in both laminoplasty and skip laminectomy groups. In addition, for recovery rate, there was no significant difference between the groups. One study reported that, regarding SF12 scores, there was no significant difference in physical health and mental health after surgery. However, regarding cervical pain, the skip laminectomy group was better than the laminoplasty group significantly. No difference was presented in postoperative ROM and the cervical lordosis between the groups. But the ROM % (post/pre) was reported to be significantly better in the skip laminectomy group in three studies. Less blood loss and shorter operation time were observed in skip laminectomy rather than laminoplasty.

Conclusions

Based on the results above, the skip laminectomy group presented better outcomes in a variety of aspects: ROM % (post/pre), complication rate, surgical trauma, etc. However, as limited study samples were included in the paper, a claim of superiority of the two approaches could not be justified. Further studies are required on the comparison between laminoplasty and skip laminectomy.     

先天性颈椎管狭窄与脊髓型颈椎病影像学表现以及预后的关系

目的 探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者先天性颈椎管狭窄(cervical spinal stenosis,CSS)与颈椎MRI改变及预后的关系.方法 回顾性分析自2006年11月至2009年11月,采用前路、后路或前后路联合手术治疗的286例CSM患者的病例资料,根据患者是否存在CSS将患者分为两组,在MRI T2加权像上评价脊髓高信号的等级以及脊髓受压程度.记录患者日本骨科学会评分标准(Japanese Orthopaedic Associatio,JOA)评分、病程和体征,包括感觉减退或者消失、Hoffman征、Babinski征、腱反射.结果 在CSM患者中CSS的发生率为33.6%,先天性CSS组的年龄、JOA评分、病程均大于无CSS组,术后临床改善率小于无CSS组.两组之间性别的差异无统计学意义(x2=0.006,P=1.00),两组之间的颈椎MRI T2加权像脊髓高信号发生率的差异有统计学意义(x2=-62.396,P＜0.001),CSS组脊髓高信号的发生率为70.8%,无CSS组脊髓高信号的发生率为22.6%.先天性CSS组脊髓受压程度相对于无CSS组严重,且先天性CSS组患者体征的数目相对较多.应用多元线性回归分析法得出术后改善率与CSS、病程、临床体征的数目和年龄有关(R2=0.565).结论 先天性CSS患者出现CSM时往往脊髓受压程度较重、MRI T2加权像脊髓内高信号出现的概率大,病程长且预后较差.

Abstract：

Objective To investigate the relationship between the cervical MR images and pathological changes, prognosis in patients with cervical spinal stenosis and cervical spondylotic myelopathy. Methods From Nov. 2006 to Nov. 2009, 286 patients with cervical spondylotic myelopathy were included through retrospective analysis. All patients were divided into two groups according to whether there was cervical stenosis, the grade of increased signal intensity (ISI) in spinal cord and the degree of spinal cord compression was evaluate in T2-weighted MR images of midian sagittal slices. JOA scale, duration of disease,Hoffmann sign, Babinski sign, sensory loss or hypoesthesia, and lower-extremity/upper-extremity hyperreflexia were recorded. Results The incidence rate of cervical spinal stenosis was 33.6% in patients with cervical spondylotic myelopathy. The study showed that the age was smaller (P＜ 0.001 ), preoperative JOA score was higher(P=0.0018), duration of disease was longer(P=0.009), and the recovery rate was lower(P＜ 0.001 )in cervical spinal canal narrowing group comparing with control group. There was no significant difference between the two groups in gender (x2=0.006,P=l.00). There was significant difference between two groups in the incidence of ISI in spinal cord through x2 test(x2=62.396,P＜ 0.001 ). Multivariate analysis indicated that the likelihood of the recovery rate of cervical myelopathy decreased with the presence of cervical spinal stenosis, duration of dieaase, number of neurological signs, age (R2=0.565). Conclusion Patients with congenitally narrow cervical spinal canal have to suffer severe spinal cord compression and high incidence of ISI in spinal cord. The duration of disease is long, and prognosis is poor.     

Acute traumatic central cord syndrome--experience using surgical decompression with open-door expansile cervical laminoplasty

BACKGROUND: Open-door expansile cervical laminoplasty (ODECL) is an effective surgical technique in the treatment of multilevel cervical spondylotic myelopathy. In the present study, we reviewed the safety and short-term neurological outcome after expansile cervical laminoplasty in the treatment of acute central cord syndrome. METHODS: We retrospectively reviewed our database over a 3-year period (January 1997-January 2001) and identified 69 surgically treated cervical spinal cord injuries, including 29 cases of acute traumatic central cord syndrome (ATCCS). Fifteen of these patients underwent expansile cervical laminoplasty, whereas 14 did not because of radiographic evidence of sagittal instability. We collected data on the preoperative and the immediate postoperative and 3-month neurological examinations. Neurological function was assessed using the Asia Spinal Injury Association (ASIA) grading system. We also reviewed the occurrence of complications and short-term radiological stability after the index procedure. RESULTS: The median age was 56 years. All patients had hyperextension injuries with underlying cervical spondylosis and stenosis in the absence of overt fracture or instability. The average delay from injury to surgery was 3 days. The preoperative ASIA grade scale was grade C, 8 patients, and grade D, 7 patients. There were no cases of immediate postoperative deterioration or at 3 months follow-up. Neurological outcome: 71.4% (10/14) of patients improved 1 ASIA grade when examined 3 months post injury. CONCLUSIONS: Surgical intervention consisting of ODECL can be safely applied in the subset of patients with ATCCS without instability who have significant cervical spondylosis/stenosis. Open-door expansile cervical laminoplasty is a safe, low-morbidity, decompressive procedure, and in our patients did not produce neurological deterioration.     

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis.

STUDY DESIGN: A matched cohort clinical and radiographic retrospective analysis of laminoplasty and laminectomy with fusion for the treatment of multilevel cervical myelopathy. OBJECTIVES: To compare the clinical and radiographic outcomes of two procedures increasingly used to treat multilevel cervical myelopathy. SUMMARY OF BACKGROUND DATA: Traditional methods of treating multilevel cervical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two techniques has not been reported. METHODS: Medical records of all patients treated for multilevel cervical myelopathy with either laminoplasty or laminectomy with fusion between 1994 and 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent laminoplasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician. RESULTS: Cohorts were well matched based on patient age, duration of symptoms, and severity of myelopathy (Nurick grade) before surgery. Mean independent follow-up was similar (25.5 and 26.2 months). Both objective improvement in patient function (Nurick score) and the number of patients reporting subjective improvement in strength, dexterity, sensation, pain, and gait tended to be greater in the laminoplasty cohort. Whereas no complications occurred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included progression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, subjacent degeneration requiring reoperation, and deep infection. CONCLUSIONS: The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.     

Cervical curvature after laminoplasty for spondylotic myelopathy--involvement of yellow ligament, semispinalis cervicis muscle, and nuchal ligament

To assess the consequences of cervical laminoplasty on postoperative lordosis, a retrospective radiographic analysis of 31 patients undergoing laminoplasty for spondylotic myelopathy was completed. Special attention was paid to lordotic changes occurring at each level over more than 2 years. Preoperative lordosis remained unchanged with the patients wearing a cervical orthosis 1 week postoperatively. However the lordosis subsequently demonstrated a significant decrease in 87% of patients over an average of 3.1 years. Lordotic alignment at C2-C3 and C6-C7 before surgery significantly decreased in 81% and 58% of patients 1 week postoperatively, and 84% and 81% at last follow up, respectively, while lordotic alignment at other levels pre- and postoperatively did not significantly change. Loss of lordotic alignment was largely attributed to detachment of semispinalis cervicis muscle on C2 and nuchal ligament on C6/C7 with a posterior approach and/or section of yellow ligament at C2-C3.     

C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation

STUDY DESIGN: Consecutive case series. OBJECTIVE: To compare the incidence and clinical characteristics of postoperative fifth cervical nerve root palsy (C5 palsy) in patients with cervical myelopathy treated by laminoplasty alone and laminoplasty with posterior instrumentation. SUMMARY OF BACKGROUND DATA: In patients who have multilevel cervical myelopathy with reducible kyphosis or instability, the authors have performed laminoplasty together with instrumented fusion to restore lordosis and stability. There seems to be a high incidence of postoperative C5 palsy in these patients. METHODS: Seventy-three patients with a mean age of 60.5 years and multilevel cervical myelopathy treated by laminoplasty from 1995 to 2005 were reviewed. Incidence, side, and severity of muscle weakness from patients with C5 palsy after posterior instrumented fusion (instrumented group) was compared with those without instrumentation (noninstrumented group). Radiologic parameters were assessed to identify predisposing factors. RESULTS: Overall 10 of 73 (14%) patients developed the C5 palsy, of which 5 (50%) of 10 patients were in instrumented group, and 5 of 63 (8%) patients were in noninstrumented. Three of 5 (60%) had the palsy on the same side of the opened lamina in the instrumented group, in the same proportion as the noninstrumented. Three (60%) patients in instrumented group developed deltoid weakness grade 1, but none in the noninstrumented had weaker than grade 3. All of the palsied in the instrumented group recovered within 2 years after surgery without removal of implant. Of the 5 patients with the palsy in the instrumented group, 3 had anterolisthesis before surgery and posterior translation of C4 on C5 by the surgery, and no patient without the palsy had the anterolisthesis. CONCLUSIONS: Posterior cervical fusion using instrumentation for restoration of lordotic alignment combined with laminoplasty is highly associated with severe postoperative C5 palsy in patients with multilevel cervical myelopathy and C4 anterolisthesis.     

颈前路椎体次全切减压钛网植骨融合联合钛板固定治疗多节段脊髓型颈椎病

目的 :探讨颈前路椎体次全切减压钛网植骨融合联合钛板固定治疗多节段脊髓型颈椎病的临床疗效。方法:对2010年10月至2013年1月收治的48例多节段脊髓型颈椎病患者进行回顾性分析,其中男37例,女11例;年龄37~76岁,平均54.6岁;2个节段病变35例,3个节段病变7例,4个节段病变6例。所有患者接受颈前路椎体次全切钛网自体颗粒骨植骨融合颈前路钛板内固定手术。进行临床和影像学随访,记录术前及术后3、6、12个月及末次随访时的ROM、JOA、VAS及SF-36评分,观察融合程度和椎管减压情况。结果:所有患者获得随访,时间14~48个月,平均27.3个月。术后12个月时,影像学资料显示所有患者达到骨性融合,椎管减压彻底,术前病变最严重处椎管矢状径为(5.13±1.32)mm,术后12个月为(9.94±1.22)mm,手术前后椎管矢状径比较差异有统计学意义(t=2.463,P=0.014);椎管减压程度为(92.15±2.35)%。术后各观察时间节点ROM、JOA、VAS及SF-36评分均较术前明显改善(P0.05);术后各观察时间节点ROM、JOA、VAS及SF-36评分比较差异无统计学意义(P0.05)。结论 :颈前路椎体次全切减压钛网植骨融合联合钛板内固定手术治疗多节段脊髓型颈椎病融合率高,减压彻底,临床症状体征改善明显,且安全性较好。