颈髓挥鞭样损伤的前路手术治疗

目的 探讨颈髓挥鞭样损伤的受伤特征和前路手术治疗效果。方法 对36例影像学证实伴有急性颈椎间盘突出的颈髓挥鞭样损伤患者行颈前路椎体次全切除、自体髂骨植骨加钢板内固定术，并进行随访。随访时间为36-54个月，平均46．4个月。结果该组患者以交通伤为主，颈椎间盘突出发生在C5-6节段和C4，5节段者最多，突出的椎间盘类型以中央型突出者居多，手术有效率为95％（34／36）。结论 对影像学证实颈髓挥鞭样损伤伴急性颈椎间盘突出症患者，颈前路减压植骨加带锁钢板内固定手术是一种良好的选择。     

经皮穿刺颈椎间盘切除术的体会(附67例报告)

目的：采用经皮穿刺颈椎间盘切除术（PCD）治疗颈椎间盘突出症。材料与方法：总结经皮穿刺腰椎间盘切除术（PLD）的经验基础上，结合颈部解剖特点，成功地将PLD技术用于经皮穿刺颈椎间盘切除（PCD），并自1993年7月-1997年6月采用PCD治疗颈椎间盘突出症共67例。结果：术后综合疗效评定结果为：优49例，良7例，无变化8例。优良率为87.5%。结论：PCD与常规经颈前路椎间盘手术相比，具有创伤小，手术方法新颖，操作简单，安全可靠，患恢复快等优点。     

经皮穿刺颈椎间盘切割抽吸术的护理

１９９３年１０月至今,我院放射科介入室应用经皮穿刺颈椎间盘切割术（ＰＣＤ）技术治疗颈椎间盘突出症,效果显著。现将治疗９９例病人的护理报告如下。一、临床资料９９例经临床和ＭＲＩ诊断为颈椎间盘突出症病人,年龄２６～６９岁。男５３例,女４６例。椎间盘突出平面１节者６２例,２节者３５例,３节者３例。突出部位颈２～３　１例,颈３～４　１８例,颈４～５　４１例,颈５～６　６２例,颈６～７　２３例。平均住院３．７天。二、护理要点（一）心理护理　ＰＣＤ术是一项新技术,采用经颈动脉三角区穿刺,属敏感危险区,病人对…     

一体化颈椎钢板融合器的临床应用

目的 评价一体化颈椎钢板融合器(PCB)的优越性。方法 颈前路椎间盘摘除后，选用适当型号的一体化颈前路钢板融合器(PCB)置入，不需透视帮助即可拧入螺钉和松质骨碎片植骨。治疗颈椎创伤伴急性椎间盘突出症15例；脊髓型颈椎病14例。术后随访4～33个月，平均16个月。结果 在15例急性颈椎间盘突出症患者中，12例颈髓不全损伤者基本恢复正常，3例颈髓完全损伤者截瘫无恢复。14例颈椎病术前日本骨科学分(JOA)评分为7～13分，平均为9.6分，术后评分为12～17分，平均15.8分，术后改善率为83.8％。21例患者接受单节段的固定，7例为双节段，1例为三节段固定。无术中并发症发生，仅有1枚螺钉松动部分脱出。供骨部位无并发症。结论 PCB的优点在于防止供骨和植骨部位并发症发生，提供即刻的生物力学稳定性，预防螺钉松动及断裂，并恢复椎间隙高度及脊柱前凸。术后无需使用颈托。     

颈椎前路一体化钢板融合器的临床应用

目的 评价颈椎前路一体化钢板融合器治疗颈椎间盘突出症的长期疗效. 方法 对54例症状性退行性颈椎间盘突出症和急性颈椎间盘突出症患者行前路椎间盘切除减压一体化钢板融合器置入术.术后行日本脊柱学会(JOA)评分,X线片观察融合情况.随访12～79个月,甲均53.2个月.结果 所有患者术中无并发症发生.随访显示椎间隙高度和脊柱前凸已恢复,无器械断裂、远期不稳定或假关节形成.1例急性椎间盘突出脊髓部分损伤患者和3例症状严重脊髓型椎间盘突出患者症状改善不明显,其余患者治疗效果良好.术后JOA评分为13～17分,平均16.1分,术后改善率为86.7%,融合率100%. 结论 颈椎前路一体化钢板融合器治疗颈椎间盘突出症有其生物力学优势,是颈椎前路融合固定一项可靠的技术.     

射频热凝靶点消融联合臭氧注射治疗颈椎间盘突出症120例

目的：观察射频热凝靶点消融联合臭氧治疗颈椎间盘突出症的疗效。方法：120例颈椎间盘突出症患者其中椎间盘膨出43例,突出77例。在C型x线下定位经皮穿刺到颈椎间盘,实施射频热凝靶点消融联合臭氧注射治疗。结果：随访3～18个月,有效116例,无效4例,有效率97％。结论：射频热凝靶点消融联合臭氧注射？肖融髓核,是治疗颈椎间盘突出症有效安全的方法。     

颈椎间盘突出的MRI诊断价值(附41例分析)

目的：探讨颈椎间盘突出的ＭＲＩ诊断。方法：对４１例椎间盘突出进行磁共振成像检查。结果：表明本病可分为中央型和侧方型突出。ＭＲＩ可直接显示颈椎间盘突出的部位、类型及颈髓和神经根的受压程度。结论：ＭＲＩ对本病的确诊具有重要价值     

低温等离子髓核成形术治疗颈椎间盘突出症的疗效分析

目的：回顾分析低温等离子髓核成形术治疗颈椎间盘突出症的临床疗效。方法：2009—01～2011-07应用低温等离子髓核成形术治疗67例（77个间隙）颈椎间盘突出症患者。其中男43例,女．24例;平均年龄52．3岁。其中C3／4间隙12个,CA／5间隙28个,C5／6间隙32个,C6／7间隙为5个。症状以持续性颈部疼痛和上肢根性症状为主,经过多种保守治疗无效。全部患者对其疗效进行随访、观察分析。结果：62例患者术后症状即刻显著减轻,5例以上肢麻木为主诉者症状无改善。本组未出现局部血肿、感染和神经损伤等并发症。结论：临床结果显示低温等离子髓核成形术创伤小、安全,对保守治疗无效而又暂无开放手术指征的颈椎间盘突出患者显示出良好的治疗前景。     

CT引导下胶原酶注射颈椎间盘溶解术的临床研究

目的:研究CT引导下胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症的价值。方法:对15例颈椎间盘突出症患者在CT引导下行胶原酶注射颈椎间盘溶解术。结果:15例均成功,随访1~16个月,优良率93.3%,未见并发症发生。结论:CT引导下行胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症安全有效,值得进一步研究。     

胶原酶经颈椎硬膜外腔置管注射治疗颈椎间盘突出症（附1O例分析）

目的：评价胶原酶经颈椎硬膜外腔置管注射治疗颈椎间盘突出症的疗效及临床应用价值。方法：对10例经保守治疗无效的颈椎间盘突出症患者，在X线下经颈椎硬膜外腔穿刺，并置入硬膜外腔导管，注入少量造影剂欧奈派克使颈椎间盘突出部位的硬膜外腔前间隙充盈满意后，注入胶原酶1200u治疗颈椎间盘突出症。结果：经术后3-4个月随诊或复查，根据改良的Macnab^[1]标准，显效3例，有效7例。结论：胶原酶经颈椎硬膜外腔置管注射治疗颈椎间盘突出症，是一种安全、微创和疗效较好的治疗方法。     

经皮穿刺椎间盘切割抽吸术治疗颈椎间盘突出症(附101例分析)

目的 探索经皮穿刺颈椎间盘切割抽吸术（ＰＣＤ）的疗效及安全性。方法 对１０１例经临床和ＭＲＩ确诊为椎间盘突出症病人施行ＰＣＤ,观察术后并发症、临床症状缓解程度和突出髓核还纳程度、椎体的稳定性。结果 ＰＣＤ术后６个月及１、２、３、４年优良率分别为８３．２％,８６．１％,８６．０％,８５．７％,６６．７％．３６例合并失稳者随访３个月至１．５年无一例失稳加剧。并发椎间盘炎１例,穿刺点小血肿３例,脊髓一过     

经皮颈椎间盘切吸加溶核对颈椎稳定性影响的实验研究

目的：探讨经皮颈椎间盘髓核切吸（ＰＣＤ）加溶核（ＣＮＬ）对山羊颈椎稳定性的影响。方法：健康成年雄性山羊７只、雌性３只,经皮颈椎间盘切吸加溶核手术：Ｃ２－３间盘２只、Ｃ３－４间盘７只、Ｃ４－５间盘１只,术前及术后摄颈椎正位、侧位（中间位、过伸及过屈位）Ｘ线片。颈椎ＭＲＩ检查为颈椎矢状位（中间位、过伸及过屈位）、手术间盘横轴位一随访６～１２个月,平均７．４个月,手术间盘上位椎体下缘与下位椎体下缘的成角     

颈椎间盘置换与相邻节段融合的治疗选择

目的 探讨椎间盘置换与相邻节段融合治疗多节段颈椎间盘突出症的临床疗效.方法 对39例多节段颈椎间盘突出症患者,Ⅰ期同时完成病变节段人工椎间盘置换和邻近节段Cage融合.本组39例多节段椎间盘突出症患者,双节段颈椎间盘突出29例,三节段颈椎间盘突出9例,四节段颈椎间盘突出1例.病变节段C3～4、C4～5,2例,C4～5、C5～6 15例,C5～6、C6-79例,C4～5、C6～7 3例,C3～4、C4～5、C5～6 4例,C4～5、C5～6、C6～7 5例,C3～4、C4～5、C5～6、C6～7 1例.临床症状以脊髓压迫为主者18例,以神经根性症状为主者21例,术后随访观察椎间盘假体稳定性、假体活动度、Cage融合状态及Cage位移等.依据日本骨科学会(JOA)评分,Odom标准评定神经功能改善情况,采用颈椎残障功能量表(neck disability index,NDI)评定术后临床症状改善和日常功能状态.结果29例双节段颈椎间盘突出症患者,选择1个节段的椎间盘置换和1个节段Cage植骨融合;9例三节段颈椎间盘突出症患者,7例行1个节段的人工椎间盘置换、2个节段Cage植骨融合;2例选择2个节段的人工椎间盘置换、1个节段Cage植骨融合.1例四节段颈椎间盘突出症患者行2个节段的人工椎间盘置换、2个节段Cage植骨融合.术后随访6个月～3年半,人工椎间盘稳定,椎间盘假体平均活动度为9.3°,Cage全部融合,无Cage松动沉陷.患者神经功能有明显改善,JOA评分由术前9.1分增加至13.2分;NDI评分由术前41.8分降至29.5分;Odom评分临床成功率(优/良/可)达到85%(33例).结论颈椎间盘置换与相邻节段融合为颈椎间盘突出症的治疗提供了新的选择方式,兼顾了颈椎的稳定和运动功能,其远期疗效有待于临床随访.

Abstract：

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup.     

Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis

Background and purposeCervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose.Material and methodsBetween March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3–0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5–C6, C6–C7 and C4–C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure.ResultsPostoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm² with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.     

过伸性颈椎损伤合并颈椎间盘撕裂伤的诊治

目的 探讨过伸性颈髓损伤合并颈椎间盘撕裂伤的诊断和前路手术治疗效果.方法 回顾性分析27例过伸性颈髓损伤合并颈椎间盘撕裂伤患者的临床资料,对其年龄分布、临床表现、X线和MRI表现、术中椎问盘损伤情况进行分析.均采用颈椎前路椎间盘切除、椎体间植骨和内固定术,依据术前、术后Frankel分级情况,ASIA运动功能评分(AMS)和改善率评价治疗效果. 结果 所有患者MRI、X线片均提示不同的病理改变,以椎前阴影增宽、椎前间隙增宽、椎间盘突出、脊髓压迫及水肿为突出特点.除1例Frankel A级患者神经功能无明显恢复外,其余患者术后均有1～3个等级的恢复.随访9～32个月,平均17.5个月.与入院时相比,术后2个月和末次随访时AMS明显增高,运动功能恢复率分别为44.9%和68.1%,差异有统计学意义.未见内置物松动、脱落或断裂等并发症,固定节段均获得骨件融合. 结论 MRI和X线检查是过伸性颈椎损伤合并椎间盘撕裂伤的重要诊断手段,一旦诊断明确应行颈椎前路手术治疗,可获得较理想的脊髓功能恢复.     

Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines

PURPOSE: The purpose of the study was to determine the difference in findings between recumbent and upright-sitting MRI of the cervical and lumbosacral spine in patients with related sign and symptoms. MATERIALS AND METHODS: A total of 89 patients were studied (lumbosacral spine: 45 patients; cervical: 44 patients). T1-weighted (TR: 350, TE: 20) fast spin echo and T2-weighted (TR: 2500, TE: 160) fast spin echo images were acquired in the sagittal and axial planes in both the recumbent and sitting-neutral positions. The images were acquired on the Upright MRI unit (Fonar Corporation, Melville, NY). Differences were sought between the recumbent and upright-sitting positions at all levels imaged, in both planes. RESULTS: The total number of cases of pathology was 68, including instances of posterior disc herniation and anterior and posterior spondylolisthesis. Focal posterior disc herniations were noted in 55 patients (cervical: 31, lumbosacral: 24) [62% of patients]. Six of these herniations (cervical: 4, lumbosacral: 2) [11%] were seen only on the upright-sitting study. Focal posterior disc herniations were seen to comparatively enlarge in size in 35 patients on the upright-seated examination (cervical: 21, lumbosacral: 14) [72%], and reduce in size in 9 patients (cervical: 5, lumbosacral: 4) [18%]. Degenerative anterior (n: 11) and posterior (n: 2) spondylolisthesis was seen in 13 patients (cervical: 0, lumbosacral: 13) [15% of patient total]. Anterior spondylolisthesis was only seen on the upright-seated examination in 4 patients (cervical: 0, lumbosacral: 4) [31%]. Anterior spondylolisthesis was comparatively greater in degree on the upright-seated study in 7 patients (cervical: 0, lumbosacral: 7) [54%]. Posterior spondylolisthesis was comparatively greater in degree on the recumbent examination in 2 patients (cervical: 0, lumbosacral: 2) [15%]. The overall combined recumbent miss rate in cases of pathology was 15% (10/68). The overall combined recumbent underestimation rate in cases of pathology was 62% (42/68). The overall combined upright-seated underestimation in cases of pathology was 16% (11/69). CONCLUSIONS: Overall, upright-seated MRI was found to be superior to recumbent MRI of the spine in 52 patents (recumbent missed pathology [n: 10]+recumbent underestimated pathology [n: 42]=52/89 total patients: 58%) in cases of posterior disc herniation and anterior spondylolisthesis. This seems to validate the importance of weight-bearing imaging in the spine that might be expected to unmask positional enlarging disc herniations and worsening spondylolisthesis. Overall, recumbent MRI was found to be superior to upright-seated MRI in 11 cases (11/89: 12%). The latter finding was possibly due to the fact that upright seated position is actually partial flexion that might be expected to reduce some cases of hypermobile posterior spondylolisthesis.     

Comparison of MRI and scanning coupled with myelography in the diagnosis of cervicobrachial neuralgia

A prospective study was undertaken to compare the accuracy of surface coil magnetic resonance imaging (MRI) and computed tomography with myelography (CTM) in the determination of cervical radiculopathy with or without myelopathy. Twenty five patients underwent both imaging studies. The separately imaging diagnosis and the surgical findings were the basis of this study. The based-MRI and based-CTM predictions were not significant. MRI predicted two disc herniations that CTM did not predict. CTM predicted a combination of disk herniation and stenosis and one more lateral stenosis that MRI did not predict. Among the fourteen patients who underwent surgery, one underwent surgery only on based-MRI prediction, it was a disc herniation; one patient was operated on only on based-CTM prediction, it was a stenosis. In these operated patients, the predictive value of the both imaging modalities was not significant. In this report the diagnostic assessment of MRI and CTM was overall the same. The major advantages of MRI were its ability to display all the cervical spine, to study the disk pathology and to delineate a signal alteration within cord substance but the disadvantage was the difficulty to characterize the osteophytes made of cortical bone which did not give signal.     

经皮穿刺切吸术治疗外伤性颈椎间盘突出症51例

目的 探讨采用经皮穿刺切吸术治疗外伤性颈椎间盘突出症的疗效及临床意义。方法 在局麻下对51例外伤性颈椎间盘突出症患者74个椎间盘行颈前路经皮穿刺切吸术,其中男32例,女19例,年龄21-58岁。全组均为屈曲性损伤,损伤部位为C3-C7,其中中央型39例,侧方型12例。结果 50例获得3-26个月随访,平均16个月,其中显效37例,有效11例,无效2例,均系合并有较严重骨性椎管狭窄或脊髓变性,优良率为94.1%(48/51)。结论 经皮穿刺切吸术是治疗外伤性颈椎间盘突出症的有效方法,严格掌握适应证,早期减压是提高手术成功率的关键。     

颈椎过伸性损伤X线片与MRI比较分析

目的：评价对比X钱片与MRI对颈椎过伸性损伤的诊断价值。材料和方法：回顾性分析收治入院的53例颈椎过伸性损伤患者的临床特点、X线片、MRI特点。结果：X线片提示损伤34例，占总数的64．15％；MRI表现有推前血肿和水肿、积液、脊髓受压变形、脊髓内水肿、前纵韧带断裂、椎间盘水平性撕裂、椎间盘突出、脊髓部分及完全性横断等以及椎管狭窄、OPLL、颈椎病等，所有患者的MRI均发现不同的损伤征象，还发现7例椎动脉损伤。结论：MRI优良的软组织成像能力使之对于颈椎过伸性损伤的检出、损伤机制和损伤程度描述均优于其他方法，是目前的最佳方法，对治疗方法的选择亦具有很好的指导意义。