内窥镜技术在颈椎前路手术中的应用

目的：探讨内窥镜下颈椎前路减压植骨融合术的手术技巧与疗效。方法：2002年8月～2005年3月应用内窥镜下颈椎前路减压植骨融合术治疗20例颈椎疾患患者，均应用自制不同型号椎间旋转撑开器及特制不同角度、不同大小的网形与方形刮匙行前路椎间盘切除，单纯PEEK cage植骨融合8例，PEEK cage植骨融合加钛板内同定2例，单纯钛cage植骨融合3例，钛cage植骨融合加钛板内同定2例，椎间植骨融合加钛板内同定5例，随访观察治疗效果。结果：术后随访3～12个月，平均7个月。患者症状体征及神经功能均明显改善。术后影像学检查手术部位减压彻底。1例发生钛cage松动，其余椎间高度无丢失，维持颈椎正常生理曲度。结论：通过对椎间盘镜部分器械和技术的改进，将其应用于颈椎前路椎间盘切除、椎间融合内同定术治疗颈椎病及颈椎间盘突出症可取得满意的效果。     

Anterior cervical discectomy without interbody fusion

BACKGROUND: The use of an interbody bone graft during anterior cervical discectomy remains a controversial topic. This study presents the outcome of 64 consecutive patients who underwent anterior cervical discectomy without an interbody fusion. METHODS: Sixty-four consecutive patients underwent anterior cervical discectomy without interbody fusion by one surgeon at Indiana University School of Medicine between April 1994 and February 1998. A retrospective analysis of these cases was performed to evaluate outcome of this procedure. Outcome was determined using the criteria of Odom and Finney. RESULTS: In our series of patients, the mean age was 49.4 years, and the mean time of follow-up was 8.5 months. The presentation was as follows: 69% radiculopathy alone, 23% combined myelopathy and radiculopathy, and 8% myelopathy. Although 31% of the patients had symptoms for more than 1 year, the mean duration of symptoms of the remainder of patients was 3.2 months. The majority of patients had single-level disease (77%); however, 25% underwent 2 level discectomies, and 2% underwent 3 level discectomies. Twenty-four patients (38%) had soft disc herniation, and 40 patients (62%) had hard disc herniation. Of the 64 patients, 91% had either good or excellent outcomes, 9% had satisfactory outcomes, and none had a poor result. Ninety-six percent of the patients with soft disc herniation had good or excellent outcomes, whereas 88% of the patients with hard disc had good or excellent outcomes (p = 0.217). Ninety-one percent of the patients who worked before surgery returned to work after their operation. None of the patients required reoperation at the operative level or exhibited instability at the operative level. Postoperative complications included transient intrascapular pain (13%), kyphotic deformity (3%), transient vocal cord paralysis (2%), and temporary dysphagia (2%). No significant difference in age or outcome existed when comparing males to females. CONCLUSION: Satisfactory results can be attained by discectomy without an interbody fusion in the surgical management of cervical disc disease.     

内窥镜下颈椎间盘切除及椎体间植骨融合术

目的:探讨内窥镜下颈椎间盘切除及椎体间植骨融合术治疗颈椎疾患的疗效。方法:经内窥镜颈椎间盘切除及植骨术治疗颈椎疾病25例,包括脊髓型颈椎病17例,神经根型颈椎病3例,交感型颈椎病2例及外伤性颈椎间盘突出症3例。结果:本组患者颈部手术出血平均80ml,18例获10~46个月(平均27个月)随访,植骨全部融合,脊髓和神经根压迫症状改善满意,除1例出现术后植骨块移位外,未见其它合并症。结论:经内窥镜下颈椎间盘切除及植骨融合术是一种创伤小、安全、可靠的手术技术,适合于颈椎间盘突出症及部分颈椎病的治疗。     

Anterior discectomy without interbody fusion for cervical disc herniation

Summary Between 1985 and 1990, 68 patients with cervical radiculopathy due to soft disc herniation were treated by anterior cervical discectomy without interbody fusion. Eleven patients were unavailable for follow-up examination. The mean follow-up was 23 months (range 12–54 months). Both clinical and radiographic follow-ups were done, and 92% of the patients was found to have excellent or good clinical results. Radiographic follow-up revealed that 34% had fused spontaneously and 66% developed fibrous healing of the disc space with an average range of mobility of 2.07 deg. All patients were shown to be stable on flexion-extension films. Complications included two transient CSF leaks. No neurologic deficits arose. One patient was reoperated and fused for intractable residual neck pain. We conclude that anterior cervical discectomy without interbody fusion is a simple, safe and effective procedure for patients with soft disc herniation.     

内窥镜下前路颈椎间盘切除及椎间融合术

目的 观察内窥镜下前路颈椎间盘切除及椎间盘切除及椎间融合术的临床疗效。方法 自2002年10月，对26例患者实施内窥镜下前路颈椎间盘切除及椎间融合术。其中获得3个月以上随访者16例，男12例，女4例；年龄23～65，平均53.2岁。颈椎外伤合并椎间盘突出症3例，脊髓型颈椎病8例，孤立性颈椎后纵韧带骨化2例，神经根型颈椎病3例。单间隙4例，双间隙12例。病变节段：C3.42个，C4.511个，C5.613个，C6.72个。术前ADL评分平均7.2分。于内窥镜下施行手术，彻底减压后植入PEEK椎间融合器。结果 手术时间50～150min，平均120min。术中出血量40～140ml，平均110ml。无一例发生术中并发症，无一例改为开放手术。术后无咽喉部刺激症状，切口内出血1例。16例患者随访3～8个月，平均6.5个月。术后ADL评分平均13.1分，ALD改善率为60.2%。结论 内窥镜下实施前路颈椎间盘切除及椎间融合术具有切口小、组织损伤轻、手术操作安全等优点。适用于C3.4～C5.6区域内的颈椎间盘突出症、脊髓型颈椎病、神经根型颈椎病、位于椎间隙的孤立性后纵韧带骨化症、颈椎外伤导致的单词隙椎间盘损伤合并颈椎不稳者。     

磷酸钙人工骨在颈椎前路椎间融合治疗颈椎病中的应用

目的:探讨磷酸钙人工骨在颈椎前路椎间融合治疗颈椎病中的应用效果。方法:2000年9月至2002年9月应用磷酸钙人工骨椎间融合结合钛板颈前路手术治疗41例颈椎病患者,随访32例共48个节段,采用JOA评分判定手术疗效,X线片判定融合效果。结果:随访18.2±7.8个月,全部患者术后未见任何过敏或毒性反应,无皮疹、高热及深部感染。JOA评分从术前10.93±2.48分提高到术后14.54±2.19分(P<0.001)。术后X线片未见人工骨塌陷、移位或脱入椎管,无钛板或螺钉松动及折断。术后48个节段中47个节段获得椎间融合,融合时间15.6±7.4个月。结论:磷酸钙人工骨可替代自体骨应用于颈椎前路椎间融合手术。     

内窥镜下颈椎前路减压植骨融合术的初步报告

目的 探讨内窥镜下颈椎前路减压植骨融合技术的可行性、临床手术技巧及疗效。方法 颈椎骨折脱位7例及颈椎间盘突出症16例，男14例，女9例；年龄23～64岁，平均41.5岁。在全麻下取右颈前偏外侧横切口（长1.6cm)，通过工作通道，在电视监控下切除颈椎间盘，扩大椎间隙。颈椎骨折脱位者采用颈前路钛钢板固定5例、高分子聚合材料GBK颈椎Cage固定1例，螺纹状钛合金Cage固定1例；颈椎间盘突出症者采用颈前路钛钢板固定2例，高分子聚合材料GBK颈椎Cage固定12例，螺纹状钛合金Cage固定2例。结果 全部病例随访6～18个月，平均12.2个月。手术切口均一期愈合，无一例发生内固定松动，椎间骨融合率100%。颈椎骨折脱位伴不全瘫或全瘫患者疗效评估采用Frankel分级标准；2例全瘫者术后分级无变化；3例不全瘫者术前均为C级，术后半年随访时2例恢复到D级，1例恢复到E级。颈椎间盘突出症患者的疗效分析采用Odom评估标准；优10例、良5例、可1例，优良率为94%。结论 通过对椎间盘手术设备和技术的改进，可将其用于颈椎前路减压植骨融合内固定术。术后短期随访效果满意。     

Anterior cervical discectomy and fusion

The science of cervical spinal surgery is a constantly developing field. The concept of the anterior approach initially described by Bailey and Badgley² has been modified many times and continues to evolve. Despite all the modifications, two basic anterior procedures are currently performed for treatment of the clinical syndromes resulting from cervical spine degeneration: anterior cervical discectomy with interbody fusion and anterior cervical corpectomy and strut grafting. The following article presents both techniques, their indications, and the possible complications that these techniques may incur. This article also discusses the relative merits of each technique and benefits of anterior versus posterior approach for the treatment of cervical spondylosis.     

Anterior cervical discectomy and fusion

A retrospective review of 94 patients who had undergone anterior cervical discectomy and fusion was performed to analyze the result in patients who had a diagnosis of posterolateral spondylosis, disc herniation, or both. Although in 23 of 94 patients additional adjacent asymptomatic levels of spondylosis were noted, only the symptomatic levels were addressed in the 94 cases. Postoperatively two cases of dysphagia were noted, as well as a 4% pseudarthrosis rate. There was an 88% good or excellent result when no additional spondylosis was present, but only a 60% good or excellent result when just the symptomatic levels were addressed, leaving unoperated adjacent levels of spondylosis.     

Anterior cervical discectomy with hydroxylapatite fusion

The outcome of microscopic anterior cervical discectomy with iliac crest interbody fusion in a group of 75 patients was compared with that of microscopic anterior cervical discectomy with synthetic hydroxylapatite fusion in a group of 84 patients. The rate of relief of myelopathy (70%) was similar in both groups, but those who underwent synthetic fusion had better long-term relief of radiculopathy, less need for a second operation at the same or an adjacent level, no resorption of the bone plug, comparable spinal alignment and stability, and the elimination of complications at the iliac crest donor site. The data suggest that hydroxylapatite fusion may be equal or superior to autologous iliac crest interbody fusion for anterior cervical disc surgery.     

Anterior cervical discectomy and interbody fusion. An experimental study using a synthetic tricalcium phosphate.

This study evaluates the histological and histochemical changes and osteogenicity of Synthos (tricalcium phosphate ceramic) implanted in the cervical intervertebral space. The cervical vertebrae from C-3 to C-6 were exposed in 20 dogs, and discectomy was performed at the third and fifth spaces. A dowel of Synthos was inserted into the third space, and a piece of fresh autologous graft from the humerus was inserted into the fifth space. The animals were divided into five groups with four animals in each. Four animals were sacrificed at each of 3, 6, 12, 18, and 22 weeks after the procedure. The C-3 to C-6 vertebrae were removed en bloc. One-half of each specimen was processed for histological examination of bone development, while the other half was processed for the two-color fluorescent labeling technique of Suzuki and Matthews for determination of osteogenesis at the time of operation and sacrifice. Various degrees of compression of the Synthos dowel were noted, with anterior and/or posterior displacement of the implant in 70% of the cases. Results indicate that the Synthos implant was biochemically and biomechanically unacceptable for the purposes of this investigation.     

Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

Acta Neurochirurgica - Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the...