Cervical spondylotic myelopathy: diagnosis and treatment.

The delineation of cervical spondylotic myelopathy as a clinical entity has improved with the development of high-quality cross-sectional neuroradiologic imaging. The natural history of this disorder is usually slow deterioration in a stepwise fashion, with worsening symptoms of gait abnormalities, weakness, sensory changes, and often pain. The diagnosis can usually be made on the basis of findings from the history, physical examination, and plain radiographs, but confirmation by magnetic resonance imaging or computed tomography and myelography is necessary. Minimal symptoms without hard evidence of gait disturbance or pathologic reflexes warrant nonoperative treatment, but patients with demonstrable myelopathy and spinal cord compression are candidates for operative intervention. Both anterior and posterior approaches have been utilized for surgical treatment of cervical myelopathy. Anterior decompression frequently requires corpectomy at one or more levels and strut grafting with bone from the ilium or fibula. Multilevel laminectomies were initially used for posterior decompression but now are either combined with fusion or replaced by laminoplasty. Any operative technique requires proper patient selection and demands adequate decompression of the canal to effect neurologic improvement. Perioperative complications can be devastating in this group of high-risk patients with cervical spondylotic myelopathy, but careful attention to detail, meticulous technique, and experience can result in excellent outcomes.     

Anterior surgical treatment for cervical spondylotic myelopathy

Cervical spondylotic myelopathy is a disease of the cervical spine causing spinal cord compression secondary to spondylosis or ossification of the posterior longitudinal ligament. Anterior surgical options include anterior cervical discectomy and fusion, cervical corpectomy, and cervical disc arthroplasty. The surgeon must choose the right surgical option to decompress the cord, restore cervical lordosis, and adequately stabilize the spine. Although these surgical procedures are considered to be highly successful, each one is associated with complications. One must exercise great care when performing anterior cervical surgery and discuss with each patient the risks and benefits of the procedures.     

后前路联合入路治疗重症脊髓型颈椎病

[目的]探讨采用后前路联合手术治疗重症脊髓型颈椎病(CSM)的临床效果。[方法]回顾性研究自1998年9月~2006年1月本院采用后前路联合手术治疗32例重症脊髓型颈椎病病例。其中,男20例,女12例;年龄41~78岁,平均53.8岁。发病节段:C3、42例,C4、59例,C5、611例,C6、710例。前路减压涉及一个椎间隙的4例,2个椎间隙一个椎体的12例,涉及3个椎间隙2个椎体以上的16例。本组所有患者均先采用颈椎后路单开门椎管成形术,1周后再行颈椎前路减压植骨或钛网植入内固定术。依据JOA评分标准,观察并记录患者的神经功能恢复情况,比较手术前、术后随访时JOA评分,评价临床治疗效果。[结果]所有患者定期随访,随访时间12~18个月(平均13.6个月),术前患者JOA评分为(6.51±1.10)分,一期术后JOA评分为(9.47±0.55)分,随访时JOA评分为(12.42±0.79)分,采用配对t检验对术前、术后随访时JOA评分进行统计学分析,有显著性差异(P<0.001,α=0.05),后前路联合手术改善率为(56.37±5.58)%。[结论]后前路联合手术为复杂的重症脊髓型颈椎病手术治疗提供了一种比较安全、可靠的方法。可提高CSM临床改善率,减少并发症发生。     

Choice of surgical treatment for multisegmental cervical spondylotic myelopathy

Three surgical procedures for multisegmental cervical spondylotic myelopathy were evaluated on the basis of a follow-up study (12-157 months) of 95 patients. Twenty-four patients were treated by extensive laminectomy, 50 by anterior interbody fusion by the Cloward and/or Smith-Robinson techniques, and 21 by subtotal spondylectomy and fusion. Results of subtotal spondylectomy were significantly (P less than 0.01) better when compared with those of the other two procedures. It was concluded that spondylosis up to three disc levels should be treated by subtotal spondylectomy and fusion regardless of the canal diameter. When involvement extended four or more levels, extensive laminectomy was recommended.     

多节段脊髓型颈椎病手术治疗的研究进展

正多节段脊髓型颈椎病(MCSM)占颈椎病总人数的8%~10%~([1]),表现为≥3个节段的病理改变,主要为椎间盘退行性变,多伴间隙变窄、椎体后缘骨质增生、生理曲度改变等,致脊髓在多层面受压、失稳,涉及节段多,损伤可互相叠加,常表现为进行性加重的脊髓及神经根受损。临床症状明显、神经功能障碍严重的患者通常需要行手术治疗。近年国内外学者对MCSM手术治疗的术式有较多的探索,主要包括前路、后路及前后联合入路。每种术     

多节段脊髓型颈椎病的手术治疗进展

脊髓型颈椎病是导致脊髓功能障碍的常见病因,治疗包括保守治疗及手术治疗.对于有明显临床症状,神经功能障碍严重或进行性加重的患者往往要进行手术治疗对1～2个节段的脊髓型颈椎病患者,选择颈前路减压植骨融合内固定术得到了普遍的认可.但是3个或3个以上的多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)的手术疗效往往难以预测,并发症发生率较高.对于MCSM的最佳手术治疗方案一直存在较多争议[1～3].现将目前常用的MCSM的手术治疗方法综述如下.     

Cervical spondylotic myelopathy. Clinical syndrome and natural history.

A wide-based spastic gait is the classical presentation of the patient with cervical spondylotic myelopathy. A complete neurologic evaluation is needed to determine the degree of involvement and to classify the clinical syndrome. The natural history seems to be one of static neurologic deficit or episodic progression.     

颈前路联合手术治疗多节段脊髓型颈椎病

目的:评价颈椎前路椎间隙减压自锁融合器结合前路短节段钢板固定治疗多节段脊髓型颈椎病的临床效果。方法:对2012年1月至2015年6月采用颈椎前路椎间隙减压自锁融合器结合前路短节段固定钢板治疗的106例多节段脊髓型颈椎病患者的临床资料进行回顾性分析,男71例,女35例;年龄42~74岁,平均(55.4±5.1)岁。受累节段:3节段82例,4节段24例。记录手术时间、术中出血量、术后引流量及住院时间;分析术前,术后5 d,术后3、6、12个月及末次随访时颈肩痛视觉评分(VAS)和日本骨科协会(JOA)评分,并计算出JOA改善率;测量术前,术后3、6、12个月及末次随访时颈椎曲度和颈椎ROM。对术后并发症进行统计分析。结果:106例手术均顺利进行,手术时间为(126.2±25.1)min,失血量为(82.1±26.3)ml。所有患者获得随访,时间12~48个月,平均(30.4±10.5)个月。颈肩痛VAS评分和JOA评分分别由术前的6.11±1.54、9.22±2.42改善为术后5 d的2.14±0.51、12.46±1.42(P0.05),术后各时间点VAS及JOA评分比较差异无统计学意义(P0.05),术后5 d JOA改善率达(56.7±21.6)%,术后各时间点JOA改善率比较差异无统计学意义(P0.05)。颈椎生理曲度术后3个月为(19.6±8.9)°比术前的(11.5±6.8)°明显改善(P0.05),术后能够获得比较满意的稳定(P0.05);而颈椎ROM由术前的(37.6±10.4)°减少为术后3个月的(18.2±5.9)°,颈椎活动减少明显(P0.05),随访过程中无明显改变(P0.05)。术后出现吞咽困难19例,轴性痛6例,脑脊液漏3例,声音嘶哑2例,保守治疗好转;3例患者各有1个椎间隙未融合(无临床症状),未出现内固定松动、断裂、移位。结论:颈椎前路椎间隙减压自锁融合器结合前路短节段钢板固定,能够减少术中损伤,恢复颈椎生理曲度,改善脊髓神经功能,减少术后并发症,是治疗多节段脊髓型颈椎病的可选方案。     

脊髓型颈椎病的前路手术治疗及争议

半个多世纪以来,在脊髓型颈椎病的手术入路选择方面脊柱外科医生的理念发生了根本的变化, 而颈椎前路手术的开展则是导致这一变化的最主要原因。1955年,Robinson和Smith首次报道了颈椎前路椎间盘摘除手术,目前颈椎前路手术在临床已被越来越广泛地应用。值此颈椎前路手术开展 60周年之际,结合自己的体会及有关文献复习,介     

3种手术方式治疗脊髓型颈椎病的疗效分析

目的 分析脊髓型颈椎病（CSM）前路3种手术方式的疗效。方法150例脊髓型颈椎病患者采用前路减压＋植骨融合术45例（A组）、前路减压＋cage融合术30例（B组）、前路减压＋钛网内植骨＋钢板内固定术75例（C组）。术后3d及6、12、24周摄颈椎正、侧位X线片。JOA评分系统评定不同手术方法的疗效。结果150例均获随访,时间6～60个月。除1例未融合外,余植骨均融合,时间为2—4个月。JOA评分均有改善,A组改善率为72．8％,B组为85．6％,C组为80．6％,B组与C组比较差异无显著性（P〉0．05）,B组和C组与A组比较差异有显著性（P〈0．05）。结论CSM的治疗关键在于充分减压及有效植骨融合,减压加椎间融合器植入术具有操作简单、出血少、减压充分、术后恢复好等优点,是治疗脊髓型颈椎病的较好方法。     

Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences

OBJECTIVE: A variety of factors may affect the surgical outcome in patients with cervical spondylotic myelopathy. The aim of this study is to analyze the prognostic factors by comparing younger and elderly patient groups on the basis of preoperative radiological and clinical data. METHODS: To assess the prognostic factors after surgery had been performed, the clinical and radiological data of 64 patients who underwent expansive laminoplasty were reviewed. Patients were classified into two groups, a younger patient group (<65 yr of age; n = 29) and an elderly patient group (>/=65 yr of age; n = 35). The neurological status of the patients was assessed by use of the Japanese Orthopaedic Association scale. Radiological features were examined with computed tomographic myelography and magnetic resonance imaging. The effects of the clinical and radiological findings on neurological outcome were investigated. RESULTS: The preoperative and postoperative mean Japanese Orthopaedic Association scores in elderly patients were significantly lower than those in younger patients. For elderly patients, the transverse area of the spinal cord at the level of maximum compression and symptom duration were the factors that predicted an excellent recovery. In contrast, the transverse area was the only predictor of excellent recovery in younger patients. Age, preoperative Japanese Orthopaedic Association score, canal diameter, and an intensity change on the spinal cord were not predictive in either age range. CONCLUSION: The transverse area of the spinal cord may be a reliable predictor of excellent recovery in both younger and elderly patient groups. Shorter symptom duration was an important factor in the excellent recovery of elderly patients.