颈椎前路融合术后相邻节段退变的临床分析

目的 探讨颈椎前路融合术后相邻节段退变（ASD）的临床特征。方法 回顾性分析80例行颈椎前路融合术治疗的颈椎退行变患者的临床资料。结果 本组术后发生ASD 39例（48.8%）;单纯头侧ASD 19例（48.7%）,单纯尾侧ASD 8例（20.5%）,头尾侧ASD 12例（30.8%）。术后发生间隔节段明显退变6例（7.5%）,均伴有ASD。单间隙组术后发生ASD 11例（50.0%）,3例（13.6%）需二次手术;2个间隙组发生ASD 22例（50.0%）,其中6例（13.6%）需要而次手术;3个间隙组发生ASD 6例（42.9%）,其中2例（14.3%）需要而次手术。结论 颈椎前路融合术促进ASD的发生,应全面掌握颈椎的生物力学特征、术前进行准确评估、术后给予正确的康复指导,以降低ASD的发生率。     

改良前路颈椎多节段减压术的临床与实践

目的 :减少前路颈椎手术创伤、提高减压效果、缩短植骨愈合时间。方法 :采用改良前入路显微多节段颈椎管减压 ,术中自体骨碎屑加医用胶粘合回植融合术。结果 :共治疗 5 4例多节段脊髓神经根、椎动脉型颈椎病。随访 3～ 18个月 ,脊髓神经功能恢复优良率达 94 44%。骨性愈合率达 10 0 %。结论 :本改良术式可行不规则形开窗、槽减压 ,避免切除过多椎体。     

前路显微外科手术治疗多节段颈椎病

目的：探讨单一或多个椎体广泛切除,显微外科手术减压,颈椎植骨融合,钛钢板颈椎固定手术治疗多节段颈椎病的疗效。方法：根据临床表现及神经影像学资料选择24例脊髓型颈椎病患,采用Caspar颈椎手术器械及新型植骨融合固定技术实施手术,于显微镜下切除病变的颈椎椎间盘、椎体和后纵韧带,高速气动磨钻磨除患椎骨赘,以自体髂骨或骨水泥行植骨融合、钛钢板固定。结果：根据Nurick神经功能评价标准,术后92%（22例）的患神经功能不同程度改善,8%（2例）的患症状无改变,无一例症状加重。结论：应用颈椎前入路显微外科手术治疗来自颈脊髓前方压迫的多节段颈椎病患（包括症状严重）,减压彻底,固定稳定,安全可行,多数患疗效满意。     

前路显微外科手术治疗多节段颈椎病

目的探讨单一或多个椎体广泛切除,显微外科手术减压,颈椎植骨融合,钛钢板颈椎固定手术治疗多节段颈椎病的疗效.方法根据临床表现及神经影像学资料选择24例脊髓型颈椎病患者,采用Caspar颈椎手术器械及新型植骨融合固定技术实施手术,于显微镜下切除病变的颈椎椎间盘、椎体和后纵韧带,高速气动磨钻磨除患椎骨赘,以自体髂骨或骨水泥行植骨融合、钛钢板固定.结果根据Nurick神经功能评价标准,术后92%(22例)的患者神经功能不同程度改善,8%(2例)的患者症状无改变,无一例症状加重.结论应用颈椎前入路显微外科手术治疗来自颈脊髓前方压迫的多节段颈椎病患者(包括症状严重者),减压彻底,固定稳定,安全可行,多数患者疗效满意.     

前路手术治疗下颈椎退变性不稳的临床分析

目的总结颈前路手术治疗下颈椎退行性不稳的经验,并探讨手术适应证。方法回顾性分析13例影像学上有颈椎不稳、伴有体位性症状病人的临床资料。采取前路颈椎不稳节段椎间盘显微切除加椎间植骨融合、钢板内固定术。结果随访13例,时间6个月~2年,平均9个月。病人症状均明显改善,11例症状完全消失,2例偶有颈背部酸胀感,融合节段均获得骨性愈合。手术前后JOA评分有统计学差异(P0.01)。结论对于影像学上出现颈椎退行性不稳同时伴有颈椎体位性症状,且两者可相互解释的病人,通过颈前路行不稳节段的融合术可获得良好的治疗效果。     

颈椎前路一体化钢板椎间融合器置入后与颈椎生物力学环境的匹配

背景：研究表明,颈椎一体化前路钢板融合器比现行钢板和融合器具有更多理论上的优势。但是目前有关其生物力学方面的研究国内尚无文献报道。 目的：观察与评价颈椎前路一体化钢板椎间融合器内固定置入后的生物力学特征。 方法：采集6具成人尸体颈椎标本,分为5组进行测试,即正常组、椎间盘摘除组、颈椎前路一体化钢板椎间融合器固定组、CBK融合器固定组及CBK融合器+Secuplate钢板联合固定组,以C5~6椎间隙为观察对象,进行生物力学实验。 结果与结论：颈椎间盘摘除后,颈椎在各个方向运动加大,刚度及强度等生物力学数值减小,脊柱失稳。与椎间盘摘除组相比,颈椎前路一体化钢板椎间融合器固定后其强度增加24%,椎体应变减小31%,刚度增加14.3%,位移减小15%(P < 0.05),颈椎前路一体化钢板椎间融合器对颈椎的力学性能影响较小,说明它能较好地与颈椎的力学环境相匹配。CBK融合器固定后抗后伸及旋转作用相对较小,同椎间盘摘除组相比差异有显著性意义(P < 0.05)。CBK融合器+Secuplate钢板联合固定组载荷强度和应变过大,与椎间盘摘除组相比其强度增加27%,椎体应变减小38%,刚度增加17%,位移减小17% (P < 0.05),颈椎刚度增大且邻近椎节的运动有增大趋势,将引起力学性能的改变。提示颈椎前路一体化钢板椎间融合器结合了颈椎前路钢板和融合器生物力学方面的优点,能较好地与颈椎的力学环境相匹配。     

不同手术方式治疗多节段脊髓型颈椎病的疗效观察

目的探讨不同手术方式对多节段脊髓型颈椎病的治疗效果。方法选取因多节段脊髓型颈椎病在我院行首次颈椎后路手术的84例患者为研究对象。根据手术方式的不同分为3组,A组行颈椎后路单开门椎管扩大椎板成形术,B组行颈椎后路全椎板切除术,C组行颈椎后路全椎板切除侧块螺钉内固定术,比较3种手术方式患者术前、术后JOA评分、VAS评分,分析颈椎后路3种手术方式对多节段脊髓型颈椎病的临床疗效。结果 3组术后3个月、末次随访JOA评分与术前相比,差异均有统计学意义(P0.05);术后3个月神经功能改善组间比较,差异均无统计学意义(P0.05);末次随访神经功能改善组间比较,差异均有统计学意义(P0.05)。3组术后3个月、末次随访VAS评分与术前相比,差异均有统计学意义(P0.05);术后3个月VAS评分组间相比,差异均无统计学意义(P0.05);末次随访VAS评分组间相比,差异均有统计学意义(P0.05)。结论颈椎后路单开门椎管扩大椎板成形术、颈椎后路全椎板切除术、颈椎后路全椎板切除侧块螺钉内固定术等3种术式治疗多节段脊髓型颈椎病短期预后较好,但颈椎后路全椎板切除侧块螺钉内固定术在远期改善患者神经功能、降低颈肩痛的发生风险方面具有显著优势,是颈椎后路治疗多节段脊髓型颈椎病理想的手术方式。     

颈前路减压植骨治疗多节段脊髓型颈椎病42例分析

2000-04～2007-06应用保留颈椎椎体后侧壁植骨融合的方法治疗多节段脊髓型颈椎病42例,效果满意,现报告如下。1临床资料1.1一般资料本组42例,男30例,女12例;年龄38～69岁,平均52岁。无诱因缓慢发病19例,无诱因突然发病11例,轻度外伤或劳累后发病12例。病程1～18年,平均3年半个月     

多节段颈椎病前路与后路减压对神经根及轴性症状的疗效评估

目的 评估多节段颈椎病前路与后路减压对神经根及轴性症状的疗效.方法 回顾性分析85例多节段颈椎病患者手术前后JOA评分及其改善率,NDI及VAS评分,Nurick分级.根据不同手术方式对85例患者分成前路及后路手术两组,并对手术疗效进行统计学分析.结果 前后路手术组JOA评分分别提升3.33分、3.77分,JOA改善率分别为(62.79±41.12)％、(50.86±50.49)％,两组间差异无统计学意义,P＜0.05.Nurick分级采用中位数M(25％、75％)表示,前后路两组术前分别为(1、3、3)和(1、3、4),术后分别为(0、0、2)和(0、1、3),均比术前有改善,两组间差异无统计学意义.但在NDI、VAS评分方面,经非参数检验后,结果显示前路组改善优于后路组.但手术相关并发症均发生在前路组.结论 前路减压手术在改善根性症状及轴性疼痛等方面可能优于后路减压,但应注意手术相关并发症.     

后路及单侧椎间孔和前路腰椎椎体间融合并置入椎弓根螺钉后相邻节段的生物力学变化

目的：比较经后路、单侧椎间孔、前路腰椎椎体间融合及附加椎弓根螺钉后相邻节段的力学性能。 方法：新鲜的雄性小牛L1~L5节段脊柱标本15具。随机取5只标本作为正常对照组,在非破坏状况下测试其力学指标后,再将15只标本随机分为3组,按要求制作L4/5前路椭圆形碳纤维Cage 1枚融合（前路腰椎椎体间融合组）、后路长方体碳纤维椎间Cage 2枚融合（后路腰椎椎体间融合组）和侧方椎间钛合金Cage 1枚融合（单侧椎间孔腰椎椎体间融合组）模型。测试完成后,每个标本附加L4/5节段双侧Moss-miamiTM椎弓根螺钉测试。 结果：3种融合方法在附加内固定前后应变和位移都高于正常对照组,强度低于正常对照组（P<0.01）,3组间以单侧椎间孔腰椎椎体间融合组变化最大,后路腰椎椎体间融合组最小（P<0.05）;在内固定前后配对比较,附加内固定后各组应变、位移增加,强度降低（P<0.05）。 结论：3种融合方法在附加内固定前后都有加速上位相邻节段退变的趋势,附加内固定比单纯融合更易导致相邻节段退变,单侧椎间孔腰椎椎体间融合退变趋势更加明显,后路腰椎椎体间融合的趋势相对较小。     

颈椎间盘置换与颈前路减压植骨融合术治疗单节段颈椎病疗效的系统评价

比较颈椎间盘置换与颈前路减压植骨融合术治疗单节段颈椎病的疗效及安全性。 资料来源：计算机检索PubMed(1966-01/2009-04)、Embase(1989-01/2009-04)、Cochrane图书馆(2009,Issue 2)临床对照试验资料库、中国生物医学文献数据库(CBM,1978-01/2009-04)、中国期刊全文数据库(CNKI,1994-01/2009-04)、维普中文科技期刊数据库(VIP,1989-01/2009-04)及所有相关文章的参考文献。 资料选择：纳入标准：①随机对照试验。②经CT或MRI证实为单一节段退行性椎间盘疾病所致的颈椎病患者,且经正规保守治疗无效者。排除标准：①患有严重骨质疏松症。②影像学上手术节段严重不稳定。③创伤。④感染。⑤肿瘤。⑥全身代谢性疾病。⑦金属过敏。⑧有颈椎解剖异常。⑨严重颈椎管狭窄或多节段病变的颈椎病。⑩颈椎曾经手术治疗或有严重器质性疾病。由2名评价者依据纳入排除标准独立筛选文献及提取资料,并按Cochrane Handbook 5.0.1对纳入研究进行偏倚风险评估及数据分析。 结局评价指标：制作统一资料提取表提取数据,内容包括研究的人口统计学资料、颈部活动范围、手术总成功率、颈部功能异常评分指数、上肢疼痛评分、平均手术时间、出血量、住院时间、不良反应及并发症,由2名评价者独立提取资料并填入表格。 结果：共纳入7个随机对照试验,包括1 400例患者。所有研究存在不同程度的选择性偏倚、实施偏倚、测量性偏倚及其他偏倚的可能性。7篇随机对照试验多数没有提供完整的原始数据且存在临床异质性,故未能进行Meta分析。4篇研究提示颈椎间盘置换优于颈前路减压植骨融合术;2篇研究肯定颈椎间盘置换近期临床疗效优于颈前路减压植骨融合术同时建议延长随访时间;1篇研究提示颈椎间盘置换对比颈前路减压植骨融合术疗效相似。 结论：颈椎间盘置换近期临床疗效优于颈前路减压植骨融合术;然而纳入研究均未报告长期随访的相关资料,所以尚不能肯定颈椎间盘置换能否防止毗邻节段的退变。     

A multicenter retrospective research of anterior debridement,decompression, bone grafting,and instrumentation for cervical tuberculosis

ABSTRACT

Objective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals.

Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis.

Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant.

Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis.

Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis     

The patient-reported outcome of chronic pain after the harvest of anterior iliac bone for anterior cervical arthrodesis

BackgroundAnterior cervical fusion (ACF) with autologous iliac bone graft is a traditional surgical method, but high rate of chronic pain (30%) at the anterior iliac crest presents a considerable hindrance to harvesting iliac bone. The memory of acute pain may become fainter as time progresses, and the incidence of chronic pain may not be as high as previously reported. The primary objective was to show the patient-reported outcome of chronic pain in the anterior iliac crest.MethodsTelephone surveys were conducted for patients with single-level ACF (group-S; n = 72; M:F = 52:20; median age, 53 years), multiple-level ACF (group-M; n = 61; M:F = 40:21; 56 years) using autologous iliac bone, and single-level ACF with a stand-alone cage (group-C; n = 53; M:F = 38:15; 51 years). Logistic regression analysis was performed to determine the risk factors, and the variables included group, age, gender, postoperative period and satisfaction with the surgical outcome.ResultsThere was no chronic pain in 87% of the patients, with no difference among the groups (p = 0.52). During the acute postoperative period, patients remembered no pain in 38/72 (53%) patients of group-S, 25/61 (41%) of group-M and 42/53 (79%) of group-C (p < 0.001). Female gender (p = 0.027; OR, 2.68; 95% CI, 1.12–6.41) was the risk factor for chronic pain.ConclusionsIliac bone harvest may not cause chronic pain in 87% of patients, and the memory of acute pain was faded in 40–50% of patients. Female gender was a risk factor for chronic pain. This information should be considered before harvesting iliac bone.     

The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: a cadaver angiographic study

OBJECTIVE: The second segment of the vertebral artery is under the risk of injury during anterior and anterolateral cervical spine procedures. To avoid such a risk, one needs to be familiar with the regional anatomy. The aim of this study was to measure the distance between the vertebral artery and the uncinate process, midline, and the medial side of the longus colli muscle using vertebral artery angiograms at the level of C6, C5, C4, and C3 vertebrae. MATERIALS AND METHODS: In 12 human cadavers, the vertebral arteries were first irrigated with water. Then the arteries were filled with silicon and barium, and finally their angiographic images were obtained. RESULTS: The transverse diameter of the vertebral artery was measured at C6, C5, C4, C3, and C2 level. The values on the left were bigger than the values on the right (p>0.05). The distance between the vertebral artery and the midline decreased from C6 (17.2+/-5.6mm on the right, 17.2+/-2.3mm on the left) to C3 (15.8+/-5.3mm on the right, 13.8+/-2.1mm on the left) (p>0.05). The distance between the apex of the uncinate process and the medial side of the vertebral artery was found to be longer at C4 (2.7+/-1.0 mm on the right, 2.2+/-1.0mm on the left) and C5 (2.5+/-1.1mm on the right, 2.5+/-1.0mm on the left) vertebra levels on the right side (p=0.339 at C4, p=0.862 at C5). The distance between the medial side of the longus colli muscle and the medial side of the vertebral artery was measured as 9.7+/-2.7 mm (9.5+/-2.9 mm on the right, 9.8+/-2.6mm on the left) at C6 level, 9.2+/-2.6mm (8.6+/-2.4mm on the right, 9.8+/-3.1mm on the left) at C5, 9.4+/-1.9 mm (9.2+/-2.1mm on the right, 9.5+/-2.0mm on the left) at C4, and 10.4+/-2.7 mm (10.5+/-3.0mm on the right, 10.1+/-2.6mm on the left) at C3 vertebra level. No significant difference was found between the right and the left (p>0.05). The angle between the vertebral artery and the midline was measured as 4.0+/-1.9 degrees on the right and 2.2+/-1.4 degrees on the left side (p=0.030). CONCLUSION: It was considered that the values obtained could be useful in anterolateral and anterior cervical approaches in terms of evaluating the position of the vertebral artery and its relation to vertebral structures. It is also concluded that the risk of injury in upper subaxial cervical spine is higher than in the lower part of the subaxial cervical spine.     

Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: A meta-analysis

Zero-profile device was applied to diminish the irritation of the esophagus in the treatment of cervical degenerative disc disease. However, the clinical application of the zero-profile device has not been testified with clinical evidence. The aim of the meta-analysis was to systematically compare the safety and effectiveness of anterior cervical discectomy and fusion with zero-profile device with plate and cage for the treatment of cervical degenerative disc disease. Electronic searches of PubMed and Embase were conducted up to May 2015. Relevant studies were included. Weighted mean difference (WMD) and 95% confidence intervals (CI) were assessed for continuous data. Risk ratio (RR) and 95% CI were assessed for dichotomous data. P value <0.05 was considered to be significant. Eleven studies were included in the meta-analysis. Compared with plate and cage, zero-p is associated with lower operation time of two-level surgery, less intraoperative blood loss, higher subsidence rate, higher JOA score, lower incidence of dysphagia in short-term (RR: 0.72, 95% CI [0.58, 0.90], P = 0.005, I² = 22%) and long-term (RR: 0.12, 95% CI [0.05, 0.30], P < 0.00001, I² = 0%) and lower Cobb angle of multilevel surgery (WMD: −3.16, 95% CI: [−4.35, −1.97], P < 0.00001, I² = 0%). No significant difference was found in one-level and two-level Cobb angle, fusion rate and operation time of one-level and three-level surgery. Both zero-p implantation and the plate and cage have respective advantages and disadvantages.     

临床干预对颈椎病患者抑郁情绪和睡眠质量的效果分析

目的观察临床干预对颈椎病患者抑郁情绪和睡眠质量的效果。方法选取我院2013—2015年住院接受治疗的颈椎病患者82例为研究对象,使用数字表法随机分组为观察组和对照组各41例,对照组给予常规护理,观察组给予焦点解决护理,观察2组睡眠质量和抑郁情绪改善情况。结果护理后,2组抑郁情绪与睡眠质量均得到改善,观察组优于对照组,差异有统计学意义(P0.05)。结论针对颈椎病患者实施焦点解决护理,可有效提高睡眠治疗,同时使得患者的抑郁情绪得到明显改善,值得应用推广。     

肌萎缩侧索硬化患者19例发病后行颈椎手术的随访观察

目的 探讨颈椎手术对肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的病情进展和预后的影响.方法 收集确诊和拟诊的ALS患者329例,记录病史、流行病学,颈椎核磁检查结果及手术史等相关资料.部分患者每3个月进行随访,直至死亡或行气管切开术.结果 329例ALS患者中,有颈椎异常者156例(47.4%),其中行颈椎手术者19例(5.8%).手术组与未手术组诊断时发病年龄、性别构成、神经功能评分差异均无统计学意义,但从发病到确诊的时间,手术组[(23.0±6.5)个月]较未手术组[(13.7±7.9)个月]明显延长(t=4.800,P=0.000).通过随访,两组诊断后1年的病情进展速度和生存时间差异无统计学意义.结论 颈椎手术后患者确诊时间延长,病情继续进展,虽然未造成明显的病情进展加快和生存时间缩短,仍应尽量避免,对ALS和脊髓型颈椎病共病的患者施行手术应慎重.     

Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: Comparison between fusion methods

This study aimed to determine the risk factors for developing adjacent segment disease (ASDz) after anterior cervical arthrodesis for the treatment of degenerative cervical disease by analyzing patients treated with various fusion methods. We enrolled 242 patients who had undergone anterior cervical fusion for degenerative cervical disease, and had at least 5 years of follow-up. We evaluated the development of ASDz and the rate of revision surgery. To identify the risk factors for ASDz, the sagittal alignment, spinal canal diameter, range of motion of the cervical spine, number of fusion segments, and fusion methods were evaluated. The patients were divided into three groups according to the fusion method: Group A contained patients who had received autogenous bone graft only (53 patients), Group B contained patients who received autogenous bone graft and plate augmentation (62 patients), and Group C contained patients who underwent cage and plate augmentation (127 patients). ASDz occurred in 33 patients, of whom 19 required additional surgery. The risk of developing ASDz was significantly higher in male patients (p = 0.043), patients whose range of motion of the cervical spine was >30° (p = 0.027), and patients with spinal canal stenosis (p = 0.010). The rate of development of ASDz was not different depending on the number of fusion segments. The rate of development of ASDz was 41.5% in Group A, 9.6% in Group B, and 5.51% in Group C (p = 0.03). In patients who underwent anterior cervical arthrodesis for degenerative disease, the occurrence of ASDz was related to age, the cervical spine range of motion, and spinal canal stenosis. Additional plate augmentation for anterior cervical arthrodesis surgery can lower the rate of ASDz development.     

Comparison of perioperative complications following staged versus one-day anterior and posterior cervical decompression and fusion crossing the cervico-thoracic junction

IntroductionMultilevel cervical pathology may be treated via combined anterior cervical decompression and fusion (ACDF) followed by posterior spinal instrumented fusion (PSIF) crossing the cervico-thoracic junction.The purpose of the study was to compare perioperative complication rates following staged versus same day ACDF combined with PSIF crossing the cervico-thoracic junction.Material and methodsA retrospective review of consecutive patients undergoing ACDF followed by PSIF crossing the cervico-thoracic junction at a single institution was performed.Patients underwent either same day (group A) or staged with one week interval surgeries (group B). The minimum follow-up was 12 months.ResultsThirty-five patients (14 females and 21 males) were analyzed. The average age was 60 years (37–82 years). There were 12 patients in group A and 23 in group B. Twenty-eight complications noted in 14 patients (40%) included: dysphagia in 13 (37%), dysphonia in 6 (17%), post-operative reintubation in 4 (11%), vocal cords paralysis, delirium, superficial incisional infection and cerebrospinal fluid leakage each in one case. Significant differences comparing group A vs. B were found in: the number of levels fused posteriorly (5 vs. 7; p = 0.002), total amount of intravenous fluids (3233 ml vs. 4683 ml; p = 0.03), length of hospital stay (10 vs. 18 days; p = 0.03) and transfusion of blood products (0 vs. 9 patients). Smoking and cervical myelopathy were the most important risk factors for perioperative complications regardless of the group.ConclusionsStaging anterior cervical decompression and fusion with posterior cervical instrumented fusion 1 week apart does not decrease the incidence of perioperative complications.