颈前路侧前方减压术治疗根型颈椎病的临床研究

目的 总结颈前路侧前方显微减压术治疗神经根型颈椎病的临床经验。方法 借助显微镜和高速磨钻对79例根型颈椎病患者行颈前路侧前方显微椎间盘摘除减压术，采用Cage或钛网自体骨融合后并使用钉板系统固定；术中同时采用体感诱发电位（SEP）进行监护。结果 79例病人术后临床症状明显好转，无严重并发症发生，无症状加重或术后复发者。随访5-48个月，影像学资料证实：神经根减压充分，融骨良好，内固定钛板位置准确。结论 颈前路侧前方显微减压术治疗神经根型颈椎病，手术创伤小，成功率高。     

人工颈椎间盘植入治疗颈椎病

目的 颈椎病前路融合术后颈椎活动度下降与邻近节段椎间盘退变加速越来越受到人们的重视,人工颈椎间盘置换术可在进行脊髓减压并提供稳定的同时保持手术节段颈椎的活动度,为颈椎病的外科治疗开辟了新的途径.方法 自2005年12月至2008年3月,对16例颈椎病患者进行显微减压后椎间植入Bryan人工颈椎间盘,平均随访时间17个月.结果 所有患者术后症状均明显缓解,脊髓功能明显改善,颈椎活动度良好,1例术后发生短暂声音嘶哑,无手术死亡率.结论 人工颈椎间盘植入为颈椎病的外科治疗开辟了新的手段,在提供颈椎稳定的同时保持手术节段颈椎的良好活动度,把握严格的适应证和手术技术能取得满意的效果.     

电生理监护下改良Cloward前路减压融合术治疗颈椎病的临床研究

目的　探讨改良Cloward前路减压融合术联合术中电生理监护治疗颈椎病的疗效。方法　借助显微镜和高速磨钻对 6 0例颈椎病患者进行颈前入路椎管内显微减压术 ,植骨后并使用钛板固定 ;术中同时采用体感诱发电位 (SEP)和运动诱发电位 (MEP)进行监护。结果　本组病例术中均未发生持续的SEP和MEP改变 ,术后无严重的并发症 ;随访 3～ 6 1个月 ,影像学检查证实 :脊髓和神经根的压迫得到了明显的改善 ,自身髂骨植入块融骨良好 ,内固定钛板位置准确 ;术后JOA评分 1 5分以上者 5 1例 ,1 3～ 1 4分者 9例 (经G检验 :P <0 0 1 ) ,无 1例患者症状复发或加重。结论　采用改良Cloward前路椎管内显微减压融合并钢板固定术联合术中神经电生理监护治疗难治性颈椎病 ,手术创伤小 ,成功率高     

椎间盘切除并植骨融合治疗颈椎病

目的：为彻底切除增生骨赘，防止椎间隙塌陷，扩大椎间孔，解除脊髓神经根压迫，提高手术治疗颈椎病疗效。方法：前方入路切除椎间盘，在Ｘ线机监测下彻底磨除增生的椎体后外侧骨赘，以植骨块撑开椎间隙。结果：１６例颈椎病患者术前ＪＯＡ计分８～１２分，平均９．６分。Ｎｕｒｉｃｋ伤残分级Ⅱ～Ⅳ级。术后１１例经１～４年随访，ＪＯＡ计分１５～１７分，平均１６分，恢复率８０％～１００％，平均９３．６％，Ｎｕｒｉｃｋ伤残分级Ｏ～Ｉ级。除１例外余植骨块融合良好。结论：椎间盘切除并植骨融合是治疗颈椎病的有效手段。但本术式不适合于后纵韧带骨化病例。     

内窥镜下前路颈椎间盘切除碳素纤维Cage置入治疗颈椎病

自1955年Robinson和Smith首次应用颈前路椎间盘切除、椎间融合以来,该技术取得了良好的临床效果。当前,内窥镜途径在治疗颈椎病方面有较好的临床效果,且Cage在临床上亦有较广泛的应用     

Bryan人工颈椎间盘置换与椎间融合治疗颈椎病的中期疗效比较

背景：国内外有许多相关报道颈人工椎间盘置换治疗颈椎病取得了非常好的近期临床疗效，但因其刚刚开展不久，缺乏长期随访结果。 目的：观察Bryan人工颈椎间盘置换治疗颈椎病的临床和影像学结果及邻近节段活动度的情况，并与椎间融合治疗方法比较。 设计、时间及地点：回顾性病例分析，于2004-10/2006-04在河北医科大学第三医院脊柱外科完成。 对象和方法：22例患者行Bryan假体置换（置换组），同期行常规颈前路椎间盘切除减压植骨融合内固定患者30例（融合组）。在术后1周、3个月、6个月、12个月、24个月进行随访，在每一次随访中拍摄颈椎前屈后伸位、左右侧屈位X射线片，观察置换组假体稳定性及融合组融合节段骨性融合情况。 主要观察指标：①材料与宿主的生物相容性。②临床疗效评估。 结果：全部病例随访最短24个月，平均30.6个月。①融合组患者术后6个月植骨全部骨性融合；内固定无松动、脱落、断裂的发生。置换组患者置换后无假体移位、脱落等并发症发生。②两组患者随访时神经功能均得到明显恢复，两组JOA评分差异无显著性意义（P > 0.05）。③置换组1例患者随访2年发生椎间自发融合，置换节段活动丢失；其余21例患者置换节段活动度与置换前差异无显著性意义（P > 0.05）。④融合组术后邻近节段的活动度较术前明显增大（P < 0.05）；而置换组置换前后邻近节段活动范围差异无显著性意义（P > 0.05）。 结论：与前路融合方法比较，中期随访结果显示Bryan人工颈椎间盘置换治疗颈椎病在取得满意临床疗效的同时能保留置换节段的活动，且避免了置换后上下邻近节段活动度的增加。     

早期颈前路手术治疗多节段急性颈椎间盘突出并脊髓损伤的研究

目的 探讨早期颈前路手术治疗多节段急性颈椎间盘突出引起的颈脊髓损伤的临床疗效. 方法 河南省人民医院急诊创伤外科自2010年1月至2011年1月采用早期颈前、钛网联合cage配合自锁钛板前路减压和重建术治疗急性颈椎间盘突出引起的脊髓损伤患者23例,其中受伤后72 h内接受手术14例,72 h后接受手术9例.回顾性分析患者的临床资料和术后脊髓损伤的恢复程度. 结果 本组患者随访6～13个月(平均11个月).X线检查显示融合节段均获骨性融合,无内固定松动断裂及椎间融合器下沉等并发症发生;除1例美国脊髓损伤协会(ASIA)分级为A级的患者症状未有改善外,其余患者术后症状均得到较好改善;治疗后2组患者的JOA评分较术前都有明显提高,且治疗后72 h内手术组JOA评分及JOA改善率高于72 h后手术组,差异有统计学意义(P＜0.05). 结论 早期颈前路手术可使多节段急性颈椎间盘突出所致脊髓损伤得到改善和恢复,手术时机越早恢复越好,术后手术节段获得即刻稳定,融合效果确定,临床效果满意.     

颈椎病手术中的融合固定

颈椎病的病理机制及临床表现比较复杂，故应根据患具体病情选择适当的手术方式。     

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。     

锚定聚醚醚酮融合器结合纳米人工骨治疗脊髓型颈椎病

背景：聚醚醚酮聚合物在体内外实验表明,它与人体组织有良好的相容性,最接近骨的弹性模量,并具有良好的塑性和硬度,是最佳的椎间融合器材料。 目的：评价锚定聚醚醚酮椎间融合器结合纳米人工骨在脊髓型颈椎病前路间盘切除后椎体间融合效果。 方法：回顾性分析2007-05/2009-09哈尔滨医科大学附属第一医院骨科收治的脊髓型颈椎病患者17例,男12例,女5例;年龄55(42~67)岁。均采用前路间盘切除后锚定聚醚醚酮融合器结合纳米人工骨椎间融合治疗。JOA评分评价神经功能恢复情况;术前、术后3个月X射线检查测量椎间高度,侧位像过伸过曲位观察融合情况。 结果与结论：术后17例患者症状均有所改善,在术后的几天内,患者的下肢肌力增加,术后肢体的灵活性较术前改善。术后3个月JOA评分较术前明显提高,手术节段稳定,椎间高度恢复满意。无并发症发生,所有病例经X射线证实均达到牢固融合。结果说明锚定聚醚醚酮融合器可以使颈椎手术节段获得即刻稳定,锚定聚醚醚酮融合器结合纳米人工骨手术创伤小,手术时间短, 融合效果确定, 并发症较低,是治疗脊髓型颈椎病一种良好的选择。     

Anterior fusion for cervical spondylosis

Summary Anterior fusion was performed on 138 patients as treatment for degenerative changes of the cervical vertebral column. The results were checked after up to 11 years in 122 patients and were found to be good in 55%, fair in 38.5% and poor in 6.5%. There were complications of phonetic paralysis in one case, Horner syndrome in two cases, 2 wound infections, and complaints about the iliac crest in 3 patients. Kyphosis at the fused segment occurred 26.1% of cases, the average angle being 15.3°, but it did not influence the clinical results. Mortality was 2%. Inadequate visualization of the nerve roots at operation was probably the reason for the segmental deficits and suggestions were made to avoid this by EMG, microsurgical technic, uncusectomy and hemifacetectomy. The results in the presence of myelopathy were much poorer, presumably because of associated degenerative changes in the older patients.

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Zusammenfassung 138 Patienten mit degenerativen Veränderungen der Halswirbelsäule wurden durch die vordere Fusion behandelt. Bei Nachuntersuchungszeiten bis zu 11 Jahren konnten die Ergebnisse bei 122 Patienten überprüft werden. 55% waren gebessert, 38,5% unverändert, 6,5% verschlechtert. Komplikationen waren Stimmbandlähmungen (1), Hornersyndrom (2), Wundinfektion (2) und Beschwerden am Beckenkamm in 3 Fällen. Die Letalität betrug 2%. Winkelbildung im fusionierten Bewegungssegment trat in 26,1% der Fälle auf. Der Durchschnittswinkel betrug 15,3%. Es bestand kein Einfluß der Kyphose auf die klinischen Ergebnisse. Diskussion der Gründe für die nicht voll befriedigenden Ergebnisse bei segmentalen Ausfällen, möglicherweise bedingt durch nicht immer ausreichende intraoperative Darstellung der Nervenwurzeln. Anregung zu weiterer Differenzierung der Ausfälle mit Hilfe des EMG, zu größerer Beachtung der mikrochirurgischen Technik, der Uncusektomie (Jung), der Facetektomie nach Frykholm. Gründe für schlechtere Ergebnisse bei Myelopathie durch Anteil von Systemerkrankungen im Krankengut und durch ungeklärte Myelopathien bei gleichzeitiger zervikaler Spondylosis.

     

Use of an integrated anterior cervical plate and cage device (PCB) in cervical anterior fusion

The aim of this study is to evaluate an integrated cage and plate device (the plate cage Benezech, PCB) filled with autogenous bone in anterior cervical discectomy and fusion. The fused segment height, lordosis, and fusion were assessed by postoperative radiographic examination at different intervals. Patients were evaluated using Odom’s criteria and the Short Form (SF)-36 Health Survey questionnaire. The mean follow-up duration was 4.1 years. Fusion was achieved in 90.0%, 96.0% and 100% of patients at 3 months, 6 months and at final visit, respectively. The fused segment height and lordosis were restored and maintained. Cage subsidence (3 mm) occurred at one level and settling was observed at three levels. An excellent-to-good result was achieved in 81.8% of patients. The data from the SF-36 questionnaire revealed significant postoperative improvement (p < 0.01) except for social function and mental health. This study suggests that patients instrumented with PCB can obtain good radiographic and clinical results and that PCB is a safe and effective device in cervical anterior fusion.     

Safety of anterior cervical discectomy and fusion using titanium-coated polyetheretherketone stand-alone cages: Multicenter prospective study of incidence of cage subsidence

This multicenter prospective study investigated cage subsidence in anterior cervical discectomy and fusion (ACDF) using titanium-coated polyetheretherketone (PEEK) stand-alone cages. This study recruited patients who underwent 1- or 2-level ACDF using titanium-coated PEEK stand-alone cages for cervical disc disease. Patients with acute trauma or past cervical spine operations were excluded. Sixty-two cages in 42 patients were eligible for analysis. Minimum follow-up was 6 months after ACDF. Significant cage subsidence was recognized in 11 of 62 cages (17.7%). Cage subsidence was predominantly moderate (14.5%), with severe subsidence found in only 2 cages (3.2%). The slowest occurrence of cage subsidence was 6 months after surgery, in 4 of 11 cages. Frequency of cage subsidence did not differ significantly between patients <65 and ≥65 years old. Patients with and without cage subsidence both demonstrated significant improvement of neurological function. Cage subsidence resulted in aggravation of local angle, but finally did not affect C2-7 angle or cervical tilt angle. Severe cage subsidence was found in only 3.2% of patients within 6 months after ACDF. Cage subsidence aggravated local angle, but finally did not affect C2-7 angle or cervical tilt angle. One- or 2-level ACDF using titanium-coated PEEK stand-alone cages appears safe and justified, even in elderly patients.     

Anterior cervical discectomy and interbody fusion with porous tantalum implant. Results in a series with long-term follow-up

Few papers have been published about the anterior cervical discectomy and fusion (ACDF) with implant of porous tantalum cages. These studies included patients submitted to operation at a single level. To our knowledge, we report the results of the largest series of ACDF with implant of porous tantalum cages. Our series included patients operated at a single or double level with a long follow-up (FU). We also discuss the pertinent literature. Clinical and outcome data of 99 consecutive patients (47 men, 52 women) submitted to ACDF with implant of porous tantalum cages (Trabecular Metal TM-S Cervical Fusion Device, Zimmer Spine, Minneapolis, MN) from June 2007 to September 2012, were retrospectively reviewed. Mean FU was 67.47 ± 19.63 months. The changes in pain were assessed using the Visual Analogue Scale (VAS). Patients were evaluated pre-operatively and at FU with the Short Form-36 Score Health Survey Version 2.0 (SF-36v2) for Physical Health and Mental Health Scores and the Neck Disability Index. We globally found a statistically significant improvement of all evaluated scores. Patients operated at two levels experienced a statistically significant improvement of all scores, with no statistical difference compared to patients operated at one level. No major complications occurred post-operatively and at FU. Only one patient (operated at two level) experienced an infection during FU. We conclude that ACDF with porous tantalum cages is a safe procedure, with long term clinical benefits (also in patients operated at two levels) and a very low rate of complications.     

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.     

Outpatient anterior cervical discectomy and fusion: A meta-analysis

Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Data from studies meeting inclusion criteria (minimum of 25 patients, control group of inpatient ACDF patients, non-duplicative data source) was then categorized and assimilated for analysis. Seven studies met inclusion criteria, encompassing a 21-year timespan. Each provided Oxford Center for Evidence-Based Medicine Level 3 evidence. The studies yielded a total of 2448 outpatient ACDF patients; only 125 (5.1%) originated from studies published prior to 2011. Single-level surgery occurred in 63.8% of patients, with 0.5% extending beyond two-level fusions. The overall complication rate was 1.8% (mean follow-up of 141.2 days); only 2% of patients required readmission. In conclusion, outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2–5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.     

3D外视镜辅助前路颈椎间盘切除融合术治疗脊髓型颈椎病的疗效

目的 探讨3D外视镜辅助前路颈椎间盘切除融合术(ACDF)治疗脊髓型颈椎病的效果.方法 回顾性分析2019年1～6月3D外视镜辅助ACDF治疗的15例脊髓型颈椎病的临床资料.术后随访12～16个月,平均(14.40±1.45)个月,采用日本骨科协会(JOA)评分评估神经功能.结果 所有病人均在3D外视镜辅助下顺利完成手...     

Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis

Pseudarthrosis occurs after approximately 2–20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3–151) months after ACDF. Median age at index surgery was 51 (range: 33–67) years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0–10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p = 0.013), had more frequent preoperative neurological deficits (p = 0.064), and lower baseline VAS scores (p = 0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2–14) months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p = 0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.     

Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery

Objective

To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty.

Methods

Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed.

Results

With a mean follow-up of 29.7±12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively.

Conclusion

Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.