内窥镜下前路颈椎间盘切除碳素纤维Cage置入治疗颈椎病25例

背景: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.目的:观察内镜技术结合碳素纤维cage置入由前路治疗颈椎病的效果.设计、时间及地点:回顾性病例分析,病例来自2003-01/2008-07南华大学附属第一医院脊柱外科.对象:选择南华大学附属第一医院脊柱外科收治的颈椎病患者25例,男15例,女10例;年龄33～58岁,平均39岁.每例患者均有不同程度的一侧肢体疼痛、麻木或乏力.在MRI上,20例患者表现为单个节段的颈椎间盘退变,5例为2个节段的退变.方法:25例患者均进行内窥镜下前路颈椎间盘切除、碳素纤维Cage置入,并在手术操作、神经症状及置入后并发症方面作了回顾性分析.置入后处理同常规的颈前路手术.主要观察指标:依据JOA评分系统评价患者神经症状的改善程度,置入后影像资料(包括生理曲度、融合情况等).结果:25例患者均顺利完成置入,置入时间80～225 min.置入后住院时间6～10 d,平均7d.置入前JOA评分为4～9分,置入后8～16分,平均改善率45.6%.所有患者均获得随访,平均随访18个月.术后复查颈椎正侧位X射线平片示cage位置良好,未出现移位.无血管损伤及感染情况出现.25例患者中2例出现了椎间隙塌陷,1例出现一过性声音嘶哑,未见其他并发症.结论:内窥镜下前路颈椎间盘切除碳素纤维cage置入治疗颈椎病具有微创、减压充分、植骨融合满意等优点,可显著减轻患者手术前的临床症状.

Microendoscopic cervical discectomy and intervertebral fusion with carbon fiber reinforced polymer Cage by anterior approach for treatment of cervical spondylosis A 25-case analysis

BACKGROUND:Techniques of antedor cervical discectomy and interbody fusion have achieved good clinical outcomes since Robinson and Smith first introduced it in 1955.Currently,microendoscopic approaches have resulted in good clinical effectiveness in treating cervical spondylosis.Cage has also been used widely in the clinic.OBJECTIVE:To find a minimally invasive method that uses microendoscopic technique and Cages to treat cervical spondylosis by anterior approach.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Spinal Surgery,First Affiliated Hospital of University of South China between January 2003 and July 2008.PARTICIPANTS:A total of 25 patients with cervical spondylosis,15 males and 10 females,averaging 39 years of age (range,33-58 years old),who received treatments at the Department of Spinal Surgery,First Affiliated Hospital of University of South China were included in this study.Each of them had unilateral limb pain,numbness or weakness in varying degrees.MRI image showed one-level cervical disc degeneration in 20 patients and two levels in 5 patients.METHODS:Twenty-five patients underwent anterior cervical microendoscopic discectomy and interbody fusion using carbon fiber reinforced polymer (CFRP) Cage.Surgical techniques,neurological outcomes and complications were retrospectively analyzed.The postoperative treatments were just like the conventional approaches.MAIN OUTCOME MEASURES:Improvements in neurological symptoms were assessed using the Japanese Orthopedic Association (JOA) grading system.Postoperative imaging data including lordosis and fusion condition were examined.RESULTS:All patients received treatments successfully.The mean surgical time was 140 minutes (range,80 to 225 minutes).The hospital stay averaged 7 days (range,6 to 10 days).Patients' neurological statuses improved to varying degrees according to the JOA grading system:7.5 pre-operative (range,4 to 9 points) to 12 post-operative (range,8 to 16 points),with the mean improvement rate of 45.6%.All cases were followed up and the mean follow-up period was 18 months (range,6 to 27 months).Postoperative images showed solid bone fusion without implant migration.No vascular injury and infection occurred.Graft collapse was found in 2 patients,and transient hoarse voice in 1 patient.No other complications were found.CONCLUSION:Anterior microendoscopic cervical discectomy and interbody fusion with CFRP Cage in treatment of cervical spondylosis have the advantages of minimal invasion,sufficient decompression,and satisfactory bone fusion,resulting in a significant relief of patients' preoperative clinical symptoms.