脊髓型颈椎病前路术后脊髓损伤的原因及防治对策

目的 探讨脊髓型颈椎病前路手术引起脊髓损伤的原因和防治策略.方法 分析2001年-2009年共749例实施前路减压融合手术的脊髓型颈椎病患者病历资料.共有5例患者在术后即刻或术后早期出现了脊髓功能下降.其中男3例,女2例;年龄48-62岁,平均52岁.2例合并有后纵韧带骨化.术前日本骨科学会(JOA)评分9-16分,平均12.4分.手术方式采用前路经颈椎间盘或椎体次全切除减压、自体髂骨或Cage融合、钛合金板内固定术.术中出血50～200 ml.2例患者术后即刻发现脊髓功能障碍加重,1例术后6 h出现下肢感觉运动消失,1例术后24 h出现一侧肢体瘫痪,1例术后5 d出现四肢麻木加重.4例患者早期给予大剂量甲基强的松龙冲击治疗.5例患者均再次行颈椎前路探查术,其中1例患者同时又行后路单开门椎管扩大成形术.结果 随访时间1～2年,平均16个月.4例患者脊髓功能(JOA评分)术后3个月均恢复或优于术前水平,术后1年均优于术前水平;1例患者术后1年神经功能仍无改善.分析脊髓损伤原因:术中减压和止血伤及脊髓2例,减压不彻底1例,血肿和止血纱布压迫各1例.结论 颈前路减压手术引起脊髓损伤的主要原因是术后延迟损伤,如果发现和处理及时,脊髓功能大多数可以恢复至术前水平.应尽量避免术中操作伤及脊髓,从而导致脊髓功能永久性障碍.

Abstract：

Objective To investigate the causes and prevention strategies of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy. Methods The clinical data of 749 patients with cervical spondylotic myelopathy treated with anterior approach surgery from 2001 to 2009 were retrospectively studied.There were five patients with spinal cord dysfunction instantly or early after operation,including three males and two females at average age of 52 years (range,48-62 years).Two patients were combined with ossification of the posterior longitudinal ligament.The Japanese Orthopaedic Association (JOA) score was average 12.4(9-16)preoperatively.The surgeries included anterior cervical diskectomy(or corpectomy)and interbody fusion(iliac bone graft or cage or titanium mesh)and locking plates fixation.The blood loss was 50-200 ml.The symptoms included instant spinal cord injury in two patients,loss of the motor and feeling of both legs at 6 h after surgery in one,paralysis of one side limbs at 24 h after surgery in one and numbness of limbs at 5 days after surgery in one.Four patients were treated by large dose of methylprednisolone.Five patients underwent anterior exploration surgery,of which one patient received posterior cervical one-door expansive laminoplasty. Results The patients were followed up for average 16 months(12-24 months).The JOA score of four patients was recovered at three months and WaS better than preoperation after surgery.The function of spinal cord of one patient showed no improvement at one year after surgery.The causes for spinal cord injury included inappropriate surgical manipulation in decompression and haemostasis in two patients,insufficient decompression in one,epidural hematoma in one and absorbable hemostatic gauze in one. Conclusions The major causes of postoperative spinal cord injury in anterior approach surgery for cervical spondylofic myelopathy are the delayed postoperative injury.The spinal cord can recover to normal and has satisfactory prognosis if discovered promptly.We must avoid the spinal cord injury by surgical Manipulation that may result in permanent neurological deficits.

Causes and prevention of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy

Objective To investigate the causes and prevention strategies of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy. Methods The clinical data of 749 patients with cervical spondylotic myelopathy treated with anterior approach surgery from 2001 to 2009 were retrospectively studied.There were five patients with spinal cord dysfunction instantly or early after operation,including three males and two females at average age of 52 years (range,48-62 years).Two patients were combined with ossification of the posterior longitudinal ligament.The Japanese Orthopaedic Association (JOA) score was average 12.4(9-16)preoperatively.The surgeries included anterior cervical diskectomy(or corpectomy)and interbody fusion(iliac bone graft or cage or titanium mesh)and locking plates fixation.The blood loss was 50-200 ml.The symptoms included instant spinal cord injury in two patients,loss of the motor and feeling of both legs at 6 h after surgery in one,paralysis of one side limbs at 24 h after surgery in one and numbness of limbs at 5 days after surgery in one.Four patients were treated by large dose of methylprednisolone.Five patients underwent anterior exploration surgery,of which one patient received posterior cervical one-door expansive laminoplasty. Results The patients were followed up for average 16 months(12-24 months).The JOA score of four patients was recovered at three months and WaS better than preoperation after surgery.The function of spinal cord of one patient showed no improvement at one year after surgery.The causes for spinal cord injury included inappropriate surgical manipulation in decompression and haemostasis in two patients,insufficient decompression in one,epidural hematoma in one and absorbable hemostatic gauze in one. Conclusions The major causes of postoperative spinal cord injury in anterior approach surgery for cervical spondylofic myelopathy are the delayed postoperative injury.The spinal cord can recover to normal and has satisfactory prognosis if discovered promptly.We must avoid the spinal cord injury by surgical Manipulation that may result in permanent neurological deficits.