后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病

 目的 探讨后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病的疗效及并发症预防。方法 2008年1月至2011年1月，采用颈椎后路手术治疗的患者43例，年龄42～74岁，平均59.6岁。手术前后采用日本骨科协会评分(Japanese Orthopaedic Association Scores，JOA)判定神经功能，颈椎功能残障指数量表(neck disability index，NDI)评价颈肩轴性痛程度，Ishihara法测定颈椎曲率指数(cervical curvature index, CI)，在MRI上测量脊髓扩大和后移程度。结果 43例患者手术平均减压(3.91±0.86)个节段(3～5个节段)。全部病例平均随访38个月(20～60个月)。术后3～6个月复查时颈椎植骨完全融合。术后JOA评分为(14.31±1.33)分，较术前(8.16±1.11)分有明显改善，临床效果优良率为95.34%。术后CI为15.30%±3.18%，较术前7.36%±9.69%有明显改善。术后颈椎中立位MRI显示最狭窄处硬膜囊前后径为(6.10±0.89) mm较术前(2.92±1.49) mm明显增加，较术前增加了108.9%。颈脊髓平均向后漂移(4.59±1.20) mm(2.97～6.68 mm)。术后NDI评分为(4.90±2.46)分，较术前(19.36±8.61)分有明显改善。随访期间均未出现C5神经根麻痹，无内固定松动、脱出、断裂等并发症发生。结论 后路选择性扩大减压、侧块螺钉内固定术治疗伴有曲度后凸的多节段颈椎病，能有效地改善神经功能，恢复和维持颈椎正常曲度，降低轴性症状和C5神经根麻痹发生率。

Selective posterior enlarged decompression and lateral mass screw fixation for multisegmental cervical spondylotic myelopathy with kyphosis

Objective To investigate the effect and prevention of complications of selective posterior enlarged decompression and lateral mass screw fixation for multisegmental cervical spondylotic myelopathy with kyphosis. Methods From January 2008 to January 2011, 43 patients with multisegmental cervical spondylotic myelopathy combined with kyphosis, aged from 42 to 74 years (average, 59.6 years), underwent selective posterior enlarged decompression and lateral mass screw fixation. The JOA (Japanese Orthopaedic Association) scoring system and Neck Disability Index (NDI) were applied to evaluate the neurological function and axial neck/shoulder pain before and after surgery, respectively. The Ishihara method was employed to measure the cervical curvature index (CI). The expanding and shifting of the spinal cord was calculated in MRI. Results The decompression range was 3 to 5 segments (average, 3.91±0.86 segments). All patients were followed up for 20 to 60 months (average, 38 months). There were significant differences between pre- and post-operative JOA score (8.16±1.11 vs. 14.31±1.33), CI (7.36%±9.69% vs. 15.30%±3.18%), anteroposterior diameter of the dural sac at the level of maximum stenosis in MRI ［(2.92±1.49) mm vs. (6.10±0.89) mm］, and NDI score (19.36±8.61 vs. 4.90±2.46). The mean spinal cord posterior shift was (4.59±1.20) mm (range, 2.97 to 6.68 mm). The complete bone graft fusion was achieved in all patients 3 to 6 months after surgery. No C5 nerve root palsy or instrument failure occurred. Conclusion The selective posterior enlarged decompression and lateral mass screw fixation is effective in treating multisegmental cervical spondylotic myelopathy with kyphosis, which can improve neurological function, recover and maintain the normal cervical curvature, and decrease the incidences of axial symptoms and C5 nerve root palsy