前路手术选择性治疗无骨折脱位的颈脊髓中央损伤综合征

目的探讨颈椎前路手术治疗无骨折脱位的颈脊髓中央损伤综合征的适应证和效果。方法回顾性分析自2004年1月以来我科收治的无骨折脱位的颈脊髓中央损伤综合征的病例资料,筛选其中21例接受前路减压植骨融合手术治疗的病例,根据影像学特点分为有1~3个节段的退变性颈椎管狭窄组17例和有4~5个节段的发育性颈椎管狭窄组4例,二组均施行颈椎前路椎间减压、植骨融合、内固定手术,前者行1~3个节段手术;后者施行2~4个节段手术。手术前后均采用ASIA评分系统评定神经功能。记录手术方式、融合节段、术前及术后神经功能、融合情况,判断颈椎前路手术治疗无骨折脱位的颈脊髓中央损伤综合征的适应证和效果。结果退变性颈椎管狭窄或者椎间盘突出的病例,接受前路减压植骨融合手术后ASIA评分有明显升高;发育性颈椎管狭窄的病例,接受严重受压的2~4个节段前路减压植骨融合手术后ASIA评分有一定恢复。结论对于非发育性颈椎管狭窄的颈脊髓中央损伤综合征患者,根据脊髓受压和局限性椎管狭窄的节段,实施1~3个节段的前路减压植骨融合手术可以起到减压并为神经功能恢复创造有利条件的目的 ;对于长节段发育性椎管狭窄病例,实施后路椎管成形术或者一期前后路联合手术是更好的选择。

Selective surgical treatment for central cord syndrome of cervical spinal cord injury without fracture or dislocation via anterior approach

Objective To evaluate the feasibility and effect of anterior cervical decompression and fusion（ACDF） in the treatment of central cord syndrome of cervical spinal cord injury（CSCI-CCS） without fracture or dislocation.Methods Totally 21 cases of CSCI-CCS treated by ACDF since January 2004 were retrospectively analyzed.The patients were divided into degenerative spinal canal stenosis group（characterized by 1~3 stenotic segments） and developmental spinal canal stenosis group（characterized by 4~5 stenotic segments）.All patients were subjected to ACDF,1~3 stenotic Segments In Degenerative spinal canal stenosis group and 2~4 stenotic segments in developmental spinal canal stenosis group.American spinal injury association（ASIA） scale was used to assess the neurologic function.The radiographic characteristics,levels of fusion,and neurological function were analyzed and documented in detail.Results In degenerative spinal canal stenosis group,the ASIA scores increased significantly in 17 cases.However,no or moderate ASIA scores increase was observed in developmental spinal canal stenosis group after receiving ACDF.Conclusion It is feasible and effective for patients with degenerative stenotic CSCI-CCS to undergo ACDF which including 1~3 segments according to the conditions of spinal cord compression and segments of spinal canal stenosis and for patients with long developmental stenotic segments,open-door expansile cervical laminoplasty or anterior and posterior combined operation is the better choice.