自锁式椎间融合器在一期后前路联合手术治疗脊髓型颈椎病中的应用(2年随访)

[目的]分析一期颈椎后路单开门椎管成型、前路椎间减压、自锁式椎间融合器自体植骨椎间融合术治疗脊髓型颈椎病的疗效.[方法]2006年9月～ 2008年4月,采用一期颈椎后路单开门椎管成型、前路椎间减压、自锁式椎间融合器自体植骨椎间融合术连续治疗脊髓型颈椎病52例；前路椎间减压单节段23例、双节段29例.记录患者术前及术后的JOA评分,在颈椎侧位X线片上测量椎间隙高度、椎间前凸角、颈椎前凸角的变化.[结果] 52例共随访24～40个月(平均30个月).52例患者在术后2周内均感到神经症状明显好转；没有发生手术相关并发症.术后6个月随访时,所有患者主诉四肢感觉、肌力、活动均较前明显改善,颈椎X线检查可见椎间已融合,椎间高度及生理曲度完好,无融合器移位、下沉、断裂发生.平均JOA评分由术前(7.3±0.5)分,提高到术后6个月(14.1±0.7)分,术后12个月(14.7±0.6)分,术后24个月(14.9±1.2)分；术后6个月随访时的JOA评分改善率:优21例,良25例,可6例,术后12个月及术后24个月时的JOA评分改善率与术后6个月无明显改变.[结论]采用一期颈椎后路单开门椎管成型、前路椎间减压、自锁式椎间融合器自体植骨椎间融合术治疗脊髓型颈椎病能获得颈髓前后方的充分减压及满意的临床疗效,能获得满意的颈椎曲度、稳定性重建及椎间融合.

Clinical application of self-anchoring cervical interbody fusion cage for treatment of cervical spondylotic myelopathy through combined posterior and anterior approach:a 2-year follow-up

[Objective]To analyse the outcome of cervical spondylotic myelopathy treated with one-term posterior cervical lamioplasty and anterior cervical discectomy and interbody fusion with self-anchoring cage.[Methods]Fifty-two patients with cervical spondylotic myelopathy were treated with above-mentioned surgical procedure.Fuctional outcome according to JOA scoring system,lordosis angle of cervical spine and intervertebral space angle and height on neutral lateral radiographs were recorded preoperatively and postoperatively.[Results]All patients were followed up for 24~40 months.No complication occurred.Sufficient decompression and solid interbody fusion were achieved in all patients.Clinical symptoms and signs were significantly relieved.The height of disk space and cervical lordosis curve were improved.Average JOA score increased from 7.3±0.5 preoperatively to 14.1±0.7 at 6 months,14.7±0.6 at 12 months and 14.9±1.2 at 24 months postoperatively.Clinical follow-up outcome at 6,12 and 24 months postoperatively were excellent in 21,good in 25 and fair in 6 patients.[Conclusion]One-term posterior cervical laminoplasty and anterior cervical discectomy and interbody fusion with self-anchoring cage are an effective surgical procedure for cervical spondylotic myelopathy.