颈椎前路显微手术减压治疗脊髓型颈椎病临床疗效

Effectiveness of anterior cervical microsurgical decompression to treat spondylotic myelopathy

目的评价颈椎前路显微手术减压治疗脊髓型颈椎病安全性与有效性。方法应用显微手术进行减压、植骨与内固定治疗。术中监测皮层体感诱发电位（CSEP）与运动诱发电位（MEP）改变及术后有无神经功能丢失。术后观察MRI图像，判断椎管减压的彻底性：根据手术前后MRI图像，测量并比较椎管与脊髓最狭窄处前后径与面积；神经功能JOA评分评价手术疗效。结果临床治疗38例，2例减压过程出现CSEP一般预警，发生率为6％；无1例CSEP危险预警与MEP消失；术后无神经功能损害加重。32例术后获MRI检查，椎管内骨赘与突出的椎间盘均完全清除。椎管前后径术后增加58．95％；椎管面积增加48．12％；脊髓前后径术后增加33．68％；脊髓面积增加37．38％。JOA评分平均改善率为65．2％。结论颈椎前路显微手术减压治疗脊髓型颈椎病安全性高、减压效果好。

Objective To evaluate the safety and efficacy of anterior cervical microsurgical decompression to treat spondylotic myelopathy. Methods Anterior cervical microsurgical decompression,graft and fixation were used to treat spondylotic myelopathy. The methods for evaluation of safety were CSEP,MEP and postoperative neurologic deficit. The methods for evaluation of efficacy were to judge if spinal canal and spinal cord got thorough decompression and measure the AP diameter and area of spinal canal and spinal cord. All data of pre- and postoperation were compared. The outcomes were evaluated using JOA score neurologic function. Results 5% of patients had common prewarning of CSEP. There was no patient with risk prewarning of CSEP and MEP disappearance. There was no patient whose postoperative neurologic deficit was more severe than preoperation. Thirty-two cases got MRI check after operation. The AP diameter of spinal canal and spinal cord increased 58.95% and 33.68%. The area of spinal canal and spinal cord increased 48.12% and 37.38%. The recovery rate of JOA score of neurologic function was 65.2%. Conclusion Anterior cervical microsurgical decompression to treat spondylotic myelopathy is safe and efficacious.