颈椎间盘突出致脊髓前动脉综合征的诊治

Diagnosis and treatments for anterior spinal artery syndrome induced by cervical disc herniation

[目的]探讨颈椎间盘突出导致脊髓前动脉综合征的诊断、治疗方法及其疗效。[方法]本组患者男13例,女5例;平均年龄35.6岁,术前均行MRI检查显示颈椎间盘突出,临床症状进行性加重,具体表现为突出节段平面以下运动功能障碍同时伴有痛温觉消失,但本体感觉正常,符合脊髓前动脉综合征的特点。术前JOA评分4～10分,平均7.6分。17例患者发病后15d内行颈椎前路减压融合术,1例按椎管内占位于外院行后路手术,效果不理想,1年后再次给予前路减压。[结果]术后随访12～24个月,平均15个月,疗效良好,术后JOA评分平均13.4分(7～15分),平均改善率61.7%,无1例出现并发症。[结论]突出的颈椎间盘可压迫脊髓前动脉使脊髓前2/3缺血而表现为脊髓前动脉综合征,患者的临床特征及MRI检查可帮助诊断,早期行前路减压融合术,效果良好。

[ Objective] To discuss the diagnosis, treatments and the outcome of anterior spinal artery syndrome induced by cervical disc herniation. [ Methods] Eighteen patients （ male 13, female 5, average age 35.6 years old） were diagnozed to experience cervical disc herniation by MRI scans. All the patients presented with severe motor paralysis with loss of sensation to pain and temperature but sparing of proprioceptive sensation, which was just like the clinical features of anterior spinal artery syndrome. The average preoperative JOA score was 7.6 points, ranged from 4 to 10. Anterior cervical decompression with fusion was performed on 17 patients within 15 days. Spinal canal occupation was found in 1 case. Posterior approach treatment was not effective and anterior approach decompression was performed 1 year later. [ Results] All these patients were followed up for an average of 15 months （ 12 to 24 months） . Seventeen patients had a good outcome. The postoperative JOA score ranged from 7 to 15 points （ 13.4 in average） and the mean JOA recovery ratio was 61.7%. All the patients recovered with no complication. [ Conclusion] A herniated cervical disc can compress the spinal anterior artery and involve with anterior spinal artery syn- drome. It can be final diagnozed with clinical features and MRI scans. The outcome is satisfactory when an early and complete anterior decompression with fusion is performed.