一期颈椎后前路联合手术结合自锁式颈椎融合器治疗脊髓型颈椎病的疗效

One-term posterior and anterior surgery combined with self-locking cervical inter-body cage in the treatment of cervical spondylotic myelopathy

目的分析一期颈椎后路单开门椎管成形、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-2009年4月,采用一期颈椎后路单开门椎管成形、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102例;前路椎间减压单节段53例、双节段49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 102例共随访12-40个月(平均1 8个月)。102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线及CT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6.9±0.8分,提高到术后6个月13.5±0.9分,术后12个月13.6±0.8分;术后6个月随访时的JOA评分改善率:优43例,良49例,可10例,术后12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形、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。

Objective To analyze the efficacy of one-term auto-grafting inter-vertebral surgery for cervical spondylotic myelopathy through posterior expansive open-door laminoplasty, anterior intervertebral decompression, and inter-body fusion with self-locking cervical inter-body cage. Methods Between September 2006 and April 2009, a total of 102 patients with cervical spondylotic myelopathy underwent a continuous above-mentioned surgical treatment. Of the 102 patients, 49 were treated with anterior inter-vertebral decompression of a single segment, and 53 of double segments. All the patients were assessed pre- and post-operatively by JOA scoring system. The changes shown from neutral lateral cervical radiographs were measured with respect to the height of inter-vertebral space, the lordosis angle of cervical spine and the lordosis angle of inter-vertebral space, Results The mean follow-up was 18 months （n=102, range, 12-40 months）. All the patients reported obvious release in their neurologic symptoms within 2 weeks post- operatively. No complication occurred. In 6 months post-operatively of follow-up, all the patients reported significant improvements in their sensation of extremities, myodynamia, and motion. The cervical screening by X-ray and MRI showed satisfactory inter-body fusion in all patients, whose inter-vertebral height and physiological curse were complete. No fusion device moved down, sank, or broke. The average JOA score increased from 6.9-4-0.8 preoperatively, to 13.5i0.9 in 6 months postoperatively, and to 13.6-4-0.8 in 12 months postoperatively. The improvements of JOA score in 6 months post-operatively showed： 43 excellent, 49 good, and 10 fair. The outcomes in 12 months post-operatively showed no significant difference with that in 6 months post-operatively. Conelusions One-term auto-grafting inter- vertebral surgery for cervical spondylotic myelopathy through posterior expansive open-door laminoptasty, anterior inter-vertebral decompression, and inter-body fusion with self-locking cervical inter-body cage can result in sufficient decompression of both anterior and posterior cervical cord, and in satisfactory clinical efficacy. Moreover, this surgery can achieve good cervical curse, reconstruction of stability, and inter-vertebral fusion.