前路手术治疗合并邻近椎间盘突出的颈椎后纵韧带骨化症

The anterior operation for cervical ossification of posterior longitudinal ligament combined with adjacent disc herniation

目的探讨前路手术治疗合并颈椎间盘突出的颈椎后纵韧带骨化症的疗效及手术时机的选择。方法自2005年1月至2011年1月我科共收治24例合并颈椎间盘突出的颈椎后纵韧带骨化症患者,其中男21例,女3例;年龄40～68岁,平均52岁,术前均行颈椎X线片、CT及MRl检查证实患有2～3个节段颈椎后纵韧带骨化,同时合并邻近椎间盘突山压迫脊髓,全部患者均行前路颈椎次全切重建联合邻近突出的椎间盘摘除Cage融合内固定术,分析比较术前术后日本骨科学会(JOA)评分并计算改善率。结果 24例患者全部获得随访,随访时间8-36个月,平均22个月。术前神经功能JOA评分4～13分,平均7.5分,术后JOA评分10～16分,平均13.6分,神经功能改善率32%～81%,平均65.6%,其中疗效优7例,良12例,一般5例,无疗效差者,优良率79.1%。结论颈椎后纵韧带骨化症常合并邻近椎间盘突出,应早期进行手术干预以避免脊髓功能出现急剧恶化;前路颈椎次全切重建联合邻近椎间盘摘除Cage融合内固定术减压彻底,并发症少,脊髓神经功能恢复良好。

Objective To investigate the efficacy and the selection of surgery time of anterior operation for cervical ossification of posterior longitudinal ligament combined with cervical disc herniation. Methods Totally 24 cases of cervical ossification of posterior longitudinal ligament combined with cervical disc herniation underwent anterior operation in our department from January 2005 to January 2011. There were 21 males and 3 females. The mean age was 52 years old （range; 40-68 years）. Preoperatively, 2-3 ossified segments of the posterior longitudinal ligament combined with contiguous cervical herniated disc compressing the spinal cord were revealed through cervical X-ray film, CT and MRI examinations. All patients were treated with the anterior cervical subtotal corpectomy combined with the discectomy of contiguous cervical herniated disc by the cage fusion surgery of internal fixation for reconstruction. The preoperative and postoperative Japanese Orthopaedic Association （JOA） scores were analyzed and compared, and the improvement rate was also calculated. Results All patients were followed up for an average period of 22 months （range; 8-36 months）. The mean JOA score of neurological function was preoperatively 7.5 points （range; 4-13 points）. The mean JOA score was postoperatively 13.6 points （range; 10-16 points）. The mean improvement rate of neurological function was 65.6% （range; 32%-81%）. The efficacy of 7 cases was excellent, 12 cases good, 5 cases fair and none bad. The excellence rate was 79.1%. Conclusions Cervical ossification of posterior longitudinal ligament often combines with contiguous cervical herniated disc resulting in spinal cord injury. To avoid the sharp deterioration of spinal cord function, early surgical intervention should be taken. The anterior cervical subtotal corpectomy combined with the discectomy of contiguous cervical herniated disc by the cage fusion surgery of internal fixation for reconstruction in the treatment of cervical ossification of posterior longitudinal ligament combined with cervical disc herniation can decompress completely, decrease complications and lead good recovery for the neurological function of the spinal cord.