脊髓型颈椎病的手术治疗

Surgical treatment of cervical spondylotic myelopathy

目的探讨脊髓型颈椎病(CSM)的手术治疗方法及其疗效。方法回顾性分析2002年1月至2011年1月我院165例CSM手术治疗病例,均有程度不等的脊髓压迫症状,42例合并发育性颈椎管狭窄。术前常规行X线、CT平扫加矢状位重建和磁共振成像(MRI)检查。其中105例行颈前路减压融合内固定手术,40例行颈后路单开门椎管扩大成形术,20例行颈后前路联合手术。结果 165例患者获8～72个月随访,平均随访时间20个月。根据日本矫形外科学会(JOA,17分)评分标准,颈前路手术平均改善率79.0%,颈后路手术平均改善率75.5%,颈后前路联合手术平均改善率83.6%。术后并发节段性神经根麻痹7例。结论 CSM一旦诊断明确,应尽早手术治疗。根据患者病情和影像学表现,确定颈椎间盘受累节段、脊髓受压程度、颈椎稳定性、颈椎发育性椎管狭窄及后纵韧带骨化存在与否,选择适合的手术方法,术中应用显微外科技术精细操作,可减少并发症,获得良好的疗效。

Objective To discuss surgical approaches and results of cervical spondylotic myelopathy （CSM）. Methods This study examined retrospectively the 165 patients with CSM from January 2002 to January 2011, which were treated operatively. All patients had different compression symptom of spinal cord. 42 patients had cervical stenosis. Cervical X-ray, CT, 2D-CT and MRI was evaluated before operation routinely. Of 165 patients, 105 were decompressed from an anterior approach, 40 from a posterior approach and 20 from anteroposterior approach. Results One hundred and sixty-five cases were followed up for 8-72 months, The average follow- up period was twenty months. According to criteria of Japan Orthopedic Association （JOA, 17） score, the mean postoperative improvement rate was 79.0% in patients treated by anterior decompression, 75.5 % in those treated by posterior decompression and 83.6% in those treated by anteroposterior decompression. There were seven patients with segmental nerve root palsy. Conclusion Once suffering from CSM, the patients should be treated operatively as early as possible. Suitable operation methods should be chosen according to patients clinical symptom and radiology evaluating, including the segment of cervical disc herniation, the extent of spinal cord compression, the stability of the cervical vertebrae, the developmental spinal stenosis and ossification of posterior longitudinal ligament. In addition, microsurgical technique was applied in operation and it is important for avoiding complications and giving good results.