伴颈神经根病的无症状颈椎退变性脊髓压迫的治疗

Treatment of asymptomatic spondylotic cervical cord compression combined with symptomatic cervical radiculopathy

目的探讨伴颈神经根病的无症状颈椎退变性脊髓压迫（asymptomatic spondylotic cervical cord compression,A-SCCC）的治疗。方法回顾分析本院2009年6月~2012年6月收治的34例伴颈神经根病的A-SCCC患者病例资料,患者入院后先接受系统的非手术治疗,如果神经功能无缓解或加重,则行手术治疗,收集患者一般情况及影像学资料,于治疗前后不同时间点通过日本骨科学会（Japanese Orthopaedic Association,JOA）评分评价临床治疗效果。结果34例患者平均随访4个月,其中23例经非手术治疗获得不同程度的改善;11例改善不明显,其中8例改手术治疗,3例患者继续非手术治疗（2例症状逐渐缓解,1例出现脊髓病临床表现）。治疗后及随访期间非手术组与手术组患者JOA评分均较治疗前明显改善,差异有统计学意义（P〈0.01）。结论多数伴颈神经根病的A-SCCC患者经过系统非手术治疗后病情可以缓解,部分仍需手术治疗,伴颈神经根病或脊髓高信号的A-SCCC不必预防性手术,但需密切观察病情变化。

Objective To investigate therapeutic methods of asymptomatic spondylotic cervical cord compression（ A-SCCC） combined with symptomatic cervical radiculopathy. Methods From June 2009 to June 2012,34 patients with A-SCCC combined with symptomatic cervical radiculopathy were included in this retrospective analysis. All the cases underwent anterior-posterior,lateral,excessive flexion and extension cervical spine X-ray and MRI. Age,gender,duration of disease and the Pavlov ratio were also collected. Conservative treatment to all patients accepted after admission system,the patients were underwent surgical operation without neural function recovery after normal conservative treatment. Before treatment and at different time points after treatment,the Japanese Orthopaedic Association（ JOA） scores were calculated to evaluate the clinical effect of treatment. Results All of 34 patients were followed up for an average of 4 months,of which 23 patients got different degrees of neural function improvements after conservative treatment,and 11 patients had no obvious improvement. Eight cases without obvious improvement underwent operation,and other 3 patients refused operation treatment of who 2 cases were relieved after continued conservative treatment,and the remaining 1 case developed with clinical manifestations of spinal cord disease. The JOA scores in both groups were significantly improved after treatment（ P〈0. 01）. Conclusion Majority of patients with A-SCCC combined with symptomatic cervical can alleviate the condition after conservative treatment,some still need operation. A-SCCC combined with symptomatic cervical radiculopathy or spinal cord high intensity signal spinal cord do not need preventive operation,but still have to observe the change of the disease closely.