对多节段脊髓型颈椎病诊断治疗的一些看法

Opinions about diagnosis and treatment of multilevel cervical spondylotic myelopathy

多节段脊髓型颈椎病的在诊断和治疗方面存在混乱,笔者复习文献结合自己临床经验体会,提出将脊髓型颈椎病依据责任节段区分为:单节段,双节段(连续型、跳跃型)和多节段(≥3节段);强调责任节段数目的确定是诊断的前提,也是手术减压范围的关键,应依靠临床、影像和电生理3个方面综合分析,仅靠影像学行预防性减压不可取,应避免手术范围扩大化。有关手术入路和手术方式仍是多节段脊髓型颈椎病研究的热点、焦点,目前尚没有治疗标准及相应的指南。笔者认为手术入路的选择提倡个体化,手术的方式遵循能简勿繁原则,多数情况下没有必要后前联合减压,同时前后路固定更是多余。

There should be confusion about diagnosis and treatment for multiple segments cervical myelopathy in some respects. The author reviewed the literature and combined with clinical experience, proposed a new classification for cervical myelopathy according to responsibility segment areas,which dividing into single segment,double segments （continues or jumping type）, multi-segment （≥ three segments ）. The responsible segments determination is the premise of diagnosis and also a key to determine surgical decompression segment. Decompression only according to imaging was not desirable, surgical segment should mainly relies on clinical, imaging, electrophysiological and comprehensive analysis to avoid surgery range expansion. Surgical approach and procedures are still the focus and hotspot of cervical myelopathy treatment, and no treatment standards and corresponding guidelines to eonsuh. The author proposes that surgical approach should advocate the individual, and surgical procedure should follow simple instead of complicate, anterior and posterior combined decompression is not necessary in most eases, and anterior and posterior fixation are not need.