脊髓型颈椎病合并腰椎管狭窄症的手术选择

目的探讨脊髓型颈椎病合并腰椎管狭窄症的临床特点、诊断及手术选择。方法回顾性分析2011年6月至2014年6月诊治的30例脊髓型颈椎病合并腰椎管狭窄症患者的临床与影像学资料。一期行颈腰椎减压手术3例，分期行颈腰椎手术11例，仅行颈椎手术10例，仅行腰椎手术6例。对比患者术前与末次随访颈腰椎JOA评分、JOA评分改善率及ODI功能障碍指数。结果30例患者均获随访，随访时间3～24个月。颈椎JOA评分由术前的（8．4±2．5）分升至末次随访的（15．1±1．0）分（P〈0．05），JOA改善率为51．6％－91．0％，平均76.3％；腰椎JOA评分由术前的（12．5±4．5）分升至末次随访的（24．6±2．4）分（P〈0．05），JOA改善率为52．4％－92.8％，平均74．4％；ODI由术前的（60．1±14．9）％降至末次随访的（21．3±10．9）％（P〈0．05）。结论正确诊断脊髓型颈椎病合并腰椎管狭窄症的关键在于详细询问病史、全面的查体以及影像学证据。手术治疗建议对颈腰椎症状并重的先行颈椎手术，症状较重侧组先做，对两组症状严重且身体状况良好可以耐受的患者一期行颈腰椎减压手术。

Objective To investigate the clinical characteristics, diagnosis and operative treatment of coexisting cervical spondylotic myelopathy （ CSM ） and lumbar spinal stenosis （ LSS ） . Methods The clinical and radiographic data of 30 patients with coexisting CSM and LSS treated in our hospital from June 2011 to June 2014 were analyzed retrospectively. Simultaneous decompressions were performed in 3 patients while staged decompressions in 11 patients. Cervical decompression was performed in 10 patients and lumbar decompression in 6 patients. The Japan Orthopaedic Association （ JOA ） scores and rates of CSM and LSS, and Oswestry disability index （ ODI ） were compared before surgery and at the final follow-up. Results All patients were followed up （ Range 6-24 months ） . There were significant differences in CSM and LSS JOA scores, and ODI between preoperative and at the final follow-up [ （8.4±2.5） vs （15.1±1.0） , （12.5±4.5） vs （24.6±2.4） , （60.1±14.9） %vs （ 21.3 ± 10.9 ） % ] . Conclusions The key points in diagnosing coexisting CSM and LSS correctly are detailed medical inquiry, the nerves system examination and radiographic evidences. Operative strategies are suggested as follows： cervical decompression should be done when cervical and lumbar symptoms are similar; surgery is considered taken firstly in the site with a severer symptom.Simultaneous decompressions can be performed in patients with severe symptoms and good physical conditions.