颈椎前路椎间盘切除椎体间植骨融合术后白索综合征1例

A case report of white cord syndrome after anterior cervical discectomy and fusion

脊髓型颈椎病是严重危害公众健康的疾病之一,颈椎前路椎间盘切除椎体间植骨融合术(ACDF)是颈椎病最为经典的传统术式之一。但ACDF除了具有操作简单、出血少等优点外亦有许多相关并发症,如血肿形成压迫、术中直接损伤脊髓等,最为凶险的当属脊髓缺血再灌注损伤(SCIRI)。白索综合征(WCS)是SCIRI影像学上的特殊表现,特点为手术颈椎相应节段的脊髓出现呈白色索状的大面积水肿。本研究报道1例ACDF术后发生瘫痪,在排除血肿压迫和术中直接损伤脊髓后证实发生了WCS,经积极行后入路扩大减压术后患者瘫痪症状明显减轻,结果表明对于ACDF术后发生WCS的早期诊断及早期手术治疗非常必要,可以最大限度地挽回患者的神经功能。

Cervical spondylotic myelopathy is one of the diseases that seriously endangers public health.Anterior cervical discectomy and fusion(ACDF)is one of the most classic traditional surgical procedures for cervical spondylosis.Although ACDF has the advantages of simple operation and less bleeding,there are still many related complications,such as hematoma formation and compression and direct spinal cord injury during operation.The most dangerous one is spinal cord ischemia⁃reperfusion injury(SCIRI).White cord syndrome(WCS)is a special imaging manifestation of SCIRI,which is characterized by a large area of white cord⁃like edema in the spinal cord of the corresponding segment of the cervical spine.This study reports a case of paralysis after ACDF.WCS was confirmed after excluding hematoma compression or direct injury to the spinal cord during surgery.The patient′s paralysis symptoms were significantly relieved after active decompression through the posterior approach.It is necessary for early diagnosis and early surgical treatment for WCS after ACDF,so as to maximize the recovery of the patient′s neurological function.