BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few s...BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.展开更多
Objective:To investigate a novel surgical method for multilevel cervical spondylotic myeIopa- thy(CSM).Methods:Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2...Objective:To investigate a novel surgical method for multilevel cervical spondylotic myeIopa- thy(CSM).Methods:Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively.All patients experienced anterior cervical decompression surgery in subsection,autograft fusion and internal fixation.Preoperative,immediate post- operative and follow-up image data,X-rays and semi-quantitative Japanese orthopaedics association(JOA) scores were used to evaluate the restoration of lordosis(Cobb's angle),intervertebral heights,the stabili- ty of the cervical spine and the improvement of neurological impairment.Results:Preoperative symptoms were markedly alleviated or disappeared in most of the patients.According to the JOA scores,the ratio of improvement in neurological function was 72.2%,including excellent in 9 cases(42.9%),good in 7 cases (33.30%),fair in 3 cases(14.3%)and poor in 2 cases(9.5%).Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine(P<0.01).There is no evidence of instrument failure during the mean follow-up period of 14.2 months(9-24 months, P>0.01).Conclusion:Anterior cervical decompression in subsection,autograft fusion and internal fixa- tion is a rational effective method for the surgical treatment of multilevel CSM.展开更多
Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusio...Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.展开更多
目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈...目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。展开更多
目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38...目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38例实施标准开放ACDF治疗,B组40例实施显微镜辅助ACDF。观察并记录两组手术参数,统计并发症发生情况,采用数字分级评分法(numerical rating scale,NRS)、日本骨科协会评分(Japanese orthopaedic association score,JOA)分别对两组术前、术后1年的疼痛度、颈椎神经功能进行评定,测量颈椎Cobb角,并计算颈椎神经功能改善率。结果B组手术用时、术中失血量均较A组少(P<0.05),术后住院时间组间比较无统计学差异(P>0.05);A组发生2例脑脊液漏,B组无并发症发生,组间比较无统计学差异(P>0.05);与同组术前相比,两组术后1年NRS、JOA评分、颈椎Cobb角均明显改善(P<0.05),而组间上述指标比较均无统计学差异(P>0.05);A组颈椎神经功能改善率89.47%与B组的92.50%相比,无统计学差异(P>0.05)。结论对颈椎病患者实施显微镜辅助ACDF的治疗效果较好,且具有手术用时短、术中失血量少等优势。展开更多
Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the a...Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study.Perioperative information,intraoperative blood loss,clinical and radiological outcomes,and complications were recorded.Japanese Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values.The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up.The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features.However,the JOA score recovery rate and SF-36 score in the anterior group were significantly higher.Persistent axial pain could be a major concern when undertaking the posterior approach.展开更多
文摘BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.
文摘Objective:To investigate a novel surgical method for multilevel cervical spondylotic myeIopa- thy(CSM).Methods:Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively.All patients experienced anterior cervical decompression surgery in subsection,autograft fusion and internal fixation.Preoperative,immediate post- operative and follow-up image data,X-rays and semi-quantitative Japanese orthopaedics association(JOA) scores were used to evaluate the restoration of lordosis(Cobb's angle),intervertebral heights,the stabili- ty of the cervical spine and the improvement of neurological impairment.Results:Preoperative symptoms were markedly alleviated or disappeared in most of the patients.According to the JOA scores,the ratio of improvement in neurological function was 72.2%,including excellent in 9 cases(42.9%),good in 7 cases (33.30%),fair in 3 cases(14.3%)and poor in 2 cases(9.5%).Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine(P<0.01).There is no evidence of instrument failure during the mean follow-up period of 14.2 months(9-24 months, P>0.01).Conclusion:Anterior cervical decompression in subsection,autograft fusion and internal fixa- tion is a rational effective method for the surgical treatment of multilevel CSM.
文摘Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
文摘目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。
文摘目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38例实施标准开放ACDF治疗,B组40例实施显微镜辅助ACDF。观察并记录两组手术参数,统计并发症发生情况,采用数字分级评分法(numerical rating scale,NRS)、日本骨科协会评分(Japanese orthopaedic association score,JOA)分别对两组术前、术后1年的疼痛度、颈椎神经功能进行评定,测量颈椎Cobb角,并计算颈椎神经功能改善率。结果B组手术用时、术中失血量均较A组少(P<0.05),术后住院时间组间比较无统计学差异(P>0.05);A组发生2例脑脊液漏,B组无并发症发生,组间比较无统计学差异(P>0.05);与同组术前相比,两组术后1年NRS、JOA评分、颈椎Cobb角均明显改善(P<0.05),而组间上述指标比较均无统计学差异(P>0.05);A组颈椎神经功能改善率89.47%与B组的92.50%相比,无统计学差异(P>0.05)。结论对颈椎病患者实施显微镜辅助ACDF的治疗效果较好,且具有手术用时短、术中失血量少等优势。
文摘目的:分析颈椎前路椎体次全切除植骨融合术(anterior cervical corpectomy and fusion,ACCF)后钛网(titanium mesh cages,TMC)沉降的发生率及其危险因素。方法:回顾性分析北京大学第三医院骨科脊柱组2019年1月~2021年12月期间实施ACCF手术的82例脊髓型颈椎病患者,其中男性44例,女性38例,年龄52.4±10.1岁(34~76岁),随访时间26.6±12.5个月(6~42个月)。根据术后3个月时融合节段高度下降是否超过2.0mm将患者分为沉降组和未沉降组。在术前、术后1d、术后3个月颈椎侧位X线片上测量C2/C7 Cobb角、手术节段Cobb角、椎体间撑开距离、融合节段高度;在术前颈椎CT上测量手术节段近端及远端椎体的CT值,评估骨质疏松情况,记录术前、末次随访的JOA评分,计算JOA评分改善率;将各变量进行单因素分析,将P<0.1的变量及有临床意义的危险因素纳入Logistic回归分析,通过受试者工作特征(receiver operating characteristic,ROC)曲线评价危险因素预测钛网沉降的风险,根据约登指数最大的原则寻找临界点。结果:58例患者(70.7%)发生了钛网沉降。沉降组与未沉降组的性别、年龄、住院时间无统计学差异(P>0.05)。沉降组与未沉降组C2/C7 Cobb角及手术节段Cobb角术后1d较术前均显著增加(P<0.05),术后3个月两组手术节段Cobb角及未沉降组C2/C7 Cobb角较术前均明显增加(P<0.05)。两组同时间点C2/C7 Cobb角及手术节段Cobb角无统计学差异(P>0.05)。沉降组术后椎间撑开距离明显大于未沉降组(3.82±1.93mm vs 2.37±1.98mm,P=0.003)。术后3个月融合节段椎体间高度未沉降组显著大于沉降组(P<0.05)。两组术前近、远端椎体的CT值无统计学差异(近端364.6±102.2HU vs 389.2±102.3HU,P=0.325;远端305.2±82.4HU vs 341.1±84.6HU,P=0.086)。末次随访时两组JOA评分改善率无统计学差异(P=0.442);两组轴性症状发生率无统计学差异(6.9%vs 12.5%,P=0.409)。Logistic回归分析结果显示,椎体间撑开距离的比值比1.496[95%置信区间(1.107,2.022),P=0.009];椎体间撑开距离预测钛网沉降的ROC曲线下面积为0.717,椎体间撑开距离临界值为1.8mm。结论:ACCF术中椎体间过度撑开是钛网沉降的独立危险因素,术中椎体间撑开距离超过1.8mm显著增加钛网沉降的发生风险。
文摘Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study.Perioperative information,intraoperative blood loss,clinical and radiological outcomes,and complications were recorded.Japanese Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values.The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up.The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features.However,the JOA score recovery rate and SF-36 score in the anterior group were significantly higher.Persistent axial pain could be a major concern when undertaking the posterior approach.
