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
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
目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—202...目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—2023年12月淮安八十二医院接收的90例双节段颈椎病患者,利用最新统计学软件生成随机序列后分为对照组、观察组,各45例。对照组予以ACCF治疗,观察组予以ACDF治疗。对比两组围手术期指标、疼痛缓解情况、颈椎功能恢复情况及不良事件发生情况。结果:观察组围手术期指标(手术时间、术中出血量、术后引流量、下床时间及住院时间)均优于对照组,差异均有统计学意义(P<0.05)。治疗前、治疗后14 d及1、2个月,两组数字评分法(numeric rating scales,NRS)评分比较,差异均无统计学意义(P>0.05)。治疗前及治疗后1、2个月,两组关节活动度(range of motion,ROM)、最狭窄处脊髓面积、颈椎生理曲线、椎管横截面积比较,差异均无统计学意义(P>0.05)。两组不良事件总发生率比较,差异无统计学意义(P>0.05)。结论:ACDF、ACCF治疗双节段颈椎病的效果不存在明显差异,但ACDF手术时间较短,且出血量较少,更适用于对手术耐受度较低的患者。展开更多
目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效...目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P>0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P<0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P<0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P<0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。展开更多
目的:探讨颈前路椎间盘切除融合术(anterior cervical discectomy with fusion,ACDF)与颈前路椎体次全切减压融合术(anterior cervical corpectomy with fusion,ACCF)治疗相邻两节段脊髓型颈椎病的临床疗效。方法:对2016年1月至2017年1...目的:探讨颈前路椎间盘切除融合术(anterior cervical discectomy with fusion,ACDF)与颈前路椎体次全切减压融合术(anterior cervical corpectomy with fusion,ACCF)治疗相邻两节段脊髓型颈椎病的临床疗效。方法:对2016年1月至2017年12月收治的相邻两节段脊髓型颈椎病37例患者的临床资料进行回顾性分析,男15例,女22例,年龄43~69岁,平均54.6岁。根据手术方法的不同分为ACDF治疗组(A组,17例)和ACCF治疗组(B组,20例)。记录两组患者的手术时间、术中出血量,比较两组患者术前及术后1、12个月颈椎融合节段Cobb角、颈椎曲度,采用日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分评价临床疗效,并观察两组术后并发症情况。结果:所有患者获得随访,时间12~24个月,平均18.5个月。手术时间、术中出血量A组分别为(106.3±22.6)min、(52.2±26.4)ml,B组分别为(115.6±16.8)min、(61.7±20.7)ml,手术时间组间差异无统计学意义(P>0.05),B组术中出血量大于A组(P<0.05)。术前及术后1、12个月颈椎曲度和颈椎融合节段Cobb角A组分别为(11.28±1.40)°、(17.56±1.90)°、(16.64±1.80)°和(4.93±4.20)°、(9.44±2.60)°、(9.25±2.80)°,B组分别为(10.59±1.20)°、(16.26±2.10)°、(15.76±2.50)°和(4.75±3.90)°、(7.98±2.10)°、(7.79±3.00)°。两组患者术后颈椎融合节段Cobb角、颈椎曲度均较术前明显改善,且A组较B组恢复更明显(P<0.05)。术前及术后1、12个月JOA评分A组分别为9.46±1.70、11.56±1.40、14.86±1.20,B组分别为9.11±1.50、11.40±1.30、15.12±1.60。两组患者术后JOA评分较术前均明显改善(P<0.05),组间同时间段比较差异无统计学意义(P>0.05)。末次随访A组出现吞咽梗阻感2例,cage移位1例,未发生钛板螺钉松动;B组出现吞咽梗阻感4例,钛网沉降2例,钛板螺钉松动1例。结论:两种颈前路减压融合术治疗两节段脊髓型颈椎病,均能有效减压,改善病椎Cobb角及颈椎生理曲度。ACDF术式可直接去除椎间水平的致压物,椎体破坏小,颈椎生理曲度恢复良好;ACCF术式椎体次全切除,操作空间大,易于去除椎体后缘骨赘及钙化的后纵韧带。长期随访显示,ACDF与ACCF术式效果良好,技术成熟,疗效接近。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.
文摘目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—2023年12月淮安八十二医院接收的90例双节段颈椎病患者,利用最新统计学软件生成随机序列后分为对照组、观察组,各45例。对照组予以ACCF治疗,观察组予以ACDF治疗。对比两组围手术期指标、疼痛缓解情况、颈椎功能恢复情况及不良事件发生情况。结果:观察组围手术期指标(手术时间、术中出血量、术后引流量、下床时间及住院时间)均优于对照组,差异均有统计学意义(P<0.05)。治疗前、治疗后14 d及1、2个月,两组数字评分法(numeric rating scales,NRS)评分比较,差异均无统计学意义(P>0.05)。治疗前及治疗后1、2个月,两组关节活动度(range of motion,ROM)、最狭窄处脊髓面积、颈椎生理曲线、椎管横截面积比较,差异均无统计学意义(P>0.05)。两组不良事件总发生率比较,差异无统计学意义(P>0.05)。结论:ACDF、ACCF治疗双节段颈椎病的效果不存在明显差异,但ACDF手术时间较短,且出血量较少,更适用于对手术耐受度较低的患者。
文摘目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P>0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P<0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P<0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P<0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。
