cases of percutaneous cervical discectomy (PCD) were performed using a set of nucleotome system. 9 patients showed good to excellent results in 12 cases,without any significant complications. The safe space of percuta...cases of percutaneous cervical discectomy (PCD) were performed using a set of nucleotome system. 9 patients showed good to excellent results in 12 cases,without any significant complications. The safe space of percutaneous puncture was suggested, e. g., the space between the carotid vessels and trachea.The procedures of PCD were introduced. The indications and contraindications of PCD and its mechanism,efficacy and prevention of complications were discussed.展开更多
This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients＇ ability to perform daily activities, reducing pain, and maintainin...This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients＇ ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months （with a mean of 5.2 months）. Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 rain and the time of two-level surgery was 165±53 min on average （from skin incision to skin suturing）. Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores （JOA scores） increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° （3.6°-6.1°） in flexion and extension position and 3.51 ° （2.5°-4.6°）, 3.42° （2.6°-4.3°） in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm） in 2 of 14 levels and between 1.5 mm and 3 mm） in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.展开更多
<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the e...<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. <strong>Aim:</strong> The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. <strong>Case presentation:</strong> A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. <strong>Conclusion:</strong> Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.展开更多
目的探讨以针刀为主的综合治疗方案治疗后外侧型颈椎间盘突出症的临床疗效。方法选择2020年1月—2022年1月泉州市正骨医院针灸推拿科收治的82例后外侧型颈椎间盘突出症患者为研究对象,给予针刀结合手法、药物、牵引等综合疗法治疗。记...目的探讨以针刀为主的综合治疗方案治疗后外侧型颈椎间盘突出症的临床疗效。方法选择2020年1月—2022年1月泉州市正骨医院针灸推拿科收治的82例后外侧型颈椎间盘突出症患者为研究对象,给予针刀结合手法、药物、牵引等综合疗法治疗。记录临床疗效、治疗前后的疼痛情况、颈椎功能障碍情况、生活质量、不良反应。结果(1)痊愈20例(24.2%),显效36例(43.9%),有效19例(23.2%),无效7例(8.5%),总体有效率为91.5%。(2)治疗前,患者平均视觉模拟评分法(visual analogue scale,VAS)评分为(5.268±0.969)分;治疗后,VAS评分为(2.317±0.910)分,差异有统计学意义(P<0.05)。(3)治疗前,颈椎功能障碍指数量表(neck disability index,NDI)评分为(434.965±4.182)分;治疗后,NDI评分为(12.122±4.448)分,差异有统计学意义(P<0.05)。(4)治疗前,患者平均生活质量调查问卷(European organization for research and treatment of cancer quality of life questionnaire core30 items,QLQ-C30)评分为(50.622±10.426)分;治疗后,QLQ-C30评分为(82.136±3.915)分,差异有统计学意义(P<0.05)。(5)治疗期间1例患者因针刀对颈椎的刺激而发生血肿,不良反应发生率为1.22%。结论针刀为主综合治疗后外侧型颈椎间盘突出症的临床疗效肯定,能有效缓解疼痛,改善患者颈椎功能障碍,是治疗此疾病的一种较理想的疗法。展开更多
Objective To evaluate the efficacy of a treatme nt modality for cervical interverte bral disc herniation which consiste d of aspiration of nucleus pulposus tissue in conjunction with nucleolysis by intravertebral disc...Objective To evaluate the efficacy of a treatme nt modality for cervical interverte bral disc herniation which consiste d of aspiration of nucleus pulposus tissue in conjunction with nucleolysis by intravertebral disc injection of collagenase.Method From June 1997to June 2000,we excuted aspiration of interverte bral disc content followed by collagenase injection that resulted in chemical neclolysis of the remainder of the nucleus pulplsus tissue in 52patien ts with 94herniated intervertebral discs.Around 600u (1ml )of collagenase per intervertebral d isc was used.The success with this treatmen t was judged by clinical observation and imaging means.Results Follow-up study ranging from 6month s to24months revealed excellent and goo d results in 90%of all patients with a ny complications.Preoperative and postoperative lateral X-ray films o f the cervical spine in hyperextensio n and hyperflexion were taken which s howed no remarkable alterations in t he stability status.Conclusions Aspiration plus nucleolysis by means of intraintervertebral disc colla genase is safe and effective for some patients with cervical interverteb ral disc herniation.展开更多
目的探讨MRI弥散张量成像(diffusion tensor imaging,DTI)对颈椎间盘突出(cervical disc herniation,CDH)相应神经根受压的评价价值。方法收集30例CDH患者与30例健康志愿者,利用VAS评分对患者进行疼痛学评分。对患者及健康志愿者进行颈...目的探讨MRI弥散张量成像(diffusion tensor imaging,DTI)对颈椎间盘突出(cervical disc herniation,CDH)相应神经根受压的评价价值。方法收集30例CDH患者与30例健康志愿者,利用VAS评分对患者进行疼痛学评分。对患者及健康志愿者进行颈椎间盘常规MRI及DTI检查,定量测量受压神经根的各向异性分数(fractional anisotropy,FA)、表观扩散系数(apparent diffusion coefficient,ADC),并进行神经根神经纤维束示踪成像(fiber tractography,FT)。比较患者受压神经根与健康志愿者神经根的FA值、ADC值差异;根据椎间盘突出层面不同,分节段比较患侧与健侧神经根的FA值、ADC值;分析FA、ADC值与病程和VAS评分的相关性。结果CDH患者的患侧受压神经根较健侧FA值显著减低(患侧vs健侧神经根,C_(5):0.201 vs 0.285,C_(6):0.232 vs 0.301,C_(7):0.228 vs 0.291),ADC值显著升高(患侧vs健侧神经根,C_(5):1.798 vs 1.553,C_(6):1.691 vs 1.537,C_(7):1.779 vs 1.600),P<0.05。FT图显示:健康志愿者双侧神经根走行自然;CDH患者的患侧神经根纤维束明显较健侧稀疏,形态欠规则,部分神经根可见压痕、移位。患侧神经根FA平均值与病程(r=-0.379,P<0.05)及VAS评分(r=-0.363,P<0.05)呈负相关,ADC平均值与VAS评分(r=0.399,P<0.05)呈正相关。结论DTI可用于定量评价CDH相应受压神经根的损伤。展开更多
Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic...Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.展开更多
文摘cases of percutaneous cervical discectomy (PCD) were performed using a set of nucleotome system. 9 patients showed good to excellent results in 12 cases,without any significant complications. The safe space of percutaneous puncture was suggested, e. g., the space between the carotid vessels and trachea.The procedures of PCD were introduced. The indications and contraindications of PCD and its mechanism,efficacy and prevention of complications were discussed.
文摘This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients＇ ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months （with a mean of 5.2 months）. Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 rain and the time of two-level surgery was 165±53 min on average （from skin incision to skin suturing）. Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores （JOA scores） increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° （3.6°-6.1°） in flexion and extension position and 3.51 ° （2.5°-4.6°）, 3.42° （2.6°-4.3°） in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm） in 2 of 14 levels and between 1.5 mm and 3 mm） in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.
文摘<strong>Background:</strong> Klippel Feil syndrome (KFS) is a congenital malformation characterised by the presence of, at least, one fused cervical segment and results from faulty segmentation along the embryo’s developing axis during weeks 3 - 8 of gestation. The KFS increases the risk for spinal cord injury after minor trauma as a result of the disturbance of the biomechanics of the cervical spine. Persons with KFS often have associated congenital anomalies. <strong>Aim:</strong> The purpose of this study was to show the surgical management difficulties of this pathology in a low income country such as Senegal and to make a review of the literature. <strong>Case presentation:</strong> A 32-year-old man developed a tetraparesis secondary to a fall from his height while carrying a bag of rice on his head. Radiological explorations revealed fusedC2-C3 and C4-C5 vertebral bodies with a C3-C4 disc herniation associated to a spine contusion. The patient underwent surgical removal of the herniated disc via an anterior approach followed by interbody fusion and anterior plating. A complete recovery was noted at 4 months follow-up. <strong>Conclusion:</strong> Understanding of the cervical spine biomechanics of Klippel-Feil anomaly may allow an optimal management of patients. Patients with KFS should be warned of the increased risk of spinal cord injury after a low velocity trauma. Timing for surgery should be shortened.
文摘目的探讨以针刀为主的综合治疗方案治疗后外侧型颈椎间盘突出症的临床疗效。方法选择2020年1月—2022年1月泉州市正骨医院针灸推拿科收治的82例后外侧型颈椎间盘突出症患者为研究对象,给予针刀结合手法、药物、牵引等综合疗法治疗。记录临床疗效、治疗前后的疼痛情况、颈椎功能障碍情况、生活质量、不良反应。结果(1)痊愈20例(24.2%),显效36例(43.9%),有效19例(23.2%),无效7例(8.5%),总体有效率为91.5%。(2)治疗前,患者平均视觉模拟评分法(visual analogue scale,VAS)评分为(5.268±0.969)分;治疗后,VAS评分为(2.317±0.910)分,差异有统计学意义(P<0.05)。(3)治疗前,颈椎功能障碍指数量表(neck disability index,NDI)评分为(434.965±4.182)分;治疗后,NDI评分为(12.122±4.448)分,差异有统计学意义(P<0.05)。(4)治疗前,患者平均生活质量调查问卷(European organization for research and treatment of cancer quality of life questionnaire core30 items,QLQ-C30)评分为(50.622±10.426)分;治疗后,QLQ-C30评分为(82.136±3.915)分,差异有统计学意义(P<0.05)。(5)治疗期间1例患者因针刀对颈椎的刺激而发生血肿,不良反应发生率为1.22%。结论针刀为主综合治疗后外侧型颈椎间盘突出症的临床疗效肯定,能有效缓解疼痛,改善患者颈椎功能障碍,是治疗此疾病的一种较理想的疗法。
文摘Objective To evaluate the efficacy of a treatme nt modality for cervical interverte bral disc herniation which consiste d of aspiration of nucleus pulposus tissue in conjunction with nucleolysis by intravertebral disc injection of collagenase.Method From June 1997to June 2000,we excuted aspiration of interverte bral disc content followed by collagenase injection that resulted in chemical neclolysis of the remainder of the nucleus pulplsus tissue in 52patien ts with 94herniated intervertebral discs.Around 600u (1ml )of collagenase per intervertebral d isc was used.The success with this treatmen t was judged by clinical observation and imaging means.Results Follow-up study ranging from 6month s to24months revealed excellent and goo d results in 90%of all patients with a ny complications.Preoperative and postoperative lateral X-ray films o f the cervical spine in hyperextensio n and hyperflexion were taken which s howed no remarkable alterations in t he stability status.Conclusions Aspiration plus nucleolysis by means of intraintervertebral disc colla genase is safe and effective for some patients with cervical interverteb ral disc herniation.
文摘目的探讨MRI弥散张量成像(diffusion tensor imaging,DTI)对颈椎间盘突出(cervical disc herniation,CDH)相应神经根受压的评价价值。方法收集30例CDH患者与30例健康志愿者,利用VAS评分对患者进行疼痛学评分。对患者及健康志愿者进行颈椎间盘常规MRI及DTI检查,定量测量受压神经根的各向异性分数(fractional anisotropy,FA)、表观扩散系数(apparent diffusion coefficient,ADC),并进行神经根神经纤维束示踪成像(fiber tractography,FT)。比较患者受压神经根与健康志愿者神经根的FA值、ADC值差异;根据椎间盘突出层面不同,分节段比较患侧与健侧神经根的FA值、ADC值;分析FA、ADC值与病程和VAS评分的相关性。结果CDH患者的患侧受压神经根较健侧FA值显著减低(患侧vs健侧神经根,C_(5):0.201 vs 0.285,C_(6):0.232 vs 0.301,C_(7):0.228 vs 0.291),ADC值显著升高(患侧vs健侧神经根,C_(5):1.798 vs 1.553,C_(6):1.691 vs 1.537,C_(7):1.779 vs 1.600),P<0.05。FT图显示:健康志愿者双侧神经根走行自然;CDH患者的患侧神经根纤维束明显较健侧稀疏,形态欠规则,部分神经根可见压痕、移位。患侧神经根FA平均值与病程(r=-0.379,P<0.05)及VAS评分(r=-0.363,P<0.05)呈负相关,ADC平均值与VAS评分(r=0.399,P<0.05)呈正相关。结论DTI可用于定量评价CDH相应受压神经根的损伤。
文摘Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.
