Chiles B W, Leonard M A, Choudhri H F, Cooper P R
Department of Neurosurgery, New York University Medical Center, New York 10016, USA.
Neurosurgery. 1999 Apr;44(4):762-9; discussion 769-70. doi: 10.1097/00006123-199904000-00041.
We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms and functional results in patients with cervical spondylotic myelopathy who underwent anterior decompressive operations. Additionally, we sought to determine which findings had predictive value for surgical outcome.
We retrospectively reviewed the records of 76 patients with cervical spondylotic myelopathy caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion performed by one surgeon. The patients were evaluated postoperatively by office visits and/or telephone interviews. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales.
The most common preoperative symptoms were deterioration of hand use (75%), upper extremity sensory complaints (82.9%), and gait difficulties (80.3%). In the upper extremities, preoperative weakness was most common in the hand intrinsic muscles (56.6%) and triceps (28.9%), and in the lower extremities, preoperative weakness was most common in the iliopsoas (38.8%) and quadriceps (26.3%). In the lower extremities, individual muscle groups had strength improvement rates from 79.1 to 88.1 %; somewhat higher rates, from 81.3 to 90.9%, were observed in the upper extremities. When evaluated by using the Cooper myelopathy scale, lower extremity functional improvement occurred in 46.7% of the patients and upper extremity functional improvement in 75.4%. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale, was noted in 79.7% of the patients who had abnormal scores preoperatively.
Strength improved at rates of approximately 80 to 90% in individual muscle groups after anterior cervical decompression. However, fewer than half of all patients experienced functional improvement in the lower extremities, a discrepancy that was probably caused by persistent spasticity rather than muscle weakness. Postoperative dysfunction in the upper extremities was caused by residual weakness as well as sensory loss. Recurrent symptomatic spondylosis at unoperated levels was calculated to occur at an incidence of 2% per year.
我们评估了接受前路减压手术的脊髓型颈椎病患者术前和术后神经体征、症状及功能结果的特定模式。此外，我们试图确定哪些发现对手术结果具有预测价值。
我们回顾性分析了76例因骨赘或椎间盘突出导致脊髓型颈椎病患者的记录，这些患者均由同一位外科医生进行了颈椎前路减压融合术。术后通过门诊随访和/或电话访谈对患者进行评估。通过客观神经检查和多种功能评分量表进行结果评估。
最常见的术前症状为手部功能恶化（75%）、上肢感觉异常（82.9%）和步态困难（80.3%）。在上肢，术前最常见的肌无力发生在手部固有肌（56.6%）和肱三头肌（28.9%）；在下肢，术前最常见的肌无力发生在髂腰肌（38.8%）和股四头肌（26.3%）。在下肢，各肌群肌力改善率为79.1%至88.1%；上肢肌力改善率略高，为81.3%至90.9%。使用库珀脊髓病量表评估时，46.7%的患者下肢功能得到改善，75.4%的患者上肢功能得到改善。使用改良的日本骨科学会量表评估，术前评分异常的患者中，79.7%总体功能得到改善。
颈椎前路减压术后各肌群肌力改善率约为80%至90%。然而，所有患者中不到一半的人下肢功能得到改善，这种差异可能是由持续性痉挛而非肌无力引起的。上肢术后功能障碍是由残余肌无力和感觉丧失导致的。未手术节段复发性症状性脊柱病的发生率经计算为每年2%。
