Kumar V G, Rea G L, Mervis L J, McGregor J M
Division of Neurosurgery, The Ohio State University Medical Center, Columbus, USA.
Neurosurgery. 1999 Apr;44(4):771-7; discussion 777-8. doi: 10.1097/00006123-199904000-00046.
To evaluate the long-term efficacy of cervical laminectomy with posterior lateral mass fusion/fixation in the treatment of patients with cervical spondylotic myelopathy (CSM).
Twenty-five patients treated for CSM by laminectomy and lateral mass fusion at the Division of Neurosurgery at The Ohio State University between 1989 and 1994 were studied retrospectively. Only patients with longer than 2-year postoperative follow-up durations were included. At follow-up examination, each patient completed an SF36 questionnaire, underwent a physical examination, underwent plain radiography showing the spinal curvature with plate and screw position, and underwent magnetic resonance imaging of the cervical spine, which evaluated dural sac decompression and spinal cord abnormalities. Patient-generated data were used for outcome measurements.
The mean follow-up duration was 47.5 months. Good outcome was defined by the presence of three criteria: ability to walk unassisted (Grade IIIA or better), ability to write unassisted, and ability to manage buttons and/or zippers unassisted. The inability to meet these criteria was defined as a poor outcome. Two patients (8%) experienced complications that resulted from the surgery. There was no instability or progression to significant kyphosis. Lesions that were hyperintense on magnetic resonance images did not correlate with outcome. Eighty percent of the patients achieved good outcomes, and 76% had improved myelopathy scores. None of the patients had late neurological deterioration. Patients with better neurological statuses at the time of surgery (Grade IIIA or better) were more likely to improve (P < 0.0001); the likelihood of a change in status for those starting with poorer grades (IIIB or worse) was not statistically significant (P < 0.08).
Cervical laminectomy with posterior fusion/fixation proved useful in the treatment of patients with CSM with straight or lordotic spines and multilevel compression. This therapy addresses the dynamic and compressive forces that are important in the pathogenesis of CSM, resulting in minimal complications and possible improvement in long-term outcomes.
评估颈椎椎板切除术联合后外侧块融合/固定术治疗脊髓型颈椎病（CSM）患者的长期疗效。
回顾性研究1989年至1994年间在俄亥俄州立大学神经外科接受椎板切除术和侧块融合治疗的25例CSM患者。仅纳入术后随访时间超过2年的患者。在随访检查中，每位患者完成一份SF36问卷，接受体格检查，进行显示椎板和螺钉位置的脊柱曲度的X线平片检查，并进行颈椎磁共振成像，以评估硬脊膜囊减压和脊髓异常情况。采用患者自身提供的数据进行疗效评估。
平均随访时间为47.5个月。良好的疗效定义为满足以下三个标准：能够独立行走（ⅢA级或更好）、能够独立书写、能够独立系纽扣和/或拉链。无法满足这些标准则定义为疗效不佳。2例患者（8%）出现手术相关并发症。未出现不稳定或进展为严重驼背的情况。磁共振图像上的高强度病变与疗效无关。80%的患者取得了良好的疗效，76%的患者脊髓病评分有所改善。无一例患者出现晚期神经功能恶化。手术时神经状态较好（ⅢA级或更好）的患者更有可能改善（P < 0.0001）；起始分级较差（ⅢB级或更差）的患者状态改变的可能性无统计学意义（P < 0.08）。
颈椎椎板切除术联合后融合/固定术被证明对治疗脊柱笔直或前凸且存在多节段压迫的CSM患者有效。该治疗方法解决了在CSM发病机制中起重要作用的动态和压迫力问题，并发症极少，且可能改善长期疗效。
