Boehm H, Greiner-Perth R, El-Saghir H, Allam Y
Department of Orthopaedic Surgery, Spine Surgery and Paraplegiology, Zentralklinik Bad Berka GmbH, Robert Koch Allee 9, 99437 Bad Berka, Germany.
Eur Spine J. 2003 Jun;12(3):268-73. doi: 10.1007/s00586-002-0522-7. Epub 2003 Mar 22.
Degenerative cervical disorders predominantly lead to anterior spinal cord compression (by bony spurs at the posterior margin of the vertebral body or by degenerated disc), which may be central and/or foraminal. In a smaller percentage of cases, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or spinal cord. The aim of this work is to present a minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy. Thirteen patients suffering from cervical radiculopathy (four patients) or myelopathy (nine patients) were operated according to this technique. In principle, the technique secures access to the diseased spinal segment via a percutaneously placed working channel (11 mm outer diameter and 9 mm inner diameter). The cervical paraspinal muscles are not deflected, but just spread between their fibres by special dilators. All further steps are performed through this channel under control of three-dimensional vision through the operating microscope. The mean follow-up period was 17 months (one patient died 9 months postoperatively), and patients were evaluated using a modified version of the Oswestry Index, called the Neck Disability Index (NDI), and the visual analogue scale (VAS) for neck and arm pain. The mean NDI (P<0.0001) improved from 13.2 (preoperatively) to 4.8 (postoperatively). The VAS for arm pain (P<0.001) and for neck pain (P<0.001) also showed marked postoperative improvement. Complete recovery of the preoperative neurological deficit was found in four patients, while the remaining eight patients showed improvement of the neurological symptoms during the follow-up period. There were no intra-operative or postoperative complications and no re-operation. The preliminary experience with this technique, and the good clinical outcome, seem to promise that this minimally invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine.
退行性颈椎疾病主要导致脊髓前方受压(由椎体后缘的骨赘或退变的椎间盘引起),受压部位可能在中央和/或椎间孔。在较小比例的病例中,椎管主要受到后方膨出的黄韧带或骨赘的侵犯,导致神经根或脊髓受压综合征。本研究的目的是介绍一种避免肌肉分离的微创后路手术方法,用于治疗神经根型颈椎病和脊髓型颈椎病。13例患有神经根型颈椎病(4例)或脊髓型颈椎病(9例)的患者接受了该技术手术。原则上,该技术通过经皮放置的工作通道(外径11mm,内径9mm)确保进入病变的脊柱节段。颈椎旁肌肉不被牵开,而是通过特殊的扩张器在其纤维之间分开。所有后续步骤均通过该通道在手术显微镜的三维视野控制下进行。平均随访期为17个月(1例患者术后9个月死亡),使用改良的奥斯威斯指数(称为颈部功能障碍指数,NDI)以及颈部和手臂疼痛的视觉模拟量表(VAS)对患者进行评估。平均NDI(P<0.0001)从术前的13.2改善至术后的4.8。手臂疼痛的VAS(P<0.001)和颈部疼痛的VAS(P<0.001)术后也显示出明显改善。4例患者术前神经功能缺损完全恢复,其余8例患者在随访期间神经症状有所改善。无术中或术后并发症,也无再次手术情况。该技术的初步经验及良好的临床结果似乎表明,这种微创技术是治疗颈椎外侧椎间盘突出症、椎间孔骨性狭窄和中央后纵韧带狭窄的传统开放手术的有效替代方法。
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