Wong Albert S, Massicotte Eric M, Fehlings Michael G
Division of Neurosurgery, University of Toronto, and Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
J Spinal Disord Tech. 2005 Feb;18 Suppl:S107-14. doi: 10.1097/01.bsd.0000128693.44276.86.
Movement disorders may be associated with advanced cervical myeloradiculopathy, which represents a major management challenge. We report on eight patients with movement disorders causing progressive cervical myeloradiculopathy who were treated successfully by cervical decompression and reconstruction.
The mean age of our patients was 44 years with a male/female ratio of 3:1. The average duration of symptoms prior to presentation was 10 months. The most common levels decompressed and reconstructed were C3-C4 and C4-C5. Six cases showed improvement, and two cases showed stabilization of neurologic status at a mean follow-up of 21 months. Our management strategy and results are interpreted in the context of a systematic review of the literature in which 78 cases are reported.
Movement disorders cause premature cervical spondylosis most commonly involving the C3-C4 and C4-C5 levels. Ventral pathology with kyphotic angulation requires corpectomy or discectomy with or without posterior decompression and reconstruction. Decompression should always be combined with segmental internal fixation. Perioperative use of botulinum toxin and halo vest immobilization can increase the rate of clinical success but requires vigilance to minimize complications. Laminectomy with lateral mass fixation may be used successfully in the absence of kyphotic deformity.
运动障碍可能与晚期颈椎脊髓神经根病相关，这是一个主要的治疗挑战。我们报告8例因运动障碍导致进行性颈椎脊髓神经根病的患者，他们通过颈椎减压和重建手术获得成功治疗。
患者的平均年龄为44岁，男女比例为3:1。就诊前症状的平均持续时间为10个月。减压和重建最常见的节段是C3-C4和C4-C5。平均随访21个月时，6例病情改善，2例神经功能状态稳定。我们的治疗策略和结果是在对78例病例报告的文献系统评价背景下进行解读的。
运动障碍导致颈椎过早退变，最常累及C3-C4和C4-C5节段。伴有后凸成角的腹侧病变需要椎体次全切除术或椎间盘切除术，可联合或不联合后路减压和重建。减压应始终与节段性内固定相结合。围手术期使用肉毒杆菌毒素和头环背心固定可提高临床成功率，但需要警惕以尽量减少并发症。在没有后凸畸形的情况下，椎板切除术加侧块固定可能会成功应用。
