Kurz L T, Herkowitz H N
Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan.
Orthop Clin North Am. 1992 Jul;23(3):495-504.
We have presented a comparative analysis of the ability of four surgical procedures to address adequately the problems sustained by a patient with symptomatic cervical myelopathy. AIA is a safe procedure whose effectiveness may be limited when the extent of disease is more than three intervertebral disk levels. ACA permits more direct and extensive access to the spinal cord and is the procedure of choice for cervical spondylotic myelopathy associated with spinal deformity. However, rigid external immobilization is necessary, and operative morbidity may be greater. Cervical laminectomy may be effective for decompressing the spinal cord when no associated spinal deformity or instability is present, provided that extensive resection of facet joints is avoided. Cervical laminaplasty is ideally suited for the patient with three or more levels contributing to a cervical myeloradiculopathy. Mild instability may be addressed by performing arthrodesis on the hinge side.
我们对四种外科手术解决有症状的颈椎脊髓病患者所遭受问题的能力进行了比较分析。前路椎间盘切除及融合术（AIA）是一种安全的手术，当疾病范围超过三个椎间盘节段时，其有效性可能会受到限制。全椎板切除减压术（ACA）能更直接、广泛地接触脊髓，是伴有脊柱畸形的脊髓型颈椎病的首选手术。然而，需要严格的外部固定，且手术发病率可能更高。当不存在相关脊柱畸形或不稳定时，颈椎椎板切除术在避免广泛切除小关节的情况下，可能对脊髓减压有效。颈椎椎板成形术非常适合有三个或更多节段导致颈脊髓神经根病的患者。轻度不稳定可通过在铰链侧进行关节融合来解决。
