Chibbaro S, Benvenuti L, Carnesecchi S, Marsella M, Pulerà F, Serino D, Gagliardi R
Department of Neurosurgery, Livorno City Hospital, Livorno, Italy.
J Clin Neurosci. 2006 Feb;13(2):233-8. doi: 10.1016/j.jocn.2005.04.011.
Recently the debate over the management of cervical spondylotic myelopathy (CSM) has regained interest; more specifically whether treatment should be operative versus non-operative, raising the question about the real effectiveness of surgery in influencing the natural history of this pathology and about the choice of the most appropriate approach (anterior vs. posterior). The authors report a retrospective review of 70 consecutive patients who underwent elective anterior cervical corpectomy and fusion with iliac crest autograft or titanium mesh and placement of an anterior cervical plate for the treatment of CSM. The patients underwent pre-and postoperative evaluation, including history, and physical and neurological examination. Patients were also evaluated pre-and postoperatively using a modified version of the Japanese Orthopedics Association Scale (mJOA), which provides a fine semi-quantitative graded evaluation of overall function. Upon discharge home, patients were followed for an average of 42 months (range, 12-63 months). Following an anterior cervical decompression of the spinal cord, 94.2% of patients improved their functional status and 5.8% were unchanged; the mean preoperative mJOA score of all patients was 12.2, the postoperative was 15.4 and the amelioration was also documented by neurophysiological studies which showed an increase in amplitude and decrease in latency of somatosensory evoked potentials and motor evoked potential in 47 patients (67%). Older age and longer duration of preoperative symptoms both were not associated with a lower postoperative mJOA score (p < 0.47, p < 0.29, respectively). Single versus multiple level decompression was not predictive of a lower postoperative mJOA score (p < 0.18). Preoperative spinal cord low signal intensity changes on T1-weighted MRI were related to a lower postoperative mJOA score (p < 0.05), whereas spinal cord high-signal intensity changes on T2-weighted MRI were related to a higher postoperative mJOA score (p < 0.01); finally a lower preoperative mJOA score was highly predictive of a lower postoperative mJOA score (p < 0.0005). Anterior cervical corpectomy and fusion for CSM appears to be an effective procedure with a more favorable neurological improvement when compared to posterior decompressive laminectomy, minimally invasive procedures or non-surgical treatment. It is also a safe procedure even in the elderly population, with low morbidity and the potential for permanent spinal cord decompression and excellent bone stability.
最近，关于脊髓型颈椎病（CSM）治疗的争论再次引发关注；更确切地说，是关于治疗应选择手术还是非手术，这引发了关于手术在影响该疾病自然病程方面的实际有效性以及最合适手术方式（前路与后路）选择的问题。作者报告了一项对70例连续患者的回顾性研究，这些患者接受了选择性颈椎前路椎体次全切除融合术，采用自体髂骨移植或钛网，并植入颈椎前路钢板来治疗CSM。患者接受了术前和术后评估，包括病史、体格检查和神经学检查。还使用日本骨科协会量表（mJOA）的改良版对患者进行术前和术后评估，该量表能对整体功能进行精细的半定量分级评估。出院后，患者平均随访42个月（范围为12 - 63个月）。在进行颈椎前路脊髓减压术后，94.2%的患者功能状态得到改善，5.8%的患者无变化；所有患者术前mJOA平均评分为12.2，术后为15.4，神经生理学研究也证实了改善情况，47例患者（67%）体感诱发电位和运动诱发电位的波幅增加、潜伏期缩短。年龄较大和术前症状持续时间较长均与术后较低的mJOA评分无关（分别为p < 0.47，p < 0.29）。单节段与多节段减压并不能预测术后较低的mJOA评分（p < 0.18）。术前T1加权磁共振成像（MRI）上脊髓低信号强度改变与术后较低的mJOA评分相关（p < 0.05），而术前T2加权MRI上脊髓高信号强度改变与术后较高的mJOA评分相关（p < 0.01）；最后，术前较低的mJOA评分高度预测术后较低的mJOA评分（p < 0.0005）。与后路减压椎板切除术、微创手术或非手术治疗相比，颈椎前路椎体次全切除融合术治疗CSM似乎是一种有效的手术方法，能带来更有利的神经功能改善。即使在老年人群中，这也是一种安全的手术，发病率低，有永久脊髓减压的潜力且骨稳定性良好。
