Kudo H, Iwano K
Orthopaedics Section, Sagamihara National Hospital, Kanagawa Prefecture, Japan.
J Bone Joint Surg Br. 1991 May;73(3):474-80. doi: 10.1302/0301-620X.73B3.1670453.
Between 1978 and 1988 a total of 27 operations were performed on 26 patients for cervical myelopathy due to rheumatoid disease in the subaxial spine. Three different causes were recognised: the first group had cord compression due to subluxation of the cervical spine itself (6 patients); the second had cord compression occurring from in front, with rheumatoid lesions of vertebral bodies or discs (6); the third had compression from behind the cord due to granulation tissue within the epidural space (14). Group I was treated by closed reduction of the subluxation followed by surgical fusion either from in front or behind. Group II was decompressed by subtotal resection of the involved vertebral bodies and discs, followed by interbody fusion. The patients in group III were decompressed by laminectomy and excision of fibrous granulation tissue from the epidural space. Good recovery of neurological function was observed after 18 of the operations, fair recovery after five, poor recovery followed three, and one was worse. Myelopathy recurred in four patients, all of whom had had anterior interbody fusion.
1978年至1988年间，对26例因类风湿性疾病导致下颈椎脊髓病的患者共实施了27次手术。确认有三种不同病因：第一组因颈椎本身半脱位导致脊髓受压（6例患者）；第二组因椎体或椎间盘类风湿性病变而从前方发生脊髓受压（6例）；第三组因硬膜外间隙内的肉芽组织导致脊髓后方受压（14例）。第一组通过闭合复位半脱位，随后从前路或后路进行手术融合治疗。第二组通过对受累椎体和椎间盘进行次全切除减压，随后进行椎间融合。第三组患者通过椎板切除术和从硬膜外间隙切除纤维肉芽组织进行减压。18例手术后观察到神经功能恢复良好，5例恢复一般，3例恢复较差，1例情况恶化。4例患者脊髓病复发，均接受过前路椎间融合术。
