Wang Hui-Min, Liu Hai-Ying, Wang Bo, Zhang Jian, Miao Ke-Nan, Chen Zhuo
Department of Spinal Surgery, People's Hospital, Peking University, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2007 Jan 2;87(1):28-31.
To evaluate the clinical results of treatment of cervical spondylotic myelopathy by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches, and to study the methodology to prevent operative complications.
28 consecutive cases with cervical spondylotic myelopathy, aged 65.3 (49 ~ 73) were treated by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches from December 2001 to December 2005. The surgical methods included decompression of spinal canal, spinal fusion, and internal fixation with the combination of anterior and posterior approaches. The patients were followed up for 16 months (6 ~ 52 months). The clinical results and complications were analyzed retrospectively. The clinical effects were evaluated by the Japanese Orthopedic Association (JOA) scoring system and Odom's criteria. The outcome of cervical spinal fusion was evaluated by X-ray plate.
There were no neural injury and wound healing problems in all patients. All postoperative patients ambulated three days after the operation. CSF leak occurring in 3 cases was cured by conservative treatment. The recovery rate by the JOA scoring system was 50% when the patients were discharged. According to the Odom scoring system, 83.3% of the patients had excellent and good effects. No evidence of implant failure was found according to the Brantigan's criteria. Interbody fusion was achieved in 3 approximately 6 months after operation in all followed-up patients. No additional operation was needed for the involved segments, the spinal cord function of the patients had been improved in a certain extent, and the surgical outcomes could be maintained.
Decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches is necessary and effective in the treatment of severe and multi-level cervical spondylotic myelopathy, but the operative trauma is relatively serious, surgeons must carefully design the operative plan and pay enough attention to the methods to prevent operative complications, especially for the elderly patients.
评估采用前后路联合椎管减压内固定治疗脊髓型颈椎病的临床效果，并探讨预防手术并发症的方法。
2001年12月至2005年12月，对28例脊髓型颈椎病患者（年龄65.3岁，49～73岁）采用前后路联合椎管减压内固定治疗。手术方法包括椎管减压、植骨融合及前后路联合内固定。对患者进行16个月（6～52个月）的随访，回顾性分析临床效果及并发症。采用日本骨科学会（JOA）评分系统和奥多姆标准评估临床疗效，通过X线片评估颈椎融合情况。
所有患者均无神经损伤及伤口愈合问题。所有术后患者术后3天即可行走。3例脑脊液漏经保守治疗治愈。出院时JOA评分系统的恢复率为50%。根据奥多姆评分系统，83.3%的患者疗效优良。根据布兰特igan标准，未发现内固定失败迹象。所有随访患者术后约6个月均实现椎间融合。受累节段无需再次手术，患者脊髓功能有一定程度改善，手术效果得以维持。
前后路联合椎管减压内固定治疗重度多节段脊髓型颈椎病是必要且有效的，但手术创伤相对较大，术者必须精心设计手术方案，充分重视预防手术并发症的方法，尤其是对于老年患者。
