Benzel E C, Lancon J, Kesterson L, Hadden T
Division of Neurosurgery, University of New Mexico School of Medicine, Albuquerque 87131.
J Spinal Disord. 1991 Sep;4(3):286-95. doi: 10.1097/00002517-199109000-00005.
Seventy-five patients who underwent surgical treatment for cervical spondylotic myelopathy were evaluated with respect to the operative procedure performed and their outcome. Forty patients underwent a laminectomy plus dentate ligament section (DLS), 18 underwent laminectomy alone, and 17 underwent an anterior cervical decompression and fusion (ACDF). The patients were evaluated postoperatively for both stability and for neurologic outcome using a modification of the Japanese Orthopaedic Association Assessment Scale. Functional improvement occurred in all but one patient in the laminectomy plus DLS group. The average improvement was 3.1 +/- 1.5 points in this group; whereas the average improvement in the laminectomy and the ACDF groups was 2.7 +/- 2.0 and 3.0 +/- 2.0 points respectively. All of the patients who improved substantially (greater than or equal to 6 points) in the laminectomy plus DLS and the laminectomy alone groups had normal cervical spine contours (lordosis). The remainder had either a normal lordosis or no curve (no kyphosis or lordosis). All patients in the ACDF group had either a straight spine or a cervical kyphosis. These factors implicate spine curvature, in addition to choice of operation, as factors which are important in outcome determination. No problems with instability occurred in either the laminectomy or the laminectomy plus DLS group. Two patients incurred problems with stability in the ACDF group. Both required reoperation. In addition, four patients in this group who initially improved, subsequently deteriorated. Six patients in the laminectomy plus DLS group had a several day febrile episode related to an aseptic meningitis process. Laminectomy plus DLS is a safe and efficacious alternative to laminectomy for the treatment of cervical spondylotic myelopathy. The data presented here suggests that myelopathic patients with a cervical kyphosis are best treated with an ACDF and that patients with a normal cervical lordosis are best treated with a posterior approach. Although some selected patients may benefit from DLS, no criteria are available which differentiate this small subset of patients.
对75例接受颈椎病性脊髓病手术治疗的患者，就其接受的手术操作及手术结果进行了评估。40例患者接受了椎板切除术加齿状韧带切断术（DLS），18例仅接受了椎板切除术，17例接受了颈椎前路减压融合术（ACDF）。术后采用改良的日本骨科协会评估量表对患者的稳定性和神经功能结果进行评估。除1例患者外，椎板切除术加DLS组的所有患者均有功能改善。该组平均改善3.1±1.5分；而椎板切除术组和ACDF组的平均改善分别为2.7±2.0分和3.0±2.0分。在椎板切除术加DLS组和单纯椎板切除术组中，所有显著改善（大于或等于6分）的患者颈椎轮廓均正常（前凸）。其余患者要么颈椎前凸正常，要么无曲度（无后凸或前凸）。ACDF组的所有患者要么脊柱变直，要么颈椎后凸。这些因素表明，除了手术选择外，脊柱曲度也是决定手术结果的重要因素。椎板切除术组或椎板切除术加DLS组均未出现稳定性问题。ACDF组有2例患者出现稳定性问题，均需再次手术。此外，该组最初改善的4例患者随后病情恶化。椎板切除术加DLS组有6例患者因无菌性脑膜炎过程出现了数天的发热期。对于颈椎病性脊髓病的治疗，椎板切除术加DLS是一种安全有效的替代椎板切除术的方法。此处提供的数据表明，颈椎后凸的脊髓病患者最好采用ACDF治疗，而颈椎前凸正常的患者最好采用后路手术治疗。尽管一些特定患者可能从DLS中获益，但尚无区分这一小部分患者的标准。
