Maurer P K, Ellenbogen R G, Ecklund J, Simonds G R, van Dam B, Ondra S L
Division of Neurosurgery, Walter Reed Army Medical Center, Washington, District of Columbia.
Neurosurgery. 1991 May;28(5):680-3; discussion 683-4.
Cervical spondylotic myelopathy appears to result from a combination of factors. The two major components are 1) compressive forces resulting from narrowing of the spinal canal, and 2) dynamic forces owing to mobility of the cervical spine. There is substantial evidence to suggest that the repetitive trauma to the spinal cord that is sustained with movement in a spondylotic canal may be a major cause of progressive myelopathy. Utilization of extensive anterior procedures that remove the diseased ventral features as well as eliminate the dynamic forces owing to the accompanying fusion have grown in popularity. Cervical laminectomy enlarges the spinal canal, but does not reduce the dynamic forces affecting the spinal cord, and may actually increase cervical mobility, leading to a perpetuation of the myelopathy. The authors propose the combination of posterior decompression and Luque rectangle bone fusion to deal with both the compressive and the dynamic factors that lead to cervical spondylotic myelopathy. Ten patients who had advanced myelopathy underwent the combined procedures. Nine of the 10 experienced significant neurological improvement, and the 10th has had no progression. The combination of posterior decompression and Luque rectangle bone fusion may offer a simple, safe, and effective alternative treatment for cervical spondylotic myelopathy.
脊髓型颈椎病似乎是由多种因素共同作用导致的。两个主要因素为：1）椎管狭窄产生的压迫力；2）颈椎活动引起的动力因素。有大量证据表明，在脊髓型椎管内，随着运动对脊髓造成的重复性创伤可能是进行性脊髓病的主要原因。采用广泛的前路手术切除病变的前方结构，并通过随之而来的融合消除动力因素，这种方法越来越受欢迎。颈椎椎板切除术可扩大椎管，但不能减少影响脊髓的动力因素，实际上还可能增加颈椎活动度，导致脊髓病持续存在。作者提出采用后路减压与鲁克矩形植骨融合术相结合的方法，来应对导致脊髓型颈椎病的压迫和动力因素。10例患有严重脊髓病的患者接受了联合手术。10例患者中有9例神经功能有显著改善；第10例病情未进展。后路减压与鲁克矩形植骨融合术相结合可能为脊髓型颈椎病提供一种简单、安全且有效的替代治疗方法。
