Gerling Michael C, Bohlman Henry H
Division of Spine, Department of Orthopedics and Rehab, SUNY Downstate, State University of New York, Brooklyn, NY 11203, USA.
Spine (Phila Pa 1976). 2008 Sep 15;33(20):E739-45. doi: 10.1097/BRS.0b013e31817f1f8b.
Case series.
Report long-term outcomes, complications, and surgical technique of cervical myopathy (CM) patients treated with posterior instrumented, cervico-thoracic (C-T) fusions.
CM is a rare, progressive, debilitating condition where weakness of neck extensor muscles results in a dropped head deformity (DHD), or severe flexible, cervico-thoracic kyphosis. Treatment algorithms are currently based on small case reports and only 1 patient's short-term surgical outcome.
Re-examination at follow-up, chart review, and radiographic analysis was carried out for all CM patients with DHD treated by the senior author. Additional outcome measures included Odom criteria, verbal rating scores for pain, and patient satisfaction ratings. Patients with less than 2-years follow-up, previous cervical spine surgery or intrinsic, structural spinal deformities were excluded.
Nine CM patients met the study inclusion criteria with average follow-up of 6 years (range, 2-17 years) and average age 67 years. Four primary and 5 secondary myopathies after radiotherapy underwent deformity correction and posterior arthrodesis with instrumentation from the second cervical level to the upper thoracic spine. Patient presentation, deformity correction, and surgical techniques are described. All pain ratings improved, satisfaction was excellent in 7 and fair in 2 patients, and Odom scores were good to excellent in 7 and fair in 2 patients. Shoulder weakness remained equivalent or improved after surgery and all ambulated independently, though 1 continued to use a walker. Eleven postoperative complications are described.
Surgical correction with posterior, instrumented C-T spinal fusion is associated with high patient satisfaction rates in CM patients with DHD. Complications are frequent but do not diminish long-term outcomes. New rod and screw instrumentation with bone morphogenic protein may improve arthrodesis and correction.
病例系列研究。
报告接受后路器械辅助下颈胸段（C-T）融合术治疗的颈肌病（CM）患者的长期疗效、并发症及手术技术。
CM是一种罕见的、进行性的、使人衰弱的疾病，颈部伸肌肌无力会导致头部下垂畸形（DHD）或严重的、可活动的颈胸段脊柱后凸。目前的治疗方案基于少量病例报告且仅有1例患者的短期手术结果。
对所有由资深作者治疗的患有DHD的CM患者进行随访复查、病历回顾及影像学分析。其他疗效指标包括奥多姆标准、疼痛的言语评分以及患者满意度评分。排除随访时间不足2年、既往有颈椎手术史或存在先天性结构性脊柱畸形的患者。
9例CM患者符合研究纳入标准，平均随访6年（范围2 - 17年），平均年龄67岁。4例原发性和5例放疗后继发性肌病患者接受了畸形矫正及从第二颈椎水平至上胸椎的后路器械辅助融合术。描述了患者表现、畸形矫正及手术技术。所有疼痛评分均有所改善，7例患者满意度为优，2例为良，7例患者的奥多姆评分良好至优秀，2例为良。术后肩部无力情况保持不变或有所改善，所有患者均能独立行走，不过有1例仍需使用助行器。描述了11例术后并发症。
后路器械辅助下C-T脊柱融合术在治疗患有DHD的CM患者中具有较高的患者满意度。并发症较为常见，但不影响长期疗效。新型带骨形态发生蛋白的棒和螺钉器械可能会改善融合及矫正效果。
