Wang Xin-Wei, Gu Tao, Yuan Wen
Department of Orthopaedics, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China.
Zhonghua Wai Ke Za Zhi. 2008 Sep 15;46(18):1424-7.
To evaluate the role of anterior decompression with resection of the posterior longitudinal ligament (PLL) on the cervical degenerative disease with sympathetic symptoms and to primarily validate our speculation on the mechanism of this entity.
Forty-seven cases suffered from cervical spondylosis from 2002 to 2007 were retrospectively reviewed. The inclusive criteria were: (1) cervical myelopathy or radiculopathy or both secondary to cervical degenerative disease; (2) complaining of unexplainable and irrelievable sympathetic symptoms such as dizziness, vertigo, etc; (3) performed with anterior cervical decompression with PLL resection and internal fixation. The JOA scores were recorded and evaluated. The sympathetic symptoms were evaluated by both 20 points evaluation system and patient's satisfaction evaluation. The posterior longitudinal ligaments of 8 rabbits were harvested and stained by Sucrose-Phosphate-glyoxylic acid (SPG) to distinguish the sympathetic nerve fibers. The results were observed and evaluated by fluorescent microscope and Image-pro plus 5.0.
All the patients were followed up for 10 to 48 months. The JOA scores before operation were 12.6 and increased to 15.2 at the final follow up. The sympathetic symptoms evaluation was 6.0 before operation and 2.8 after. The satisfactory evaluation was excellent in 19 cases, good in 16, fair in 8 and poor in 4. The effective rate was 87.5%. The SPG stain showed that there were plenty of sympathetic post-ganglia fibers in the cervical PLL, which were distributed like a web, and there were more fibers distributed at the interspaced zone than at the vertebral body zone. The density of the sympathetic nerve fibers in the C(2/3), C(3/4) and C(4/5) were greater than those in C(5/6) and C(6/7); while the density in the shallow layer were greater than those in the deep layer.
The sympathetic nerve fibers distributed in the cervical PLL maybe another one significant factor causing sympathetic symptom of cervical spondylosis. The anterior cervical decompression with resection of PLL can relieve the sympathetic symptoms of the patients.
评估前路减压并切除后纵韧带（PLL）治疗伴有交感神经症状的颈椎退变性疾病的作用，并初步验证我们对该病症机制的推测。
回顾性分析2002年至2007年收治的47例颈椎病患者。纳入标准为：（1）继发于颈椎退变性疾病的脊髓型颈椎病或神经根型颈椎病或两者兼有；（2）主诉有头晕、眩晕等无法解释且难以缓解的交感神经症状；（3）接受了前路颈椎减压并切除PLL及内固定手术。记录并评估日本骨科学会（JOA）评分。采用20分评估系统和患者满意度评估对交感神经症状进行评估。取8只兔的后纵韧带，用蔗糖 - 磷酸 - 乙醛酸（SPG）染色以区分交感神经纤维。通过荧光显微镜和Image - pro plus 5.0观察并评估结果。
所有患者均随访10至48个月。术前JOA评分为12.6分，末次随访时增至15.2分。交感神经症状评估术前为6.0分，术后为2.8分。满意度评估中，优19例，良16例，可8例，差4例。有效率为87.5%。SPG染色显示，颈椎PLL中有大量交感节后纤维，呈网状分布，间隙区的纤维分布多于椎体区。C（2/3）、C（3/4）和C（4/5）节段交感神经纤维密度大于C（5/6）和C（6/7）节段；浅层密度大于深层。
分布于颈椎PLL的交感神经纤维可能是导致颈椎病交感神经症状的另一个重要因素。前路颈椎减压并切除PLL可缓解患者的交感神经症状。
