Zhang Jianqiao, Jin Caiyi, Zeng Zhongyou, Song Yongxing, Wang Bin, Sun Detao
No.2 Department of Orthopaedics, Hospital of Zhejiang Armed Polic Force, Jiaxing Zhejiang 314000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Dec;24(12):1476-9.
To evaluate the clinical effects of anterior segmental decompression and autograft fusion in treating multi-level cervical spondylotic myelopathy (CSM).
Between January 2007 and May 2009, 23 patients with multi-level CSM were treated with anterior segmental decompression, autograft fusion, and internal fixation. There were 16 males and 7 females with an average age of 58 years (range, 49-70 years). Consecutive 3 segments of C3, 4, C4, 5, and C5, 6 involved in 15 cases and C4, 5, C5, 6, and C6, 7 in 8 cases. All patients suffered sensory dysfunction in limbs and trunk, hyperactivity of tendon reflexes of both lower extremities, walking with limp, and weakening of hand grip. Cervical MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord. The disease duration was 6 to 28 months (12.5 months on average). Japanese Orthopaedic Association (JOA) score system was adopted for therapeutic efficacy evaluation. JOA scores were recorded preoperatively, 1 week, 3 months, and 12 months postoperatively.
Dura tear occurred in 1 case and was treated by filling with gelatin sponge during operation; no cerebrospinal fluid leakage was observed after operation. All the incisions healed by first intention. All cases were followed up 12 to 24 months (15.1 months on average), and no vertebral artery injury or recurrent laryngeal nerve injury occurred. The nervous symptoms in all cases were improved significantly within 1 week after operation. Lower limb muscle strength increased, upper limb abnormal sensation disappeared, and limb moved more agile. A 2-mm collapses of titanium mesh into upper terminal plate were found in 1 case and did not aggravated during follow-up. The other internal fixator was in appropriate situation, and the fusion rate was 100%. The JOA score increased from 9.1 +/- 0.3 preoperatively to 14.3 +/- 0.4 at 12 months postoperatively with an improvement rate of 65.8% +/- 0.2%, showing significant difference (P < 0.01). According to Odom evaluation scale, the results were excellent in 10 cases, good in 8 cases, fair in 4 cases, and poor in 1 case.
Anterior segmental decompression and autograft fusion is a recommendable technique for multi-level CSM, which can make full decompression, conserve the stability of cervical cord, and has high fusion rate.
评估前路节段性减压及自体骨移植融合术治疗多节段脊髓型颈椎病（CSM）的临床效果。
2007年1月至2009年5月，对23例多节段CSM患者行前路节段性减压、自体骨移植融合及内固定术。其中男性16例，女性7例，平均年龄58岁（49 - 70岁）。15例累及C3、4，C4、5，C5、6连续3个节段，8例累及C4、5，C5、6，C6、7。所有患者均有四肢及躯干感觉功能障碍、双下肢腱反射亢进、行走跛行及握力减弱。颈椎MRI显示椎间盘退变、突出及颈髓受压。病程6至28个月（平均12.5个月）。采用日本骨科学会（JOA）评分系统评估治疗效果。记录术前、术后1周、3个月及12个月的JOA评分。
术中1例发生硬脊膜撕裂，术中用明胶海绵填充处理；术后未观察到脑脊液漏。所有切口均一期愈合。所有病例随访12至24个月（平均15.1个月），未发生椎动脉损伤或喉返神经损伤。所有病例术后1周内神经症状均明显改善。下肢肌力增强，上肢异常感觉消失，肢体活动更灵活。1例钛网向终板上方塌陷2 mm，随访期间未加重。其他内固定情况良好，融合率为100%。JOA评分术前为9.1±0.3，术后12个月为14.3±0.4，改善率为65.8%±0.2%，差异有统计学意义（P < 0.01）。根据Odom评估标准，优10例，良8例，可4例，差1例。
前路节段性减压及自体骨移植融合术是治疗多节段CSM的一种值得推荐的技术，可实现充分减压，保留颈椎稳定性，融合率高。
