Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
J Neurosurg Spine. 2011 Jun;14(6):689-96. doi: 10.3171/2011.2.SPINE10601. Epub 2011 Mar 18.
The authors discuss their successful preliminary experience with 36 cases of cervical spondylotic disease by performing facetal distraction using specially designed Goel cervical facet spacers. The clinical and radiological results of treatment are analyzed. The mechanism of action of the proposed spacers and the rationale for their use are evaluated. Between 2006 and February 2010, 36 patients were treated using the proposed technique. Of these patients, 18 had multilevel and 18 had single-level cervical spondylotic radiculopathy and/or myelopathy. The average follow-up period was 17 months with a minimum of 6 months. The Japanese Orthopaedic Association classification system, visual analog scale (neck pain and radiculopathy), and Odom criteria were used to monitor the clinical status of the patient. The patients were prospectively analyzed. The technique of surgery involved wide opening of the facet joints, denuding of articular cartilage, distraction of facets, and forced impaction of Goel cervical facet spacers into the articular cavity. Additionally, the interspinous process ligaments were resected, and corticocancellous bone graft from the iliac crest was placed and was stabilized over the adjoining laminae and facets after adequately preparing the host bone. Eighteen patients underwent single-level, 6 patients underwent 2-level, and 12 patients underwent 3-level treatment. The alterations in the physical architecture of spine and canal dimensions were evaluated before and after the placement of intrafacet joint spacers and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of pain, radiculopathy, and myelopathy. Analysis of radiological features suggested that the distraction of facets with the spacers resulted in an increase in the intervertebral foraminal dimension (mean 2.2 mm), an increase in the height of the intervertebral disc space (range 0.4-1.2 mm), and an increase in the interspinous distance (mean 2.2 mm). The circumferential distraction resulted in reduction in the buckling of the posterior longitudinal ligament and ligamentum flavum. The procedure ultimately resulted in segmental bone fusion. No patient worsened after treatment. There was no noticeable implant malfunction. During the follow-up period, all patients had evidence of segmental bone fusion. No patient underwent reexploration or further surgery of the neck. Distraction of the facets of the cervical vertebra can lead to remarkable and immediate stabilization-fixation of the spinal segment and increase in space for the spinal cord and roots. The procedure results in reversal of several pathological events related to spondylotic disease. The safe, firm, and secure stabilization at the fulcrum of cervical spinal movements provided a ground for segmental spinal arthrodesis. The immediate postoperative improvement and lasting recovery from symptoms suggest the validity of the procedure.
作者讨论了他们使用专门设计的 Goel 颈椎关节突撑开器对 36 例颈椎病患者进行关节突撑开的初步成功经验。分析了治疗的临床和放射学结果。评估了所提出的间隔物的作用机制及其使用的基本原理。在 2006 年至 2010 年 2 月期间，使用该技术治疗了 36 例患者。其中 18 例为多节段，18 例为单节段颈椎病性神经根病和/或脊髓病。平均随访时间为 17 个月，最短为 6 个月。采用日本矫形协会（Japanese Orthopaedic Association，JOA）分类系统、视觉模拟评分（颈部疼痛和神经根病）和 Odom 标准监测患者的临床状况。前瞻性分析了这些患者。手术技术包括关节突关节的广泛开放、关节软骨的去除、关节突的撑开以及将 Goel 颈椎关节突撑开器强行压入关节腔。此外，切除棘突间韧带，并在充分准备宿主骨后，将髂嵴的皮质松质骨移植物放置并固定在相邻的椎板和关节突上。18 例患者接受单节段治疗，6 例患者接受 2 节段治疗，12 例患者接受 3 节段治疗。在放置关节内间隔物前后以及至少 6 个月的随访后，评估脊柱物理结构和椎管尺寸的变化。所有患者的疼痛、神经根病和脊髓病症状均有不同程度的缓解。放射学特征分析表明，关节突撑开器的撑开导致椎间孔尺寸增加（平均 2.2mm）、椎间盘间隙高度增加（范围 0.4-1.2mm）和棘突间距离增加（平均 2.2mm）。周向撑开导致后纵韧带和黄韧带的卷曲减少。该手术最终导致节段性骨融合。治疗后无患者病情恶化。没有明显的植入物功能障碍。在随访期间，所有患者均有节段性骨融合的证据。没有患者需要再次接受颈部探查或进一步手术。颈椎关节突的撑开可导致脊柱节段显著且即刻稳定固定，并增加脊髓和神经根的空间。该手术可逆转与颈椎病相关的多种病理事件。在颈椎运动的枢轴处安全、牢固和稳定的固定为节段性脊柱关节融合术提供了基础。术后即刻改善和持续缓解症状表明该手术的有效性。
