Department of Orthopaedic and Trauma Surgery, School of Medicine, University "Magna Græcia" of Catanzaro, V.le Europa (Loc. Germaneto), 88100 Catanzaro, Italy.
Eur Spine J. 2013 Jan;22(1):128-34. doi: 10.1007/s00586-012-2457-y. Epub 2012 Aug 2.
To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors.
A total of 14 cases with a 10-year postoperative follow-up were available (82.4 % of the surviving patients). Patients underwent preoperative and postoperative neurological examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up.
The mean improvement of the clinical status of patients on the Nurick scale was 1.43 ± 0.51 (range 1-2) with respect to the baseline values (p < 0.001), with a 62.5 % recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p = 0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p = 0.039), spasticity (p = 0.017), and bladder dysfunction (p = 0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in eight and six patients, respectively.
The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients' preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.
评估 Cloward 颈椎前路减压融合术治疗脊髓型颈椎病的长期疗效，并确定可能的临床预后预测因素。
共纳入 14 例术后 10 年随访的患者（占存活患者的 82.4%）。患者接受术前和术后神经学检查。症状严重程度根据 Nurick 量表分级。术前进行 MRI 测量，术前和随访时拍摄颈椎 X 线片。
患者的 Nurick 量表评分平均改善 1.43±0.51（范围 1-2），与基线值相比具有统计学意义（p<0.001），恢复率为 62.5%。单因素分析发现，Nurick 量表评分的改善与随访时间呈正相关，且与年龄调整相关（p=0.042）。Nurick 分级改善与术前下肢反射亢进（p=0.039）、痉挛（p=0.017）和膀胱功能障碍（p=0.048）直接相关。随访时，分别有 8 例和 6 例患者在手术节段上方和下方出现相邻椎间盘病变。
Cloward 技术是治疗脊髓型颈椎病安全有效的方法。患者术前的神经功能状态和随访时间影响术后步行能力改善的程度。
