Kim Sung-Duk, Ha Ho-Gyun, Lee Cheol-Young, Kim Hyun-Woo, Jung Chul-Ku, Kim Jong Hyun
Department of Neurosurgery, Konyang University Hospital, Daejon, Koera.
Department of Neurosurgery, Konyang University Hospital, Daejon, Koera. ; Department of Neurosurgery, Teun Teun Hospital, Daejon, Korea.
J Korean Neurosurg Soc. 2014 Aug;56(2):114-20. doi: 10.3340/jkns.2014.56.2.114. Epub 2014 Aug 31.
At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure.
Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images.
In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm(2) (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability.
Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.
目前，颈髓减压的金标准技术是手术减压与融合。但是，已有许多与颈椎融合相关的并发症报道。我们采用扩大前路颈椎椎间孔切开术（EACF）技术对颈髓前外侧部分进行减压，并报告该手术的临床结果和疗效。
2008年至2013年连续对53例患者采用EACF进行手术。所有手术均由同一外科医生经单侧入路完成。本研究纳入了22例出现神经根性和/或脊髓病症状的患者。他们术前的磁共振扫描图像均显示有颈髓受压。
手术结果方面，14例患者（64%）评定为优，6例（27%）为良。术后颈髓前后径的平均差值为0.92mm（p<0.01），横截面积为9.77mm²（p<0.01）。动态影像学研究显示，术后平均平移（椎体后滑脱）为0.36mm，手术节段椎间盘高度丢失为0.81mm。Cobb角的变化减小至3.46，显示有轻度后凸。平均椎体切除率为11.47%。未发生与手术相关的并发症。仅1例接受两级减压的患者因术后不稳定，作为二期手术需要在一个节段进行前路融合。
采用EACF技术成功实现了颈髓减压。该手术将成为治疗脊髓受压病变的一种替代性手术选择。需要进行长期随访和更大样本量的进一步研究。
