Yeh Kuang-Ting, Lee Ru-Ping, Chen Ing-Ho, Yu Tzai-Chiu, Peng Cheng-Huan, Liu Kuan-Lin, Wang Jen-Hung, Wu Wen-Tien
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC; Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC.
J Chin Med Assoc. 2015 Jun;78(6):364-9. doi: 10.1016/j.jcma.2015.03.009. Epub 2015 May 2.
When treating patients who have multilevel cervical spondylotic myelopathy (MCSM) with short-segment kyphosis, instability, or major anterior foci, long-level anterior decompression with fusion is often a standard method but can cause obvious loss of range of motion and usually needs further posterior stabilization. For MCSM with correctable kyphosis or simple instability, laminectomy with lateral-mass instrumented fusion is also a treatment of choice, but all the involved segments are immobilized. Combining expansive open-door laminoplasty (EOLP) and anterior short-segment fusion may be an alternative treatment to save more motion segments.
This study included 109 patients who exhibited MCSM with combined local kyphosis, instability, and anterior pathology, and received EOLP and concomitant anterior short-segment fusion. The patients were enrolled from August 2005 to July 2012. Nurick scores and Japanese Orthopedics Association cervical myelopathy scores were used to evaluate the functional outcomes. Follow-up plain films were collected and magnetic resonance imaging was conducted to assess the radiographic outcomes.
One year after the operation, the Japanese Orthopedics Association recovery rate was 83.4 ± 16.6%. The improvement in the functional scores and decrease in neck pain were significant. The canal width improved without further collapse at 12 months. The preservation of range of motion was approximately 57% at 1 year.
EOLP with adjunct anterior short-segment decompression fusion yields an excellent outcome for MCSM patients who exhibit concomitant short-segment kyphosis, instability or major anterior pathology. Performing laminoplasty first is safer for the spinal cord due to its posterior shifting while anterior procedures are being done.
在治疗患有短节段后凸、不稳定或主要前方病灶的多节段脊髓型颈椎病（MCSM）患者时，长节段前路减压融合术通常是标准方法，但会导致明显的活动度丧失，且通常需要进一步的后路稳定手术。对于伴有可矫正后凸或单纯不稳定的MCSM，椎板切除术联合侧块器械融合术也是一种治疗选择，但所有受累节段均被固定。联合扩大开门椎板成形术（EOLP）和前路短节段融合术可能是一种可保留更多活动节段的替代治疗方法。
本研究纳入了109例表现为MCSM合并局部后凸、不稳定和前方病变的患者，他们接受了EOLP及同期前路短节段融合术。患者于2005年8月至2012年7月入组。采用Nurick评分和日本骨科协会脊髓病评分评估功能结局。收集随访X线平片并进行磁共振成像以评估影像学结果。
术后1年，日本骨科协会恢复率为83.4±16.6%。功能评分改善且颈部疼痛减轻显著。12个月时椎管宽度改善且无进一步塌陷。1年时活动度保留率约为57%。
对于伴有短节段后凸、不稳定或主要前方病变的MCSM患者，EOLP联合前路短节段减压融合术可产生优异的疗效。先行椎板成形术对脊髓更安全，因为在进行前路手术时脊髓会向后移位。
