Skovrlj Branko, Qureshi Sheeraz A
Department of Neurosurgery, North Jersey Spine Group, Wayne, NJ, USA.
Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA -
J Neurosurg Sci. 2017 Jun;61(3):325-334. doi: 10.23736/S0390-5616.16.03906-0. Epub 2016 Oct 27.
Degenerative disorders of the cervical spine requiring surgical intervention have become increasingly more common over the past decade. Traditionally, open surgical approaches have been the mainstay of surgical treatment. More commonly, minimally invasive techniques are being developed with the intent to decrease surgical morbidity and iatrogenic spinal instability. This study will review four minimally invasive cervical techniques that have been increasingly utilized in the treatment of degenerative cervical spine disease. A series of PubMed-National Library of Medicine searches were performed. Only articles in English journals or with published with English language translations were included. Level of evidence of the selected articles was assessed. The significant incidence of postoperative dysphagia following ACDF has led to the development and increased use of zero-profile, stand-alone anterior cervical cages. The currently available literature examining the safety and effectiveness of zero-profile interbody devices supports the use of these devices in patients undergoing single-level ACDF. A multitude of studies demonstrating the significant incidence and impact of axial neck pain following open posterior spine surgery have led to a wave of research and development of techniques aimed at minimizing posterior cervical paraspinal disruption while achieving appropriate neurological decompression and/or spinal fixation. The currently available literature supports the use of minimally invasive posterior cervical laminoforaminotomy for the treatment of single-level radiculopathy. The literature suggests that fluoroscopically-assisted percutaneous cervical lateral mass screw fixation appears to be a technically feasible, safe and minimally invasive technique. Based on the currently available literature it appears that the DTRAX® expandable cage system is an effective minimally invasive posterior cervical technique for the treatment of single-level cervical radiculopathy. Minimally invasive posterior cervical techniques continue to expand with the improvement of surgical instrumentation, microsurgical techniques and improved understanding of spinal biomechanics. While several MIS approaches already exist, there is a need for advanced and improved techniques for use in posterior cervical surgery.
在过去十年中，需要手术干预的颈椎退行性疾病越来越普遍。传统上，开放手术方法一直是手术治疗的主要手段。更常见的是，正在开发微创技术，以降低手术发病率和医源性脊柱不稳定。本研究将回顾四种越来越多地用于治疗退行性颈椎疾病的微创颈椎技术。进行了一系列PubMed-国立医学图书馆搜索。仅纳入英文期刊文章或有英文翻译发表的文章。评估所选文章的证据水平。ACDF术后吞咽困难的高发生率促使零轮廓、独立式前路颈椎椎间融合器的开发和使用增加。目前研究零轮廓椎间融合器安全性和有效性的文献支持在接受单节段ACDF的患者中使用这些装置。大量研究表明开放后路脊柱手术后轴颈痛的高发生率及其影响，引发了一波旨在尽量减少颈椎后路椎旁组织破坏同时实现适当神经减压和/或脊柱固定的技术研发热潮。目前的文献支持使用微创后路颈椎板间孔切开术治疗单节段神经根病。文献表明，透视辅助下经皮颈椎侧块螺钉固定似乎是一种技术上可行、安全且微创的技术。根据目前的文献，DTRAX®可扩张椎间融合器系统似乎是治疗单节段颈椎神经根病的一种有效的微创后路颈椎技术。随着手术器械、显微外科技术的改进以及对脊柱生物力学的更好理解，微创后路颈椎技术不断发展。虽然已经存在几种MIS方法，但仍需要先进和改进的技术用于颈椎后路手术。
