Bou Monsef Jad N, Siemionow Krzysztof B
Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA.
J Craniovertebr Junction Spine. 2017 Oct-Dec;8(4):316-321. doi: 10.4103/jcvjs.JCVJS_69_17.
Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs).
This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages.
Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels.
The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis.
Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan.
Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.
脊髓型颈椎病（CSM）是一种进行性疾病，可导致严重残疾。单节段狭窄可通过前路或后路技术有效减压。然而，多节段病变可能具有挑战性，尤其是在存在严重椎管狭窄的情况下。三节段前路减压融合术的骨不连发生率较高，吞咽困难持续时间较长。后路多节段椎板切除并椎间孔切开术会破坏使用侧块螺钉（LMS）进行稳定固定所需的骨量。
这是首例采用颈椎后路椎间融合器治疗多节段脊髓型颈椎病的病例系列研究。
3例患者有颈部疼痛加重、双侧上肢麻木和步态障碍病史，检查结果符合脊髓神经根病。颈椎磁共振成像显示多节段脊柱退变，导致三个颈椎节段出现中度至重度双侧椎间孔狭窄。
患者接受了多节段颈椎后路椎板切除术，并在三个节段的双侧小关节之间植入椎间融合器进行器械融合。术前及每次随访时收集Oswestry功能障碍指数和视觉模拟评分。分析术前和术后图像，观察颈椎排列变化和融合情况。
术后，所有患者的神经症状和颈部疼痛均有明显改善。术后6周神经根症状完全消失。在12个月的随访中，X线和计算机断层扫描显示融合牢固。
在多节段颈椎椎板切除融合治疗脊髓型颈椎病神经根病时，颈椎后路椎间融合器可能是LMS的一种替代选择。
