Deora Harsh, Kim Se-Hoon, Behari Sanjay, Rudrappa Satish, Rajshekhar Vedantam, Zileli Mehmet, Parthiban Jutty K B C
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea.
Neurospine. 2019 Sep;16(3):408-420. doi: 10.14245/ns.1938250.125. Epub 2019 Sep 30.
This study was performed to review the literature and to present the most up-to-date information and recommendations on the indications, complications, and success rate of anterior surgical techniques for cervical spondylotic myelopathy (CSM). The commonly performed anterior surgical procedures are multiple-level anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion and its variants (skip corpectomy and hybrid surgery), and oblique corpectomy without fusion.
A comprehensive literature search and analysis were performed using MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and the Web of Science for peer-reviewed articles published in English during the last 10 years.
Corpectomy is mandated for ventral compression of fewer than 3 vertebral segments where single-level disc and osteophyte excision is inadequate to decompress the cord. Endoscopic or oblique partial corpectomy improves the sagittal canal diameter by 67% and obviates the need for an additional bone graft procedure.
The indications of anterior surgery in patients with CSM include a straightened or kyphotic spine with a compression level lower than 3. With an appropriate choice of implants and meticulous surgical technique, surgical complications can be seen only rarely. Improvements after anterior surgery for CSM have been reported in 70% to 80% of patients.
本研究旨在回顾文献，呈现关于脊髓型颈椎病（CSM）前路手术技术的适应证、并发症及成功率的最新信息和建议。常用的前路手术包括多节段颈椎间盘切除融合术、颈椎椎体次全切除融合术及其变体（跳跃式椎体次全切除术和混合手术），以及非融合斜行椎体次全切除术。
使用MEDLINE（PubMed）、Cochrane对照试验注册库和科学网对过去10年以英文发表的同行评议文章进行全面的文献检索和分析。
对于少于3个椎体节段的腹侧压迫，若单节段椎间盘和骨赘切除不足以减压脊髓，则需进行椎体次全切除术。内镜或斜行部分椎体次全切除术可使矢状管直径增加67%，且无需额外的植骨手术。
CSM患者前路手术的适应证包括脊柱变直或后凸且压迫节段低于3个。通过合理选择植入物和精细的手术技术，手术并发症很少见。据报道，70%至80%的CSM患者前路手术后病情有所改善。
