Schoen Clinic Hamburg Eilbek, Academic Hospital of the Eppendorf University Medical Center - Clinic for Spine Surgery, Hamburg, Germany.
Science Office of the Orthopedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Academic Hospital of the Eppendorf University Medical Center - 2, Hamburg, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2022 Mar;83(2):187-193. doi: 10.1055/s-0041-1723811. Epub 2021 Oct 11.
Single-level circumferential or pincer stenosis (PS) affects few patients with degenerative cervical myelopathy (DCM). The surgical technique and medium-term results of a one-session microsurgical 360-degree (m360°) procedure are presented.
Between 2013 and 2018, the data of 23 patients were prospectively collected out of 371 patients with DCM. The m360° procedure comprised a microsurgical anterior cervical decompression and fusion (ACDF), with additional plate fixation, followed by flipping the patient and performing a microsurgical posterior bilateral decompression via a unilateral approach in crossover technique.
The mean age of the patients was 72 years (range: 50-84); 17 patients were males. The mean follow-up time was 12 months (range: 6-31). The patients filled in the patient-derived modified Japanese Orthopaedic Association (P-mJOA) questionnaire on average 53 months after surgery. One patient received a two-level ACDF. Lesions were mostly (92%) located at the C3/C4 (8/24), C4/C5 (7/24), and C5/C6 (7/24) levels. Functional X-rays showed segmental instability in 10 of 23 patients (44%). All preoperative T2-weighted magnetic resonance imaging (MRI) showed an intramedullary hyperintensity. The median preoperative mJOA score was 13 (range 3), and it improved to 16 (range 3) postoperatively. The mean improvement rate in the mJOA score was 73%. When available, postoperative MRI confirmed good circumferential decompression with persistent intramedullary hyperintensity. There were two complications: a long-lasting radicular paresthesia at C6 and a transient C5 palsy. No revision surgery was required.
The one-session m360° procedure was found to be a safe surgical procedure for the treatment of PS, and the medium-term clinical outcome was satisfactory.
单节段环形或钳夹型狭窄（PS）仅影响少数退行性颈椎脊髓病（DCM）患者。本文介绍了一种单节段经皮 360 度（m360°）显微手术治疗该疾病的手术技术和中期结果。
2013 年至 2018 年，前瞻性收集了 371 例 DCM 患者中的 23 例患者的数据。m360°手术包括显微前路颈椎减压融合术（ACDF），并进行附加钢板固定，然后翻转患者，采用单侧入路交叉技术行后路双侧减压。
患者的平均年龄为 72 岁（范围：50-84 岁）；17 例为男性。平均随访时间为 12 个月（范围：6-31 个月）。术后平均 53 个月时，患者填写了改良后的日本骨科协会评分（P-mJOA）问卷。1 例患者接受了 2 节段 ACDF。病变主要位于 C3/C4（8/24）、C4/C5（7/24）和 C5/C6（7/24）水平。23 例患者中有 10 例（44%）功能 X 射线显示节段性不稳定。所有术前 T2 加权磁共振成像（MRI）均显示髓内高信号。术前 mJOA 评分中位数为 13（范围 3），术后改善至 16（范围 3）。mJOA 评分的平均改善率为 73%。有术后 MRI 随访的患者均显示良好的环形减压，髓内高信号持续存在。有 2 例并发症：C6 神经根性感觉异常持续存在，C5 瘫痪一过性。无需再次手术。
单节段 m360°手术是治疗 PS 的一种安全手术方法，中期临床结果满意。
