Arizumi Fumihiro, Maruo Keishi, Kishima Kazuya, Yoshie Norichika, Kusukawa Tomoyuki, Tachibana Toshiya
Department of Orthopedic Surgery, Hyogo Medical University, Nishinomiya, Japan.
Spine Surg Relat Res. 2022 Feb 10;6(5):448-452. doi: 10.22603/ssrr.2021-0193. eCollection 2022 Sep 27.
Reports of myelopathy with C7 anterior spondylolisthesis are extremely rare, and the surgical outcomes, clinical features, and their effects remain unknown. We describe six patients who underwent surgery for C7 spondylolisthesis with myelopathy.
Six patients who underwent operative treatment for C7 spondylolisthesis with myelopathy were retrospectively reviewed. C7 spondylolisthesis was defined as an anterior slippage of more than 2 mm on X-ray or computed tomography (CT). The images were evaluated using radiography, magnetic resonance imaging (MRI), and CT. Clinical outcomes were evaluated using the thoracic Japanese Orthopedic Association (T-JOA) score and Frankel grade.
Facet joint arthrosis was observed in all patients at the C7/T1 level. MRI revealed a juxta-facet cyst in the spinal segment in three cases and a high signal change in four cases. We could visualize C7 anterior slippage from the lateral radiograph in one case. The mean time from onset to diagnosis was 95 (range, 7-280) months. Posterior spinal fusion using pedicle screws and interlaminectomy was performed in five cases. Cystectomy with partial laminectomy was performed in one case with a juxta-facet cyst. The mean JOA score was 6±0.7 preoperatively and improved to 9±1.5 at the final follow-up. The Frankel grades of all patients improved by more than one grade.
In this study, myelopathy with C7 spondylolisthesis was relatively severe, and we believe that the mechanical stress between the rigid thoracic vertebrae and the movable cervical spine may cause C7 spondylolisthesis. Posterior spinal fusion and partial laminectomy for C7 spondylolisthesis with myelopathy resulted in satisfactory outcomes.
关于伴有C7椎体前滑脱的脊髓病的报道极为罕见，其手术效果、临床特征及其影响尚不清楚。我们描述了6例因C7椎体滑脱伴脊髓病而接受手术治疗的患者。
对6例因C7椎体滑脱伴脊髓病而接受手术治疗的患者进行回顾性研究。C7椎体滑脱定义为X线或计算机断层扫描（CT）显示椎体向前滑脱超过2mm。使用X线摄影、磁共振成像（MRI）和CT对图像进行评估。使用胸段日本骨科协会（T-JOA）评分和Frankel分级评估临床结果。
所有患者在C7/T1水平均观察到小关节骨关节炎。MRI显示3例患者脊髓节段有近关节囊肿，4例患者有高信号改变。1例患者通过侧位X线片可观察到C7椎体前滑脱。从发病到诊断的平均时间为95（范围7 - 280）个月。5例患者采用椎弓根螺钉后路脊柱融合术和椎板间切除术。1例有近关节囊肿的患者行囊肿切除术及部分椎板切除术。术前平均JOA评分为6±0.7，末次随访时提高至9±1.5。所有患者的Frankel分级均提高了一级以上。
在本研究中，伴有C7椎体滑脱的脊髓病相对严重，我们认为僵硬的胸椎和可活动的颈椎之间的机械应力可能导致C7椎体滑脱。对于伴有脊髓病的C7椎体滑脱，后路脊柱融合术和部分椎板切除术取得了满意的效果。
