Goel Atul, Vutha Ravikiran, Shah Abhidha, Prasad Apurva, Shukla Ashutosh Kumar, Maheshwari Shradha
Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India.
Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, India.
J Craniovertebr Junction Spine. 2024 Jan-Mar;15(1):74-82. doi: 10.4103/jcvjs.jcvjs_11_24. Epub 2024 Mar 13.
The authors analyze their published work and update their experience with 374 cases of cervical radiculopathy and/or myelopathy related to spinal degeneration that includes ossification of the posterior longitudinal ligament (OPLL). The role of atlantoaxial and subaxial spinal instability as the nodal point of pathogenesis and focused target of surgical treatment is analyzed.
During the period from June 2012 to November 2022, 374 patients presented with acute or chronic symptoms related to radiculopathy and/or myelopathy that were attributed to degenerative cervical spondylotic changes or due to OPLL. There were 339 males and 35 females, and their ages ranged from 39 to 77 years (average 62 years). All patients were treated for subaxial spinal stabilization by Camille's transarticular technique with the aim of arthrodesis of the treated segments. Atlantoaxial stabilization was done in 128 cases by adopting direct atlantoaxial fixation in 55 cases or a modified technique of indirect atlantoaxial fixation in 73 patients. Decompression by laminectomy, laminoplasty, corpectomy, discoidectomy, osteophyte resection, or manipulation of OPLL was not done in any case. Standard monitoring parameters, video recordings, and patient self-assessment scores formed the basis of clinical evaluation.
During the follow-up period that ranged from 3 to 125 months (average: 59 months), all patients had clinical improvement. Of 130 patients who had clinical evidences of severe myelopathy and were either wheelchair or bed bound, 116 patients walked aided (23 patients), or unaided (93 patients) at the last follow-up. One patient in the series was operated on 24 months after the first surgery by anterior cervical route for "adjacent segment" disc herniation. No other patient in the entire series needed any kind of repeat or additional surgery for persistent, recurrent, increased, or additional related symptoms. None of the screws at any level backed out or broke. There were no implant-related infections. Spontaneous regression of the size of osteophytes was observed in 259 patients where a postoperative imaging was possible after at least 12 months of surgery.
Our successful experience with only spinal fixation without any kind of "decompression" identifies the defining role of "instability" in the pathogenesis of spinal degeneration and its related symptoms. OPLL appears to be a secondary manifestation of chronic or longstanding spinal instability.
作者分析其已发表的研究工作，并更新他们对374例与脊柱退变相关的神经根型颈椎病和/或脊髓型颈椎病（包括后纵韧带骨化症，OPLL）的经验。分析寰枢椎和下颈椎不稳在发病机制中的关键作用以及作为手术治疗重点靶点的作用。
在2012年6月至2022年11月期间，374例患者出现与神经根型颈椎病和/或脊髓型颈椎病相关的急性或慢性症状，这些症状归因于退行性颈椎病变或OPLL。其中男性339例，女性35例，年龄在39至77岁之间（平均62岁）。所有患者均采用卡米尔经关节技术进行下颈椎稳定手术，目的是使治疗节段融合。128例患者进行了寰枢椎稳定手术，其中55例采用直接寰枢椎固定，73例采用改良的间接寰枢椎固定技术。在任何情况下均未进行椎板切除术、椎板成形术、椎体次全切除术、椎间盘切除术、骨赘切除术或OPLL的处理。标准监测参数、视频记录和患者自我评估评分构成了临床评估的基础。
在3至125个月（平均59个月）的随访期内，所有患者临床症状均有改善。130例有严重脊髓型颈椎病临床证据且需轮椅或卧床的患者中，116例在末次随访时能够借助辅助（23例）或独立行走（93例）。该系列中有1例患者在首次手术后24个月因“相邻节段”椎间盘突出接受了前路颈椎手术。在整个系列中，没有其他患者因持续性、复发性、加重性或额外的相关症状需要任何重复或额外的手术。任何节段的螺钉均未松动或断裂。没有发生与植入物相关的感染。在259例患者中，术后至少12个月进行影像学检查时，观察到骨赘大小自发缩小。
我们仅通过脊柱固定而不进行任何“减压”的成功经验，确定了“不稳”在脊柱退变及其相关症状发病机制中的决定性作用。OPLL似乎是慢性或长期脊柱不稳的继发表现。
