Zhang Xinyu, Peng Baogan, Ma Zengbiao, Wu Bing, Liu Chunyu, Li Yongchao
Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing, China.
Department of Orthopaedics, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
World Neurosurg. 2024 Nov;191:e772-e778. doi: 10.1016/j.wneu.2024.09.041. Epub 2024 Sep 12.
Anterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function.
To investigate the feasibility and indications of single anterior cervical discectomy and fusion (ACDF) for the treatment of p-CSM.
The data of 21 p-CSM patients who were treated with ACDF at a single center from 2019 to 2022 were collected. Neurologic status was evaluated by the Japanese Orthopedic Association scoring system. The radiologic parameters included the percentage of space occupied by the spinal canal, the cervical sagittal Cobb angle, and the cross-sectional area of the spinal cord before and after the operation. Complications and spinal cord compression rates were also observed. Correlations between the decompressive effects and various prognostic factors were statistically analyzed.
The mean follow-up period was 24.1 ± 3.55 months. The average Japanese Orthopedic Association score significantly increased, with a mean recovery rate of 65.88 ± 8.97%. The fusion rate was satisfactory. Correlation analysis revealed that the number of operation segments and age were important predictors of decompressive effects. There was no further deterioration of spinal cord function after the operation.
ACDF is an effective method for treating pincer spinal cord compression in terms of neurologic recovery, radiologic parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.
颈椎脊髓前后方受压通常称为钳夹型脊髓型颈椎病（p-CSM），一般建议手术治疗；然而，关于手术入路的选择存在一些争议，因为单纯前路或后路手术无法有效缓解对侧压迫，而联合手术可能会导致与创伤及颈椎功能影响相关的问题。
探讨单节段颈椎前路椎间盘切除融合术（ACDF）治疗p-CSM的可行性及适应证。
收集2019年至2022年在单一中心接受ACDF治疗的21例p-CSM患者的数据。采用日本骨科协会评分系统评估神经功能状态。影像学参数包括椎管占位百分比、颈椎矢状位Cobb角以及手术前后脊髓横截面积。观察并发症及脊髓压迫率。对减压效果与各种预后因素之间的相关性进行统计学分析。
平均随访时间为24.1±3.55个月。日本骨科协会评分平均显著提高，平均恢复率为65.88±8.97%。融合率满意。相关性分析显示，手术节段数和年龄是减压效果的重要预测因素。术后脊髓功能无进一步恶化。
就神经恢复、影像学参数、融合率及并发症而言，ACDF是治疗钳夹型脊髓压迫的有效方法，尤其适用于年龄小于60岁、单手术节段的患者。
