Burger R, Tonn J C, Vince G H, Hofmann E, Reiners K, Roosen K
Neurochirurgische Klinik, Universität Würzburg.
Zentralbl Neurochir. 1996;57(2):62-9.
Cervical median corpectomy as an alternative to laminoplasty and laminectomy has been suggested as an effective treatment for cervical spondylotic myelopathy (CSM) in cases of multisegmental spondylotic stenosis. We report on our experience with this procedure with particular reference to neurological outcome and complications. Median corpectomy was performed in 17 cases (3 female, 14 male; mean age 59 yrs, (41-80 yrs.) with cervical myelopathy (CM) and radiologically diagnosed multisegmental spondylotic stenosis and spinal cord compression seen on MRI. The degree of stenosis was determined by means of the modified Pavlov's index (ratio between spinal canal width at the level of the intervertebral disc and the diameter of the vertebral body itself). 3/17 patients suffered from acute, 4/17 from subacute and 10/17 from chronic CM. Single level corpectomy was performed in 9 cases, one and a half vertebrae were removed in 2 cases and dual level corpectomy was performed in the remaining 6 cases. All patients received an autologous bone graft and AO - anterior plate stabilization or were stabilized as described by Morscher. Postoperative follow - up was possible in 16/17 cases over a mean time of 13.5 months. Myelopathy was graded according to Nurick's scale. Postoperatively, 12% with chronic CM improved by two grades, 38% (2 pts, with acute, 3 with subacute and 1 with chronic CM) improved by one grade. The other patients remained stable, none showed worsening of their myelopathy. Paresis improved in 92%, sensory deficits in 69%, spasticity in 73%, pain in 60%, and vegetative disturbances in 100% of all patients presenting these preoperative symptoms respectively. One patient died due to esophageal perforation and subsequent lethal mediastinitis caused by screw loosening 4 months following surgery and after initial neurological improvement. 4 other patients experienced screw loosening, three with acataposis, one remained clinically asymptomatic with concomitant graft displacement in two of these. One patient had to be re-operated due to a hematoma at the iliac crest and 2 suffered from a pelvic fracture of the spina iliaca at the site of graft removal. With respect to the neurological improvement, especially to the motor function and spasticity, median corpectomy can be regarded as an effective procedure in selected cases with cervical myelopathy, even when treatment related complications are taken into consideration.
颈椎椎体次全切除术可作为椎板成形术和椎板切除术的替代方法，对于多节段脊髓型颈椎病（CSM）伴脊髓狭窄的病例，已被认为是一种有效的治疗方法。我们报告了我们在该手术方面的经验，特别提及神经功能结果和并发症。对17例（3例女性，14例男性；平均年龄59岁，41 - 80岁）患有颈椎病（CM）且经MRI检查显示有多节段脊髓型狭窄和脊髓受压的患者实施了椎体次全切除术。狭窄程度通过改良的帕夫洛夫指数（椎间盘水平椎管宽度与椎体本身直径之比）来确定。17例患者中，3例为急性CM，4例为亚急性CM，10例为慢性CM。9例行单节段椎体次全切除术，2例切除一个半椎体，其余6例行双节段椎体次全切除术。所有患者均接受自体骨移植和AO前路钢板固定或采用莫舍尔描述的方法进行固定。17例患者中有16例获得了平均13.5个月的术后随访。根据努里克量表对脊髓病进行分级。术后，慢性CM患者中有12%改善了两级，38%（急性2例、亚急性3例、慢性1例）改善了一级。其他患者病情稳定，无一例脊髓病恶化。所有术前有相应症状的患者中，92%的轻瘫、69%的感觉障碍、73%的痉挛、60%的疼痛以及100%的自主神经功能障碍得到改善。1例患者术后4个月因螺钉松动导致食管穿孔及随后致命的纵隔炎死亡，最初神经功能曾有改善。另外4例患者出现螺钉松动，3例有吞咽困难，其中1例虽临床无症状，但伴有植骨移位。1例患者因髂嵴血肿需再次手术，2例在植骨取出部位发生髂骨骨盆骨折。就神经功能改善而言，尤其是运动功能和痉挛方面，即使考虑到与治疗相关的并发症，颈椎椎体次全切除术在某些颈椎病病例中仍可被视为一种有效的手术方法。
