Chen T Y, Dickman C A, Eleraky M, Sonntag V K
Department of Neurosurgery, Chang Gung Medical College, Taoyuan, Taiwan.
Spine (Phila Pa 1976). 1998 Nov 15;23(22):2398-403. doi: 10.1097/00007632-199811150-00007.
A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients.
To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury.
The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients.
Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively.
The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group.
Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.
对37例颈椎间盘突出症伴不完全性脊髓损伤患者进行了一项前瞻性研究，以评估减压在这些患者中的作用。
评估先前存在颈椎间盘突出症的患者在轻微颈部损伤后发生不完全性脊髓综合征的手术和非手术治疗效果。
颈椎间盘突出症伴不完全性脊髓损伤的手术治疗效果存在争议，但仍是一种治疗选择。本研究结果阐明了此类患者手术治疗的益处。
回顾性比较37例颈椎间盘突出症患者的影像学检查结果及基于脊髓损伤后运动功能评分的治疗效果。16例患者接受手术治疗，21例患者接受非手术治疗。
16例接受手术治疗的患者中，13例（81.2%）在术后2天内神经功能状况得到改善。在规定的随访间隔比较两组患者的改善情况，手术组和非手术组在1个月和6个月随访时存在统计学显著差异（P<0.006）。然而，21例接受非手术治疗的患者中，13例（62%）在2年随访时恢复至至少3级肌力，但恢复速度比手术组慢。
虽然在创伤后的最初几个月，无骨损伤的不完全性脊髓损伤后神经功能改善缓慢，但超过60%的患者在2年随访时神经功能恢复至肌力高于3级。然而，与非手术治疗相比，手术减压可使神经功能立即改善、神经功能恢复更快、可早期活动、长期神经功能结局更好、住院时间更短且与长期卧床相关的并发症更少。
