背景:脊髓型颈椎病(CSM)是一种非常常见且具有破坏性的脊柱疾病。先天性宫颈狭窄(CCS)是最常见的原因。我们旨在阐明安全性,有效性,手术结合椎板成形术和人工椎间盘置换术(ADR)治疗神经根病的CSM患者的可行性,特别是用于保持颈椎的活动范围(ROM)。
方法:2008年8月至2019年4月,本研究纳入了39例由CCS引起的多发性CSM患者。所有患者均先行椎管成形术,然后行ADR。我们使用回顾性数据收集来评估功能和放射学结果,特别是关于ROM的保存。
结果:每位患者都接受了至少2年的术后随访。日本骨科协会的评分在6个月时显示出很大的改善。在随访期间保留了ADR指数级ROM。轴下Cobb角也可以保留在整个颈椎中,椎管直径可扩大52.6%以上。没有严重的并发症或副作用,没有病人需要二次手术。
结论:我们的目标是在没有过多椎间盘置换的情况下,充分减压治疗多个级别的CSM。我们能够直接扩大这些CCS患者的椎管,并且只需要1或2级ADR就可以治疗相关的神经根病。这种联合手术策略是安全的,有效,并且能够保留颈椎的ROM。
方法:
BACKGROUND: Cervical spondylotic myelopathy (CSM) is a very common and devastating spinal disease. Congenital cervical stenosis (CCS) is the most common cause. We aimed to elucidate the security, effectivity, and feasibility of surgery combining laminoplasty with artificial disc replacement (ADR) to treat CSM patients with radiculopathy, especially for preserving the range of motion (ROM) of the cervical spine.
METHODS: Between August 2008 and April 2019, 39 patients with multiple CSM caused by CCS were enrolled in the present study. All patients received laminoplasty first and then ADR. We used a retrospective collection of data for evaluating the functional and radiologic outcomes, especially regarding preservation of ROM.
RESULTS: Each patient underwent at least a 2-year postoperative follow-up. The Japanese Orthopedic Association score showed great improvements at 6 months. The ADR index-level ROM was preserved during follow-up. The subaxial Cobb angle could also be retained in the whole cervical spine, and the spinal canal diameter could be expanded by more than 52.6%. There were no severe complications or side effects, and no patients needed secondary surgery.
CONCLUSIONS: We aimed to treat multiple levels of CSM with adequate decompression without too many intervertebral disc replacements. We were able to expand the spinal canal directly for these patients with CCS and needed only 1- or 2-level ADR to treat them with associated radiculopathy. This combined surgical strategy was secure, effective, and was able to preserve the ROM of the cervical spine.
METHODS: