EFFECT OF ANTERIOR CERVICAL SPINAL CORD COMPRESSION FACTOR IN TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIYuwei ¹ ,  WANGHaijiao ¹ , WANGYisheng ² , LIUHongjian ²

1. Department of Orthopedics, the First Affiliated Hospital of Luohe Medical College, Luohe Henan, 462000, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University;

Corresponding?author：

WANGHaijiao, Email: 460910316@qq.com

Keywords：

Cervical spondylotic myelopathy; Cervical stenosis; Posterior cervical laminoplasty

DOI：

10.7507/1002-1892.20150238

Video：

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Objective To observe the effectiveness of posterior cervical laminoplasty, and to determine the significance of the classification of spinal cord compression of multi-level cervical spondylotic myelopathy (CSM). Methods The clinical data were analyzed from 1 216 cases of multi-level CSM undergoing posterior cervical laminoplasty between February 1998 and February 2013. The patients were divided into 4 groups: soft anterior spinal cord compression and light canal occupation (<50%) in 569 cases (46.8%, group A), soft anterior spinal cord compression and heavy canal occupation (≥ 50%) in 365 cases (30.0%, group B), bony anterior spinal cord compression and light canal occupation in 210 cases (17.3%, group C), and bony anterior spinal cord compression and heavy canal occupation in 72 cases (5.9%, group D). There was no significant difference in gender, age, disease duration, lesion level, and complications among 4 groups (P>0.05). Because of different levels of spinal cord compression, there were significant differences in visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score among 4 groups (P<0.05). Results Cerebrospinal fluid leakage occurred in 9 cases (2 cases in group A, 1 case in group B, 3 cases in group C, and 3 cases in group D), and was cured after symptomatical treatment. There was no postoperative complication of wound infection, lamina re-closing, or C₅ nerve root paralysis in 4 groups. The follow-up time ranged from 24 to 74 months (mean, 35 months). In group D, 17 patients (23.6%) had deteriorated symptom at 6-12 months after operation, and good recovery was achieved in the patients of the other 3 groups. At last follow-up, the JOA score and VAS score were significantly improved when compared with the preoperative scores in 4 groups (P<0.05); the JOA score, improvement rate, and VAS score of group D were significantly lower than those of groups A, B, and C (P<0.05), but there was no significant difference among groups A, B, and C (P>0.05). Conclusion In the multi-level CSM, the anterior compression of the spinal cord should be classified, this has a guiding significance for the prognosis of CSM and the choice of surgical method.

Citation： LIYuwei, WANGHaijiao, WANGYisheng, LIUHongjian. EFFECT OF ANTERIOR CERVICAL SPINAL CORD COMPRESSION FACTOR IN TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1099-1103. doi: 10.7507/1002-1892.20150238 Copy

1.	連鴻凱, 黃金承, 劉紀恩. 多節段脊髓型頸椎病不同手術方法早期臨床療效探討. 中國修復重建外科雜志, 2014, 28(10):1231-1235.
2.	馬迅, 陳輝, 曹凱, 等. 不同影像學特點的脊髓型頸椎病的手術治療. 中華骨科雜志, 2014, 34(10):983-991.
3.	唐超, 黃金承, 程旭光. 單開門椎管成形術不同椎板開門角度治療多節段脊髓型頸椎病. 中華實驗外科雜志, 2014, 31(11):2608-2610.
4.	孫宇, 潘勝發, 張鳳山, 等. 椎管狹窄合并巨大椎間盤突出或骨贅的脊髓型頸椎病的手術治療. 中國脊柱脊髓雜志, 2006, 16(5): 346-350.
5.	胡有谷, 陳曉良, 劉勇, 等. 關于頸椎病命名及分類的討論——脊髓型頸椎病與頸椎管狹窄之間的關系及命名探討. 中國脊柱脊髓雜志, 2003, 13(4):203-204.
6.	王義生, 張弛, 唐囯皓, 等. 錨定釘在多節段脊髓型頸椎病單開門椎管擴大術中的應用. 中國脊柱脊髓雜志, 2012, 22(1):20-23.
7.	李玉偉, 王海蛟, 嚴曉云, 等. 頸椎單開門椎管擴大成形術不同椎板固定方法治療多節段脊髓型頸椎病的療效分析. 中國脊柱脊髓雜志, 2013, 23(11):973-978.
8.	李玉偉, 王海蛟, 王玉記, 等. 后路單開門與一期前后路手術減壓治療前后受壓脊髓型頸椎病的療效比較. 中國脊柱脊髓雜志, 2010, 20(3):99-102.
9.	方釗, 田融, 孫天威, 等. 后路單開門聯合椎間孔切開術與前路減壓融合術治療混合型頸椎病的療效比較. 中華骨科雜志, 2014, 34(8):799-806.
10.	孟德福, 孫天威, 田融, 等. 頸后路單開門椎管成形術聯合椎間孔切開對預防術后C₅神經根癱的影響. 中國修復重建外科雜志, 2014, 28(4):463-467.
11.	辛健, 薛海鵬, 徐展望. 頸椎后路雙開門椎板成形術LA椎板夾的臨床應用. 中國脊柱脊髓雜志, 2015, 25(1):88-89.
12.	韋敏克, 尹東, 梁斌, 等. 頸后路椎管擴大減壓微型鈦板固定椎板成形術與傳統頸椎后路單開門椎管擴大減壓術治療頸椎病的比較研究. 中國矯形外科雜志, 2014, 22(19):1751-1755.
13.	江帥, 卜海富, 隋聰, 等. 多節段脊髓型頸椎病兩種手術方式的療效比較. 臨床骨科雜志, 2015, 18(1):18-22.
14.	劉曉偉, 趙建寧, 許斌. 頸后路減壓手術后軸性疼痛及其預防措施的研究進展. 中國脊柱脊髓雜志, 2014, 24(6):567-570.
15.	Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy:a prospective randomized control clinical study. Eur Spine J, 2010, 19(5):713-719.
16.	Kiely PD, Quinn JC, Du JY, et al. Posterior surgical treatment of cervical spondylotic myelopathy:review article. HSS J, 2015, 11(1): 36-42.
17.	李玉偉, 王海蛟, 嚴曉云. 改良頸椎管擴大成型術治療脊髓型頸椎病的遠期療效分析. 中國脊柱脊髓雜志, 2003, 13(10):615-616.
18.	胡勇, Todd J Albert. 頸椎術后并發第5頸椎神經根麻痹研究進展. 中華外科雜志, 2013, 51(9):846-850.

1. 連鴻凱, 黃金承, 劉紀恩. 多節段脊髓型頸椎病不同手術方法早期臨床療效探討. 中國修復重建外科雜志, 2014, 28(10):1231-1235.
2. 馬迅, 陳輝, 曹凱, 等. 不同影像學特點的脊髓型頸椎病的手術治療. 中華骨科雜志, 2014, 34(10):983-991.
3. 唐超, 黃金承, 程旭光. 單開門椎管成形術不同椎板開門角度治療多節段脊髓型頸椎病. 中華實驗外科雜志, 2014, 31(11):2608-2610.
4. 孫宇, 潘勝發, 張鳳山, 等. 椎管狹窄合并巨大椎間盤突出或骨贅的脊髓型頸椎病的手術治療. 中國脊柱脊髓雜志, 2006, 16(5): 346-350.
5. 胡有谷, 陳曉良, 劉勇, 等. 關于頸椎病命名及分類的討論——脊髓型頸椎病與頸椎管狹窄之間的關系及命名探討. 中國脊柱脊髓雜志, 2003, 13(4):203-204.
6. 王義生, 張弛, 唐囯皓, 等. 錨定釘在多節段脊髓型頸椎病單開門椎管擴大術中的應用. 中國脊柱脊髓雜志, 2012, 22(1):20-23.
7. 李玉偉, 王海蛟, 嚴曉云, 等. 頸椎單開門椎管擴大成形術不同椎板固定方法治療多節段脊髓型頸椎病的療效分析. 中國脊柱脊髓雜志, 2013, 23(11):973-978.
8. 李玉偉, 王海蛟, 王玉記, 等. 后路單開門與一期前后路手術減壓治療前后受壓脊髓型頸椎病的療效比較. 中國脊柱脊髓雜志, 2010, 20(3):99-102.
9. 方釗, 田融, 孫天威, 等. 后路單開門聯合椎間孔切開術與前路減壓融合術治療混合型頸椎病的療效比較. 中華骨科雜志, 2014, 34(8):799-806.
10. 孟德福, 孫天威, 田融, 等. 頸后路單開門椎管成形術聯合椎間孔切開對預防術后C₅神經根癱的影響. 中國修復重建外科雜志, 2014, 28(4):463-467.
11. 辛健, 薛海鵬, 徐展望. 頸椎后路雙開門椎板成形術LA椎板夾的臨床應用. 中國脊柱脊髓雜志, 2015, 25(1):88-89.
12. 韋敏克, 尹東, 梁斌, 等. 頸后路椎管擴大減壓微型鈦板固定椎板成形術與傳統頸椎后路單開門椎管擴大減壓術治療頸椎病的比較研究. 中國矯形外科雜志, 2014, 22(19):1751-1755.
13. 江帥, 卜海富, 隋聰, 等. 多節段脊髓型頸椎病兩種手術方式的療效比較. 臨床骨科雜志, 2015, 18(1):18-22.
14. 劉曉偉, 趙建寧, 許斌. 頸后路減壓手術后軸性疼痛及其預防措施的研究進展. 中國脊柱脊髓雜志, 2014, 24(6):567-570.
15. Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy:a prospective randomized control clinical study. Eur Spine J, 2010, 19(5):713-719.
16. Kiely PD, Quinn JC, Du JY, et al. Posterior surgical treatment of cervical spondylotic myelopathy:review article. HSS J, 2015, 11(1): 36-42.
17. 李玉偉, 王海蛟, 嚴曉云. 改良頸椎管擴大成型術治療脊髓型頸椎病的遠期療效分析. 中國脊柱脊髓雜志, 2003, 13(10):615-616.
18. 胡勇, Todd J Albert. 頸椎術后并發第5頸椎神經根麻痹研究進展. 中華外科雜志, 2013, 51(9):846-850.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF ANTERIOR CERVICAL SPINAL CORD COMPRESSION FACTOR IN TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

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