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.	连鸿凯, 黄金承, 刘纪恩. 多节段脊髓型颈椎病不同手术方法早期临床疗效探讨. 中国修复重建外科杂志, 2014, 28(10):1231-1235.
2.	马迅, 陈辉, 曹凯, 等. 不同影像学特点的脊髓型颈椎病的手术治疗. 中华骨科杂志, 2014, 34(10):983-991.
3.	唐超, 黄金承, 程旭光. 单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病. 中华实验外科杂志, 2014, 31(11):2608-2610.
4.	孙宇, 潘胜发, 张凤山, 等. 椎管狭窄合并巨大椎间盘突出或骨赘的脊髓型颈椎病的手术治疗. 中国脊柱脊髓杂志, 2006, 16(5): 346-350.
5.	胡有谷, 陈晓良, 刘勇, 等. 关于颈椎病命名及分类的讨论——脊髓型颈椎病与颈椎管狭窄之间的关系及命名探讨. 中国脊柱脊髓杂志, 2003, 13(4):203-204.
6.	王义生, 张弛, 唐囯皓, 等. 锚定钉在多节段脊髓型颈椎病单开门椎管扩大术中的应用. 中国脊柱脊髓杂志, 2012, 22(1):20-23.
7.	李玉伟, 王海蛟, 严晓云, 等. 颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析. 中国脊柱脊髓杂志, 2013, 23(11):973-978.
8.	李玉伟, 王海蛟, 王玉记, 等. 后路单开门与一期前后路手术减压治疗前后受压脊髓型颈椎病的疗效比较. 中国脊柱脊髓杂志, 2010, 20(3):99-102.
9.	方钊, 田融, 孙天威, 等. 后路单开门联合椎间孔切开术与前路减压融合术治疗混合型颈椎病的疗效比较. 中华骨科杂志, 2014, 34(8):799-806.
10.	孟德福, 孙天威, 田融, 等. 颈后路单开门椎管成形术联合椎间孔切开对预防术后C₅神经根瘫的影响. 中国修复重建外科杂志, 2014, 28(4):463-467.
11.	辛健, 薛海鹏, 徐展望. 颈椎后路双开门椎板成形术LA椎板夹的临床应用. 中国脊柱脊髓杂志, 2015, 25(1):88-89.
12.	韦敏克, 尹东, 梁斌, 等. 颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究. 中国矫形外科杂志, 2014, 22(19):1751-1755.
13.	江帅, 卜海富, 隋聪, 等. 多节段脊髓型颈椎病两种手术方式的疗效比较. 临床骨科杂志, 2015, 18(1):18-22.
14.	刘晓伟, 赵建宁, 许斌. 颈后路减压手术后轴性疼痛及其预防措施的研究进展. 中国脊柱脊髓杂志, 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.	李玉伟, 王海蛟, 严晓云. 改良颈椎管扩大成型术治疗脊髓型颈椎病的远期疗效分析. 中国脊柱脊髓杂志, 2003, 13(10):615-616.
18.	胡勇, Todd J Albert. 颈椎术后并发第5颈椎神经根麻痹研究进展. 中华外科杂志, 2013, 51(9):846-850.

1. 连鸿凯, 黄金承, 刘纪恩. 多节段脊髓型颈椎病不同手术方法早期临床疗效探讨. 中国修复重建外科杂志, 2014, 28(10):1231-1235.
2. 马迅, 陈辉, 曹凯, 等. 不同影像学特点的脊髓型颈椎病的手术治疗. 中华骨科杂志, 2014, 34(10):983-991.
3. 唐超, 黄金承, 程旭光. 单开门椎管成形术不同椎板开门角度治疗多节段脊髓型颈椎病. 中华实验外科杂志, 2014, 31(11):2608-2610.
4. 孙宇, 潘胜发, 张凤山, 等. 椎管狭窄合并巨大椎间盘突出或骨赘的脊髓型颈椎病的手术治疗. 中国脊柱脊髓杂志, 2006, 16(5): 346-350.
5. 胡有谷, 陈晓良, 刘勇, 等. 关于颈椎病命名及分类的讨论——脊髓型颈椎病与颈椎管狭窄之间的关系及命名探讨. 中国脊柱脊髓杂志, 2003, 13(4):203-204.
6. 王义生, 张弛, 唐囯皓, 等. 锚定钉在多节段脊髓型颈椎病单开门椎管扩大术中的应用. 中国脊柱脊髓杂志, 2012, 22(1):20-23.
7. 李玉伟, 王海蛟, 严晓云, 等. 颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析. 中国脊柱脊髓杂志, 2013, 23(11):973-978.
8. 李玉伟, 王海蛟, 王玉记, 等. 后路单开门与一期前后路手术减压治疗前后受压脊髓型颈椎病的疗效比较. 中国脊柱脊髓杂志, 2010, 20(3):99-102.
9. 方钊, 田融, 孙天威, 等. 后路单开门联合椎间孔切开术与前路减压融合术治疗混合型颈椎病的疗效比较. 中华骨科杂志, 2014, 34(8):799-806.
10. 孟德福, 孙天威, 田融, 等. 颈后路单开门椎管成形术联合椎间孔切开对预防术后C₅神经根瘫的影响. 中国修复重建外科杂志, 2014, 28(4):463-467.
11. 辛健, 薛海鹏, 徐展望. 颈椎后路双开门椎板成形术LA椎板夹的临床应用. 中国脊柱脊髓杂志, 2015, 25(1):88-89.
12. 韦敏克, 尹东, 梁斌, 等. 颈后路椎管扩大减压微型钛板固定椎板成形术与传统颈椎后路单开门椎管扩大减压术治疗颈椎病的比较研究. 中国矫形外科杂志, 2014, 22(19):1751-1755.
13. 江帅, 卜海富, 隋聪, 等. 多节段脊髓型颈椎病两种手术方式的疗效比较. 临床骨科杂志, 2015, 18(1):18-22.
14. 刘晓伟, 赵建宁, 许斌. 颈后路减压手术后轴性疼痛及其预防措施的研究进展. 中国脊柱脊髓杂志, 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. 李玉伟, 王海蛟, 严晓云. 改良颈椎管扩大成型术治疗脊髓型颈椎病的远期疗效分析. 中国脊柱脊髓杂志, 2003, 13(10):615-616.
18. 胡勇, Todd J Albert. 颈椎术后并发第5颈椎神经根麻痹研究进展. 中华外科杂志, 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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