Objective: To evaluate the effectiveness of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy for treating cervical radiculo-myelopathy.
Methods: Between January 2010 and January 2012, 58 patients with cervical radiculo-myelopathy were treated by posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy. There were 31 males and 27 females, with an average age of 52.7 years (range, 41-72 years). The mean disease course was 5.4 years (range, 3-15 years). The preoperative Japanese Orthopaedic Association (JOA) score was 7.8±1.3, and visual analogue scale (VAS) score was 6.8±1.7. There were 37 cases of inter-vertebral disc herniation and ligamentum flavum hypertrophy, 11 cases of vertebral osteophyte formation with the osteophyte spinal canal occupational ratio of 51.7%±18.1%, and 10 cases of inter-vertebral disc herination with cervical instability. Preoperative cervical curvature was (-5.5±12.5)°. The fixed segments included C3-7 in 29 cases, C4-7 in 19 cases, and C3-6 in 10 cases. Foraminotomy was performed in 135 nerve foramina (mean, 2.33 foramina).
Results: The mean operation time was 204 minutes (range, 167-260 minutes), and the mean blood loss was 273 mL (range, 210-378 mL). No injury of vertebral artery or nerve root occurred during operation. Postoperative subcutaneous hematoma and cervical axial pain occurred in 1 case and 8 cases, respectively; and no nerve root palsy was observed. The patients were followed up 2.1-4.3 years (mean, 3.4 years). The postoperative JOA score was significantly increased to 14.1±1.7 (t=-27.672, P=0.000), with an improvement rate of 68.5%±21.9%. Postoperative VAS score was significantly decreased to 2.1±1.1 (t=15.168, P=0.000). The imaging examination showed adjacent segmental degeneration in 1 patient, who had no clinical symptom. There was no screw loosening or pseudoarthrosis formation during follow-up. The cervical curvature was (13.6±5.1)° at 5 days and was (13.2±4.8)° at 2 years, showing significant difference when compared with preoperative one (P<0.05). The osteophyte spinal canal occupational ratio was 36.5%±10.4% at 2 years, showing significant difference when compared with preoperative one (t=6.921, P=0.000).
Conclusions: The procedure of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy is effect in treating cervical radiculo-myelopathy. The spinal cord and nerve root can be adequately decompressed by laminectomy and foraminotomy. The lateral mass screw fixation can correct the cervical curvature and further reduce the tension to spinal cord.
目的: 探讨颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗脊髓合并神经根受压的混合型颈椎病疗效。.
方法: 2010年1月-2012年1月，采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗58例混合型颈椎病患者。男31例，女27例；年龄41～72岁，平均52.7岁。病程3～15年，平均5.4年。术前日本骨科协会（JOA）评分为（7.8±1.3）分，疼痛视觉模拟评分（VAS）为（6.8±1.7）分。椎间盘突出伴黄韧带肥厚37例，椎体后缘骨赘形成11例（骨赘椎管占有率为51.7%±18.1%），颈椎不稳合并椎间盘突出10例。颈椎曲度为（-5.5±12.5）°。螺钉固定节段：C3～7 29例，C4～7 19例，C3～6 10例；共切开椎间孔135个，平均每例2.33个。.
结果: 手术时间167～260 min，平均204 min；术中出血量为210～378 mL，平均273 mL。术中无椎动脉、神经根损伤发生。术后1例发生皮下血肿，8例轴性疼痛；均无颈神经根麻痹症状发生。患者均获随访，随访时间2.1～4.3年，平均3.4年。术后2年，JOA评分为（14.1±1.7）分，显著高于术前，比较差异有统计学意义（t=-27.672，P=0.000）；JOA评分改善率为68.5%±21.9%。VAS评分为（2.1±1.1）分，较术前显著降低，比较差异有统计学意义（t=15.168，P=0.000）。影像学复查示，1例邻近节段发生退变，但未出现临床症状；随访期间无螺钉松动、无假关节形成。术后5 d及2年颈椎曲度分别为（13.6±5.1）、（13.2±4.8）°，与术前比较差异均有统计学意义（P＜0.05）。术后2年11例骨赘椎管占有率为36.5%±10.4%，与术前比较差异有统计学意义（t=6.921，P=0.000）；随访期间骨赘残余压迫逐渐吸收。.
结论: 对脊髓合并神经根受压的混合型颈椎病，采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗可获得满意疗效。术中扩大椎板切除（椎板切除和椎间孔切开）能充分缓解脊髓及神经根受压症状，侧块螺钉内固定在纠正颈椎曲度的同时，可进一步降低脊髓及神经根张力。.
Keywords: Cervical curvature; Cervical radiculo-myelopathy; Cervical spine degeneration; Posterior cervical decompression.