前路经椎间隙减压固定融合术治疗伴交感神经症状颈椎病的疗效分析

Analysis of anterior discectomy and fusion for treating cervical spondylosis accompanied by sympathetic symptoms

中文关键词:  颈椎病  交感神经症状  颈前路经椎间隙减压术  后纵韧带  疗效

英文关键词:Cervical spondylosis  Sympathetic symptoms  Discectomy  Posterior longitudinal ligament  Outcome

中文摘要:

  【摘要】 目的：探讨前路经椎间隙减压固定融合术治疗伴交感神经症状颈椎病的临床疗效。方法：回顾性分析2001年10月~2010年10月手术治疗的伴有明显头晕、头痛等交感神经症状的颈椎病患者156例，其中脊髓型59例，脊髓-神经根混合型97例。病变涉及单节段108例，2个节段39例，3个节段6例，4个节段3例。对全部病变节段行前路经椎间隙减压固定融合术，术中均彻底切除病变椎间隙处后纵韧带。观察比较术前、术后1周及末次随访时临床症状及影像学情况，采用交感神经症状20分法和JOA 17分法评定交感神经症状和脊髓神经功能改善情况。在颈椎正侧位及伸屈动力位X线片上进行影像学评价。结果：32例患者术后有一过性咽喉部疼痛不适感，经对症处理于术后3~5d症状均消失；无脑脊液漏、感染和血管、神经损伤。随访8~42个月，平均25个月。交感神经症状评分术前6.4±1.7分，术后1周1.6±1.7分，末次随访时2.4±1.4分，主观满意率79%；JOA评分术前9.8±2.4分，术后1周11.9±2.5分，末次随访12.9±2.2分。术后1周、末次随访时交感神经症状评分和JOA评分与术前比较均有统计学差异（P＜0.05），末次随访时与术后1周比较无统计学差异（P>0.05）。末次随访时X线片显示手术节段均已融合，颈椎稳定性良好，无内固定松动和断裂。2例于术后3年因脊髓神经症状加重行二次后路减压手术。结论：颈前路经椎间隙减压固定融合术结合术中彻底切除病变椎间隙处后纵韧带治疗伴交感神经症状颈椎病的疗效良好。

英文摘要:

  【Abstract】 Objective：To investigate surgical results of anterior discectomy and fusion in treating cervical spondylosis accompanied by sympathetic symptoms.Method：A retrospective study was performed on 156 patients with cervical spondylosis myelopathy or myelopathy and radiculopathy accompanied by sympathetic symptoms such as dizzy and headache between October 2001 and October 2010.There were 59 with myelopathy whereas 97 with myelopathy and radiculopathy.The cases included single level（108 cases），two levels（39 cases），three levels（6 cases） and four levels（3 cases）.All the compression levels underwent anterior discectomy and fusion surgery with posterior longitudinal ligament（PLL） resection at the area of decompression.Clinical and radiologic evaluations were taken and compared at baseline，one week post-operation and final follow-up.Neurological status was evaluated by Japanese Orthopedic Association（JOA） scores and sympathetic symptoms were evaluated with sympathetic symptoms 20-point scoring system.Antero-posterior，lateral and extension-flextion radiographs were used to evaluate the radiologic outcomes.Result：Postoperatively，32 patients experienced transient sore throat and pharyngolaryngeal malaise，which was absent 3 to 5 days after surgery by fog inhalation therapy.No leakage of cerebrospinal fluid，infection and injury of vessels and nerves were observed.The average follow-up was 25 months（range，8 to 42 months）.The sympathetic symptoms score was 6.4±1.7 before surgery，1.6±1.7 one week after surgery，and 2.4±1.4 at the final follow-up，with the subjective satisfactory rate of 79%.The corresponding JOA scores were 9.8±2.4，11.9±2.5，and 12.9±2.2 respectively.A significant difference was observed regarding sympathetic symptoms scores and JOA scores before surgery and one week after surgery or at the final follow-up（P＜0.05），but no statistical significance between which of one week after surgery and the final follow-up（P>0.05）.Radiographs at the final follow-up indicated absolute postoperative fusion and reliable cervical stability without fixation failure or breakage.Two patients experienced deterioration in spinal cord function 3 years after surgery，and a subsequent revision of posterior decompression was performed.Conclusion：Cervical spondylosis accompanied by sympathetic symptoms can be managed successfully by the anterior discectomy and fusion with resection of PLL at the area of decompression.