神经根型颈椎病椎间孔内神经根受压的原因分析及减压方式选择

The causes analysis and decompression mode choice for the cervical spondylotic radiculopathy with nerve root compression in foramen

中文关键词:  神经根型颈椎病  椎间孔  前路减压

英文关键词:Cervical spondylotic radiculopathy  Intervertebral foramen  Anterior decompression

中文摘要:

  【摘要】 目的：分析神经根型颈椎病患者椎间孔内神经根受压的原因，选择合理的减压方式。方法：2010年1月~2013年8月，我院共收治神经根型颈椎病患者178例，其中56例为椎间孔内神经根受压所致的单侧神经根型颈椎病，术前VAS评分为8.99±1.01分（7~10分）；颈椎功能障碍指数（NDI）为41.15±7.12分（37~49分）。根据术前影像学资料判断椎间孔内神经根受压的原因分为3组：单纯椎间盘压迫，14例（A组）；单纯骨性压迫，22例（B组）；混合压迫（椎间盘+骨性压迫），20例（C组）。A组切除椎间盘至钩椎关节，适当扩大椎间孔，取出突出髓核；B、C组切除椎间盘至钩椎关节后，将钩突基底部内侧磨平，充分显露钩突后部、上位椎体后下角及钩椎关节间隙，刮除上位椎体后下角及部分增生的钩突。减压后均行椎间植骨内固定。使用Surgimap软件测量患者术前颈椎双斜位X线片上病变节段的双侧椎间孔面积，将健侧与患侧的椎间孔面积进行对比。比较3组患者术前及末次随访时VAS评分和NDI，同时比较3组的手术时间、术中出血量和术后住院时间。结果：3组患者术前健侧椎间孔面积无显著性差异（P＞0.05），B组和C组的患侧椎间孔面积均较A组明显狭窄（P＜0.05）；B组和C组无显著性差异（P＞0.05）；B组和C组的患侧椎间孔面积均较各自的对侧椎间孔面积明显狭窄（P＜0.05）；而A组患侧椎间孔面积较对侧无明显狭窄（P＞0.05）。3组患者均顺利完成手术，B、C组与A组相比术中出血量较多，手术时间和术后住院天数较长（P＜0.05）；B组与C组比较无显著性差异（P＞0.05）。术后3组患者均无神经症状加重、感染及脑脊液漏等并发症发生。56例患者均获得随访，随访时间27.2±8.9个月（12~52个月），3组术前VAS评分和NDI比较无显著性差异（P＞0.05），末次随访时亦无显著性差异（P＞0.05）；3组末次随访时与术前比较均有显著性差异（P＜0.05）。结论：术前根据影像学资料分析神经根型颈椎病患者椎间孔内神经根受压的原因，进行针对性的减压手术可取得良好效果。

英文摘要:

  【Abstract】 Objectives: To analyze the reasons of nerve root compression in foramen in patients with cervical spondylotic radiculopathy, and to provide rational methods for decompression. Methods: From January 2010 to August 2013, 178 patients with cervical spondylotic radiculopathy were admitted in our hospital, and 56 of them had unilateral cervical spondylotic radiculopathy with nerve root compression in foramen. Preoperative VAS was 7-10(average, 8.99±1.01) and NDI was 37-49(average, 41.15±7.12). According to preoperative radiological data, the patients were divided into three groups based on the reasons of nerve root compression in foramen: simple disc compression, 14 cases(group A); simple bony compression, 22 cases(group B); mixed compression, 20 cases(group C). In group A, cervical discs plus uncovertebral joints were removed, and the affected foramen was slightly enlarged. In group B and C, after the removal of uncovertebral joint, the medial part of the uncinate process was spurred to fully expose the posterior edge of uncinate process, as well as the inferior and posterior edge of the upper vertebra and the uncovertebral joint space. After that, the inferior-posterior osteophyte of the upper vertebra and the hyperosteogeny part of uncinate process were also spurred. Bone grafting, fusion and internal fixation were performed for all patients after decompression. The bilateral foraminal area of the corresponding segment was measured in double oblique X-ray by Surgimap software, and the comparison between foraminal area of the affected side and the contralateral side was performed. Preoperative and final follow-up VAS and NDI scores of three groups were compared respectively. Operation time, blood loss and hospital stay of the three groups were also compared. Results: Preoperative foraminal area on the contralateral side of the three groups showed no significant difference. Foraminal area on the affected side of group B and C was smaller than that of group A, while group B and group C had no difference. For group B and C, foraminal area on the affected side was smaller than that on the contralateral side, while foraminal area of group A on the affected side showed no difference with that on the contralateral side. Compared with group B and C, group A had younger age, less blood loss, shorter operation time and long hospital stay. No significant difference was found between group B and C. No neurological deterioration, infection or cerebrospinal fluid leakage was found. Fifty-six patients had a follow-up time of over 12 months, with a mean follow-up time of 27.2±8.9 months(range, 12-52 months). There was no significant difference in VAS or NDI score among three groups at preoperation and final follow-up. VAS and NDI of the three groups at the final follow-up were significantly different with those at preoperation. Conclusions: Based on different reasons causing nerve root compression in cervical foramen, targeted decompression procedure may lead to satisfactory clinical outcomes for cervical spondylotic radiculopathy.