颈椎椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸的中长期疗效

Mid-to-long term efficacy of laminoplasty combined with pedicle screw correction and fusion in the treatment of multilevel compressed myelopathy accompanied with degenerative kyphosis of cervical spine

中文关键词:  多节段压迫性颈脊髓病  退变性后凸  椎弓根螺钉  脊髓前缘角  椎板成形椎管扩大术

英文关键词:Multilevel compressed cervical myelopathy  Degenerative kyphosis  Pedicle screw  Cervical spinal cord anterior angle  Laminoplasty

中文摘要:

  【摘要】 目的：观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效。方法：回顾性分析2008年3月~2019年9月，采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者，其中男11例，女7例，年龄52.3±8.1岁；颈椎后纵韧带骨化症（ossification of posterior longitudinal ligament，OPLL）合并慢性颈脊髓病5例，脊髓型颈椎病13例。减压节段：17例为C3~C7，1例为C3~T1，术中固定融合3.8±1.0个椎体。12例患者出院时（术后2周左右）复查颈椎MRI，11例患者获得随访，随访时间2.1~13.5年（10.5±2.8年）。在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角，在颈椎MRI上测量脊髓前缘角及改良K线，末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况。术前及末次随访时进行JOA评分及颈痛VAS评分。结果：18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸，术后2周为3.8°±8.0°前凸，有显著性差异（P<0.01）； 术前C2~C7颈椎Cobb角为1.3°±9.4°前凸，术后2周为5.8°±7.0°前凸，无显著性差异（P＞0.05）。12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸，术后2周为1.3°±5.2°后凸，有显著性差异（P<0.01）；C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸，术后2周为1.1°±6.3°前凸，有显著性差异（P<0.01）。7例（39%）患者术后出现C5神经根麻痹，均在术后1~4个月内完全恢复。术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合，后凸矫形角度无丢失；颈椎MRI显示脊髓无受压，正中矢状位片显示脊髓前缘角无丢失。11例患者JOA评分术前8.0±2.8分，末次随访时15.6±0.9分，有显著性差异（P<0.01），JOA评分改善率（83±14）%；颈痛VAS评分术前为2.2±3.0分，末次随访时为1.1±1.2分，术前与末次随访时相比无显著性差异（P>0.05）。结论：对于合并有退变性颈椎后凸的多节段受压的慢性压迫性颈脊髓病，采用椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术可以获得长期稳定、良好的脊髓功能改善的效果。

英文摘要:

  【Abstract】 Objectives: To study the mid-to-long term efficacy of laminoplasty combined with pedicle screw correction and fusion in treating the patients with multilevel compressed myelopathy accompanied with degenerative kyphosis of cervical spine. Methods: 18 patients of multilevel compressed myelopathy accompanied with degenerative kyphosis of cervical spine treated with posterior approach of open door laminoplasty combined with pedicle screw correction and fusion in our Hospital between March 2008 and September 2019 were retrospectively studied. There were 11 males and 7 females, aged 52.3±8.1 years old. Before surgery, 5 patients were diagnosed with ossification of posterior longitudinal ligament(OPLL) combimed with chronical cervical myelopathy, and the other 13 were with cervical spondylotic myelopathy(CSM). The range of decompression levels was C3-C7 in 17 patients and C3-T1 in 1 patient, and the number of vertebrae fixed and fused was 3.8±1.0. 12 cases out of the total were exmined with cervical MRI on discharge(about 2 weeks after surgery); And 11 cases were followed up for 2.1-13.5 years(10.5±2.8 years). Cobb angle was measured on lateral cervical X-rays and cervical spinal cord anterior angle(CSCAA) and modified K-line were measured on MRI before operation and on discharge, and fusion condition and loss of kyphosis correction angle were evaluated on the X-rays at final follow-up. Visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) score were collected before operation and at final follow-up. Results: The local Cobb angle was recovered to 3.8°±8.0° lordosis at 2 weeks after surgery from the preoperative 6.6°±6.5° kyphosis significantly(P<0.01); And the C2-C7 Cobb angle of cervical spine changed to 5.8°±7.0° lordosis at 2 weeks after surgery from the preoperative 1.3°±9.4° lordosis(P＞0.05). Of the 12 cases examined with MRI on discharge, the mean local CSCAA was improved from the preoperative 11.1°±4.2° kyphosis to 1.3°±5.2° kyphosis at 2 weeks after surgery, with significant difference(P<0.01); And the mean C2-C7 CSCAA was changed from 6.5°±4.4° kyphosis before operation to 1.1°±6.3° lordosis at 2 weeks after surgery, with significant difference(P<0.01). 7 cases(39%) suffered from C5 palsy after surgery, and all recovered completely in 1-4 months after surgery. Of the 11 patients followed up for 10 years and more, lateral X-ray of cervical spine showed bony fusion in all the operated segments without loss of kyposis correction angle; And MRI showed no compression of spinal cord, and no loss of CSCAA on mid-sagittal images; JOA score was 8.0±2.8 before surgery and 15.6±0.9 at final follow up, with significant difference(P<0.01), and the mean recovery rate of JOA score was (83±14)%; Neck pain VAS was 2.2±3.0 before surgery and 1.1±1.2 at final follow-up, and there was no statistical difference in between(P>0.05). Conclusions: For the patients of multilevel compressed myelopathy accompanied with degenerative kyphosis of cervical spine, open door laminoplasty combined with pedicle screw correction and fusion can achieve a long term stable and effective improvement in spinal cord function.