Cervical spondylotic myelopathy: Patterns of neurological deficit and recovery after anterior cervical decompression
Cervical spondylotic myelopathy: Patterns of neurological deficit and recovery after anterior cervical decompression
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DOI：
10.1097/00006123-199904000-00041
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发表时间：
1999-04-01
期刊：
影响因子：
4.8
通讯作者：
Cooper, PR
中科院分区：
文献类型：
--
作者：
Chiles, BW;Leonard, MA;Cooper, PR
目的：探讨脊髓型颈椎病患者行前路减压手术前后神经系统症状、体征和功能恢复的特点。此外，我们试图确定哪些发现对手术结果有预测价值。方法：我们回顾了76例由骨赘或椎间盘突出引起的脊髓型颈椎病患者，他们接受了一位外科医生的颈椎前路减压融合术。术后通过办公室访问和/或电话采访对患者进行评估。结果：术前最常见的症状为手功能减退(75%)、上肢感觉不适(82.9%)、步态困难(80.3%)。上肢以手内肌(56.6%)和三头肌(28.9%)最常见，而下肢以髂腰肌(38.8%)和股四头肌(26.3%)最常见。在下肢，个体肌肉组的力量改善率从79.1%到88.1%；在上肢，力量改善率略高，从81.3%到90.9%。采用库珀脊髓病评分，46.7%的患者下肢功能改善，75.4%的患者上肢功能改善。根据日本骨科协会评分标准的修改，79.7%的患者在术前有异常评分。结论：颈椎前路减压术后各肌群的力量改善率约为80%~90%。然而，只有不到一半的患者经历了下肢功能的改善，这种差异可能是由于持续性痉挛而不是肌肉无力造成的。术后上肢功能障碍是由残存的虚弱和感觉丧失引起的。根据计算，未手术节段复发的症状性脊椎病的发生率为每年2%。
OBJECTIVES: We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms and functional results in patients with cervical spondylotic myelopathy who underwent anterior decompressive operations. Additionally, we sought to determine which findings had predictive value for surgical outcome.METHODS: We retrospectively reviewed the records of 76 patients with cervical spondylotic myelopathy caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion performed by one surgeon. The patients were evaluated postoperatively by office visits and/or telephone interviews. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales.RESULTS: The most common preoperative symptoms were deterioration of hand use (75 %), upper extremity sensory complaints (82.9%), and gait difficulties (80.3%). In the upper extremities, preoperative weakness was most common in the hand intrinsic muscles (56.6%) and triceps (28.9%), and in the lower extremities, preoperative weakness was most common in the iliopsoas (38.8%) and quadriceps (26.3%). In the lower extremities, individual muscle groups had strength improvement rates from 79.1 to 88.1 %; somewhat higher rates, from 81.3 to 90.9%, were observed in the upper extremities. When evaluated by using the Cooper myelopathy scale, lower extremity functional improvement occurred in 46.7% of the patients and upper extremity functional improvement in 75.4%. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale, was noted in 79.7% of the patients who had abnormal scores preoperatively.CONCLUSION: Strength improved at rates of approximately 80 to 90% in individual muscle groups after anterior cervical decompression. However, fewer than half of all patients experienced functional improvement in the lower extremities, a discrepancy that was probably caused by persistent spasticity rather than muscle weakness. Postoperative dysfunction in the upper extremities was caused by residual weakness as well as sensory loss. Recurrent symptomatic spondylosis at unoperated levels was calculated to occur at an incidence of 2% per year.