CERVICAL KYPHOSIS AND MYELOPATHY - TREATMENT BY ANTERIOR CORPECTOMY AND STRUT-GRAFTING
CERVICAL KYPHOSIS AND MYELOPATHY - TREATMENT BY ANTERIOR CORPECTOMY AND STRUT-GRAFTING
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DOI：
10.2106/00004623-198971020-00002
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发表时间：
1989-02-01
影响因子：
5.3
通讯作者：
BOHLMAN, HH
中科院分区：
文献类型：
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作者：
ZDEBLICK, TA;BOHLMAN, HH
在1976年至1984年期间，14名患有严重颈椎后凸畸形和脊髓病的患者接受了前路减压和关节融合术。八个有脊椎病，五个是外伤，一个是良性硬膜内肿瘤。在14例患者中，有8例在3、4或5个颈椎椎板切除术后发生了严重的脊柱后凸和脊髓病。椎板切除术已经完成了治疗椎关节强硬的五名患者，创伤性病变的两名，和一个肿瘤。考虑到所有14例患者，平均每例患者切除2.25个椎体，随后融合的平均程度为3.25个节段。8名患者（其中6名患有椎关节强硬; 1名，创伤性病变; 1名，肿瘤）采用平均跨越4.10个节段的腓骨移植物进行治疗，6名患者（其中4名患有创伤性病变，2名患有椎关节强硬）采用平均跨越270个节段的髂骨移植物进行治疗。在五名患有创伤性病变的患者中，四名接受了前路减压和关节固定术，并结合在同一麻醉期间进行的后路关节固定术。在3名患者中，前路移植物在术后即刻脱位。三名患者中有两名由于之前的椎板切除术而出现后部不稳定，第三名患者由于技术困难而导致移植物移位。对其中2个移植物进行翻修以恢复稳定性。在最近的随访中，14例融合中有12例是牢固的。另外两名患者分别于术后6个月和10个月死亡，死亡前的X线片显示融合牢固。后凸畸形的平均矫正量为32度，从平均45度减少到平均13度。除一名患者外，所有患者的神经功能都有一定程度的恢复; 9名患者完全恢复，4名患者部分恢复。剩下的一名患者疼痛缓解，但他仍然完全四肢瘫痪，尽管他有一些感觉保留。在术前无法行走的4名患者中，3名患者术后能够行走。前路减压融合术后无一例神经功能丧失。我们的结论是，在存在严重的颈椎后凸畸形和脊髓病的情况下，充分的脊髓前路减压，矫正后凸畸形，并使用支柱移植物进行前路关节融合术可以获得良好的结果，而不会产生过度的风险。
Between 1976 and 1984, fourteen patients who had severe cervical kyphosis and myelopathy were treated with anterior decompression and arthrodesis. Eight had had spondylosis; five, a traumatic injury; and one, a benign intradural tumor. In eight of the fourteen patients, the severe kyphosis and myelopathy had developed after a laminectomy of three, four, or five cervical vertebrae. The laminectomy had been done for the treatment of spondylosis in five patients, of a traumatic lesion in two, and of a tumor in one. Considering all fourteen patients, an average of 2.25 vertebral bodies was removed from each, and the average extent of the subsequent fusion was 3.25 levels. Eight patients (six of whom had spondylosis; one, a traumatic lesion; and one, a tumor) were treated with a fibular graft that spanned an average of 4.10 levels, and six patients (four of whom had a traumatic lesion and two, spondylosis) were treated with an iliac graft that spanned an average of 270 levels. Of the five patients who had a traumatic lesion, four were treated with anterior decompression and arthrodesis, combined with posterior arthrodesis that was performed during the same period of anesthesia. In three patients, the anterior graft dislodged during the immediate postoperative period. Two of the three patients had posterior instability due to a prior laminectomy, and in the third the graft dislodged because of technical difficulties. Two of these grafts were revised to restore stability. At the latest follow-up, twelve of the fourteen fusions were solid. In the other two patients, who died six and ten months postoperatively, the fusion had been solid, as shown by radiographs, before the time of death. The average amount of correction of the kyphotic deformities was 32 degrees, a reduction from an average of 45 degrees to an average of 13 degrees. All but one patient had some recovery of neural function; nine had complete and four, partial recovery. The remaining patient had relief of pain, but he continued to be completely quadriplegic although he had some sensory sparing. Of the four patients who had been unable to walk preoperatively, three were able to walk postoperatively. No patient lost neural function after the anterior decompression and arthrodesis. We concluded that, in the presence of severe cervical kyphosis and myelopathy, adequate anterior decompression of the spinal cord, correction of the kyphosis, and anterior arthrodesis using a strut graft can yield excellent results without undue risk.