Cervical myelopathy. current diagnostic and treatment strategies.
Cervical myelopathy. current diagnostic and treatment strategies.
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DOI：
10.1016/s1529-9430(02)00566-1
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Vaccaro, Alexander F
中科院分区：
文献类型：
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作者：
Edwards, Charles C 2nd;Riew, K Daniel;Vaccaro, Alexander F
脊髓型颈椎病是由脊髓功能障碍引起的多种临床综合征。潜在原因有很多，但一个或多个层面的脊椎病是最常见的病因。自然史研究表明，大多数患者的临床病程各不相同，神经功能逐渐恶化。虽然前瞻性临床比较有限，但现有文献表明，手术治疗可以可靠地阻止脊髓病的进展，并可能导致大多数患者的功能改善。手术程序的选择必须根据具体的临床和放射学因素仔细个体化。虽然在一两个运动节段的前路减压和融合手术具有可预测的结果，但涉及三个或更多节段的手术与发病率增加相关。治疗多节段脊髓型颈椎病的新技术包括前路减压360度融合、混合椎体切除术/前路颈椎间盘切除术和融合技术以及动态前路颈椎钢板的使用。针对前凸矢状面排列患者的另一种技术是椎板成形术，该技术具有长期良好至优异结果的良好记录。
Cervical myelopathy is a varied clinical syndromes resulting from spinal cord dysfunction. Underlying causes are numerous, but spondylosis at one or more levels is the most common etiology. Natural history studies have demonstrated a variable clinical course with gradual neurologic deterioration in a majority of patients. While prospective clinical comparisons are limited, existing literature suggests that operative management reliably arrests the progression of myelopathy and may lead to functional improvement in a majority of patients. The selection of surgical procedures must be carefully individualized based on specific clinical and radiographic factors. Whereas anterior decompression and fusion procedures at one or two motion segments have predictable results, procedures involving three or more levels are associated with increased morbidity. Newer techniques for the treatment of multilevel cervical myelopathy include anterior decompression with 360-degree fusion, hybrid corpectomy/anterior cervical discectomy and fusion techniques and the use of dynamic anterior cervical plates. An alternative technique for patients with a lordotic sagittal alignment is laminoplasty, which has a proven track record of long-term good to excellent results.