COMBINED CERVICAL POSTERIOR-ANTERIOR OPERATION FOR TREATMENT OF CERVICAL SPINAL CANAL STENOSIS WITH REVERSE ARCH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Wei ^1,2 , MA Xinlong ³ , SUN Tianwei ² , FANG Zhao ² , ZHANG Xueli ² , CUI Zijian ²

1Graduate School of Tianjin Medical University, Tianjin, 300070, P.R.China;;
2Department of Spine Surgery, Tianjin Union Medicine Centre, Nankai University People’s Hospital;;
3Department of Orthopaedics, General Hospital of Tianjin Medical University. Corresponding author: MA Xinlong, E-mail: maxinlong8686@sina.com;

Corresponding author：

Keywords：

Cervical spinal canal stenosis; Internal fixation; Spinal fusion; Laminoplasty

DOI：

10.7507/1002-1892.20130090

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Objective To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch. Methods Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years (range, 38-62 years) and an average disease duration of 25 months (range, 18-60 months). All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology (CR) of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4-7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale (VAS) score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association (JOA) score to assess the nerve function improvement. Results All incisions healed by first intention. All patients were followed up 9-32 months (mean, 15.4 months). Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up (3.25 ± 1.54) was significantly lower than that at preoperation (6.55 ± 1.52) (P lt; 0.05); JOA score at last follow-up (10.45 ± 4.23) was significantly higher than that at preoperation (7.05 ± 1.32) (P lt; 0.05); and cervical curvature value at last follow-up [(6.53 ± 3.12) mm] was significantly higher than that at preoperation [(3.22 ± 5.15) mm] (P lt; 0.05). Conclusion Combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch is a safe and effective surgical method.

Citation： HU Wei,MA Xinlong,SUN Tianwei,FANG Zhao,ZHANG Xueli,CUI Zijian. COMBINED CERVICAL POSTERIOR-ANTERIOR OPERATION FOR TREATMENT OF CERVICAL SPINAL CANAL STENOSIS WITH REVERSE ARCH. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 385-388. doi: 10.7507/1002-1892.20130090 Copy

1.	J, 2010, 19(2): 347-348.
2.	周方宇, 李锋, 方忠, 等. 一期前后路联合手术治疗多节段颈椎间盘突出合并后纵韧带骨化症. 中国组织工程研究与临床康复, 2010, 14(4): 726-731.
3.	Koakutsu T, Morozumi N, Ishii Y, et al. Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc heriation: a prospective multicenter study. J Orthop Sci, 2012, 15(1): 71-78.
4.	Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
5.	李勤, 田伟. 应根据特点选择退行性颈椎管狭窄症的前后路手术方法. 中华医学杂志, 2011, 91(31): 2161-2162.
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7.	Williams KE, Paul R, Dewan Y. Functional outcome of corpectomy in cervical spondylotic myelopathy. Indian J Orthop, 2009, 43(2): 205-209.
8.	刘金望, 白云深, 邵国喜, 等. 老年多节段颈椎间盘突出症并发育性颈椎管狭窄两种后路手术的疗效比较. 中国老年学杂志, 2011, 31(17): 3251-3253.
9.	Aoyama T, Hida K, Akino M, et al. Ultra-early MRI showing no abnormality in a fall victim presenting with tetraparesis. Spinal Cord, 2007, 45(10): 695-699.
10.	张国庆, 陈伯华, 西永明, 等. 后路椎板成形并突出髓核摘除治疗颈椎管狭窄并颈椎间盘突出症. 中华神经外科杂志, 2010, 26(1): 59-61.
11.	罗春山, 邱冰, 李波, 等. Ⅰ期后前路减压、植骨固定术治疗严重下颈椎椎管骨性狭窄. 中华创伤杂志, 2011, 27(8): 684-687.
12.	Yoon JY, Chang H, Park KB, et al. Effect of the number of involved spinal cord segments on gait function in patients with cervical spondylotic myelopathy. Asian Spine J, 2012, 6(4): 233-240.
13.	程真, 王林峰, 申勇, 等. 颈椎曲度及椎间高度变化对颈后路减压术后疗效的影响. 中华骨科杂志, 2012, 32(4): 304-308.
14.	Uehara M, Takahashi J, Ogihara N, et al. Cervical pedicle screw fixation combined with laminoplasty for cervical spondylotic myelopathy with instability. Asian Spine J, 2012, 6(4): 241-248.
15.	唐延军, 刘建锋, 王宪俊, 等. 经关节螺钉、侧块螺钉在颈椎后路双向内固定术中的应用. 中国临床研究, 2010, 23(2): 103-105.
16.	尹华, 赵银必. 三种置钉方法在下颈椎经椎弓根螺钉置入过程中的比较. 中国组织工程研究与临床康复, 2011, 15(22): 4040-4044.
17.	Luk KD, Kamath V, Avadhani A, et al. Cervical laminoplasty. Eur Spine.
18.	杨海松, 陈德玉, 史建刚. 伴颈椎后纵韧带骨化的颈椎间盘突出症手术治疗. 中华骨科杂志, 2010, 30(1): 98-103.
19.	Islam MA, Islam MA, Habib MA, et al. Anterior cervical discectomy, fusion and stabilization by plate and screw—early experience. Bangladesh Med Res Counc Bull, 2012, 38(2): 62-66.

1. J, 2010, 19(2): 347-348.
2. 周方宇, 李锋, 方忠, 等. 一期前后路联合手术治疗多节段颈椎间盘突出合并后纵韧带骨化症. 中国组织工程研究与临床康复, 2010, 14(4): 726-731.
3. Koakutsu T, Morozumi N, Ishii Y, et al. Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc heriation: a prospective multicenter study. J Orthop Sci, 2012, 15(1): 71-78.
4. Kong Q, Zhang L, Liu L, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976), 2011, 36(13): 1030-1036.
5. 李勤, 田伟. 应根据特点选择退行性颈椎管狭窄症的前后路手术方法. 中华医学杂志, 2011, 91(31): 2161-2162.
6. Tofuku K, Koga H, Kawabata N, et al. Dorsally sequestered cervical disc herniation. Spine (Phila Pa 1976), 2007, 32(26): E837-840.
7. Williams KE, Paul R, Dewan Y. Functional outcome of corpectomy in cervical spondylotic myelopathy. Indian J Orthop, 2009, 43(2): 205-209.
8. 刘金望, 白云深, 邵国喜, 等. 老年多节段颈椎间盘突出症并发育性颈椎管狭窄两种后路手术的疗效比较. 中国老年学杂志, 2011, 31(17): 3251-3253.
9. Aoyama T, Hida K, Akino M, et al. Ultra-early MRI showing no abnormality in a fall victim presenting with tetraparesis. Spinal Cord, 2007, 45(10): 695-699.
10. 张国庆, 陈伯华, 西永明, 等. 后路椎板成形并突出髓核摘除治疗颈椎管狭窄并颈椎间盘突出症. 中华神经外科杂志, 2010, 26(1): 59-61.
11. 罗春山, 邱冰, 李波, 等. Ⅰ期后前路减压、植骨固定术治疗严重下颈椎椎管骨性狭窄. 中华创伤杂志, 2011, 27(8): 684-687.
12. Yoon JY, Chang H, Park KB, et al. Effect of the number of involved spinal cord segments on gait function in patients with cervical spondylotic myelopathy. Asian Spine J, 2012, 6(4): 233-240.
13. 程真, 王林峰, 申勇, 等. 颈椎曲度及椎间高度变化对颈后路减压术后疗效的影响. 中华骨科杂志, 2012, 32(4): 304-308.
14. Uehara M, Takahashi J, Ogihara N, et al. Cervical pedicle screw fixation combined with laminoplasty for cervical spondylotic myelopathy with instability. Asian Spine J, 2012, 6(4): 241-248.
15. 唐延军, 刘建锋, 王宪俊, 等. 经关节螺钉、侧块螺钉在颈椎后路双向内固定术中的应用. 中国临床研究, 2010, 23(2): 103-105.
16. 尹华, 赵银必. 三种置钉方法在下颈椎经椎弓根螺钉置入过程中的比较. 中国组织工程研究与临床康复, 2011, 15(22): 4040-4044.
17. Luk KD, Kamath V, Avadhani A, et al. Cervical laminoplasty. Eur Spine.
18. 杨海松, 陈德玉, 史建刚. 伴颈椎后纵韧带骨化的颈椎间盘突出症手术治疗. 中华骨科杂志, 2010, 30(1): 98-103.
19. Islam MA, Islam MA, Habib MA, et al. Anterior cervical discectomy, fusion and stabilization by plate and screw—early experience. Bangladesh Med Res Counc Bull, 2012, 38(2): 62-66.

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Chinese Journal of Reparative and Reconstructive Surgery

COMBINED CERVICAL POSTERIOR-ANTERIOR OPERATION FOR TREATMENT OF CERVICAL SPINAL CANAL STENOSIS WITH REVERSE ARCH

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