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首页> 外文期刊>European Spine Journal >Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases
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Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases

机译：基于放射学受压方式的颈椎病性脊髓病的手术方法：前瞻性分析129例

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This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol based on POC and determine its efficacy. Average follow-up period was 2.8 years. Following POCs were identified: POC I: one or two levels of anterior cord compression. POC II: one or two levels of anterior and posterior compression. POC III: three levels of anterior compression. POC III variant: similar to POC III, associated with significant medical morbidity. POC IV: three or more levels of anterior compression in a developmentally narrow canal or with multiple posterior compressions. POC IV variant: similar to POC IV with one or two levels, being more significant than the others. POC V: three or more levels of compression in a kyphotic spine. Anterior decompression and reconstruction was chosen for POC I, II and III. Posterior decompression was chosen in POC III variant because they had more incidences of preoperative morbidity, in spite of being radiologically similar to POC III. Posterior surgery was also performed for POC IV and IV variant. For POC IV variant a targeted anterior decompression was considered after posterior decompression. The difference in the mJOA score before and after surgery for patients in each POC group was statistically significant. Anterior surgery in MCM had better result (mJOA = 15.9) versus posterior surgery (mJOA = 14.96), the difference being statistically significant. No major graft-related complications occurred in multilevel groups. The better surgical outcome of anterior surgery in MCM may make a significant difference in surgical outcome in younger and fitter patients like those of POC III whose expectations out of surgery are more. Judicious choice of anterior or posterior approach should be made after individualizing each case.
机译：这是对129例颈椎病（CSM）手术患者的前瞻性分析。 CSM，尤其是多级CSM（MCM）手术管理的前瞻性数据很少，因此难以做出手术决策。该研究的目的是（1）识别脐带受压（POC）的放射学模式，以及（2）提出基于POC的手术方案并确定其疗效。平均随访期为2。8年。确定了以下POC：POC I：一或两个水平的前脐带压迫。 POC II：前后压缩一到两个水平。 POC III：三个水平的前路压迫。 POC III变体：与POC III相似，具有明显的医学发病率。 POC IV：在狭窄的发育中或多次后加压的情况下，前压达到三个或更多水平。 POC IV变体：类似于POC IV，具有一个或两个级别，比其他级别更重要。 POC V：后凸脊柱的三个或三个以上压缩水平。 POC I，II和III选择了前路减压和重建。尽管在放射学上与POC III相似，但在POC III变体中选择后路减压是因为它们的术前发病率更高。还对POC IV和IV变体进行了后路手术。对于POC IV变体，在后减压后考虑进行有针对性的前减压。每个POC组患者手术前后mJOA得分的差异具有统计学意义。 MCM前路手术的结果（mJOA = 15.9）优于后路手术（mJOA = 14.96），差异具有统计学意义。在多水平组中，没有发生重大的移植相关并发症。在MCM中，前期手术的手术效果更好，可能对年轻且健康的患者（如对POC III的手术效果更高的患者）的手术效果产生重大影响。在对每个病例​​进行个体化之后，应明智地选择前入路还是后入路。

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