Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusio...Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.展开更多
Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we co...Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.展开更多
Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging （MRI） between patients with and without developmental cervical...Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging （MRI） between patients with and without developmental cervical stenosis and its clinical significance.Methods A total of 264 patients with cervical spondylotic myelopathy who had decompression surgeries were recruited.The average follow-up was 29 months.Based on their lateral radiographs,they were divided into stenosis group and non-stenosis group.On the magnetic resonance images,the ratio of the sagittal diameter of the dural sac to that of the vertebral body was measured and calculated as MRI Pavlov ratio at the mid-vertebral level on T2-weighted sagittal images from C3 to C7.The ratio of the transverse area of the spinal cord to that of the dural sac was measured and calculated as occupation ratio on T2-weighted axial images at the same levels.The MRI Pavlov ratio and occupation ratio were compared between the two groups.The stenosis group was further divided into space-reserving and non-space-reserving subgroups based on the occupation ratios; then clinical parameters were compared between the two subgroups to determine the clinical significance of the reserving space.Results The MRI Pavlov ratio of the stenosis group was significantly smaller than that of the non-stenosis group at C3-C7 （P ＜0.01）,while the occupation ratio was significantly larger only at C7 （P ＜0.05）.For the space-reserving subgroup,the postoperative recovery rate was lower （P ＜0.05）.The postoperative recovery rate was （23±6）％ in anterior approach,larger than （-23±15）％ in posterior approach （P ＜0.05）.Conclusions Developmental cervical stenosis is associated with a smaller sagittal diameter of the dural sac,but does not lead to a significant decrease in intra-dural space available for the cord.For patients with normal intra-dural space,the recovery after anterior decompression surgery was better than posterior approach.展开更多
文摘Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
文摘Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.
文摘Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging （MRI） between patients with and without developmental cervical stenosis and its clinical significance.Methods A total of 264 patients with cervical spondylotic myelopathy who had decompression surgeries were recruited.The average follow-up was 29 months.Based on their lateral radiographs,they were divided into stenosis group and non-stenosis group.On the magnetic resonance images,the ratio of the sagittal diameter of the dural sac to that of the vertebral body was measured and calculated as MRI Pavlov ratio at the mid-vertebral level on T2-weighted sagittal images from C3 to C7.The ratio of the transverse area of the spinal cord to that of the dural sac was measured and calculated as occupation ratio on T2-weighted axial images at the same levels.The MRI Pavlov ratio and occupation ratio were compared between the two groups.The stenosis group was further divided into space-reserving and non-space-reserving subgroups based on the occupation ratios; then clinical parameters were compared between the two subgroups to determine the clinical significance of the reserving space.Results The MRI Pavlov ratio of the stenosis group was significantly smaller than that of the non-stenosis group at C3-C7 （P ＜0.01）,while the occupation ratio was significantly larger only at C7 （P ＜0.05）.For the space-reserving subgroup,the postoperative recovery rate was lower （P ＜0.05）.The postoperative recovery rate was （23±6）％ in anterior approach,larger than （-23±15）％ in posterior approach （P ＜0.05）.Conclusions Developmental cervical stenosis is associated with a smaller sagittal diameter of the dural sac,but does not lead to a significant decrease in intra-dural space available for the cord.For patients with normal intra-dural space,the recovery after anterior decompression surgery was better than posterior approach.
