Objective To evaluate the role of anterior decompression with resection of the posterior longitudinal ligament(PLL)on the cervical degenerative disease with sympathetic symptoms and to primarily validate onr speculation on the mechanism of this entity.Methods Forty-seven ca8es suffered from cervical spondylesis from 2002 to 2007 were retrospectively reviewed.The inclusive criteria were:(1)cervicalmyelopathy or radiculopathy or both secondary to cervical degenerative disease;(2)complaining of unexplainable and irrelievable sympathetic symptoms such as dizziness,vertigo,etc;(3)performed with anterior cervical decompression with PLL resection and internal fixation.The JOA scores were recorded and evaluated.The sympathetic symptoms were evaluated by both 20 points evaluation system and patient's satisfaction evaluation.The posterior longitudinal ligaments of 8 rabbits were harvested and stained by Sucrose-Phosphate-glyoxylic acid(SPG)to distinguish the sympathetic nerve fibers.The results were observed and evaluated by fluorescent microscope and Image-pro plus 5.0.Results All the patients were followed up for 10 to 48 months.The JOA scores before operation were 12.6 and increased to 15.2 at the final follow up.The sympathetic symptoms evaluation was 6.0 before operation and 2.8 after.The satisfactory evaluation was excellent in 19 cases,good in 16,fair in 8 and poor in 4.The effective rate was 87.5%.The SPG stain showed that there were plenty of sympathetic post-ganglia fibers in the cervical PLL.which were distributed like a web.and there were more fibers distributed at the interspaced zone than at the vertebral body zone.The density of the sympathetic nerve fibers in the C2/3,C3/4and C4/5 were greater than these in C5/6 and C6/7;while the density in the shallow layer were greater than those in the deep layer.Conclusions The sympathetic nerve fibers distributed in the cervical PLL maybe another one significant factor causing sympathetic symptom of cervical spondylesis.The anterior cervical decompression with resection of PLL Call relieve the sympathetic symptoms of the patients.%目的 分析切除后纵韧带的颈前路减压术在治疗伴交感神经症状颈椎病中的意义及机制.方法 回顾分析2002至2007年颈椎病手术患者47例.入选条件:(1)脊髓型或神经根型或脊髓.神经根混合型颈椎病;(2)均伴头晕等交感神经症状;(3)均行颈前路减压植骨融合内固定术,术中均切除后纵韧带.以JOA评分评价神经功能,20分评分法及患者主观满意度评价交感神经症状.切取8只家兔颈椎后纵韧带.乙醛酸染色,荧光显微镜下观察后纵韧带内是否存在交感神经纤维,并用图像分析软件分析其分布特点.结果 随访10～48个月,术前JOA评分12.6分,末次随访15.2分.术前交感症状评分6.0分,术后2.8分;主观满意度评价:优19例,良16例,可8例,差4例,有效率87.5%.动物实验结果显示颈椎后纵韧带上存在大量呈网状分布的交感神经节后纤维,椎间隙区分布较椎体区密集;后纵韧带浅层较深层密集;C2/3、C3/4、C3/4、C4/5节段较C5/6、C6/7密集.结论 颈后纵韧带上分布的交感神经可能是引发颈交感神经症状的另一重要因素.颈前路减压植骨融合术在治疗伴有交感神经症状的颈椎病中有一定作用.
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