颈前路椎间融合器植入治疗神经根型颈椎病：椎间孔变化与效果的关系

摘要

BACKGROUND: Cervical intervertebral foramen stenosis induced by cervical spondylosis of nerve root type usual y requires surgical treatment. The ways mainly include anterior cervical discectomy and fusion and cervical posterior intervertebral foramen decompression. Which is the best way is stil inconclusive. With innovation, anterior cervical discectomy and fusion for cervical spondylosis of nerve root type has become the mainstream in the current treatment. OBJECTIVE: To study the relationship between curative effects and intervertebral foramen-associated parameter changes in patients with cervical spondylosis of nerve root type after anterior cervical discectomy and fusion. METHODS: From March 2011 to April 2013, 132 patients with cervical spondylosis of nerve root type were treated with anterior cervical discectomy and fusion in the Changzheng Hospital Affiliated to the Second Military Medical University. Neck pain and arm pain visual analogue score, neck disability index score and imaging changes were evaluated before and after treatment. RESULTS AND CONCLUSION: 132 patients were fol owed up for 25(4-28) months. Significant differences in neck pain visual analogue scale, anterior intervertebral disc height, posterior intervertebral disc height, intervertebral foramen height, anterior and posterior diameters of the intervertebral foramen, the area of the intervertebral foramen, and the Cobb angle of the fused segment were detected in al patients before and after treatment (P < 0.05). Posterior intervertebral disc height was positively correlated with intervertebral foramen area (r=0.427, P=0.000). The increased Cobb angle of the fused segment was negatively associated with the size of intervertebral foramen (r=-0.273, P=0.003). Intervertebral foramen area was negatively associated with arm pain visual analogue score (r=-0.502, P=0.000). These results indicated that anterior cervical discectomy and fusion with an interbody fusion cage can obviously enlarge intervertebral foramen in patients with cervical spondylosis of nerve root type, and obtain good curative effect. The size of the intervertebral foramen is negatively related to the axial pain. The reconstruction of the intervertebral disc height is necessary to expand the intervertebral foramen. However, the increase of the curvature fusion segments is not helping to expand the intervertebral foramen.%背景：神经根型颈椎病引起的颈椎椎间孔狭窄通常需要手术方式治疗，其方式主要包括颈前路椎间融合器植入融合以及颈后路椎间孔减压，何种为最佳的方式仍未有定论，随着融合器技术革新，使得颈前路椎间融合器植入治疗神经根型颈椎病成为目前的主流治疗方式。目的：确定神经根型颈椎病患者经颈前路椎间融合器植入治疗后疗效与椎间孔相关参数变化的关系。方法：收集2011年3月至2013年4月在解放军第二军医大学附属长征医院采用颈前路减压椎间植骨融合治疗椎间孔狭窄神经根型颈椎病132例，评价治疗前后颈部疼痛和臂部疼痛的目测类比评分、颈椎功能障碍指数评分及患者影像学变化。结果与结论：132例治疗后获得平均25(4-28)个月随访。所有患者治疗前后颈部疼痛目测类比评分、椎间盘前端高度、椎间盘后端高度、椎间孔高度、椎间孔前后径、椎间孔面积、融合节段的 Cobb 角，差异有显著性意义(P <0.05)。椎间盘后端的高度与椎间孔的面积正相关(r=0.427，P=0.000)，而融合节段 Cobb 角的增加则与椎间孔的大小负相关(r=-0.273，P=0.003)。椎间孔的面积与臂部疼痛目测类比评分负相关(r=-0.502， P=0.000)。提示颈前路减压椎间植骨融合通过椎间融合器的植入能够使神经根型颈椎病患者椎间孔显著变大，并获得良好的疗效。椎间孔的大小与轴性疼痛负相关。椎间盘高度的重建对扩大椎间孔十分必要，然而融合节段曲度的增加对扩大椎间孔并无帮助。