颈前路椎管减压术后复发致邻近节段颈髓受压:1例报道及相关原因探讨

目的:颈前路椎管减压术是治疗颈椎病的重要方法,但术后少数患者发生邻近融合节段的退行性变,甚至需要二次手术治疗。本文旨在分析术后再次退变的原因,以期为广大外科医师提供参考。方法:报道1例该病再次手术的患者,回顾其疾病发展过程和治疗经过,并结合该病例综述国内外相关文献,深入探讨术后复发原因。结果:颈前路椎管减压术后复发主要有三类原因:1手术入路和手术方法的选择不恰当;2手术减压不充分,未能彻底解除潜在的颈髓压迫;3椎间融合后生物力学改变,相应颈椎节段应力不平衡。结论:对于需再次手术的患者,术前应仔细分析上次手术效果不佳或术后复发的原因,妥善选择再手术的方式。

Adjacent Segmental Cervical Spinal Compression caused by Anterior Cervical Fusion: a Case Report and Reasons Discussion

Objective:Spinal canal anterior decompression is an important treatment for cervical spondylosis. However, a few patients have adjacent segment degeneration after surgery, thus leading to corresponding neurological symptoms and second operation. This article aims to analyze potential reasons and to provide a reference for surgeons.Methods:One case who were underwent the second spinal canal anterior decompression were reported here. We reviewed the medical history and treatment course. Aditionally we extensively reviewed relative literatures to deeply discuss the potential reasons.Results:There are three possible mechanisms for postoperative re-compression. Firstly, the surgical approaches may be improper. Secondly, the decompression may be insufficient, failing to completely or definitively decompress the spinal cord. Thirdly, the biomechanics of adjacent segmental cervical vertebras may change after cervical fusion.Conclusion:For postoperative recurrent patients, carefully evaluating recurrent reasons are of vital importance to the treatment plan decision.