多节段颈椎退行性疾病后路手术的临床研究
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摘要
第一部分改良型单开门椎板成形内固定术治疗多节段颈椎退行性疾病疗效分析
目的：评估并分析改良型单开门椎板成形内固定术治疗多节段颈椎退行性疾病的疗效
方法：住院患者中回顾性的纳入26名患有多节段脊髓型颈椎病或后纵韧带骨化症患者,均接受了改良单开门椎板成形术联合微型钛板固定,并在门轴侧植入骨泥。观测并比较术前术后JOA评分,X光片(正侧位及过伸过屈侧位),三维CT及MRI。
结果：术后平均随访时间为22个月(12-34个月),所有患者术后6月均达到门轴侧的骨性融合,JOA改善率为60.7%,术后轴性症状发生率为23%,颈椎活动度平均丢失3.2度,没有内固定失败或术后神经症状加重的情况发生。
结论：改良微型钛板固定单开门椎板成形术是一项安全有效的治疗多节段颈椎退行性疾病的手术方法。它能够保留颈椎的生理活动,降低术后轴性症状的发生,并能够避免了融合手术相关并发症。
第二部分改良型单开门椎板成形术与全椎板切除植骨融合内固定术治疗多节段颈椎退行性疾病的临床对照研究
目的：比较改良型微型钛板固定单开门椎板成形术与全椎板切除联合内固定术的临床疗效
方法：住院患者中回顾性的纳入41名患有多节段脊髓型颈椎病或后纵韧带骨化症并接受手术治疗的患者,其中23名采用了全椎板切除联合内固定术,18例患者采用了选择性改良单开门椎板成形术联合微型钛板固定,并在门轴侧植入骨泥。观测并比较术前术后JOA评分,X光片,三维CT及MRI。
结果：改良型单开门组平均随访期为26个月,而全椎板切除术组平均随访期为30个月。单开门组所有患者在术后6个月门轴侧均已融合。在JOA改善率、手术时间、内固定相关并发症等方面,两组之间没有明显区别,而在轴性症状发病率以及颈椎活动度减少程度方面,单开门组明显低于传统全椎板切除组。
结论：与传统全椎板切除术相比较,改良型单开门椎板成形术临床疗效更为显著,术后并发症更低。进一步来说,单开门手术可以保留运动节段,减少轴性症状的发病率,并避免融合相关并发症。
第三部分颈椎后路手术术后轴性症状危险因素分析
目的通过对两种颈椎后路手术的临床随访与疗效评价,探究分析术后轴性症状发病的危险因素。
方法2005年6月～2011年6月,纳入多节段脊髓型颈椎病或后纵韧带骨化症行后路手术治疗的患者,其中全椎板切除植骨融合内固定手术86例,单开门椎板成形内固定术45例,搜集两组患者术前年龄、性别、症状、手术节段、术中出血量、手术时间、术后引流量、出院时间、术前术后X片、JOA评分,随访术后轴性症状持续时间及严重程度。
结果术后随访6-36个月。年龄、性别、手术时间、出血量、术后颈椎曲度变化及JOA改善率与轴性症状发病率无明显相关,单开门椎板成形组术后轴性症状发病率及严重程度明显低于全椎板切除组,术前就有颈肩痛症状以及手术节段累计颈2颈7节段的患者,术后均由更高的风险发生轴性症状。
结论：选择合适的手术方式、谨慎选择手术节段,术中尽量保护后方肌肉韧带复合体,对于减少术后轴性症状有着重要的意义。
Part1Plate-only open-door laminoplasty with fusion in treatment of multilevel degenerative cervical disease
Objective:To evaluate safety and efficacy of improved plate-only fixation open door laminoplasty with supraspinal ligament preserved.
Methods:Thirty-five patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was put on the hinge side to promote fusion, with no bone struts on the open side. The JOA score, X-ray,3-dimensional CT and MRI were used for the pre-and postoperative evaluation.
Results:The mean follow-up period was22months (12-34months), and all patients had achieved osseous fusion within6months after the operation. The JOA improvement was60.7%; a23%incidence of axial neck pain and a3.2°loss of ROM were observed in the patients who underwent open-door laminoplasty. No instrumentation failure or clinical deterioration was observed in our study.
Conclusion:The research showed that open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical range of motion, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion.
Part2Clinical evaluation of improved open-door laminoplasty with miniplate fixation and fusion versus laminectomy in cervical degenerative disease, a retrospective cohort study
Objective:to evaluate clinical efficacy of an improved open-door laminoplasty with pre-bend miniplate fixation and fusion as well as early post-operative exercise.
Methods:Among41patients diagnosed as multilevel OPLL or cervical spondylotic myelopathy,23patients were enrolled for conventional posterior laminectomy and fusion, and18patients were enrolled for selective open-door laminoplasty with miniplate fixation, with bone debris on hinge side to promote fusion. The JOA score, X-ray (including forced flexion and extension),3-dimenstional CT and MRI were used for the pre-and post-operative evaluation.
Results:The mean follow-up period was26months for the laminoplasty group and30months for the laminectomy group. All patients in laminoplasty group gained osseous fusion6months after operation. No significant difference in JOA score improvement, surgical time, and complications related to instrumentation was observed between two groups. In contrast, the incidence of axial neck pain and loss of ROM in the open-door laminoplasty group was significantly lower than that in the conventional laminectomy group.
Conclusions:Compared with conventional laminectomy, open-door laminoplasty with miniplate fixation is a safe, simple and lowly invasive surgery for multilevel cervical disease with profound clinical efficacy. Moreover, the improved open-door laminoplasty can maintain the cervical motion rage, reduce the incidence of post-operative axial neck pain and avoid the complications related to fusion.
Part3Risk factor analysis of axial syndromes after laminectomy or laminoplasy.
Objective:To identify the risk factor of axial syndromes after laminectomy or laminoplasty by evaluate the clinical efficacy and safety of the cervical surgeries.
Methods:Patients presented with multilevel ossification of posterior longitude ligament or cervical myelopathy between2005.6to2011.6were enrolled into the research,86patients received laminectomy and fusion, while45patients received plate-only instrumented laminoplasty. The parameter include age, gender, axial syndromes before surgery, operated level, operation time, blood loss in surgery, drainage volume, discharge days, JOA score and X-ray before and after surgery, as well as the severity and duration of axial syndromes after surgery were collected.
Results:The mean follow-up period was6-36months. Age, gender, operation time, blood loss in surgery, drainage volume, discharge days, JOA score improvement and Ishihara index had no significant correlation with the incidence of axial syndromes. And laminectomy had a high correlation with the axial syndromes, as well as axial syndromes before operation and if C2or C7was involved in the surgery.
Conclusion:The research showed that laminectomy, C2or C7involved, and axial syndromes before surgery could induce a higher risk of axial syndromes.
目的：评估并分析改良型单开门椎板成形内固定术治疗多节段颈椎退行性疾病的疗效
方法：住院患者中回顾性的纳入26名患有多节段脊髓型颈椎病或后纵韧带骨化症患者,均接受了改良单开门椎板成形术联合微型钛板固定,并在门轴侧植入骨泥。观测并比较术前术后JOA评分,X光片(正侧位及过伸过屈侧位),三维CT及MRI。
结果：术后平均随访时间为22个月(12-34个月),所有患者术后6月均达到门轴侧的骨性融合,JOA改善率为60.7%,术后轴性症状发生率为23%,颈椎活动度平均丢失3.2度,没有内固定失败或术后神经症状加重的情况发生。
结论：改良微型钛板固定单开门椎板成形术是一项安全有效的治疗多节段颈椎退行性疾病的手术方法。它能够保留颈椎的生理活动,降低术后轴性症状的发生,并能够避免了融合手术相关并发症。
第二部分改良型单开门椎板成形术与全椎板切除植骨融合内固定术治疗多节段颈椎退行性疾病的临床对照研究
目的：比较改良型微型钛板固定单开门椎板成形术与全椎板切除联合内固定术的临床疗效
方法：住院患者中回顾性的纳入41名患有多节段脊髓型颈椎病或后纵韧带骨化症并接受手术治疗的患者,其中23名采用了全椎板切除联合内固定术,18例患者采用了选择性改良单开门椎板成形术联合微型钛板固定,并在门轴侧植入骨泥。观测并比较术前术后JOA评分,X光片,三维CT及MRI。
结果：改良型单开门组平均随访期为26个月,而全椎板切除术组平均随访期为30个月。单开门组所有患者在术后6个月门轴侧均已融合。在JOA改善率、手术时间、内固定相关并发症等方面,两组之间没有明显区别,而在轴性症状发病率以及颈椎活动度减少程度方面,单开门组明显低于传统全椎板切除组。
结论：与传统全椎板切除术相比较,改良型单开门椎板成形术临床疗效更为显著,术后并发症更低。进一步来说,单开门手术可以保留运动节段,减少轴性症状的发病率,并避免融合相关并发症。
第三部分颈椎后路手术术后轴性症状危险因素分析
目的通过对两种颈椎后路手术的临床随访与疗效评价,探究分析术后轴性症状发病的危险因素。
方法2005年6月～2011年6月,纳入多节段脊髓型颈椎病或后纵韧带骨化症行后路手术治疗的患者,其中全椎板切除植骨融合内固定手术86例,单开门椎板成形内固定术45例,搜集两组患者术前年龄、性别、症状、手术节段、术中出血量、手术时间、术后引流量、出院时间、术前术后X片、JOA评分,随访术后轴性症状持续时间及严重程度。
结果术后随访6-36个月。年龄、性别、手术时间、出血量、术后颈椎曲度变化及JOA改善率与轴性症状发病率无明显相关,单开门椎板成形组术后轴性症状发病率及严重程度明显低于全椎板切除组,术前就有颈肩痛症状以及手术节段累计颈2颈7节段的患者,术后均由更高的风险发生轴性症状。
结论：选择合适的手术方式、谨慎选择手术节段,术中尽量保护后方肌肉韧带复合体,对于减少术后轴性症状有着重要的意义。
Part1Plate-only open-door laminoplasty with fusion in treatment of multilevel degenerative cervical disease
Objective:To evaluate safety and efficacy of improved plate-only fixation open door laminoplasty with supraspinal ligament preserved.
Methods:Thirty-five patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was put on the hinge side to promote fusion, with no bone struts on the open side. The JOA score, X-ray,3-dimensional CT and MRI were used for the pre-and postoperative evaluation.
Results:The mean follow-up period was22months (12-34months), and all patients had achieved osseous fusion within6months after the operation. The JOA improvement was60.7%; a23%incidence of axial neck pain and a3.2°loss of ROM were observed in the patients who underwent open-door laminoplasty. No instrumentation failure or clinical deterioration was observed in our study.
Conclusion:The research showed that open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical range of motion, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion.
Part2Clinical evaluation of improved open-door laminoplasty with miniplate fixation and fusion versus laminectomy in cervical degenerative disease, a retrospective cohort study
Objective:to evaluate clinical efficacy of an improved open-door laminoplasty with pre-bend miniplate fixation and fusion as well as early post-operative exercise.
Methods:Among41patients diagnosed as multilevel OPLL or cervical spondylotic myelopathy,23patients were enrolled for conventional posterior laminectomy and fusion, and18patients were enrolled for selective open-door laminoplasty with miniplate fixation, with bone debris on hinge side to promote fusion. The JOA score, X-ray (including forced flexion and extension),3-dimenstional CT and MRI were used for the pre-and post-operative evaluation.
Results:The mean follow-up period was26months for the laminoplasty group and30months for the laminectomy group. All patients in laminoplasty group gained osseous fusion6months after operation. No significant difference in JOA score improvement, surgical time, and complications related to instrumentation was observed between two groups. In contrast, the incidence of axial neck pain and loss of ROM in the open-door laminoplasty group was significantly lower than that in the conventional laminectomy group.
Conclusions:Compared with conventional laminectomy, open-door laminoplasty with miniplate fixation is a safe, simple and lowly invasive surgery for multilevel cervical disease with profound clinical efficacy. Moreover, the improved open-door laminoplasty can maintain the cervical motion rage, reduce the incidence of post-operative axial neck pain and avoid the complications related to fusion.
Part3Risk factor analysis of axial syndromes after laminectomy or laminoplasy.
Objective:To identify the risk factor of axial syndromes after laminectomy or laminoplasty by evaluate the clinical efficacy and safety of the cervical surgeries.
Methods:Patients presented with multilevel ossification of posterior longitude ligament or cervical myelopathy between2005.6to2011.6were enrolled into the research,86patients received laminectomy and fusion, while45patients received plate-only instrumented laminoplasty. The parameter include age, gender, axial syndromes before surgery, operated level, operation time, blood loss in surgery, drainage volume, discharge days, JOA score and X-ray before and after surgery, as well as the severity and duration of axial syndromes after surgery were collected.
Results:The mean follow-up period was6-36months. Age, gender, operation time, blood loss in surgery, drainage volume, discharge days, JOA score improvement and Ishihara index had no significant correlation with the incidence of axial syndromes. And laminectomy had a high correlation with the axial syndromes, as well as axial syndromes before operation and if C2or C7was involved in the surgery.
Conclusion:The research showed that laminectomy, C2or C7involved, and axial syndromes before surgery could induce a higher risk of axial syndromes.
引文
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6. Kanemura A, Doita M, Iguchi T, et al. Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty[J]. J Neurosurg Spine. 2008;8(2):121-128.
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14. IizukaH, ShimizuT, TatenoK, et al. Extensormusculature of the cervical spine after laminoplasty:morphologicevaluation by coronal view of themagnetic resonance image[J]. Spine, 2001;26(20):2220-2226.
15.韩雨.张永刚,张雪松.颈椎椎板切除融合术后轴性疼痛[J].现代生物医学进展；2011；3：515-518.
16.许立新.余天东,张斌,等.颈椎后路侧块钢板内固定术的疗效观察[J].中国矫形外科杂志；2006：14：832-836.
17.曹俊明,中勇,杨大龙,等.颈椎椎板成形术后颈部轴性症状的影响因素及防治[J].中国矫形外科杂志；2008；16：1629-1631.
18. MunehitoY, Tetsuya T, Mamoru K, et al. Does reconstruction of posterior ligamentous complex with extensor musculature decrease axial syndromes after cervical laminoplasty[J]. Spine; 2002,27:1414-1418.
19.张为,陈百成,丁文元,等.术后围领佩戴时间对颈椎轴性症状的影响[J].1中国康复医学杂志；2007；22：129-132.
[1]Kim TJ, Bae KW, Uhm WS, et al. Prevalence of ossification of the posterior longitudinal ligament of the cervical spine[J]. Joint Bone Spine,2008,75(4):471-474.
[2]Cunningham MR, Hershman S, Bendo J. Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy[J]. Spine (Phila Pa 1976),2010, 35(5):537-543.
[3]Kaiser MG. Multilevel cervical spondylosis. Neurosurg Clin N Am,2006,17(3):263-275.
[4]Liu T, Yang HL, Xu YZ, et al. ACDF With the PCB Cage-Plate System Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy[J]. J Spinal Disord Tech,2010, 24(4):213-220.
[5]DuBois CM, Bolt PM, Todd AG, et al. Static versus dynamic plating for multilevel anterior cervical discectomy and fusion[J]. Spine J,2007,7(2):188-193.
[6]Nunley PD, Jawahar A, Kerr EJ,3rd, et al. Choice of plate may affect outcomes for single versus multilevel ACDF:results of a prospective randomized single-blind trial[J]. Spine J, 2009,9(2):121-127.
[7]李建光,苗军,夏群.前路椎间融合器在多节段脊髓型颈椎病治疗中的应用[J].中华骨科杂志,2007,27(8)：576-579.
[8]Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy:a prospective randomized control clinical study[J]. Eur Spine J,2010,19(5):713-719.
[9]张儒,赵凤东,范顺武,等.前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病[J].中华骨科杂志,2010,30(9)：837-841
[10]Wei-bing X, Wun-Jer S, Gang L, et al. Reconstructive techniques study after anterior decompression of multilevel cervical spondylotic myelopathy[J]. J Spinal Disord Tech,2009, 22(7):511-515.
[11]Ying Z, Xinwei W, Jing Z, et al. Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy:a randomized control clinical study[J]. Spine (Phila Pa 1976),2007,32(14):1482-1487.
[12]袁文,张颖,王新伟,等.保留椎体后壁的椎体次全切除术治疗多节段颈椎病的前瞻性研究[J].中华外科杂志,2006,44(16)：1087-1090.
[13]Hwang SL, Lee KS, Su YF, et al. Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease [J]. J Spinal Disord Tech,2007,20(8):565-570.
[14]Brazenor GA. Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis:analysis of outcome with long-term follow-up and interview by independent physician[J]. Spine (Phila Pa 1976),2007,32(1):63-71.
[15]Ikenaga M, Shikata J, Tanaka C. Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy[J]. Spine (Phila Pa 1976),2006,31(14):1568-1574; discussion 1575.
[16]Okawa A, Sakai K, Hirai T, et al. Risk Factors for Early Reconstruction Failure of Multilevel Cervical Corpectomy With Dynamic Plate Fixation[J]. Spine (Phiia Pa 1976),2010, 36(9):E582-587.
[17]Acosta FL, Jr., Aryan HE, Ames CP. Successful outcome of six-level cervicothoracic corpectomy and circumferential reconstruction:case report and review of literature on multilevel cervicothoracic corpectomy[J]. Eur Spine J,2006,15 Suppl (5):670-674.
[18]Lu J, Wu X, Li Y, et al. Surgical results of anterior corpectomy in the aged patients with cervical myelopathy [J]. Eur Spine J,2008,17(1):129-135.
[19]Lee MJ, Bazaz R, Furey CG, et al. Risk factors for dysphagia after anterior cervical spine surgery:a two-year prospective cohort study[J]. Spine J,2007,7(2):141-147.
[20]Ashkenazi E, Smorgick Y, Rand N, et al. Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy:a hybrid decompression and fixation technique[J]. J Neurosurg Spine,2005,3(3):205-209.
[21]Hillard VH, Apfelbaum RI. Surgical management of cervical myelopathy:indications and techniques for multilevel cervical discectomy[J]. Spine J,2006,6(6 Suppl):242S-251S.
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[32]茅剑平,田伟,刘波.等.保留C2和C7棘突肌肉止点的改良颈椎后路椎板扩大成型术 的疗效分析[J].中华医学杂志,2010,90(5)：337-341.
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[34]王伟,高成杰,任龙喜.颈椎后纵韧带骨化症病变范围涉及第二颈椎时后路减压与伸肌重建策略[J].中华外科杂志,2008,46(18)：1419-1423.
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[38]Morio Y, Yamamoto K, Teshima R, et al. Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft[J]. Spine (Phila Pa 1976),2000,25(2):190-196.
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[44]Song KJ, Johnson JS, Choi BR, et al. Anterior fusion alone compared with combined anterior and posterior fusion for the treatment of degenerative cervical kyphosis[J]. J Bone Joint Surg Br,2010,92(11):1548-1552.
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[47]Cardoso MJ, Rosner MK. Multilevel cervical arthroplasty with artificial disc replacement[J]. Neurosurg Focus,2010,28(5):E19.
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2. Yusof MI, Hassan E, Abdullah S. Predicted cervical canal enlargement and effective cord decompression following expansive laminoplasty using cervical magnetic resonance imaging[J]. Surg Radiol Anat.2010;33(2):109-115.
3. Tsuji T, Asazuma T, Masuoka K, et al. Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2-year follow-up study[J]. Eur Spine J. 2007;16(12):2072-2077.
4. Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy[J]. Spine (Phila Pa 1976).1983;8(7):693-699.
5. Khan SN, Edmonds EW, Titelman RM, et al. Using suture anchors for cervical aminoplasty: a reliable, safe, and simple technique[J]. Am J Orthop (Belle Mead NJ).2008;37(8):400-402.
6. Ono A, Yokoyama T, Numasawa T, et al. Dural damage due to a loosened hydroxyapatite intraspinous spacer after spinous process-splitting laminoplasty [J]. Report of two cases. J Neurosurg Spine.2007;7(2):230-235.
7. Kanemura A, Doita M, Iguchi T, et al. Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty[J]. J Neurosurg Spine. 2008;8(2):121-128.
8. Rhee JM, Register B, Hamasaki T, et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J]. Spine (Phila Pa 1976).2011;36(1):9-14.
9. Matsumoto M, Watanabe K, Tsuji T, et al. Risk factors for closure of lamina after open-door laminoplasty [J]. J Neurosurg Spine.2008;9(6):530-537.
10. Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis[J]. Spine (Phila Pa 1976). 2005;30(22):2544-2549.
11.曹俊明,申勇,杨大龙,等.颈椎椎板成形术后颈部轴性症状的影响因素及防治[J].中国矫形外科杂志.2008；16(21)：1629-1631
12. Sakaura H, Hosono N, Mukai Y, et al. Preservation of muscles attached to the C2 and Cl spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty[J]. Spine (Phila Pa 1976).2010;35(16):E782-786.
13. Kawaguchi Y, Kanamori M, Ishiara H, et al. Preventive measures for axial symptoms following cervical laminoplasty[J]. J Spinal Disord Tech.2003;16(6):497-501.
14. Liu J, Ebraheim NA, Sanford CG, et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty[J]. Spine J.2007;7(2):159-164.
1. Tsuji T, Asazuma T, Masuoka K, et al. Retrospective cohort study between selective and standard C3-7 laminoplasty. Minimum 2-year follow-up study[J]. Eur Spine J. 2007;16(12):2072-2077.
2. Cabraja M, Abbushi A, Koeppen D, et al. Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy:sagittal alignment and clinical outcome[J]. Neurosurg Focus 2010;28(3):E15.
3. Punjaisee S. Laminectomy and postero-lateral mass plating for multilevel cervical spondylotic myelopathy [J]. J Med Assoc Thai 2004;87(7):768-773.
4. Hardman J, Graf O, Kouloumberis PE, et al. Clinical and functional outcomes of laminoplasty and laminectomy[J]. Neurol Res 2010;32(4):416-420.
5. Ono A, Yokoyama T, Numasawa T, et al. Dural damage due to a loosened hydroxyapatite intraspinous spacer after spinous process-splitting laminoplasty[J]. Report of two cases. J Neurosurg Spine.2007;7(2):230-235.
6. Kanemura A, Doita M, Iguchi T, et al. Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty[J]. J Neurosurg Spine. 2008;8(2):121-128.
7. Rhee JM, Register B, Hamasaki T, et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J]. Spine (Phila Pa 1976).2011;36(1):9-14.
8. Hansen-Schwartz J, Kruse-Larsen C, Nielsen CJ. Follow-up after cervical laminectomy, with special reference to instability and deformity[J], Br J Neurosurg 2003;17(4):301-305.
9. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament:effects on cervical alignment, spinal cord compression, and neurological outcome[J]. Neurosurgery 2003;52(5):1081-1087; discussion 1087-1088.
10. Heller JG, Edwards CC,2nd, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy:an independent matched cohort analysis[J]. Spine (Phila Pa 1976) 2001;26(12):1330-1336.
11. Azmi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration[J]. Neurosurg Focus 2003;15(3):E6
12. Lopez-Espina CG, Amirouche F, Havalad V. Multilevel cervical fusion and its effect on disc degeneration and osteophyte formation[J]. Spine (Phila Pa 1976) 2006:31(9):972-978.
13. Kato M, Nakamura H, Konishi S, Dohzono S.et al. Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty[J]. Spine 2008;33(14):E455-E459
14. Morio Y, Yamamoto K, Teshima R, et al. Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft[J]. Spine (Phila Pa 1976),2000,25(2):190-196.
15. Wada E, Suzuki S, Kanazawa A, et al. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy:a long-term follow-up study over 10 years[J]. Spine (Phila Pa 1976),2001,26(13):1443-1447; discussion 1448.
16. Liu J, Ebraheim NA, Sanford CG, Jr., et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty [J]. Spine J 2007;7(2):159-164.
1. Motosuneya T, Maruyama T, Yamada H. et al.Long-term results of tension-band laminoplasty for cervical stenotic myelopathy:a ten-year follow-up[J].J Bone Joint Surg Br; 2011;93(1):68-72.
2. Kato M, Nakamura H, Konishi S, et al. Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty[J]. Spine;2008; 33(14):E455-E459
3. Wada E, Suzuki S, Kanazawa A, et al. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy:a long-term follow-up study over 10 years[J]. Spine; 2001;26(13):1443-1448
4. Higashino K, Katoh S, Sairyo K, et al. Preservation of Cl spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy[J]. Int Orthop; 2006; 30(5):362-365
5. Kawaguchi Y, Matsui H, Ishihara H, et al. Axial symptoms after en bloc cervical laminoplasty[J]. J Spinal Disord;1999; 12(5):392-395
6. Kato M. Nakamura H, Konishi S, et al. Effect of preserving paraspinal muscles on postoperative axial pain in the selective cervical laminoplasty[J]. Spine; 2006; 33(14):E455-E459
7. Ohnari H. Sasai K. Akagi S, et al. Investigation of axial symptoms after cervical laminoplasty using questionnaire survey[J]. Spine J; 2006; 6(3):221-227
8. Yoshida M, Tamaki T, Kawakami M, et al. Does reconstruction of posterior ligamentous complex with extensor musculature decrease axial symptoms after cervical laminoplasty [J]. Spine; 2002; 27(13):1414-1418
9. 潘胜发,孙宇,朱振军,等.单开门颈椎管扩大成形术后轴性症状与颈椎稳定性的相关观察[J].中国脊柱脊髓杂志；2003；13(10)：604-607.
10. Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication[J]. Spine;1996; 21(17):1969-1973.
11. Sasai K. Saito T, Ohnari H, et al. Microsurgical posterior herniotomy with en bloc laminoplasty:alternative method for treating cervical disc herniation[J]. J Spinal Disord Tech; 2005;18(2):171-177.
12. Sakaura H, Hosono N, Mukai Y, et al. Persistent local pain after posterior spine surgery for thoracic lesions[J]. J Spinal Disord Tech; 2007; 20(3):226-228.
13.张为,陈百成,申勇,等.颈3椎板切除单开门成形术对颈椎轴性症状的影响[J].中华骨科杂志,2006,26(8)：544-548.
14. IizukaH, ShimizuT, TatenoK, et al. Extensormusculature of the cervical spine after laminoplasty:morphologicevaluation by coronal view of themagnetic resonance image[J]. Spine, 2001;26(20):2220-2226.
15.韩雨.张永刚,张雪松.颈椎椎板切除融合术后轴性疼痛[J].现代生物医学进展；2011；3：515-518.
16.许立新.余天东,张斌,等.颈椎后路侧块钢板内固定术的疗效观察[J].中国矫形外科杂志；2006：14：832-836.
17.曹俊明,中勇,杨大龙,等.颈椎椎板成形术后颈部轴性症状的影响因素及防治[J].中国矫形外科杂志；2008；16：1629-1631.
18. MunehitoY, Tetsuya T, Mamoru K, et al. Does reconstruction of posterior ligamentous complex with extensor musculature decrease axial syndromes after cervical laminoplasty[J]. Spine; 2002,27:1414-1418.
19.张为,陈百成,丁文元,等.术后围领佩戴时间对颈椎轴性症状的影响[J].1中国康复医学杂志；2007；22：129-132.
[1]Kim TJ, Bae KW, Uhm WS, et al. Prevalence of ossification of the posterior longitudinal ligament of the cervical spine[J]. Joint Bone Spine,2008,75(4):471-474.
[2]Cunningham MR, Hershman S, Bendo J. Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy[J]. Spine (Phila Pa 1976),2010, 35(5):537-543.
[3]Kaiser MG. Multilevel cervical spondylosis. Neurosurg Clin N Am,2006,17(3):263-275.
[4]Liu T, Yang HL, Xu YZ, et al. ACDF With the PCB Cage-Plate System Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy[J]. J Spinal Disord Tech,2010, 24(4):213-220.
[5]DuBois CM, Bolt PM, Todd AG, et al. Static versus dynamic plating for multilevel anterior cervical discectomy and fusion[J]. Spine J,2007,7(2):188-193.
[6]Nunley PD, Jawahar A, Kerr EJ,3rd, et al. Choice of plate may affect outcomes for single versus multilevel ACDF:results of a prospective randomized single-blind trial[J]. Spine J, 2009,9(2):121-127.
[7]李建光,苗军,夏群.前路椎间融合器在多节段脊髓型颈椎病治疗中的应用[J].中华骨科杂志,2007,27(8)：576-579.
[8]Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy:a prospective randomized control clinical study[J]. Eur Spine J,2010,19(5):713-719.
[9]张儒,赵凤东,范顺武,等.前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病[J].中华骨科杂志,2010,30(9)：837-841
[10]Wei-bing X, Wun-Jer S, Gang L, et al. Reconstructive techniques study after anterior decompression of multilevel cervical spondylotic myelopathy[J]. J Spinal Disord Tech,2009, 22(7):511-515.
[11]Ying Z, Xinwei W, Jing Z, et al. Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy:a randomized control clinical study[J]. Spine (Phila Pa 1976),2007,32(14):1482-1487.
[12]袁文,张颖,王新伟,等.保留椎体后壁的椎体次全切除术治疗多节段颈椎病的前瞻性研究[J].中华外科杂志,2006,44(16)：1087-1090.
[13]Hwang SL, Lee KS, Su YF, et al. Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease [J]. J Spinal Disord Tech,2007,20(8):565-570.
[14]Brazenor GA. Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis:analysis of outcome with long-term follow-up and interview by independent physician[J]. Spine (Phila Pa 1976),2007,32(1):63-71.
[15]Ikenaga M, Shikata J, Tanaka C. Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy[J]. Spine (Phila Pa 1976),2006,31(14):1568-1574; discussion 1575.
[16]Okawa A, Sakai K, Hirai T, et al. Risk Factors for Early Reconstruction Failure of Multilevel Cervical Corpectomy With Dynamic Plate Fixation[J]. Spine (Phiia Pa 1976),2010, 36(9):E582-587.
[17]Acosta FL, Jr., Aryan HE, Ames CP. Successful outcome of six-level cervicothoracic corpectomy and circumferential reconstruction:case report and review of literature on multilevel cervicothoracic corpectomy[J]. Eur Spine J,2006,15 Suppl (5):670-674.
[18]Lu J, Wu X, Li Y, et al. Surgical results of anterior corpectomy in the aged patients with cervical myelopathy [J]. Eur Spine J,2008,17(1):129-135.
[19]Lee MJ, Bazaz R, Furey CG, et al. Risk factors for dysphagia after anterior cervical spine surgery:a two-year prospective cohort study[J]. Spine J,2007,7(2):141-147.
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