微创颈椎管成形术椎管容积变化实验及临床研究
|
摘要
背景和目的
脊髓型颈椎病(cervical spondylotic myelopathy, CSM)是指以颈椎间盘退变为基础,在此基础上出现椎间盘突出、椎体后缘骨赘、后纵韧带骨化、小关节退变增生、黄韧带增生钙化等,以上一种或几种因素共同参与导致颈椎管狭窄,造成脊髓或脊髓周围血管受压,最终导致不同程度的脊髓神经功能障碍。临床主要表现为颈肩部不适、肢体麻木、躯干“束带”感、行走不稳、双下肢踩棉花感、腱反射亢进、肌肉萎缩等,严重者可导致瘫痪。CSM是最严重的一类颈椎病,占颈椎病的5%-10%,好发于50岁以上的老年人,其发病隐匿,临床上极少数处于长期稳定阶段,70-80%表现为慢性进行性恶化,致残率极高,是威胁老年患者身体健康的常见疾病。因此多主张在脊髓功能出现不可逆性损伤之前采取积极治疗措施。多数学者认为自发病起3-6个月内治疗,可获得较好的脊髓功能恢复,病程越短效果越好。
目前,CSM治疗方法很多,从病情轻重考虑,可分为非手术治疗和手术治疗；从手术入路可分为颈前路和颈后路手术,由于CSM的临床表现个体差异较大,目前对该病的治疗各执己见,尤其是多阶段CSM。目前对多节段CSM的治疗采取颈后路手术的占多数。即可直接处理后面的黄韧带增厚、小关节增生等致压因素,而且可通过扩大椎管,使脊髓利用“弓弦”原理后移,间接处理脊髓前方的压迫。
后路手术包括全椎板或半椎板切除术、椎管扩大成形术,后路椎板切除术由于破坏了椎板、小关节等重要结构,颈椎管完整性丧失,术后颈椎不稳、反曲畸形、医源性压迫等并发症发生率高,目前已基本被椎管扩大成形术所替代。
单开门和双开门颈椎管扩大成形术是目前治疗多节段脊髓型颈椎病的主要方法,但它们均存在棘突韧带复合体等结构破坏大甚至完全切除、可能影响疗效的问题。故我们提出微创颈椎管成形术,观察其椎管容积扩大情况,分析减压效果及临床疗效。
方法
选取12个完整颈5椎骨干燥标本模拟微创颈椎管成形术,采取手术前后自身对照方法,分为对照组和实验组(包括双侧椎板“长槽状”切开、棘突及椎板整体均匀后移1mm组、2mm组、3mm组,共三组)。手术前后采用螺旋CT薄层扫描,并在CT后处理工作站利用3D测量工具分别测量各组完整骨性椎管容积。
2010年9月-2011年9月,36例脊髓型颈椎病患者在我科行微创颈椎管成形术。按照日本矫形外科学会JOA评分法,自身对照评价术前、术后脊髓神经功能恢复情况。
结果
对照组12个颈5椎骨标本的椎管容积平均为1592±331mm3,后移1、2、3mm组的骨性椎管容积分别平均为1727±357mm3、1861±386mm3、2001±416mm3;容积改善率分别为8.53±1.05%、16.93±1.78%、25.75±2.97%；后移2mm组与后移1mm组相比,p<0.05,有统计学意义；后移3mm组与后移2mm组相比,后移3mm组与后移1mm组相比p<0.05,有统计学意义。36例患者手术时间平均为75分钟(50-105),出血量平均为375mL(300-450),术前JOA评分7.97±1.73,末次随访时JOA评分13.14±1.74,p<0.05,有统计学意义,JOA评分平均改善率58.55±13.71%,优良率为83.3%(优9例,良21例,一般6例)。
结论
标本模拟可较好反映微创颈椎管成形术的椎管容积变化,为其临床实现有效减压提供可靠的指导依据。
BACKGROUND AND OBJECTIVE
Cervical spondylotic myelopathy (CSM) is based on the cervical intervertebral disc degeneration, on this basis, appear the cervical intervertebral disc herniation、 vertebral rear osteophyte、posterior longitudinal ligament ossification、 facet joint degeneration and hyperplasia、 yellow ligament hyperplasia ossification and so on. More than one or several factors participate in the cervical spinal canal stenosis, causeed the blood vessel that around spinal cord or spinal cord compression, eventually lead to different degrees of spinal cord and nerve dysfunction。 The main Clinical manifestations of CSM are the neck and shoulder discomfort、numbness、 trunk"belted"sense、 walking instability、 the lower limbs feeling stepped on cotton、 tendon reflex hyperfuncion、 muscle atrophy, even severe cases can lead to paralysis。 CSM is the most serious type of cervical spondylosis, accord for5%-10%of cervical spondylosis, occurs in the olderly people over50, its incidence of occult, clinically rare in a long-term stable phase,70-80%of the performance was chronic
progressive deterioration, and with high morbidity, is threatening the health of elderly patients with common diseases,Therefore, many advocate aggressive treatment measures before irreversible damage in the spinal cord function。 Most scholars believe that within three to six months onset of treatment, can achieve good spinal cord function recovery,the short course of the disease, the better results。
At present, there are many theropy methods about CSM,consider with the disease severity, can be divided into non-surgical therapy and operation therapy; from the surgical approach, can be divided into cervical anterior and posterior treatment。 Due to individual difference in the clinical manifestations of the CSM,each hold their own views on the treatment of the disease, especially in multilevel CSM,current treatment multiple segmental CSM to majority of cervical posterior approach。 Can directly deal with compression factors such as the yellow ligament thickening、 small joint hyperplasia and so on, but also by expanding vertebral canal, so the spinal cord backward use "bowstring"principle.to indirect deal with the front compression factors of spinal cord.posterior surgery including laminectomy or semi-lainectomy、 laminoplasty, posterior laminectomy due to damage the important structure of cervical such as lamina、facet joint, the Integrity of cervical spinal canal loss, lead to high incidence of postoperateive complications, like cervical instability、 deformity of Inflection、iatrogenic oppression。At present laminectomy has been replaced by cervical laminoplasty.
single-door and double-door of posterior cervical laminopalsry are now the main methods to treat cervical spondylotic myelopathy(CSM),but they all have the same question that with the spinous process ligament complex damaged, even completely resected and affect the curative effect. So we puts forword cervical minimally invasive laminoplasty, to observe the canal volume expansion and analyse the effect of decompression and curative effect.
METHODS
took12dry specimens of the fifth cervical vertebra to simulate cervical minimally invasive laminoplasty, self-control before and after surgerys, divided into control and experimental groups (including three groups that with bilateral plate long strip slotted、spinous and vertebral plate retruded by1mm、2mm、3mm), the specimens were thin-slice scanned with spiral CT,measured the volume of bony cervical canal with the3D tools in CT workstation respectively.
Selected46CSM patients received cervical minimally invasive laminoplasty from9th2010to9th2011in our department,.according toJapanese Orthopaedic Association (JOA) scoring system, neurologic function were evaluated before and after surgery through self-control.
RESULTS
about the12dry specimens of the fifth cervical vertebra, average cervical bony spinal canal volume of their the control group was1592±331mm3,,average cervical bony spinal canal volume of concessions1mm、2mm、3mm were respective1727±357mm3、1861、386mm3、2001±416mm3;the improvement rate of the capacity were respective8.53、1.05%、16.93±1.78%、25.75±2.97%, the concessions2mm group compared with lmm group, p<0.05,it had the statistical significance,the3mm group compared with the2mm group, p<0.05,it had the statistical significance,the3mm group compared with the lmm group, p<0.05,it had the statistical significance, patiens group:the average surgery time was75minutes (50-105),and the average amount of bleeding was375ml (300-450),the JOA score was7.97±1.73before surgery and was13.14±1.74in final followed-up,the JOA score improvement rate was58.55±13.71%,the excellent and good rates were obtained in83.3%(9excellent,21good,6fair). Specimens simulation can better reflect the spinal canal volume of cervical minimally invasive lamionplasty, provides a reliable basis for guiding effective decompression.
CONCLUSION
Specimens simulation can better reflect the spinal canal volume of cervical minimally invasive lamionplasty, provides a reliable basis for guiding effective decompression.
脊髓型颈椎病(cervical spondylotic myelopathy, CSM)是指以颈椎间盘退变为基础,在此基础上出现椎间盘突出、椎体后缘骨赘、后纵韧带骨化、小关节退变增生、黄韧带增生钙化等,以上一种或几种因素共同参与导致颈椎管狭窄,造成脊髓或脊髓周围血管受压,最终导致不同程度的脊髓神经功能障碍。临床主要表现为颈肩部不适、肢体麻木、躯干“束带”感、行走不稳、双下肢踩棉花感、腱反射亢进、肌肉萎缩等,严重者可导致瘫痪。CSM是最严重的一类颈椎病,占颈椎病的5%-10%,好发于50岁以上的老年人,其发病隐匿,临床上极少数处于长期稳定阶段,70-80%表现为慢性进行性恶化,致残率极高,是威胁老年患者身体健康的常见疾病。因此多主张在脊髓功能出现不可逆性损伤之前采取积极治疗措施。多数学者认为自发病起3-6个月内治疗,可获得较好的脊髓功能恢复,病程越短效果越好。
目前,CSM治疗方法很多,从病情轻重考虑,可分为非手术治疗和手术治疗；从手术入路可分为颈前路和颈后路手术,由于CSM的临床表现个体差异较大,目前对该病的治疗各执己见,尤其是多阶段CSM。目前对多节段CSM的治疗采取颈后路手术的占多数。即可直接处理后面的黄韧带增厚、小关节增生等致压因素,而且可通过扩大椎管,使脊髓利用“弓弦”原理后移,间接处理脊髓前方的压迫。
后路手术包括全椎板或半椎板切除术、椎管扩大成形术,后路椎板切除术由于破坏了椎板、小关节等重要结构,颈椎管完整性丧失,术后颈椎不稳、反曲畸形、医源性压迫等并发症发生率高,目前已基本被椎管扩大成形术所替代。
单开门和双开门颈椎管扩大成形术是目前治疗多节段脊髓型颈椎病的主要方法,但它们均存在棘突韧带复合体等结构破坏大甚至完全切除、可能影响疗效的问题。故我们提出微创颈椎管成形术,观察其椎管容积扩大情况,分析减压效果及临床疗效。
方法
选取12个完整颈5椎骨干燥标本模拟微创颈椎管成形术,采取手术前后自身对照方法,分为对照组和实验组(包括双侧椎板“长槽状”切开、棘突及椎板整体均匀后移1mm组、2mm组、3mm组,共三组)。手术前后采用螺旋CT薄层扫描,并在CT后处理工作站利用3D测量工具分别测量各组完整骨性椎管容积。
2010年9月-2011年9月,36例脊髓型颈椎病患者在我科行微创颈椎管成形术。按照日本矫形外科学会JOA评分法,自身对照评价术前、术后脊髓神经功能恢复情况。
结果
对照组12个颈5椎骨标本的椎管容积平均为1592±331mm3,后移1、2、3mm组的骨性椎管容积分别平均为1727±357mm3、1861±386mm3、2001±416mm3;容积改善率分别为8.53±1.05%、16.93±1.78%、25.75±2.97%；后移2mm组与后移1mm组相比,p<0.05,有统计学意义；后移3mm组与后移2mm组相比,后移3mm组与后移1mm组相比p<0.05,有统计学意义。36例患者手术时间平均为75分钟(50-105),出血量平均为375mL(300-450),术前JOA评分7.97±1.73,末次随访时JOA评分13.14±1.74,p<0.05,有统计学意义,JOA评分平均改善率58.55±13.71%,优良率为83.3%(优9例,良21例,一般6例)。
结论
标本模拟可较好反映微创颈椎管成形术的椎管容积变化,为其临床实现有效减压提供可靠的指导依据。
BACKGROUND AND OBJECTIVE
Cervical spondylotic myelopathy (CSM) is based on the cervical intervertebral disc degeneration, on this basis, appear the cervical intervertebral disc herniation、 vertebral rear osteophyte、posterior longitudinal ligament ossification、 facet joint degeneration and hyperplasia、 yellow ligament hyperplasia ossification and so on. More than one or several factors participate in the cervical spinal canal stenosis, causeed the blood vessel that around spinal cord or spinal cord compression, eventually lead to different degrees of spinal cord and nerve dysfunction。 The main Clinical manifestations of CSM are the neck and shoulder discomfort、numbness、 trunk"belted"sense、 walking instability、 the lower limbs feeling stepped on cotton、 tendon reflex hyperfuncion、 muscle atrophy, even severe cases can lead to paralysis。 CSM is the most serious type of cervical spondylosis, accord for5%-10%of cervical spondylosis, occurs in the olderly people over50, its incidence of occult, clinically rare in a long-term stable phase,70-80%of the performance was chronic
progressive deterioration, and with high morbidity, is threatening the health of elderly patients with common diseases,Therefore, many advocate aggressive treatment measures before irreversible damage in the spinal cord function。 Most scholars believe that within three to six months onset of treatment, can achieve good spinal cord function recovery,the short course of the disease, the better results。
At present, there are many theropy methods about CSM,consider with the disease severity, can be divided into non-surgical therapy and operation therapy; from the surgical approach, can be divided into cervical anterior and posterior treatment。 Due to individual difference in the clinical manifestations of the CSM,each hold their own views on the treatment of the disease, especially in multilevel CSM,current treatment multiple segmental CSM to majority of cervical posterior approach。 Can directly deal with compression factors such as the yellow ligament thickening、 small joint hyperplasia and so on, but also by expanding vertebral canal, so the spinal cord backward use "bowstring"principle.to indirect deal with the front compression factors of spinal cord.posterior surgery including laminectomy or semi-lainectomy、 laminoplasty, posterior laminectomy due to damage the important structure of cervical such as lamina、facet joint, the Integrity of cervical spinal canal loss, lead to high incidence of postoperateive complications, like cervical instability、 deformity of Inflection、iatrogenic oppression。At present laminectomy has been replaced by cervical laminoplasty.
single-door and double-door of posterior cervical laminopalsry are now the main methods to treat cervical spondylotic myelopathy(CSM),but they all have the same question that with the spinous process ligament complex damaged, even completely resected and affect the curative effect. So we puts forword cervical minimally invasive laminoplasty, to observe the canal volume expansion and analyse the effect of decompression and curative effect.
METHODS
took12dry specimens of the fifth cervical vertebra to simulate cervical minimally invasive laminoplasty, self-control before and after surgerys, divided into control and experimental groups (including three groups that with bilateral plate long strip slotted、spinous and vertebral plate retruded by1mm、2mm、3mm), the specimens were thin-slice scanned with spiral CT,measured the volume of bony cervical canal with the3D tools in CT workstation respectively.
Selected46CSM patients received cervical minimally invasive laminoplasty from9th2010to9th2011in our department,.according toJapanese Orthopaedic Association (JOA) scoring system, neurologic function were evaluated before and after surgery through self-control.
RESULTS
about the12dry specimens of the fifth cervical vertebra, average cervical bony spinal canal volume of their the control group was1592±331mm3,,average cervical bony spinal canal volume of concessions1mm、2mm、3mm were respective1727±357mm3、1861、386mm3、2001±416mm3;the improvement rate of the capacity were respective8.53、1.05%、16.93±1.78%、25.75±2.97%, the concessions2mm group compared with lmm group, p<0.05,it had the statistical significance,the3mm group compared with the2mm group, p<0.05,it had the statistical significance,the3mm group compared with the lmm group, p<0.05,it had the statistical significance, patiens group:the average surgery time was75minutes (50-105),and the average amount of bleeding was375ml (300-450),the JOA score was7.97±1.73before surgery and was13.14±1.74in final followed-up,the JOA score improvement rate was58.55±13.71%,the excellent and good rates were obtained in83.3%(9excellent,21good,6fair). Specimens simulation can better reflect the spinal canal volume of cervical minimally invasive lamionplasty, provides a reliable basis for guiding effective decompression.
CONCLUSION
Specimens simulation can better reflect the spinal canal volume of cervical minimally invasive lamionplasty, provides a reliable basis for guiding effective decompression.
引文
[1]Hirabayashi K. Expansive open-door laminoplasty for cervical spondylotic myelopathy[J]. Shujutsu,1978; 32:1159-1163.
[2]Kaner T,Sasan M,Clinical outcomes following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy[J].Turkish Neurosurgery,2009,19 (2):121-126.
[3]Wang，MY,Shah S,Green BA.Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy[J].Surg Neurol,2004,62 (6):487-493.
[4]Hale JJ.Gruson KI,Spivac JM.Laminoplasty:a review of its role in compressive cervical myelopathy[J].Spine J,2006,6(6 suppl):289-298.
[5]Chiba K,Ogawa Y,Ishii K,et al.Long-term results of expansive open-door laminoplasty for cervical myelopathy:average 14-year follow-up study[J].Spine,2006,31 (26):2998-3005.
[6]Matsumoto M,Chiba K,Toyama Y,et al. Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes:posterior surgery by laminoplasty[J].Spine, 2012,37 (5):E303-E308.
[7]Sakaura H,Hosono N,Mukai Y,et al.Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation:a comparative study of laminoplasty and anterior spinal fusion[J].Spine,2005,30 (7) 756-759.
[8]Hardman J,Graf 0, Kouloumberis PE et al.Clinical and functional outcomes of laminoplasty and laminectomy.[J].Neurological Research,2010,32 (4):416-420.
[9]Shiraishi T, Fukuda K,Yato Yet al.Results of skip laminoplasty-minimum 2-Year follow-up study compared with open-door laminoplasty[J].Spine,2003,28 (24):2667-2672.
[10]Saita K,Hoshino Y.Cervical pain after laminoplasty [A].In:Cervical Laminoplasty[M].Springer,2003.169-174.
[11]Luk KD,Kamath V,Avadhani A, et al.Cervical laminoplasty[J].European spine journal, 2010,19 (2):347-348.
[12]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.
[13]Takeskita K,Peterson ET,Bylski-Austrow D,et al.The nuchal ligament Restrains cervical spine flexion.Spine.2004,29:E388-E393.
[14]Kawaguchi Y,Kanamori M,Ishihara H,et al.Minimum 10-year followup after en bloc cervical laminoplasty.Clin Orthop Relat Res,2003, (411):129-139.
[15]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,2007,32 (2):159.
[16]Barrey C,Mertens P,Rumelhart C,et al.Biomechanical evaluation of cervical lateral mass fixation:a comparison of the Roy-Camille and Magerl screw techniques. [J] Neurosurg,2004:(3 Suppl Spine):268-276.
[17]Stemper BD, Marawar SV,Yoganandan N,et al.Quantitative anatomy of subaxial cervical lateral mass:an analysis of safe screw lengths for Roy-Camille and magerl techniques[J].Spine,2008,33 (8):893-897.
[18]楚戈,白靖平,锡林.宝勒日,等.无x射线引导下颈椎侧块钉植入技术的应用[J].中国组织工程研究与临床康复,2009,13(13)：2460-2464
[19]席新华,吴强,唐华军,等.成人下颈椎椎体与关节突关节倾角的X射线测量数据[J].中国组织工程研究与临床康复,2009,13(4)：662-666.
[20]Chiewvit P, Tritakam SO,Phawjinda A,et al. Predictive value of magnetic resonance imaging in cervical spondylotic myelopathy in prognostic surgical outcome[J].J Med Assoc Thai,2011,94 (3):346-354.
[21]Won-Sang Cho, Chun Kee Chung, Tae-Ahn Jahng etal. Post-Laminectomy Kyphosis in Patients with Cervical Ossification of the Posterior Longitudinal Ligament:Does It Cause Neurological Deterioration?[J] Korean Neurosurg Soc2008,43:259-264.
[22]Nassr A,Eck JCJPonnappan RK,et al.The incidence of C5 palsy after multilevel cervical decompression procedures:a review of 750 consecutive cases[J].Spine,2012,37 (3): 174-178.
[23]Greiner-Perth R,Elsaghir H,El-Meshtawy M.The incidence of C5-C6 radiculopathy as a complication of extenstive cervical decompressionrown results and review of literature.Neurosurg ev 2005;28:137-42.
[24]Sakaura H,Hosono N, Mukai Y,et al.C5 Palsy after decompression surgery for cervical myelopathy:review of the literarure[J].Spine,2003,28(21):2447-2451.
[25]Kong Q,Zhang L,Liu L,et al.Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty[J].Spine,2011,36 (13): 1030-1036.
[26]Hashimoto M,Mochizuki M,Aiba A, et al.C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases[J]. Eur Spine J,2010,19(10):1702-1710.
[27]Imagama S,Mstsuyama Y,Yukawa Y,et al.C5 palsy after cervical laminoplasty:a multicentrestudy[J].J Bone Joint Surg Br,2010,92 (3):393-400.
[28]张为,李鹏飞,杨大龙,等.颈椎后路减压术后脊髓后移的临床意义[J].中国矫形外科杂志,2011,19(1)：11-14.
[29]Minoda Y,Nakamura H,Konishi S,et al.Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine.Spine,2003,28:1123-1127.
[30]Kyakumachi T,Satoh E,Yoshimoto T,et al.Segmental motor paralysis so called C5 nerve palsy after cervical laminoplasty[J].J Jpn Spine Res Soc,2006,17 (2):21-27.
[31]张春霖,姜岩,钟楚楠,等.脊髓型颈椎病钛板双向固定颈椎管扩大成形术治疗58例体会[J].郑州大学学报(医学版),2007,43(2)：584-586.
[32]Iizuka H, Nakajima T,Iizuka Y,et al.Cervical malalignment after laminoplasty:relationship to deep extensor musculature of the cervical spine and neurological outcome[J].J Neurosurg Spine,2007,7:610-614.
[33]John M,Rhee. MD,Bradley R,et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J]. Spine, 2010,36 (1):9-14.
[34]Kotani Y,Abumi K,Ito M et al.Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle-preserving approach:impact on cervical spine function and quality of life[J].European spine jourmal,2009,18(5):663-671.
[35]Takeshita K,Seichi A,Akune T,et al.Can laminoplasty maintain the cervical alignment even when the lamina is contained? Spine (Phila Pa 1976),2005,30 (11):1294-1298.
[36]Hosono N.Sakaura H, Mukai Y, et al.C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial nick pain.Eur. Spine J,2006,15(9):1375-1379.
[37]Fujibayashi S,Neo M,Yoshida M,et al.Neck muscle strength before and after cervical laminoplasty:relation to axial symptoms[J].J Spinal Disord Tech,2010,23(3):197-202.
[38]Iizuka H,Nakajima T,Iizuka Y,et al. Cervical malalignment after laminoplasty:relationship to deep extensor musculature of the cervical spine and neurological outcome[J]. Neurosurg Spine,2007,7 (6):610-614.
[39]Takeuchi K, Yokoyama T, Aburakawa S,et al.Axial sympotoms aftercervical laminoplasty with C3 laminectomy compared with conventional C3-7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis[J].Spine (Phila Pa 1976),2005,30 (22):2544-9.
[40]董福龙,申才良,江曙,等.颈椎椎管容积的动态CT测量及其临床意义[J].中国矫形外科杂志,2008,16(9)：682-686,701.
[1]MarkB, RichardA, HowardW, et al. Cervical spondylotic myleopathy current concept review[J]. J Bone Joint Stag,1993,75(A),1:119
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京：人民军医出版社1998.5：1462—1485
[3]Lawrence JS. Disc degeneration:its frequency in relationship to symptoms [J]. Aan Rheum Dis,1969,28(2):121-137
[4]Miyamoto S, Yonenobu K, Ono K. ExperimenCal cervi cal spondylosis in the mouse[J]. Spine,1991; 16(Suppl):495-500.
[5]Nagano T, Yonenobu K, Mivamoto S, etal. Distrjbution ofthe basic fi hroblast growLh factor and its receptor gene expression in normal and degenerated rat intervertebral discs[J]. Spine,1995; 20:1972-1979
[6]LestineWF, Wiesel SW, The pathogenesis of cervical spondylosis. Clin Orthop,1989: 239:69 - 93
[7]Baba H, Furusawa N, Limura S, Late. Radiographic findings after anterior cervical fusjonfor spondylotic myeloradio-lopathy, spine,1993:18:2167.
[8]Pavlov H.Torg JS, Robie B, et al. Cervical spinal stenosis:determination with vertebral body ratio method[J]. Radiology,1987,164(3):771-775.
[9]Crandall PH, Batgdert U. Long-term following of surgical treatmeot of cervical spondylotic myelopathy. J Neurosurg,1966:25:57.
[10]贾连顺,袁文,倪斌,等颈椎管发育性狭窄与脊髓型颈椎病(J).颈腰痛杂志,1999；20(1)：9—11.
[11]Parke WW.Correlative anatomy of cervical spondyioticmyelopthy.spine,1988,13:861-863.
[12]Al-Mefty O, Harkey HL, Marawi I, et al. Experimental chronic com-pressive cervical myelopathy[J]. J Neurosurg,1993,79(4):550-561.
[13]蔡钦林,黄云钟,杨文,等。慢性压迫性颈脊髓病超微病理变化的实验研究.中国脊柱脊髓杂志,1996：6(6)：254.
[14]陈锋.脊髓型颈椎病脊髓微血管神经元微环境改变实验研究[J].中国矫形外科杂志,2004,12(13)：1009—1010.
[15]傅强,侯铁胜,刘善荣,等.大鼠脊髓压迫性损伤后神经细胞的死亡方式.第二军医大学学报,1997：18(6)：557.
[16]Emery SE.Cervical spondylotic myelopathy:diagnosis and treatment[J]J Am Acad Orthop Surg,2001,9 (6):376-388.
[17]马如龙,田伟,李世和,等.临床cT、MRI对脊髓型颈椎病的诊断价值.云南医药,1998：19(1)：33—34.
[18]蒋振松,张佐伦,刘立成,等.脊髓型颈椎病患者的颈椎cT测量及其临床意义[J].中国脊柱脊髓杂志,2003,13：220—223.
[19]董福龙,申才良,江曙,等.颈椎椎管容积的动态CT测量及其临床意义[J].中国矫形外科杂志,2008,16(9)682-686.
[20]Suri A, Chabbra RP, Mehta VS, et al. Effect of intramedullary signal chageson the surgical outcome of patients with cervical spondylotic myelopathy[J]. spine 2003,3:33-45.
[21]Matsumoto M, Toyama Y. Increased signal intensity of the spinal cord on magneticresonance images in cervical compressive myelopathy [J]. Spine,2000.25: 677-682.
[22]Maertens de Noordhout A, RemcIe JM,Pepin JL, et al, Magnetic stimulation of the motor cortex in cervical spondyIosis [J].Neurology 1991; 41:75.
[23]BrunhoIzI C Clous D. Central motor conduction time to uper and lower limbs in cervical lord lesions [J]. Arch NeuroI 1994; 51:245.
[24]Wehling P, Cleveland S, Reinecke J. et al, Magnetic stimulation as a diagnostic toot in cervical nerve root compression and compression induced neuropathy [J]. Spinal Dis 1995; 8:304.
[25]Moeti P,Marchetti G.Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy:a case series[J].The Journal of Orthopaedic and Sports Physical Therapy,2001,31(4):207-213.
[26]Koyanagi T,Predicat ability of operative results of cervical compression myelopathy based on preoperative compued to mographic[J]. Spine,1993,182:1958-1963.
[27]孙宇哲,巩顺东,李政等.脊髓型颈椎病的手术治疗[J].中国临床医学影响杂志,2008,19(7)：522-523.
[28]Fareg ID, McAfee PC. Davis RF. et al. Pseudoarthrosis of the cervical spine after anterior arthrodesis[J]. J Bone and Surg,1990,72A:1171-1177.
[29]曾明,林庆光,赵新建等.不同方式的颈椎前路减压植骨融合术治疗颈椎病[J].中国脊柱脊髓杂志,2000,10(3)：160-162.
[30]Thalgott JS,Xiongsheng C,Giuffre JM,Single stage anterior cervical reconstruction with titanium mesh cages, local autograft, and anterior plating[J].Spine,2003,3(4):294-300.
[31]Joseph C, et al. outcome analysis of noninstrumented al lte"or cervical discectomy and jnterbody f-usion in 348 patients. [J]. Spine,1998; 23:188.
[32]王晓凡,韩向阳,贾光辉等,前路三种手术方式治疗脊髓型颈椎病的疗效分析[J].延安大学学报(医学版),2008,6(3)：39-41.
[33]王恒龙,姜振国,朱剑等.脊髓型颈椎病前路手术48例临床分析[J].实用骨科杂志,2009,15(6)：445-447.
[34]Kaiser MG, Haid Rw Jr, subach BR, et al. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neumsurgery,2002,50:229-236.
[35]刘鹏,赵建华,李起鸿等.两种前路术式治疗多节段脊髓型颈椎病的对比研究[J].中国修复重建外科杂志,2006,20(4)：362-366.
[36]Tureyen K.Disc height loss after mrciodiscectomy with titanium intervertebral cage fusion[J].Eur Spine J,2003,12(5):513-516.
[37]Porter RW,Craw ford NR,Chamberlain RH,et al.Biom echanical analysis of multilevel cervical corpectomy and plate constructs.JN eurosurg,2003,99 (1):98-103.
[38]Singh K,Vaccaro AR,Kim J,et al.Enhancement of stability following anterior cervical corpectomy:a biomechanical study.Spine,2004,29 (8):845-849.
[39]Gercek E,Arlet V,Delisle J,et al.Subsidence of stand-alone cervical cages in anterior interbody fusion:warning.Eur Spine J,2003,12 (5):513-6.
[40]EPSTEIN N.Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament:review of operative technique and assessment of 65 multilevel circumferential procedures[J].SurgNeurol,2001,55:313-324.
[41]孔凡奇,王志烈,谢辉,等.颈前路减压植骨钛板内固定治疗脊髓型颈椎病[J].实用骨科杂志.2009,15(1)：36-38.
[42]梁延琛,聂林,侯勇,等.人工颈椎间盘假体置换术治疗脊髓型颈椎病的临床效果[J].山东大学学报(医学版),2008,46(12)：102—105.
[43]Geroge JK,Nathan ER.Incidence and outcome of kyphotic deformity following lamienctomg for cervical spondylotic myelopathg[J].J Neurosurg (Spine):2002,93 (7) 199.
[44]Wang JM,Roh KJ,Kin DJ,et al.A new method of stabilizing the elevated lam inate open-door lam inoplasty using an anchor system[J].J Bone Joint Surg Am,1999,19 (9): 1005-1008.
[45]王义生,张弛,唐国皓,等.锚钉定在多节段脊髓型颈椎病单开门椎管扩大术中的应用[J].中国脊柱脊髓杂志,2012,22(1)：20-23.
[46]任喜龙,王相利,王少波,等.单开门棘突重建颈椎管扩大成形术治疗脊髓型颈椎病[J].中国脊柱脊髓杂志,2001,11(3)：136-138.
[47]Yue WM,Tan CT,Tan SB,et al.Results of cervical laminoplasty and a comparison between single and double trap-door technique[J].J Spinal Disord,2000,13 (4):329-335.
[48]Matsumura A,Yanaka K,Akutsu H,et al.Combined laminoplasty with osterior mass plate for unstable spondylotic cervical canal stenosis-technical note[J].Neurol Med Chir (Tokyo),2003,43 (10):514-529.
[49]王景续,尹西盟,宫树一,等.颈椎后路侧块钢板螺钉置入治疗多节段颈椎病伴颈椎失稳[J].中国组织工程研究,2012,16(3)：2411-2414.
[50]Emery SE,Bohiman HH,Bolesta MJ,et al.Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic, yelopathy[J].J Bone Joint Surg (Am) 1998,80 (7):941-951.
[51]Huang RC,Giardi FP,Poynton AR,er al.Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decomp ression and fusion with lateral mass plate fixation and local bone graft[J].J Spinal Disord Tech,2003,12 (6):123-129.
[52]马雷,中勇,杨大龙,等.前后路手术与单纯前路或后路手术治疗颈椎孤立型后纵韧 带骨化症的对比研究[J].中国脊柱脊髓杂志,2012,22(10)：884-888.
[53]Wang MY,Green BA.Open-door crewicla expansile decomp ression of spinal cord SurgNeuro,1997,8:63-71.
[54]李展振,龙享国,祝海炳,等.射频消融髓核成形术治疗颈椎间盘突出症初步临床报道[J].骨与关节损伤杂志,2002,17(4)：244.
[55]张春霖,赵玉果..后路椎间盘镜下应用B-Twin治疗腰椎失稳症65例[J].郑州大学学报(医学版),2009,44(2)：448-450.
[56]钟家云,黄其裕,赵德兵,等.椎间盘镜下建立椎弓根通道行后路腰椎椎体间融合术的研究[J].广西医学,2010,32(9)：1043-1045.
[57]周跃,张峡,王卫东,等.内窥镜下颈椎前路减压植骨融合术的初步报告[J].中华骨科杂志,2004,24(2)：75-79.
[58]Fehlings MQSmith JS,Kopjar B,Arnold PM,Yoon ST,Vaccaro AR,et al.perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AO Spine North America cervical spondylotic myelopathy study.J Neurosurg Spine 2012;16:425-32.
[59]Kopjar B,Fehlings M,Yoon TS,et al.Predictors of success in the surgical treatment for cervical spondylotic myelopathy:Analysis of the AOSpine North America Multi-center prospective study in 260 patients.Presented at the Annual meeting of the American Association of Neurological Surgeons.Denver:Colarado;2011.
[60]Matz PG,Holly LT,Mummaneni PV,Anderson PA,Groff MW,Heary RF,et al.Anterior cervical surgery for the treatment of cervical degenerative myelopathy.J Neurosurg Spine 2009; 11:170-3.
[61]Furlan JC,Kalsi-Ryan S,Kailaya-vasan A,Massicotte EM,Fehlings MG.Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy:A prospective study of 81 cases.J Neurosurg Spine 2011; 14:348-55.
[2]Kaner T,Sasan M,Clinical outcomes following cervical laminoplasty for 19 patients with cervical spondylotic myelopathy[J].Turkish Neurosurgery,2009,19 (2):121-126.
[3]Wang，MY,Shah S,Green BA.Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy[J].Surg Neurol,2004,62 (6):487-493.
[4]Hale JJ.Gruson KI,Spivac JM.Laminoplasty:a review of its role in compressive cervical myelopathy[J].Spine J,2006,6(6 suppl):289-298.
[5]Chiba K,Ogawa Y,Ishii K,et al.Long-term results of expansive open-door laminoplasty for cervical myelopathy:average 14-year follow-up study[J].Spine,2006,31 (26):2998-3005.
[6]Matsumoto M,Chiba K,Toyama Y,et al. Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes:posterior surgery by laminoplasty[J].Spine, 2012,37 (5):E303-E308.
[7]Sakaura H,Hosono N,Mukai Y,et al.Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation:a comparative study of laminoplasty and anterior spinal fusion[J].Spine,2005,30 (7) 756-759.
[8]Hardman J,Graf 0, Kouloumberis PE et al.Clinical and functional outcomes of laminoplasty and laminectomy.[J].Neurological Research,2010,32 (4):416-420.
[9]Shiraishi T, Fukuda K,Yato Yet al.Results of skip laminoplasty-minimum 2-Year follow-up study compared with open-door laminoplasty[J].Spine,2003,28 (24):2667-2672.
[10]Saita K,Hoshino Y.Cervical pain after laminoplasty [A].In:Cervical Laminoplasty[M].Springer,2003.169-174.
[11]Luk KD,Kamath V,Avadhani A, et al.Cervical laminoplasty[J].European spine journal, 2010,19 (2):347-348.
[12]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.
[13]Takeskita K,Peterson ET,Bylski-Austrow D,et al.The nuchal ligament Restrains cervical spine flexion.Spine.2004,29:E388-E393.
[14]Kawaguchi Y,Kanamori M,Ishihara H,et al.Minimum 10-year followup after en bloc cervical laminoplasty.Clin Orthop Relat Res,2003, (411):129-139.
[15]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,2007,32 (2):159.
[16]Barrey C,Mertens P,Rumelhart C,et al.Biomechanical evaluation of cervical lateral mass fixation:a comparison of the Roy-Camille and Magerl screw techniques. [J] Neurosurg,2004:(3 Suppl Spine):268-276.
[17]Stemper BD, Marawar SV,Yoganandan N,et al.Quantitative anatomy of subaxial cervical lateral mass:an analysis of safe screw lengths for Roy-Camille and magerl techniques[J].Spine,2008,33 (8):893-897.
[18]楚戈,白靖平,锡林.宝勒日,等.无x射线引导下颈椎侧块钉植入技术的应用[J].中国组织工程研究与临床康复,2009,13(13)：2460-2464
[19]席新华,吴强,唐华军,等.成人下颈椎椎体与关节突关节倾角的X射线测量数据[J].中国组织工程研究与临床康复,2009,13(4)：662-666.
[20]Chiewvit P, Tritakam SO,Phawjinda A,et al. Predictive value of magnetic resonance imaging in cervical spondylotic myelopathy in prognostic surgical outcome[J].J Med Assoc Thai,2011,94 (3):346-354.
[21]Won-Sang Cho, Chun Kee Chung, Tae-Ahn Jahng etal. Post-Laminectomy Kyphosis in Patients with Cervical Ossification of the Posterior Longitudinal Ligament:Does It Cause Neurological Deterioration?[J] Korean Neurosurg Soc2008,43:259-264.
[22]Nassr A,Eck JCJPonnappan RK,et al.The incidence of C5 palsy after multilevel cervical decompression procedures:a review of 750 consecutive cases[J].Spine,2012,37 (3): 174-178.
[23]Greiner-Perth R,Elsaghir H,El-Meshtawy M.The incidence of C5-C6 radiculopathy as a complication of extenstive cervical decompressionrown results and review of literature.Neurosurg ev 2005;28:137-42.
[24]Sakaura H,Hosono N, Mukai Y,et al.C5 Palsy after decompression surgery for cervical myelopathy:review of the literarure[J].Spine,2003,28(21):2447-2451.
[25]Kong Q,Zhang L,Liu L,et al.Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty[J].Spine,2011,36 (13): 1030-1036.
[26]Hashimoto M,Mochizuki M,Aiba A, et al.C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases[J]. Eur Spine J,2010,19(10):1702-1710.
[27]Imagama S,Mstsuyama Y,Yukawa Y,et al.C5 palsy after cervical laminoplasty:a multicentrestudy[J].J Bone Joint Surg Br,2010,92 (3):393-400.
[28]张为,李鹏飞,杨大龙,等.颈椎后路减压术后脊髓后移的临床意义[J].中国矫形外科杂志,2011,19(1)：11-14.
[29]Minoda Y,Nakamura H,Konishi S,et al.Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine.Spine,2003,28:1123-1127.
[30]Kyakumachi T,Satoh E,Yoshimoto T,et al.Segmental motor paralysis so called C5 nerve palsy after cervical laminoplasty[J].J Jpn Spine Res Soc,2006,17 (2):21-27.
[31]张春霖,姜岩,钟楚楠,等.脊髓型颈椎病钛板双向固定颈椎管扩大成形术治疗58例体会[J].郑州大学学报(医学版),2007,43(2)：584-586.
[32]Iizuka H, Nakajima T,Iizuka Y,et al.Cervical malalignment after laminoplasty:relationship to deep extensor musculature of the cervical spine and neurological outcome[J].J Neurosurg Spine,2007,7:610-614.
[33]John M,Rhee. MD,Bradley R,et al. Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures[J]. Spine, 2010,36 (1):9-14.
[34]Kotani Y,Abumi K,Ito M et al.Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle-preserving approach:impact on cervical spine function and quality of life[J].European spine jourmal,2009,18(5):663-671.
[35]Takeshita K,Seichi A,Akune T,et al.Can laminoplasty maintain the cervical alignment even when the lamina is contained? Spine (Phila Pa 1976),2005,30 (11):1294-1298.
[36]Hosono N.Sakaura H, Mukai Y, et al.C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial nick pain.Eur. Spine J,2006,15(9):1375-1379.
[37]Fujibayashi S,Neo M,Yoshida M,et al.Neck muscle strength before and after cervical laminoplasty:relation to axial symptoms[J].J Spinal Disord Tech,2010,23(3):197-202.
[38]Iizuka H,Nakajima T,Iizuka Y,et al. Cervical malalignment after laminoplasty:relationship to deep extensor musculature of the cervical spine and neurological outcome[J]. Neurosurg Spine,2007,7 (6):610-614.
[39]Takeuchi K, Yokoyama T, Aburakawa S,et al.Axial sympotoms aftercervical laminoplasty with C3 laminectomy compared with conventional C3-7 laminoplasty:a modified laminoplasty preserving the semispinalis cervicis inserted into axis[J].Spine (Phila Pa 1976),2005,30 (22):2544-9.
[40]董福龙,申才良,江曙,等.颈椎椎管容积的动态CT测量及其临床意义[J].中国矫形外科杂志,2008,16(9)：682-686,701.
[1]MarkB, RichardA, HowardW, et al. Cervical spondylotic myleopathy current concept review[J]. J Bone Joint Stag,1993,75(A),1:119
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京：人民军医出版社1998.5：1462—1485
[3]Lawrence JS. Disc degeneration:its frequency in relationship to symptoms [J]. Aan Rheum Dis,1969,28(2):121-137
[4]Miyamoto S, Yonenobu K, Ono K. ExperimenCal cervi cal spondylosis in the mouse[J]. Spine,1991; 16(Suppl):495-500.
[5]Nagano T, Yonenobu K, Mivamoto S, etal. Distrjbution ofthe basic fi hroblast growLh factor and its receptor gene expression in normal and degenerated rat intervertebral discs[J]. Spine,1995; 20:1972-1979
[6]LestineWF, Wiesel SW, The pathogenesis of cervical spondylosis. Clin Orthop,1989: 239:69 - 93
[7]Baba H, Furusawa N, Limura S, Late. Radiographic findings after anterior cervical fusjonfor spondylotic myeloradio-lopathy, spine,1993:18:2167.
[8]Pavlov H.Torg JS, Robie B, et al. Cervical spinal stenosis:determination with vertebral body ratio method[J]. Radiology,1987,164(3):771-775.
[9]Crandall PH, Batgdert U. Long-term following of surgical treatmeot of cervical spondylotic myelopathy. J Neurosurg,1966:25:57.
[10]贾连顺,袁文,倪斌,等颈椎管发育性狭窄与脊髓型颈椎病(J).颈腰痛杂志,1999；20(1)：9—11.
[11]Parke WW.Correlative anatomy of cervical spondyioticmyelopthy.spine,1988,13:861-863.
[12]Al-Mefty O, Harkey HL, Marawi I, et al. Experimental chronic com-pressive cervical myelopathy[J]. J Neurosurg,1993,79(4):550-561.
[13]蔡钦林,黄云钟,杨文,等。慢性压迫性颈脊髓病超微病理变化的实验研究.中国脊柱脊髓杂志,1996：6(6)：254.
[14]陈锋.脊髓型颈椎病脊髓微血管神经元微环境改变实验研究[J].中国矫形外科杂志,2004,12(13)：1009—1010.
[15]傅强,侯铁胜,刘善荣,等.大鼠脊髓压迫性损伤后神经细胞的死亡方式.第二军医大学学报,1997：18(6)：557.
[16]Emery SE.Cervical spondylotic myelopathy:diagnosis and treatment[J]J Am Acad Orthop Surg,2001,9 (6):376-388.
[17]马如龙,田伟,李世和,等.临床cT、MRI对脊髓型颈椎病的诊断价值.云南医药,1998：19(1)：33—34.
[18]蒋振松,张佐伦,刘立成,等.脊髓型颈椎病患者的颈椎cT测量及其临床意义[J].中国脊柱脊髓杂志,2003,13：220—223.
[19]董福龙,申才良,江曙,等.颈椎椎管容积的动态CT测量及其临床意义[J].中国矫形外科杂志,2008,16(9)682-686.
[20]Suri A, Chabbra RP, Mehta VS, et al. Effect of intramedullary signal chageson the surgical outcome of patients with cervical spondylotic myelopathy[J]. spine 2003,3:33-45.
[21]Matsumoto M, Toyama Y. Increased signal intensity of the spinal cord on magneticresonance images in cervical compressive myelopathy [J]. Spine,2000.25: 677-682.
[22]Maertens de Noordhout A, RemcIe JM,Pepin JL, et al, Magnetic stimulation of the motor cortex in cervical spondyIosis [J].Neurology 1991; 41:75.
[23]BrunhoIzI C Clous D. Central motor conduction time to uper and lower limbs in cervical lord lesions [J]. Arch NeuroI 1994; 51:245.
[24]Wehling P, Cleveland S, Reinecke J. et al, Magnetic stimulation as a diagnostic toot in cervical nerve root compression and compression induced neuropathy [J]. Spinal Dis 1995; 8:304.
[25]Moeti P,Marchetti G.Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy:a case series[J].The Journal of Orthopaedic and Sports Physical Therapy,2001,31(4):207-213.
[26]Koyanagi T,Predicat ability of operative results of cervical compression myelopathy based on preoperative compued to mographic[J]. Spine,1993,182:1958-1963.
[27]孙宇哲,巩顺东,李政等.脊髓型颈椎病的手术治疗[J].中国临床医学影响杂志,2008,19(7)：522-523.
[28]Fareg ID, McAfee PC. Davis RF. et al. Pseudoarthrosis of the cervical spine after anterior arthrodesis[J]. J Bone and Surg,1990,72A:1171-1177.
[29]曾明,林庆光,赵新建等.不同方式的颈椎前路减压植骨融合术治疗颈椎病[J].中国脊柱脊髓杂志,2000,10(3)：160-162.
[30]Thalgott JS,Xiongsheng C,Giuffre JM,Single stage anterior cervical reconstruction with titanium mesh cages, local autograft, and anterior plating[J].Spine,2003,3(4):294-300.
[31]Joseph C, et al. outcome analysis of noninstrumented al lte"or cervical discectomy and jnterbody f-usion in 348 patients. [J]. Spine,1998; 23:188.
[32]王晓凡,韩向阳,贾光辉等,前路三种手术方式治疗脊髓型颈椎病的疗效分析[J].延安大学学报(医学版),2008,6(3)：39-41.
[33]王恒龙,姜振国,朱剑等.脊髓型颈椎病前路手术48例临床分析[J].实用骨科杂志,2009,15(6)：445-447.
[34]Kaiser MG, Haid Rw Jr, subach BR, et al. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neumsurgery,2002,50:229-236.
[35]刘鹏,赵建华,李起鸿等.两种前路术式治疗多节段脊髓型颈椎病的对比研究[J].中国修复重建外科杂志,2006,20(4)：362-366.
[36]Tureyen K.Disc height loss after mrciodiscectomy with titanium intervertebral cage fusion[J].Eur Spine J,2003,12(5):513-516.
[37]Porter RW,Craw ford NR,Chamberlain RH,et al.Biom echanical analysis of multilevel cervical corpectomy and plate constructs.JN eurosurg,2003,99 (1):98-103.
[38]Singh K,Vaccaro AR,Kim J,et al.Enhancement of stability following anterior cervical corpectomy:a biomechanical study.Spine,2004,29 (8):845-849.
[39]Gercek E,Arlet V,Delisle J,et al.Subsidence of stand-alone cervical cages in anterior interbody fusion:warning.Eur Spine J,2003,12 (5):513-6.
[40]EPSTEIN N.Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament:review of operative technique and assessment of 65 multilevel circumferential procedures[J].SurgNeurol,2001,55:313-324.
[41]孔凡奇,王志烈,谢辉,等.颈前路减压植骨钛板内固定治疗脊髓型颈椎病[J].实用骨科杂志.2009,15(1)：36-38.
[42]梁延琛,聂林,侯勇,等.人工颈椎间盘假体置换术治疗脊髓型颈椎病的临床效果[J].山东大学学报(医学版),2008,46(12)：102—105.
[43]Geroge JK,Nathan ER.Incidence and outcome of kyphotic deformity following lamienctomg for cervical spondylotic myelopathg[J].J Neurosurg (Spine):2002,93 (7) 199.
[44]Wang JM,Roh KJ,Kin DJ,et al.A new method of stabilizing the elevated lam inate open-door lam inoplasty using an anchor system[J].J Bone Joint Surg Am,1999,19 (9): 1005-1008.
[45]王义生,张弛,唐国皓,等.锚钉定在多节段脊髓型颈椎病单开门椎管扩大术中的应用[J].中国脊柱脊髓杂志,2012,22(1)：20-23.
[46]任喜龙,王相利,王少波,等.单开门棘突重建颈椎管扩大成形术治疗脊髓型颈椎病[J].中国脊柱脊髓杂志,2001,11(3)：136-138.
[47]Yue WM,Tan CT,Tan SB,et al.Results of cervical laminoplasty and a comparison between single and double trap-door technique[J].J Spinal Disord,2000,13 (4):329-335.
[48]Matsumura A,Yanaka K,Akutsu H,et al.Combined laminoplasty with osterior mass plate for unstable spondylotic cervical canal stenosis-technical note[J].Neurol Med Chir (Tokyo),2003,43 (10):514-529.
[49]王景续,尹西盟,宫树一,等.颈椎后路侧块钢板螺钉置入治疗多节段颈椎病伴颈椎失稳[J].中国组织工程研究,2012,16(3)：2411-2414.
[50]Emery SE,Bohiman HH,Bolesta MJ,et al.Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic, yelopathy[J].J Bone Joint Surg (Am) 1998,80 (7):941-951.
[51]Huang RC,Giardi FP,Poynton AR,er al.Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decomp ression and fusion with lateral mass plate fixation and local bone graft[J].J Spinal Disord Tech,2003,12 (6):123-129.
[52]马雷,中勇,杨大龙,等.前后路手术与单纯前路或后路手术治疗颈椎孤立型后纵韧 带骨化症的对比研究[J].中国脊柱脊髓杂志,2012,22(10)：884-888.
[53]Wang MY,Green BA.Open-door crewicla expansile decomp ression of spinal cord SurgNeuro,1997,8:63-71.
[54]李展振,龙享国,祝海炳,等.射频消融髓核成形术治疗颈椎间盘突出症初步临床报道[J].骨与关节损伤杂志,2002,17(4)：244.
[55]张春霖,赵玉果..后路椎间盘镜下应用B-Twin治疗腰椎失稳症65例[J].郑州大学学报(医学版),2009,44(2)：448-450.
[56]钟家云,黄其裕,赵德兵,等.椎间盘镜下建立椎弓根通道行后路腰椎椎体间融合术的研究[J].广西医学,2010,32(9)：1043-1045.
[57]周跃,张峡,王卫东,等.内窥镜下颈椎前路减压植骨融合术的初步报告[J].中华骨科杂志,2004,24(2)：75-79.
[58]Fehlings MQSmith JS,Kopjar B,Arnold PM,Yoon ST,Vaccaro AR,et al.perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AO Spine North America cervical spondylotic myelopathy study.J Neurosurg Spine 2012;16:425-32.
[59]Kopjar B,Fehlings M,Yoon TS,et al.Predictors of success in the surgical treatment for cervical spondylotic myelopathy:Analysis of the AOSpine North America Multi-center prospective study in 260 patients.Presented at the Annual meeting of the American Association of Neurological Surgeons.Denver:Colarado;2011.
[60]Matz PG,Holly LT,Mummaneni PV,Anderson PA,Groff MW,Heary RF,et al.Anterior cervical surgery for the treatment of cervical degenerative myelopathy.J Neurosurg Spine 2009; 11:170-3.
[61]Furlan JC,Kalsi-Ryan S,Kailaya-vasan A,Massicotte EM,Fehlings MG.Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy:A prospective study of 81 cases.J Neurosurg Spine 2011; 14:348-55.