颈椎病02课件.pptVIP

Cervical Spondylotic Myelopathy: A Review of the Evidence Eric Klineberg, MD Orthop Clin N Am 41 (2010) 193–202 Cervical spondylotic myelopathy (CSM) is the most common progressive spinal cord disorder in patients more than 55 years old. More than 50% of middle-aged patients show radiographic evidence of cervical disease, but only 10% have clinically significant root or cord compression. CSM is also the most common cause of acquired spasticity in later life and may lead to progressive spasticity and neurologic decline.1 There are multiple symptoms of myelopathy, including motor and sensory disturbances, but the onset is usually insidious. Lower extremities are affected first, and patients can complain of gait disturbance, with degeneration of the spinocerebellar and cortico-spinal tracts. The upper extremities can then become affected with loss of coordination and difficulty with fine motor tasks.2 However, the symptoms can be much more subtle and may involve axial neck pain, scapular pain, or a progres-sive broad-based gait. Often, the patient’s spouse notices the disturbance earliest as an unfamiliar walking pattern. GOALS This article explores some of the controversies in CSM and reviews pertinent articles, specifically prospective and randomized clinical trials when possible, to obtain the cleanest and least biased data. The 4 current controversial topics that surround CSM are: (1) natural history of mild CSM; (2) surgical approach: anterior versus poste-rior; (3) laminoplasty or laminectomy; and (4)cervical arthroplasty for CSM. NATURAL HISTORY The natural history of CSM is not well known. Historically surgical treatment has been the main-stay for progressive CSM. Traction and soft collars have not been shown to alter the natural course of the disease.3 There have been several series studying patients treated conservatively, and 26% to 50% of patients may deteriorate neurolog-ically over time. Clark and Robinson4 found that 5% of patie