颈前椎间盘切除融合术是一种颈部手术,包括摘除受损的椎间盘以减轻脊髓或神经根压力,减轻相应的疼痛、无力、麻木和刺痛。椎间盘切除术是一种手术减压方式,所以这个手术也可以称为颈前路减压术。
Anterior cervical discectomy and fusion (ACDF) is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.
手术分两个部分:
颈椎前路椎间盘切除术。手术通过颈椎前路或前部(颈部),从内脏鞘和血管鞘之间,将椎间盘从两个椎体的终板之间移除。
融合。融合手术在椎间盘切除术后即刻进行,其目的是为了稳定节段。融合包括将植骨和/或植入物放置在椎间盘原来的位置,以便为该病变节段重建稳定性和强度。
The surgery has 2 parts:
- Anterior cervical discectomy. The surgery is approached through the anterior, or front, of the cervical spine (neck). The disc is then removed from between two vertebral bones.
- Fusion. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. A fusion involves placing bone graft and/or implants where the disc originally was in order to provide stability and strength to the area.
虽然该手术最常见的是治疗有症状的颈椎间盘突出症,但也可用于退行性椎间盘疾病。通常还可以清除由关节炎引起的骨刺并减轻与颈椎狭窄相关的症状。
ACDF可用于颈椎的一个节段或多个节段。
While this surgery is most commonly done to treat a symptomatic cervical herniated disc, it may also be done for cervical degenerative disc disease. It is also commonly done to remove bone spurs (osteophytes) caused by arthritis and to alleviate the symptoms associated with cervical spinal stenosis.
ACDF may be done for one level, or for more than one level, of the cervical spine.
颈椎前入路:
ACDF采用前入路进行,颈前路具有几个典型的优点:
直接切除椎间盘。前入路允许直接切除颈椎间盘,解除突出椎间盘导致狭窄、脊髓或神经压迫和症状,神经和脊髓减压更加直接。前入路从颈部顶部C2节段向下至颈胸节,称为C7-T1节段。
更少的疼痛。颈前路仍是颈椎手术最常见的入路,因为它的入路简单,与后路手术相比,患者的切口疼痛更少。在颈部前面做了一个皮肤切口后,沿着天然的间隙就可以一直到椎间盘的前方。属于典型的微创手术,所以前路的手术的疼痛很轻微。
Anterior Cervical Surgery Approach
An ACDF is done with an anterior approach, which means that the surgery is done through the front of the neck as opposed to through the back of the neck. This approach has several typical advantages:
- Direct access to the disc. The anterior approach allows direct visualization of the cervical discs, which are usually involved in causing the stenosis, spinal cord or nerve compression, and symptoms. Removal of the discs results in direct nerve and spinal cord decompression. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervicothoracic junction, called the C7-T1 level, which is where the cervical spine joins with the upper spine (thoracic spine).
Less postoperative pain. Spine surgeons often prefer this approach because it provides access to the spine through a relatively uncomplicated pathway. The patient tends to have less incisional pain from this approach than from a posterior operation.
After a skin incision is made in the front of the neck, only one thin vestigial muscle needs to be cut, after which anatomic planes can be followed right down to the spine. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery.