Summary
Eighty four cases are described in whom an account of various cervical syndromes a ventral fusion has been performed since 1962 by Cloward's method. Of 29 cases with brachialgia, a good result was obtained in twenty five. Seventeen times brachialgia presented combined with a cephalgia. Of these the result was favourable in sixteen. Seven out of eight cases with cephalgia obtained a good result. Among thirty patients with cervical myelopathies, with various clinical presentations, positive results were achieved in fourteen.
From these personal experiences one concludes that fusion can be avoided under some circumstances if only one disc is excenterated. If more discs have to be operated upon, fusion becomes essential. With subluxation fractures of the cervical certebrae, ventral fusion can replace the prolonged extension treatment and immobilisation which would otherwise be necessary, and thereby ease the nursing and shorten the course of the illness. In such cases the bone dowel must frequently be fixed additionally by steel cramps.
The type of bone material is, according to these results, of secondary importance.
The indication for operation cannot be based only on the clinical-neurological findings and on the radiographs of the cervical spine. In addition to myelography, discography especially has proved itself. It is technically simple and no complications were seen in our series of cases.
The difficulty of selecting patients with cervical myelopathy for operation is especially referred to.
Résumé
Rapport de 84 cas de fusion vertébrale par la méthode de Cloward pratiquée depuis 1962 pour des syndrômes cervicaux variés.
Sur les 29 cas de brachialgies, un bon résultat a été obtenu dans 25 cas.
Sur 17 cas de brachialgies associées aux céphalées, le résultat était favorable dans 16 cas.
Sur 8 cas de céphalalgies, 7 cas ont obtenu de bons résultats.
Sur 30 cas de myélopathies cervicales avec des manifestations cliniques variées, des résultats positifs ont été obtenus dans 14 cas.
De ces expériences, les auteurs ont tiré certaines conclusions:
-
1∘
— avec un seul disque enlevé, la fusion vertébrale peut être évitée dans certaines circonstances;
-
2∘
— si plusieurs disques avaient été enlevés, la fusion vertébrale deviendrait obligatoire. Dans les luxation fractures cervicales, la fusion vertébrale peut remplacer le traitement par extension prolongée et l'immobilisation, le nursing est plus aisé, la durée de la maladie sera raccourcie.
Dans ces derniers cas, le greffon osseux doit être fixé par des vis d'acier.
Le type de greffon osseux est d'importance secondaire d'après ces résultats.
L'indication opératoire ne doit pas être portée seulement sur les données neurologiques et les radiographies simples de la colonne cervicale. Il faut se baser sur la myélographie et la discographie qui sont techniquement simples, et n'ont pas provoqué de complications dans notre série de cas.
Enfin l'indication opératoire est très difficile à porter chez les malades atteints de myélopathie cervicale.
Riassunto
Gli AA. riferiscono su 84 casi, nei quali, dal 1962 a oggi, fu effettuata la fusione ventrale secondo Cloward per varie sindromi cervicali.
Su 29 casi di brachialgia si ebbero risultati favorevoli in 25 casi. In 17 casi la brachialgia era associata a cefalgia: in 16 di essi si ebbero risultati soddisfacenti. In 8 casi di cefalgia si ebbe 7 volte un buon risultato. In 30 mielopatie cervicali con differenti quadri morbosi, si ebbero risultati positivi in 14 casi.
In base alle esperienze degli AA., si può rinunziare eventualmente alla fusione, quando venga estratto un solo disco. Se invece devono essere operati vari dischi, la fusione é indispensabile. Nelle fratture con lussazione della porzione cervicale della colonna vertebrale, la fusione ventrale può essere sostituita da una lunga terapia con l'estensione del capo e messa a riposo. In questi casi il tassello osseo deve essere spesso fissato con l'aggiunta di morsetti d'acciaio. Il genere di materiale osseo é di importanza secondaria, secondo l'opinione degli AA.
La decisione sull'intervento non può essere prese soltanto in base al reperto clinico-neurologico ed alle semplici radiografie della porzione cervicale della colonna vertebrale.
A questo scopo si é affermata, accanto alla mielografia, la discografia. Essa é semplice dal punto di vista tecnico, né ha dato luogo a complicazioni nella casistica degli AA.
Viene messa molto in risalto la difficoltà della decisione sull'intervento operatorio nelle mielopatie cervicali.
Resumen
Se recogen 84 casos de fusion vertebral realizada con el método de Cloward, empleado desde 1962, en síndromes cervicales diversos.
En 29 casos de braquialgias se obtuvo un buen resultado en 25.
En 17 casos de braquialgias asociadas a cefaleas el resultado fué favorable en 16.
En 8 casos de cefalalgias se obtuvieron buenos resultados en 7.
En 30 casos de mielopatías cervicales con manifestaciones clínicas variadas los resultados fueron positivos en 14.
De esta experiencia los autores han Ilegado a ciertas conclusiones:
-
1.
— cuando solo se extirpa un solo disco la fusión puede ser evitada en algunos casos;
-
2.
— si se han extirpado varios discos la fusión vertebral se hace necesaria. En las luxaciones-fracturas cervicales la fusión puede reemplazar al tratamiento con extensión prolongada e inmovilización, los cuidados médicos para el enfermo son mas cómodos y la enfermedad se acorta.
En estos últimos casos el injerto oseo debe ser fijado con tornillos de acero.
El tipo de injerto oseo tiene una importancia secundaria, según los resultados de los autores.
La indicación operatoria debe sentarse no solamente teniendo en cuenta los datos neurológicos y las radiografías simples de la columna, sino después de practicar la mielografía y la discografía, que son técnicas simples y que no han ocasionado complicaciones en nuestra serie de casos.
Por último, en los enfermos con mielopatías cervicales la indicación operatoria es muy dífícil de establecer.
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Grote, W., Röttgen, P. Die ventrale Fusion bei der zervikalen Osteochondrose und ihre Behandlungsergebnisse. Acta neurochir 16, 218–240 (1967). https://doi.org/10.1007/BF01793127
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DOI: https://doi.org/10.1007/BF01793127