关于手术治疗颈椎病的现状分析

颈椎病目前是骨科多发病种，手术通常是颈椎病治疗的一类建议，比如手臂有严重的放射性疼痛或在核磁共振扫描中显示神经根被病变髓核严重压迫时。

症状是治疗方法的选择条件

手术会产生痛疼，这是肯定的，虽然是为了治疗颈椎病，但终究不利于患者的生理健康恢复。虽然手术的愿望，只是为了加速颈椎健康的恢复。

颈椎病并不总是需开放手术治疗。如果症状轻微或没有进展，还是推荐保守疗法或者观察，也可以使用微创技术治疗。

如果脊髓型颈椎手术进行，外科医生通常会告诉病人，这次行动是为了阻止事情变得更糟，而不是改善任何已经发生的症状，这意味着，当麻醉药效消失后，疼痛依然强烈。

手术的类型使用将取决于疼痛或神经损害位置（病灶），比如椎间盘突出或椎管狭窄。

目前欧美国家采用的外科手术包括：

颈椎前路椎间盘切除术，这是用在椎间盘突出或骨赘（骨刺）压迫神经时。医生会在患者的脖子前面切口，切除病变髓核或者增生骨刺。

颈椎椎板切除术，外科医生将在患者脖子后面的做切口，取出椎板以消除脊髓压迫。

颈椎椎间盘钻孔术，通过椎盘钻孔释放盘内压力将受压迫的神经根释放，一般情况而言，大多数人宁愿选择椎前路椎间盘切除术。

人工椎间盘置换，这是一项新的手术技术，采用人工椎间盘取代受损较严重的椎盘，这种方法也在逐渐成熟中。

其他手术方法，类目比较多，各国称谓也不相同，不做具体分析。

手术的并发症：

患者如果决定手术，应该知晓手术的好处与安全风险，这是行医之道。像所有的外科手术，颈椎手术具有一定的并发症与风险，包括：

1.     罕见的全身麻醉相关的并发症，如心脏病，血液凝块的肺或过敏性反应；

2.     瘫痪，这可能发生，如果手术进入椎管后出血或脊神经的血液供应被破坏；

3.     手术后的伤口，这是通常不严重，可以用抗生素治疗的感染（感染更多更深的脊柱严重但少见）

4.     损害神经和血管，这种情况时有发生。

苏州康立医院骨科学术论文已在美国颈椎论坛发表，以下是英文版：

On the status of surgical treatment of cervical spondylosis

you have severe radiating arm pain that is not settling and nerve root compression is shown on your MRI scan.you have symptoms and signs of a progressive myelopathy (see Cervical spondylosis - symptoms ) Surgery can sometimes be useful for radiating arm pain due to cervical spondylosis, but it does not benefit neck pain.

Most people with radiating arm pain and cervical radiculopathy will actually get better themselves eventual。Therefore the idea of surgery is simply to speed up natural recovery.

Cervical myelopathy does not always need an operation either.

If the symptoms are mild or not progressing, it may be better to leave things alone and 'wait and see'.If surgery for cervical myelopathy is carried out, the surgeon will usually tell the patient that the operation is to stop things getting worse rather than to improve any symptoms that have already occurred.

The type of surgery used will depend on the underlying cause of your pain or nerve damage, such as a slipped disc or a narrowing of your spinal canal.

Surgical techniques that may be used include:

Anterior cervical discectomy, which is used when a slipped disc or osteophyte (lump of extra bone) is pressing on a nerve.

The surgeon will make an incision in the front of your neck and remove the problem disc or piece of bone.

This procedure results in a fusion across the disc joint.

Cervical laminectomy.

The surgeon will make an incision (small cut) in the back of your neck and remove the pieces of bone contributing to compression of your spinal cord.

Cervical foraminotomy. This is where a particular nerve root is released by making a cut in the back of your neck.

It is used in more select circumstances than an anterior cervical discectomy.

Prosthetic intervertebral disc replacement.

This relatively new surgical technique involves removing a worn disc in the spine and replacing it with an artificial disc.

The results of this technique have been promising, but as it is still a very new technique, there is no evidence about how well it works in the long term or whether there will be any complications.

Like all surgical procedures, surgery on the cervical spine carries some risk of complications, including:

rare complications associated with general anaesthetic, such as heart attack, blood clot in the lung or an allergic reaction

paralysis, which could occur if there is bleeding into the spinal canal after surgery or the blood supply of spinal nerves is damaged

infection of your wound after surgery, which is not usually serious and can be treated with antibiotics (deeper spinal infection is more serious but very rare)

damage to nerves and blood vessels, which occurs in rare cases

If it is decided that you could benefit from surgery, your consultant will discuss the specific risks and benefits in your situation.