颈腰综合征诊断及外科治疗的研究进展

doi:10.3760/cma.j.issn.2095-7041.2019.06.022

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摘要目的总结颈腰综合征(TSS)诊断和外科治疗的研究进展。方法在中国知网、万方数据、中国生物医学文献数据库和PubMed 数据库,分别以“颈腰综合征”“椎管狭窄”“颈椎”“腰椎”“同期手术”“分期手术”和“tandem spinal stenosis” “canal stenosis” “cervical” “lumber” “simultaneous” “staged”为关键词,检索2000年1月—2019年2月与TSS的解剖学、流行病学、临床表现、影像检查、外科治疗有关的文献进行分析总结。共检索文献489篇,纳入45篇,其中中文文献15篇和英文文献30篇。结果 TSS的发病率为0.12%~34%,好发年龄为20~76岁,临床表现复杂,应综合评估患者症状和体征,并结合多种影像学证据才能明确诊断。其手术治疗方式存在争议,目前多数研究认为同期手术和分期手术在手术疗效和并发症方面没有统计学差异。同期手术可缩短手术时间、住院时间和住院费用。分期手术单次手术创伤小,对于耐受差的老年患者更适用;部分患者在主要受压部位减压后,次要受压部位的症状可能同时得以缓解从而避免二期手术治疗。结论 TSS在当代脊柱外科临床中并不少见,全面的体格检查和影像学评估,能更有效地发现多部位压迫,依据病变程度选择同期或分期手术均能获得满意的临床疗效。

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	雷涛
	高显达
	申勇

关键词 ：椎管狭窄, 颈腰综合征, 颈椎, 腰椎, 诊断, 外科手术

Abstract：Objective To summarize the progress of tandem spinal stenosis (TSS) to provide a theoretical basis for the clinical diagnosis and treatment.Methods A computer-based online search of CNKI, Wanfang Data, China Biology Medicine Disc and PubMed databases were undertaken to identify the articles about TSS published from January 2000 to February 2019, with the key words of “tandem spinal stenosis” “spinal stenosis” “cervical vertebrae” “lumber vertebrae” “simultaneous operation” “staging operation”. The anatomy, epidemiology, clinical feature, imaging and surgical treatment were summarized. A total of 489 related literatures were retrieved, and 45 literatures were finally included according to the inclusion and exclusion criteria, including 15 Chinese literatures and 30 English literatures.Results The incidence of TSS was 0.12% to 34%, and the age of onset was 20-76 years old. The clinical manifestation of TSS was complex. The patients' symptoms, signs and imaging evidence should be comprehensively evaluated. The surgical procedures were controversial. Most studies showed that there was no statistical difference in operative efficacy and complications between staged operation and simultaneous operation. But simultaneous operation could shorten operation time, hospitalization days and costs. The surgical trauma of staged operation was less, which was more suitable for the elderly patient with poor tolerance. After first-stage operation, the symptoms might be relieved and the second-stage operation might be avoided.Conclusions TSS is not rare in contemporary spine surgery. Comprehensive physical examination and imaging evaluation are necessary to discover the multiregional spinal stenosis. TSS can be effectively managed by either simultaneous surgical intervention, or staged decompressions.

Key words： Spinal stenosis Tandem spinal stenosis Cervical vertebrae Lumber vertebrae Diagnosis Surgical procedures

收稿日期: 2019-03-06

基金资助:河北省医学科学研究课题计划(20190622)

通讯作者: 申勇,Email:shenyonglaoshi@126.com

引用本文:

雷涛, 高显达, 申勇. 颈腰综合征诊断及外科治疗的研究进展[J]. 中华解剖与临床杂志, 2019, 24(6): 622-626.
Lei Tao, Gao Xianda, Shen Yong. Research progress on diagnosis and treatment for tandem spinal stenosis. Chinese Journal of Anatomy and Clinics, 2019, 24(6): 622-626.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.06.022 或 http://www.cjac.com.cn/CN/Y2019/V24/I6/622

[1]	Yamada T, Yoshii T, Yamamoto N, et al. Clinical outcomes of cervical spinal surgery for cervical myelopathic patients with coexisting lumbar spinal canal stenosis (tandem spinal stenosis): A retrospective analysis of 297 cases[J]. Spine(Phila Pa 1976), 2018, 43(4): E234-E241. DOI:10.1097/BRS.0000000000002289.
[2]	Yamada T, Yoshii T, Yamamoto N, et al. Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases[J]. J Orthop Surg Res, 2018, 13(1): 60. DOI:10.1186/s13018-018-0765-6.
[3]	Teng P, Papatheodorou C. Combined cervical and lumbar spondylosis[J]. Arch Neurol, 1964, 10(3): 298-307. DOI:10.1001/archneur.1964.00460150068007.
[4]	Epstein NE, Epstein JA, Carras R, et al. Coexisting cervical and lumbar spinal stenosis: diagnosis and management[J]. Neurosurgery, 1984, 15(4): 489-496. DOI:10.1227/00006123-198410000-00003.
[5]	Dagi TF, Tarkington MA, Leech JJ. Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression[J]. J Neurosurg, 1987, 66(6): 842-849. DOI:10.3171/jns.1987.66.6.0842.
[6]	赵定麟, 张文明, 李国栋, 等. 颈椎病[M]. 上海: 上海科学技术文献出版社, 1988: 338.
[7]	Bajwa NS, Toy JO, Ahn NU. Is congenital bony stenosis of the cervical spine associated with congenital bony stenosis of the thoracic spine? An anatomic study of 1072 human cadaveric specimens[J]. J Spinal Disord Tech, 2013, 26(1): E1-E5. DOI:10.1097/BSD.0b013e3182694320.
[8]	Chen Y, Chen DY, Wang XW, et al. Single-stage combined decompression for patients with tandem ossification in the cervical and thoracic spine[J]. Arch Orthop Trauma Surg, 2012, 132(9): 1219-1226. DOI:10.1007/s00402-012-1540-5.
[9]	Hu PP, Yu M, Liu XG, et al. Surgeries for patients with tandem spinal stenosis in cervical and thoracic spine: combined or staged surgeries?[J]. World Neurosurg, 2017, 107: 115-123. DOI:10.1016/j.wneu.2017.07.129.
[10]	Hong CC, Liu KP. A rare case of multiregional spinal stenosis: clinical description, surgical complication, and management concept review[J]. Global Spine J, 2015, 5(1): 49-54. DOI:10.1055/s-0034-1378139.
[11]	Lee MJ, Garcia R, Cassinelli EH, et al. Tandem stenosis: a cadaveric study in osseous morphology[J]. Spine J, 2008, 8(6): 1003-1006. DOI:10.1016/j.spinee.2007.12.005.
[12]	Bajwa NS, Toy JO, Young EY, et al. Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1072 human cadaveric specimens[J]. J Neurosurg Spine, 2012, 17(1): 24-29. DOI:10.3171/2012.3.SPINE111080.
[13]	Nagata K, Yoshimura N, Hashizume H, et al. The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: the Wakayama spine study[J]. Eur Spine J, 2017, 26(10): 2529-2535. DOI:10.1007/s00586-017-5072-0.
[14]	Kikuike K, Miyamoto K, Hosoe H, et al. One-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis on cervical and lumbar spine: analyses of clinical outcomes with minimum 3 years follow-up[J]. J Spinal Disord Tech, 2009, 22(8): 593-601. DOI:10.1097/BSD.0b013e3181929cbd.
[15]	Kawaguchi Y, Oya T, Abe Y, et al. Spinal stenosis due to ossified lumbar lesions[J]. J Neurosurg Spine, 2005, 3(4): 262-270. DOI:10.3171/spi.2005.3.4.0262.
[16]	LaBan MM, Green ML. Concurrent (tandem) cervical and lumbar spinal stenosis: a 10-yr review of 54 hospitalized patients[J]. Am J Phys Med Rehabil, 2004, 83(3): 187-190. DOI:10.1097/01.phm.0000113405.48879.45.
[17]	石海浪, 王欢, 崔少千, 等. 颈腰综合征及其手术治疗[J]. 中国矫形外科杂志, 2017, 25(1): 53-57. DOI:10.3977/j.issn.1005-8478.2017.01.11.
[18]	王春生, 常楚. 颈腰综合征及其治疗[J]. 颈腰痛杂志, 2007, 28(3): 240-241. DOI:10.3969/j.issn.1005-7234.2007.03.029.
[19]	Ghobrial GM, Oppenlander ME, Maulucci CM, et al. Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: a review[J]. Clin Neurol Neurosurg, 2014, 124: 114-118. DOI:10.1016/j.clineuro.2014.06.012.
[20]	Yamada T, Yoshii T, Yamamoto N, et al. Surgical outcomes for lumbar spinal canal stenosis with coexisting cervical stenosis (tandem spinal stenosis): a retrospective analysis of 565 cases[J]. J Orthop Surg Res, 2018, 13(1): 60. DOI:10.1186/s13018-018-0765-6.
[21]	Lee SH, Kim KT, Suk KS, et al. Asymptomatic cervical cord compression in lumbar spinal stenosis patients: a whole spine magnetic resonance imaging study[J]. Spine(Phila Pa 1976), 2010, 35(23): 2057-2063. DOI:10.1097/BRS.0b013e3181f4588a.
[22]	Yamada T, Yoshii T, Yamamoto N, et al. Clinical outcomes of cervical spinal surgery for cervical myelopathic patients with coexisting lumbar spinal canal stenosis (tandem spinal stenosis): a retrospective analysis of 297 cases[J]. Spine(Phila Pa 1976), 2018, 43(4): E234-E241. DOI:10.1097/BRS.0000000000002289.
[23]	Swanson BT. Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy[J]. J Man Manip Ther, 2012, 20(1): 50-56. DOI:10.1179/2042618611Y.0000000010.
[24]	Miyazaki M, Kodera R, Yoshiiwa T, et al. Prevalence and distribution of thoracic and lumbar compressive lesions in cervical spondylotic myelopathy[J]. Asian Spine J, 2015, 9(2): 218-224. DOI:10.4184/asj.2015.9.2.218.
[25]	潘亚林. 神经电生理检查在颈腰综合征治疗中的作用[J]. 中华实用诊断与治疗杂志, 2011, 25(9): 929-930.
[26]	黄玉国, 申勇, 丁文元, 等. 颈腰综合征的临床特点和手术治疗[J]. 中国矫形外科杂志, 2007, 15(15): 1187-1188. DOI:10.3969/j.issn.1005-8478.2007.15.023.
[27]	Felbaum DR, Fayed I, Stewart JJ, et al. Relief of lumbar symptoms after cervical decompression in patients with tandem spinal stenosis presenting with primarily lumbar pain[J]. Cureus, 2016, 8(12): e940. DOI:10.7759/cureus.940.
[28]	张涛, 徐建广, 周蔚, 等. 颈腰综合征分期手术治疗的效果分析[J]. 脊柱外科杂志, 2011, 9(1): 11-13. DOI:10.3969/j.issn.1672-2957.2011.01.003.
[29]	胡继平, 樊宇平, 车凤义, 等. 颈腰综合征的临床治疗分析[J]. 颈腰痛杂志, 2009, 30(1): 37-38. DOI:10.3969/j.issn.1005-7234.2009.01.011.
[30]	刘志伟, 杨惠林, 张志明, 等. 颈腰综合征的诊断及其手术治疗22例分析[J]. 苏州大学学报(医学版), 2008, 28(1): 154-155. DOI:10.3969/j.issn.1673-0399.2008.01.056.
[31]	石海浪, 王欢, 崔少千, 等. 颈椎减压手术治疗以坐骨神经痛为表现的颈腰综合征的临床效果分析[J]. 中国骨与关节杂志, 2016, 5(11): 808-811. DOI:10.3969/j.issn.2095-252X.2016.11.003.
[32]	Alvin MD, Alentado VJ, Lubelski D, et al. Cervical spine surgery for tandem spinal stenosis: the impact on low back pain[J]. Clin Neurol Neurosurg, 2018, 166: 50-53. DOI:10.1016/j.clineuro.2018.01.024.
[33]	Luo CA, Kaliya-Perumal AK, Lu ML, et al. Staged surgery for tandem cervical and lumbar spinal stenosis: which should be treated first?[J]. Eur Spine J, 2019, 28(1): 61-68. DOI:10.1007/s00586-018-5795-6.
[34]	刘学鹏, 孙海燕, 刘希华, 等. 对颈腰综合征患者施行一期颈腰椎减压手术的临床效果分析[J]. 脊柱外科杂志, 2013, 11(4): 209-213. DOI:10.3969/j.issn.1672-2957.2013.04.004.
[35]	Krishnan A, Dave BR, Kambar AK, et al. Coexisting lumbar and cervical stenosis (tandem spinal stenosis): an infrequent presentation. Retrospective analysis of single-stage surgery (53 cases)[J]. Eur Spine J, 2014, 23(1): 64-73. DOI:10.1007/s00586-013-2868-4.
[36]	Schaffer JC, Raudenbush BL, Molinari C, et al. Symptomatic triple-region spinal stenosis treated with simultaneous surgery: case report and review of the literature[J]. Global Spine J, 2015, 5(6): 513-521. DOI:10.1055/s-0035-1566226.
[37]	吴康, 李浩曦, 胡朝晖, 等. 同期手术治疗颈腰椎椎管狭窄症[J]. 实用骨科杂志, 2014, 20(5): 394-398. DOI:10.13795/j.cnki.sgkz.2014.05.003.
[38]	Hu P, Yu M, Liu X, et al. One-staged combined decompression for the patients with cervico-thoracic tandem spinal stenosis[J]. Eur Spine J, 2017, 26(2): 374-381. DOI:10.1007/s00586-016-4497-1.
[39]	熊建, 薛峰, 党育, 等. 颈腰综合征患者腰椎术后无骨折脱位颈脊髓损伤1例报告[J]. 中国脊柱脊髓杂志, 2008, 18(9): 719-720. DOI:10.3969/j.issn.1004-406X.2008.09.021.
[40]	Eskander MS, Aubin ME, Drew JM, et al. Is there a difference between simultaneous or staged decompressions for combined cervical and lumbar stenosis?[J]. J Spinal Disord Tech, 2011, 24(6): 409-413. DOI:10.1097/BSD.0b013e318201bf94.
[41]	Naderi S, Mertol T. Simultaneous cervical and lumbar surgery for combined symptomatic cervical and lumbar spinal stenoses[J]. J Spinal Disord Tech, 2002, 15(3): 229-232. DOI:10.1097/00024720-200206000-00011.
[42]	Overley SC, Kim JS, Gogel BA, et al. Tandem spinal stenosis: a systematic review[J]. JBJS Rev, 2017, 5(9): e2. DOI:10.2106/JBJS.RVW.17.00007.
[43]	隰建成, 白一冰, 穆小静, 等. 椎间孔镜联合低温等离子射频治疗颈腰综合征[J]. 实用骨科杂志, 2011, 17(8): 673-676. DOI:10.3969/j.issn.1008-5572.2011.08.001.
[44]	何齐芳. 腰椎非融合固定结合椎间孔镜治疗多节段腰椎椎管狭窄症[J]. 中华全科医学, 2015, 13(7): 1206-1208. DOI:10.16766/j.cnki.issn.1674-4152.2015.07.033.
[45]	刘波, 田伟, 李勤, 等. 选择性神经根封闭在多节段腰椎疾患的定位作用[J]. 中华外科杂志, 2002, 40(3): 200. DOI:10.3760/j:issn:0529-5815.2002.03.027.