tailieunhanh - Cổ tử cung : Chẩn đoán và điều trị

Phân định myelopathy spondylotic cổ tử cung như một thực thể lâm sàng đã được cải thiện với sự phát triển của cao chất lượng hình ảnh neuroradiologic cắt ngang. Lịch sử tự nhiên của rối loạn này thường làm chậm sự suy giảm trong một thời trang theo từng bước, với các triệu chứng xấu đi của dáng đi bất thường, | Cervical Spondylotic Myelopathy Diagnosis and Treatment Sanford E. Emery MD Abstract The delineation of cervical spondylotic myelopathy as a clinical entity has improved with the development of high-quality cross-sectional neuroradiologic imaging. The natural history of this disorder is usually slow deterioration in a stepwise fashion with worsening symptoms of gait abnormalities weakness sensory changes and often pain. The diagnosis can usually be made on the basis of findings from the history physical examination and plain radiographs but confirmation by magnetic resonance imaging or computed tomography and myelography is necessary. Minimal symptoms without hard evidence of gait disturbance or pathologic reflexes warrant nonoperative treatment but patients with demonstrable myelopathy and spinal cord compression are candidates for operative intervention. Both anterior and posterior approaches have been utilized for surgical treatment of cervical myelopathy. Anterior decompression frequently requires corpectomy at one or more levels and strut grafting with bone from the ilium or fibula. Multilevel laminectomies were initially used for posterior decompression but now are either combined with fusion or replaced by laminoplasty. Any operative technique requires proper patient selection and demands adequate decompression of the canal to effect neurologic improvement. Perioperative complications can be devastating in this group of high-risk patients with cervical spondylotic myelopathy but careful attention to detail meticulous technique and experience can result in excellent outcomes. J Am Acad Orthop Surg 2001 9 376-388 Cervical spondylosis results from the nearly universal process of degeneration of the disks and joints of the cervical spine. These changes in the spinal motion segments have doubtless existed since the evolution of man but our understanding of the pathoanatomy and clinical conditions associated with cervical spondylosis is relatively recent. Classic