若疼痛不消退且所有症状、体征以及诊断性检查提示单一神经根受压,神经减压手术对某些患者可能有帮助。[8]Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis and management. J Bone Joint Surg Am. 2007 Jun;89(6):1360-78.
http://www.ncbi.nlm.nih.gov/pubmed/17575617?tool=bestpractice.com
[19]Van Zundert J, Huntoon M, Patijn J, et al. 4. Cervical radicular pain. Pain Pract. 2010 Jan-Feb;10(1):1-17.
http://www.ncbi.nlm.nih.gov/pubmed/19807874?tool=bestpractice.com
神经减压的手术方法有多种(这方面仍在争议),但一般根据患者的症状、累及的节段数和颈椎 MRI 扫描的特定解剖,选择前路颈椎间盘切除融合术 (ACDF) 或后路神经减压术。
通常需要至少 2-3 个月的保守治疗。由于神经根型颈椎病很少出现明显的肌力下降或者神经功能改变,是否行手术减压主要取决于患者主观疼痛感和不适的程度。
另一方法是行颈椎关节成形术,放置人工椎间盘替代移植和骨板,以避免骨融合并保留了运动功能;多项随机研究已经开展,但是这些手术并未在各地常规开展。[44]Boselie TF, Willems PC, van Mameren H, et al. Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976). 2013 Aug 1;38(17):E1096-107.
http://www.ncbi.nlm.nih.gov/pubmed/23656959?tool=bestpractice.com
[48]Gao F, Mao T, Sun W, et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine (Phila Pa 1976). 2015 Dec;40(23):1816-23.
http://www.ncbi.nlm.nih.gov/pubmed/26571063?tool=bestpractice.com
[49]Janssen ME, Zigler JE, Spivak JM, et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized US Food and Drug Administration investigational device exemption study. J Bone Joint Surg Am. 2015 Nov 4;97(21):1738-47.
http://www.ncbi.nlm.nih.gov/pubmed/26537161?tool=bestpractice.com
尽管已开展这些随机研究,但目前尚无明确的证据证实,与前路椎间切除融合术 (ACDF) 相比,关节成形术能更好地缓解上肢根性痛。不过,虽然尚无明确数据表明,关节成形术可预防随着时间推移出现临近节段狭窄,但与 ACDF 相比,关节成形术后二次手术率可能更低。[44]Boselie TF, Willems PC, van Mameren H, et al. Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976). 2013 Aug 1;38(17):E1096-107.
http://www.ncbi.nlm.nih.gov/pubmed/23656959?tool=bestpractice.com
[48]Gao F, Mao T, Sun W, et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine (Phila Pa 1976). 2015 Dec;40(23):1816-23.
http://www.ncbi.nlm.nih.gov/pubmed/26571063?tool=bestpractice.com
[49]Janssen ME, Zigler JE, Spivak JM, et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized US Food and Drug Administration investigational device exemption study. J Bone Joint Surg Am. 2015 Nov 4;97(21):1738-47.
http://www.ncbi.nlm.nih.gov/pubmed/26537161?tool=bestpractice.com
[50]Shriver MF, Lubelski D, Sharma AM, et al. Adjacent segment degeneration and disease following cervical arthroplasty: a systematic review and meta-analysis. Spine J. 2016 Feb;16(2):168-81.
http://www.ncbi.nlm.nih.gov/pubmed/26515401?tool=bestpractice.com
颈前路椎间盘切除术疼痛较轻,但是可能出现吞咽问题。[8]Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis and management. J Bone Joint Surg Am. 2007 Jun;89(6):1360-78.
http://www.ncbi.nlm.nih.gov/pubmed/17575617?tool=bestpractice.com
[21]Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Guidelines for the surgical management of cervical degenerative disease. 2009 [internet publication].
https://thejns.org/spine/view/journals/j-neurosurg-spine/11/2/article-p101.xml
[52]Smith-Hammond CA, New K, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical and lumbar procedures. Spine. 2004 Jul 1;29(13):1441-6.
http://www.ncbi.nlm.nih.gov/pubmed/15223936?tool=bestpractice.com
颈后路椎间盘切除术可能导致颈部疼痛加重,但是通常不发生融合,因而能保留脊柱的运动功能。