{"title":"退行性颈椎病手术治疗的算法路线图:叙述性综述。","authors":"Dong-Ho Lee, Hyung Rae Lee, Kiehyun Daniel Riew","doi":"10.31616/asj.2023.0413","DOIUrl":null,"url":null,"abstract":"<p><p>Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11065509/pdf/","citationCount":"0","resultStr":"{\"title\":\"An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review.\",\"authors\":\"Dong-Ho Lee, Hyung Rae Lee, Kiehyun Daniel Riew\",\"doi\":\"10.31616/asj.2023.0413\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.</p>\",\"PeriodicalId\":8555,\"journal\":{\"name\":\"Asian Spine Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11065509/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2023.0413\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2023.0413","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
颈椎退行性脊髓病(DCM)是导致残疾的主要原因,其手术治疗对患者的神经功能预后至关重要。鉴于 DCM 的表现和严重程度各不相同,治疗方案也多种多样。外科医生在选择最合适的手术方法时往往面临挑战,因为没有放之四海而皆准的答案。这篇叙述性综述旨在通过介绍一种结构化的治疗算法来帮助治疗 DCM 的决策过程。作者根据算法对手术方案进行了分类,概述了每种情况下适合的治疗方法。根据需要手术的水平数和 K 线状态确定了四种主要情况:(1) K 线(+)且≤ 3 个水平;(2) K 线(+)且≥ 3 个水平;(3) K 线(-)且≤ 3 个水平;(4) K 线(-)且≥ 3 个水平。考虑到手术级别和 K 线状态,这种分类有助于确定前路或后路方法的适当性以及融合的必要性。由于 DCM 的手术情况复杂,治疗方法多样,因此可以通过使用算法方法进行有效管理。此外,最大限度减少分期和应对挑战性条件的手术技术有可能提高 DCM 治疗的效果。
An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review.
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.