Twenty cases of myelopathy secondary to cervical spondylosis had been treated by anterior expansive decompression and interbody iliac bone graft. Follow-up for 8 to 42 months, the therapeutic results were satisfactory without any obvious complications. The techniques of fenestration and bone graft were introduced. The advantages of this operation were discussed.
To probe the etiopathogenisis of adjacent-segment disease by analyzing the imageology data and cl inical neurological function in patients with anterior cervical discectomy and fusion (ACDF) harvested by long-term follow-up. Methods A retrospective study was performed on 52 patients who had undergone ACDF with perfect documents from January 1990 to April 2003. Of the patients, 45 were males and 7 were females with a mean age of 48.5 years (range from 25 to 72 years). There was the fusion of 10 one-levels, 38 two-levels and 4 three-levels. The cervical anterior-posterior and lateral X-ray, CT and MRI examination were performed before the operation. Cl inical neurological function was recorded by the Nurick score, and this score at 6 weeks after the operation was compared with the later follow-up. In the radiological examination, the motion of adjacent vertebrae and osteophyte formation were reviewed on X-ray and CT, and were converted to the semi-quantitative degeneration score according to the Goffin method. The correlation between Nurick score or degeneration score and the age at operation or fusion levels was compared by Spearman correlation coefficients. The cervical canal sizes of adjacent level and remote level on MRI were reviewed and compared with each other by t test. Results The follow-up period was 3 to 10 years, 6.9 years on average. There was difference in the Nurick score between the 6th week after operation (1.07 ± 0.84) and the later follow up (1.92 ± 1.28) by rank test (P lt; 0.05). There was no correlation between the Nurick score change and the age at operation (r = 0.21, P gt; 0.05) or fused levels(r = 0.30, P gt; 0.05) by Spearman correlation coefficients. There was obvious difference in degeneration score between the 6th week after operation (0.73 ± 0.67) and the later follow up (1.58 ± 1.06), (P lt; 0.01). There was no correlation between the degeneration score change and the age at operation (r = 0.35, P gt; 0.05) or fusion levels (r = 0.38, P gt; 0.05) by Spearman correlation coefficients. The cervical canal size reductions were (1.7 ± 1.1) mm at superioradjacent level, (1.2 ± 0.6) mm at inferior adjacent level and (0.30 ± 0.68) mm at remote level. There was obvious difference between superior or inferior and remote level by t test (P lt; 0.01). The adjacent level developed prominent degeneration together with nerve function change after the fusion operation and displayed correlation between degeneration and nerve function change(r = 0.41, P lt; 0.05). Conclusion The adjacent-segment disease after interbody fusion is produced by multiple factors. The natural progression in adjacent disc, biomechanical natural change resulting from interbody fusion, destruction to l igament structure in front of cervical vertebrae by operation, and bone graft model are important factors not to be ignored.
Objective To evaluate the clinical effect of percutaneous laser disc decompression (PLDD) in the treatment of cervical disc herniation. Methods From March 2003 to December 2005, 47 patients with cervical disc herniation(96 cervical disc) were treated with PLDD. There were 25 males and 22 females with an average age of 56 years, ranging from 37 to72 years. The lesion were located at the levels of C3,4 in 20 discs, C4,5 in 27 discs, C5,6 in 31 discs, C6,7 in 18 discs. The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance. Laser reduced the intradisc pressure through the vaporization of disc nucleu. The adopted laser was semiconducted with a wavelength of 810 nm. Each laser output power was15 W with 1 s emission and 2 s interval. The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat, ranging from 300 to 1 000 J.Results Of 47 patients,42 were followed up for 3 to 31 months (mean 13 months). The clinical evaluation was classified as excellent in 18 cases (42.9%), good in 14 cases (33.3%), fair in 6 cases (14.3%) and poor in 4 cases (9.5%). The general response rate was 90.5%. The excellent and good rate was 76.2%. No complications occurred. Conclusion PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication. The manipulation of PLDD is easy, safe and mini-invasive.
ObjectiveTo review the research progress of C5 palsy (C5P) after cervical surgery, providing new clinical intervention ideas for the C5P patients. MethodsThe relevant literature domestically and abroad was extensively consulted and the latest developments in the incidence, risk factors, manifestations and diagnosis, prevention, and intervention measures of C5P were systematically expounded. ResultsC5P is characterized by weakness in the C5 nerve innervation area after cervical decompression surgery, manifested as limited shoulder abduction and elbow flexion, with an incidence rate more than 5%, often caused by segmental spinal cord injury or mechanical injury to the nerve roots. For patients with risk factors, careful operation and preventive measures can reduce the incidence of C5P. Most of the patients can recover with conservative treatment such as drug therapy and physical therapy, while those without significant improvement after 6 months of treatment may require surgical intervention such as foraminal decompression and nerve displacement. ConclusionCurrently, there has been some advancement in the etiology and intervention of C5P. Nevertheless, further research is imperative to assess the timing of intervention and surgical protocol.
【摘要】 目的 探讨颈椎后纵韧带骨化症(OPLL)的CT表现及其诊断价值。 方法 回顾性分析2004年11月-2009年10月收治的6 480例颈椎患者的CT图像资料，观察后纵韧带骨化块的形态、位置及与椎管的关系，计算椎管狭窄率。 结果 6 480例颈椎CT图像中，37例发现OPLL，占0.57%（37/6 480）。颈椎后纵韧带骨化块表现为点状、条状、线状、平板状、山丘状、蕈伞状及花边状，呈现局限型、节段型、连续型、混合型特点。C4、C5及C6为颈椎后纵韧带骨化常见位置。骨化块平均厚度为4.12 mm，骨化块致椎管矢状径狭窄率为10.20%～49.18%，多位于椎管前方中间位置。椎管狭窄率gt;34.10%，临床症状明显。 结论 CT检查能较好地显示颈椎后纵韧带骨化块的特征及椎管的狭窄程度，是临床医生选择手术方案和术后评估预后的一种较好方法。【Abstract】 Objective To study the CT manifestations of ossification of posterior longitudinal ligament (OPLL) and to evaluate diagnostic value. Methods Retrospective analysis was made on the cervical spine CT images of 6 480 cases, and 37 cases of OPLL were found. The shape, location of the ossification pieces and the sagital diameter of cervical spinal canal and the stenotic rate were observed and measured. Results The ossified pieces were manifested as dots, belts, lines, boards, mounds, mushrooms and flower margins in shape. They were continuous, segmental, solitary or mixed. OPLL usually was found at C4, C5 and C6. The average thickness of the ossified pieces was 4.12 mm. The spinal stenotic rate ranged from 10.20% to 49.18% due to OPLL. The ossified pieces were often found at the middle of the back edge of cervical vertebrae bodies. There were obvious symptoms when the stenotic rate of sagital diameter of cervical spinal canal was over 34.10%. Conclusion CT is an optimal modality for diagnosis of OPLL of cervical spine and cervical spinal stenosis, and may help the clinicians to select or valuate operation project.
Objective To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting (n=35, outpatient setting group) or in inpatient setting (n=35, inpatient setting group). There was no significant difference between the two groups (P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group (P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss (P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference (t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.
Objective To develop a high-accuracy, better-safety and low-cost cervical pedicle locator system for guiding cervical pedicle screw placement. Methods Cervical pedicle screw locator system was made of stainless steel. Ten cervical specimens from voluntary donation were divided into two groups according to compatibil ity design: control group inwhich 60 screws were planted into C2-7 by free hand; and experimental group in which 60 screws were planted into C2-7 under the guidance of three-dimensional locator system. The condition of screw insertion was observed and the accuracy was evaluated by the integrity of pedicle walls. Results In the control group, 32 screws (53.33%) were placed inside the pedicles and 28 (46.67%) were outside; 9 screws (15.00%) led to nerve root injury, 5 screws (8.33%) caused vertebral artery injury and no spinal cord injury occurred; and the qual ification ratio of screw insertion was 76.67% (excellent 32, fair 14, poor 14). While in the experimental group, 54 screws (90.00%) were placed inside the pedicles and 6 (10.00%) were outside; 1 screw (1.67%) caused vertebral artery injury and no nerve root injury and spinal cord injury occurred; and the qual ification ratio of screw insertion was 98.33% (excellent 54, fair 5, poor 1). There was significant difference between the two groups (P lt; 0.05). Conclusion Cervical pedicle screw locator system has the advantages of easy manipulation, high accuracy of screw placement and low cost. With further study, it can be appl ied to the cl inical.
Objective To explore the occurrence condition of the neck axial symptom (AS) after cervical Bryan artificial disc replacement combined with anterior cervical discectomy and fusion (Hybrid surgery) and traditional anterior cervical discectomy and fusion (ACDF surgery) to treat the two-level cervical disease, and to do contrastive analysis. Methods Between August 2006 and March 2010, 18 patients underwent Hybrid surgery (group A) and 30 patients underwent two-level ACDF surgery (group B). There was no significant difference in age, gender, disease duration, type, and operated segment between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, cervical curvature of the operated segment, total range of motion (ROM) of C2-7, ROM of the adjacent segment, and incidence of neck AS were recorded and compared between before operation and at last follow-up. Results All the patients were followed up 18-34 months (24.1 months on average). In both groups, the JOA and NDI scores at last follow-up had significantly improvement when compared with preoperative scores (P lt; 0.01), but there was no significant difference between 2 groups at preoperation and last follow-up (P gt; 0.05). The kyphosis incidence of the operated segment in group B was significantly higher than that in group A (χ2=5.333, P=0.021). There was no significant difference in the total ROM of C2-7 between at preoperation and last follow-up in group A (t=0.410, P=0.685); the total ROM of C2-7 at last follow-up was significantly lower than that at preoperation in group B (t=3.007, P=0.006); and significant difference was found between 2 groups at last follow-up (t=2.664, P=0.013). At last follow-up, ROM of the superior and inferior adjacent segments in group B increased obviously (P lt; 0.05) and was significantly higher than that in group A (t=2.252, P=0.033; t=2.203, P=0.037). The incidence of neck AS were 16.7% in group A and 46.7% in group B, showing significant difference at last follow-up (χ2=4.427, P=0.035). Conclusion Compared with two-level ACDF surgery, Hybrid surgery has good outcomes. At the same time, it can maintain the curvature of operated segments and total ROM, avoid excessive increased ROM of the adjacent segments, and reduce the incidence of neck AS.
摘要:目的:研究一种能够显示颈椎关节突关节及关节间隙的最佳投照摄影位置的方法。方法:观察50例非脊柱疾病患者,在透视下利用传统颈椎斜位的基础上,继续增大角度20°～25°,使人体冠状面与床面的夹角逐渐增大至65°～70°角的范围,此时颈椎(C3～C7)关节突关节在电视上显示最佳时,然后进行点片获取C3~C7关节突关节X线照片。结果: 经透视点片获取422个关节突关节,其中C3显示48个,C4 为96个,C5 为98个,C6 为98个,C7为82个;经统计学χ2检验,颈C3~C7关节突关节在同一椎体的不同侧面及性别间显示率无差异(Pgt;0.05)。在摄影时,笔者设计将躯干冠状面与胶片成65°～70°角的范围,颈椎略呈屈曲位,头部略向对侧外旋,使头部冠状面与胶片成45°角,中心线下移至第五椎体下缘平行射入,经透视确定位置后点片,可得到清晰的关节突关节影像,此摄影位置称可视颈椎关节突关节投照位。结论:可视的颈椎节突关节投照位置能清晰显示颈椎关节突关节及关节间隙。Abstract: Objective: To study the best projection position of cervical articular facet. Methods:The cervical facet angle which was the join angle between sagittal plane of body and the continual line of cervical facet was measured on cervical Xrayed images showed and to the film in 50 healthy people. Results: The facet angle was 65°70°,during projection, the coronal plane of body in the form of 65°70° to the film, this projection position was called cervical facet position. Conclusion: seeingredients cervical facet and its interspaces of join can be showed clearly in the cervical facet position of projection.