Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
Objective To explore changes in the height and width of the cervical intervertebral foramina of C6,7 before and after the C5,6 discetomy, the replacement or the anterior intervertebral fusion so as to provide the theoretical basis for the clinical practice. Methods Eleven fresh cervical spinal specimenswere obtained from young adult cadavers. The specimens of C5,6 were divided into the integrity group, the discectomy group, the artificial disc replacement group, and the intervertebral fusion group. The range of variety (ROV) of the C6,7 intervertebral foramen dimensions (height, width) before and after the loading tests (0.75, 1.50 Nm) were measured in the 4 groups. Results The C6,7 intervetebral foramen height and width increased significantly during flexion (Plt;0.01) but decreased significantly during extension (Plt;0.01). There was a significantdifference between the two test conditions in each of the 4 groups (Plt;0.01). However, in the two test conditions there was no significant difference in ROV of the C6,7 intervetebral foramen height and width during flexion and extension betweenthe integrity group, the discectomy, and the artificial disc replacement group（Pgt;0.05）, but a significant difference in the above changes existed in the intervertebral fusion group when compared with the other 3 groups (Plt;0.05). In the same group and under the same conditions, the ROV of the C6,7 intervetebral foramen height and width was significantly different in the two test conditions (Plt;0.01). Conclusion The results have indicated thatartificial disc replacement can meet the requirements of the normal cervical vitodynamics. The adjacent inferior cervical intervetebral foramen increases during flexion but decreases during extension. The intervertebral fusion is probably one of the causes for the cervical degeneration or the accelerated degeneration and for the cervical spondylotic radiculopathy and the brachial plexus compression.
Objective To study the cl inical appl ication of anchoring cervical intervertebral fusion cage (ACIFC) in anterior cervical discectomy with fusion. Methods From November 2006 to June 2007, 21 cases of degenerative cervical disease were treated with anterior cervical discectomy, bone graft by ACIFC and anchoring stators, and 28 ACIFCs were implanted. There were 12 males and 9 females aged 25-68 years old (average 47.9 years old). The course of disease rangedfrom 3 days to15 years (median 2.3 years). There were 7 patients with single-segment cervical spondylosis, 3 with two-segment cervical spondylosis, 2 with single-segment lower cervical spine instabil ity, 4 with single-segment cervical spondylosis and lower cervical spine instabil ity, and 5 with cervical disc herniation. Postoperatively, X-ray films were taken regularly to detect the fusion of bone graft and the intervertebral height of fused segment was measured. The symptoms, signs and cervical functions of patient before operation, shortly after operation and during the follow-up period were evaluated by “40 score” system. And the occurrence of postoperative axial symptom (AS) was assessed with the standard set by Zeng Yan et al. Results All incisions healed by first intention. AS occurred in 1 case 48 hours after operation and was improved from poor to good after symptomatic treatment. No other kind of compl ication was identified or reported during intra-operative and postoperative period. All the cases were followed up for 16-24 months (average 20.5 months), and fusion was reached in all the intervertebral discs. Evaluated by “40 score” system, the average score for the cervical spinal cord function before operation, shortly after operation and during the final follow-up period was 26.2, 30.6, and 35.5 points, respectively, indicating there were significant differences between different time points (P lt; 0.05). During the follow-up period of above 1 year, the average improvement rate was 67.4%. The average intervertebral height before operation, shortly after operation and during the last follow-up period were 1.9, 4.4 and 4.3 mm, respectively, showing there were significant differences between the preoperation and the immediate postoperative and last follow-up periods (P lt; 0.05). No degeneration of adjacent segment was observed during the follow-up period. Conclusion Using ACIFC in bone graft fusion and internal fixation for degenerative cervical disease is convenientand fast, has wide range of indications with satisfying cl inical effect, and can achieve obvious therapeutic effect in restoring and maintaining cervical intervertebral height.
Objective To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases. Methods From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation(including 3 cases of congenital odontoid disconnection，4 cases of old odontoid fracture，2 cases of new odontoid fracture(typeⅡC), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture； 2 cases of tumor of C2; 1case of giant neurilemoma of C2,3 with instability after the resection oftumors. JOA score before operation was 8.3±3.0. Results The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mmwithout affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was14.6±2.2. JOA improvement rates were 73%-91%(mean 82%). Conclusion The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has betteroutcomes, wider indications if conducted properly.
Objective To compare the loss of anterior column heightand cervical Cobb angle with three different types of anterior cervical discectomy and fusion(ACDF). Methods A prospective randomized study was performed on 60 patients who had undergone ACDF with the autologous iliac crest graft (group A, n=20), the autogenous bone and the anterior cervical locking plates (group B, n=20), and Syncage-C filled with the local autograft reamings (group C, n=20) from January 1998 to January 2003. The patients diagnosed as having cervical radiculopathy (RP) and cervical spondylotic myelopathy (CSM) were indicated for ACDF. Of the patients, 41 were male and 19 female with a mean age of 57 years (range, 36-68) and their average course of disease was 6.2 months (range, 1-36). There were 36 one-level and 24 two-level fusions from C3,4 to C7,T1. Radiological measurements were performed on the cervical radiographs taken before operation, 7 days and 3 months after operation, and on the last day of the follow-up; then, the height and Cobb angle of the fused segment, functional restoration, and clinical outcome were evaluated in the three groups. Results The followup of more than 2 years (range,2-7) showed that the average loss of anterior column height and Cobb angle of the fused segments in groups A and B, which had not preserved the-endplate, hada greater increase than that in group C, which had preserved the endplate. Of the patients, 12 had autograft collapse, 3 autograft displacement, and 10 postural abnormality between the fused segments, most of which happened in groups A andB. The fusion rate was 93.3% (56 cases) according the strict arthrodesis critera; their excellent and good rate in the functional assessment was 83.3% (RP 90.4%, CSM 79.5%); the overall satisfactory (excellent and good) rates in groups A,B and C were 75%, 85% and 90%, respectively. Conclusion To increase the resistance to graft subsidence, which is a major reason for narrowness of the fused segments, and to maintain normal cervical curvature, we should improve our skills of bone grafting performance, preserve the endplate, carefully evaluate the degree of osteoporosis before operation, and use anterior cervical locking plate and /or fusion with Syncage-C when necessary.
ObjectiveTo investigate the effect of non-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening on patients with cervical vertebra disease of the nerve root type. MethodsSixty patients diagnosed with cervical vertebra disease of the nerve root type between April 2007 and June 2009 were divided randomly into therapy group (n=30), treated with non-heated silver needle decompression, and control group (n=30), treated with physical therapy. Then, we observed the total effective rate, positive physical signs and electrophysiological indexes of the patients 3, 6, 12, and 24 months after treatment. ResultsThe total effective rate was 96.7%, 93.3%, 93.3% and 86.7% in the therapy group 3, 6, 12, and 24 months after treatment, while it was 80.0%, 63.3%, 60.0%, and 50.0% in the control group, and the diTherence between the two groups in each time point was significant (P<0.05). The rate of positive sign in the top pressure test and Brachial plexus traction test lowered significantly 3, 6, and 12 months after treatment in both the two groups (P<0.05), while the rate lowered significantly only in the therapy group 2 years after treatment (P<0.05). Paraspinal tenderness lowered significantly at each time point in the therapy group after treatment (P<0.05), while the decrease in the control group had no significance (P<0.05). The interpeak latency of somatosensory evoked potential N9-N13 got significantly shorter at each time point after treatment in the therapy group (P<0.05), while this only happened at the time points of 3 and 6 months after treatment in the control group (P<0.05). The latency of wave F got significantly shorter at each time point after treatment in the therapy group (P<0.05), while the shortening only occurred 6 months after treatment in the control group (P<0.05). ConclusionNon-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening is an effective treatment for patients with cervical vertebra disease of the nerve root type.
ObjectiveTo assess the causal relationship between cervical vertebra related disorders and essential hypertension using a bidirectional two-sample Mendelian randomization study approach. MethodsThe research data comes from the genome-wide association study dataset. Four types of cervical vertebra related disorders: cervicalgia, cervical disc disorders, cervical root disorders, injury of nerves and spinal cord at neck level, as well as data on essential hypertension, were selected for the study. Relevant single nucleotide polymorphisms were selected as instrumental variables to assess the causal relationship between cervical vertebra related disorders and essential hypertension mainly by inverse variance weighted model ratio. Cochran's Q test was used to detect heterogeneity, MR-Egger intercept term and MR-PRESSO was used to detect multiplicity, and leave-one-out method was used for sensitivity analysis. ResultsCervicalgia had a positive causal relationship with the essential hypertension (OR=1.01, 95%CI 1.00 to1.02, P=0.019). Essential hypertension had a positive causal relationship with the cervical disc disorders (OR=4.08, 95%CI 1.57 to10.61, P=0.004). There was no significant causal relationship between cervical root disorders, injury of nerves and spinal cord at neck level and essential hypertension. Reliability assessment indicates that the study results were reliable. ConclusionCervicalgia is a risk factor for essential hypertension; Essential hypertension is a risk factor for cervical disc lesions; There is no correlation between cervical root disorders, injury of nerves and spinal cord at neck level and essential hypertension.
ObjectiveTo explore the effects of core stable training on cervical vertebrae pain, cervical function and balance ability in patients with neck type cervical spondylopathy (NTCS).MethodsFrom January to August 2018, 98 patients with NTCS were treated. According to the odd and even bed numbers, 49 patients were enrolled in the observation group and 49 were in the control group. The patients in the control group was given Kinesio tape treatment, and the observation group was given core stability training based on the treatment of the control group. Cervical vertebrae pain was assessed by Visual Analogue Scale (VAS), Clinical Assessment Scale for Cervical Spondylosis (CASCS) and Neck Disability Index (NDI); cervical vertebra activity were used to assess the cervical; the Berg Balance Scale (BBS) was used to assess patients’ balance before intervention and at the 4th week of intervention. The incidence of complications during the intervention and the effective of treatment 4 weeks after intervention were recorded. The recurrence rate 6 months after the intervention was recorded.ResultsThere were no significant difference in CASCS, NDI, VAS, and BBS scores between the two groups before intervention (P>0.05). At the 4th week of the intervention, the CASCS and BBS scores of the two groups were higher than those before the intervention, and the VAS and NDI scores were lower than those before the intervention (P<0.05); and the CASCS and BBS scores in observation group at the 4th week of the intervention were higher than that of control group, and VAS and NDI scores were lower than those of the control group (P<0.05). There was no significant difference in the activity of the cervical vertebrae before intervention in both of the two groups (P>0.05). At the 4th week of the intervention, the activity of the cervical vertebrae in all directions was bigger than that of before the intervention in both of the two groups (P<0.05), and that in observation group were bigger than that of the control group (P<0.05). The effective rate at the 4th week in the observation group (95.92%) was higher than that in the control group (81.83%)(P<0.05). The recurrence rate 6 months after intervention in the observation group (6.38%) was lower than that in the control group (22.50%) (P<0.05).ConclusionCore stability training can relieve cervical spondylosis in NTCS patients, and improve the cervical function and patients’ balance; it has high safety and stable efficacy.
Objective To summarize the methods andskills of anterior cervical locking plate systems in clinical application and to analyze the causes of some complications as well as give some preventive or remedial countermeasures. Methods From 1998 to 2002, 159 patients with cervical spondylotic myelopathy,fracturedislocation,tumor or tuberculosis of the cervical spine were treated with anterior locking plate systems. The complications were reviewed and analyzed. Results Ten kinds of complications related to anterior locking plate systems occurred in 21 patients. Most of the complications were caused by improperly-selecting implants, experience and technique deficiency. Conclusio The important preventive or remedial countermeasures are correctly-selecting patients, meticulous preoperative preparation, properly-selecting implants, standard and skillful manipulation and rational postoperative protection.
ObjectiveTo design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application.MethodsThe clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C4, 5 in 2 cases, C5, 6 in 6 cases, and C6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient’s quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria.ResultsAll operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient’s feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores (P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively (P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%.ConclusionThe P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.