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Background: Neck pain with radiculopathy and neurodeficit is a common problem in working population. Methods: 50 patients underwent ACDF with C5-C6 the commonest level to be affected. The cases were analyzed preoperatively and at 3 months, 6 months using NDI and VAS. Decrease in pre operative and 1 year post operative VAS score, Preoperative and postoperative NDI was statistically significant.Conclusion: Symptoms of neck pain, tingling, and weakness reduced after 1 year follow up. Discussion: From our study, it is evident that there is significant decrease in parameters like neck pain, tingling and radiculopathy postoperatively also there was significant decrease in NDI at 6 months follow-up.
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Objective To evaluate the effect of acupuncture and massage combined with anterior cervical decompression and bone grafting for the treatment of cervical spondylotic myelopathy, and to analyze the mechanism of action and provide guidance for clinical prevention and treatment.Methods A total of 62 patients with cervical spondylotic myelopathy were enrolled in our hospital from October 2013 to October 2014.The patients were divided into treatment group and control group according to random number table.The control group was treated with anterior decompression and bone grafting, and the treatment group received acupuncture and massage combined with anterior cervical decompression and bone grafting and internal fixation.The changes of JOA score, TCM syndrome score, VAS score and quality of life score before and after treatment were observed and the prognosis was evaluated.Results After treatment,the JOA score, quality of life score of the two groups were significantly increased than those before treatment, while the TCM symptom scores, VAS scores were significantly decreased.The improvement effect of the treatment group was better than that of the control group(P<0.05);The prognosis of the treatment group is better than that of the control group(P<0.05).Conclusion The treatment of cervical spondylotic myelopathy with acupuncture and massage combined with anterior decompression and bone grafting and internal fixation can significantly improve the clinical efficacy and prognosis, and the safety is higher.
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Objectives@#To study the relationship between the anatomical parameters of transverse foramen and intervertebral discs in the cross-section of the cervical spine in healthy adults, and to evaluate the risk of vertebral artery injury in the anterior cervical spine surgery.@*Methods@#There were 24 healthy adults(12 male, 12 female) underwent neck CT angiography with clear vertebral artery and the adjacent structure imaging from June to December 2014 in Huashan Hospital, Fudan University. The anatomical parameters of vertebral artery V2 segment with lower cervical vertebrae and intervertebral discs were measured by cross-sectional images of C3-6. The corresponding parameters of different sex and both sides of the same segment were analyzed by independent samples t-test and paired t test, respectively. The least significant difference(LSD) t test was used to compare the corresponding data between different segments.@*Results@#The vertebral artery was not walking in the middle of the transverse foramen in healthy individual, but partial medial, partial front walking. Transverse diameter of transverse foramen in male and female were 6.62-6.89 mm and 6.21-6.45 mm, and sagittal diameter was 5.41-6.48 mm and 5.40-6.10 mm, respectively.The transverse foramen were slightly oval. The distance between vertebral artery and midline in male and female were 14.23-16.12 mm and 13.60-15.04 mm, respectively, which was much larger than the width of cervical vertebral corpectomy. Compared with C3-4, intervertebral disc, the transverse distance between the vertebral artery and the uncovertebral joint of C4-5, C5-6 was smaller, and the distance from the vertebral artery to the posterior margin of the uncovertebral joint was relatively small, the difference was statistically significant (t=2.449, P=0.022). The distance from vertebral artery to the posterior margin of uncinate process was 1/5-2/5 of the distance between the anterior and posterior edge of the corresponding segmental vertebra.@*Conclusion@#Based on this anatomical study, the risk of vertebral artery injury in conventional anterior cervical decompression is small, and the risk of vertebral artery injury in different segments is slightly different.
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Related literature and studies concerning the kinematics in patients after cervical arthrodesis have extensive?ly reviewed and comprehensively analyzed in 4 terms of changes in adjacent segment range of motion, motion segment per?cent contributions, motion pattern of cervical facet joints, and deviated center of rotation at adjacent segments. These report?ed researches of in-vivo kinematics after cervical arthrodesis are almost on the sagittal plane. Few data have been reported on the 6DOF kinematics under physiological loading conditions. Whether adjacent segment pathology caused by hypermobili?ty remains controversial. Long-term follow-up of large sample randomized controlled studies and obtaining the accurate 6DOF kinematics are the best way to resolve controversy.
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<p><b>OBJECTIVE</b>To analyze the causes of muscular paralysis due to C₅ nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way.</p><p><b>METHODS</b>From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C₅ nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case.</p><p><b>RESULTS</b>The follow up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C₅ nerve root palsy to 14.48±2.10 at final follow up, with significant difference(<0.05).</p><p><b>CONCLUSIONS</b>More complicated factors result in C₅ nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication.</p>
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@#Objective To evaluate the neurological function of cervicalspondylotic radiculopathy by somatosensory evoked potentials (SEP) and provide an objective basis for selecting the best operation occasion. Methods 60 patients with C6 and C7 radiculopathies were divided into 3 groups according to the results of SEP: normal group (n=22), mildly abnormal group (n=30) and severely abnormal group (n=8). All the patients underwent anterior cervical decompression and fusion. They were assessed with Neck Disability Index (NDI) before and after treatment. Results The postoperative NDI scores of all the groups improved significantly (P<0.001), especially in the normal group.Conclusion SEP, which can reflect the severity of cervicalspondylotic radiculopathy objectively and predict prognosis.
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It is of great importance for surgery efficacy and avoidance of complications to reconstruct cervical curve, intervertebral height and cervical stability. Anterior cervical decompression includes discectomy and subtotal corpectomy. The former reconstruction comprises simple bone graft, bone graft with plating, cage implantation, cage with plating and total disc replacement.The latter comprises simple bone graft, bone graft with plating, titanium mesh cage with plating, conbinding cage and titanium mesh cage with plating. The common problem is loss of intervertebral height or nonunion occurring in a part of patients.Total disc replacement may preserve motion of affected levels but narrow indication. Based in the decompression, the best method should be choosen to reconstruct cervical stability and intervertebral height.
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Objective To observe the clinical effects of anterior plates with titanium mesh and bone graft (auto and allo) in treatment of cervical spine fractures. Methods 42 cases of fractures of cervical spine treated with anterior plates with titanium mesh. Results The bone graft (auto and allo) were followed up for 4 to 28 months (mean 17 months). The preoperative and postoperative nerve functions were evaluated according to JOA criteria. The cervical curvatures, sink or shift of the mesh and bone fusion were evaluated by X rays. There were no significant complications during perioperative periods. The functions of spinal cord were improved, the cervical curvatures were restored, and no sinking or shifting of the mesh was observed. There was also no loosening of plate or screw. The fusion began 3.5 months postoperatively, and a good fusion could be observed 1 year postoperatively. Conclusion By application of anterior plates with titanium mesh and bone graft (auto and allo) in treatment of cervical spine fractures, the cervical curvature and stability can be restored, the iliac lesion and long operation duration caused by the harvest from ilium can be avoided, better fusion and quicker recovery can be obtained.