ABSTRACT
Objective@#To determine the value of hyperextension MRI evaluation in determining whether to perform decompression therapy after reduction of reducible atlantoaxial dislocation as well as assess the decompression effect.@*Methods@#A retrospective case series study was conducted to analyze 24 patients with atlantoaxial dislocation admitted to Honghui Hospital affiliated to Xi'an Jiaotong University from May 2015 to May 2017. There were 10 males and 14 females, aged 40-74 years, with an average age of 52 years. There were 14 patients with os odontoideum, four patients with odontoid fracture, and six patients with transverse atlantal ligament rupture. Hyperextension MRI was performed to assess spinal cord compression for all patients. Eight patients with anterior spinal cord compression (Group A) underwent posterior atlantoaxial arch decompression plus atlantoaxial internal fixation reduction and bone graft fusion; 16 patients without anterior compression of the spinal cord (Group B) underwent only atlantoaxial internal fixation reduction and bone graft fusion. Intraoperative and postoperative complications were recorded. Spinal cord compression index and improvement rate of spinal cord decompression were evaluated by routine cervical spine MRI. Japanese Orthopedic Association (JOA) score was used to evaluate the clinical effect.@*Results@#All patients were followed up for 3-24 months, with an average of 9.3 months. There was no nerve or vertebral artery injury during the operation, and no screw loosening occurred after surgery. The spinal cord compression index (0.37±0.18) in Group A at the last follow-up was significantly lower than that before operation (0.73±0.22) (P<0.05), while the index in Group B (0.19±0.20) at the last follow-up was also lower than that before operation (0.61±0.25) (P<0.05). The improvement rate of spinal cord decompression was 67.11% in Group A and 70.61% in Group B. The final JOA score of Group A was (13.29±3.68)points, which was significantly better than the preoperative JOA [(5.61±2.74)points] (P<0.05). The final JOA score in Group B [(14.13±3.45)points] was also significantly better than the preoperative JOA [(7.32±2.90)points] (P<0.05). Improvement rate of JOA was 57.31% in Group A and 59.91% in Group B.@*Conclusions@#Hyperextension MRI of cervical vertebra can effectively judge whether the anterior spinal cord is compressed after reduction of atlantoaxial dislocation. It has important clinical significance for decompression treatment during reduction and internal fixation of reducible atlantoaxial dislocation. At the same time, posterior atlantoaxial arch resection and decompression can effectively relieve the compression of the spinal cord after reduction of atlantoaxial dislocation.
ABSTRACT
Objective To determine the value of hyperextension MRI evaluation in determining whether to perform decompression therapy after reduction of reducible atlantoaxial dislocation as well as assess the decompression effect. Methods A retrospective case series study was conducted to analyze 24 patients with atlantoaxial dislocation admitted to Honghui Hospital affiliated to Xi'an Jiaotong University from May 2015 to May 2017. There were 10 males and 14 females, aged 40-74 years, with an average age of 52 years. There were 14 patients with os odontoideum, four patients with odontoid fracture, and six patients with transverse atlantal ligament rupture. Hyperextension MRI was performed to assess spinal cord compression for all patients. Eight patients with anterior spinal cord compression ( Group A ) underwent posterior atlantoaxial arch decompression plus atlantoaxial internal fixation reduction and bone graft fusion; 16 patients without anterior compression of the spinal cord ( Group B ) underwent only atlantoaxial internal fixation reduction and bone graft fusion. Intraoperative and postoperative complications were recorded. Spinal cord compression index and improvement rate of spinal cord decompression were evaluated by routine cervical spine MRI. Japanese Orthopedic Association ( JOA) score was used to evaluate the clinical effect. Results All patients were followed up for 3-24 months, with an average of 9. 3 months. There was no nerve or vertebral artery injury during the operation, and no screw loosening occurred after surgery. The spinal cord compression index (0. 37 ± 0. 18) in Group A at the last follow-up was significantly lower than that before operation (0. 73 ± 0. 22) (P<0. 05), while the index in Group B (0. 19 ± 0. 20) at the last follow-up was also lower than that before operation (0. 61 ± 0. 25) (P<0. 05). The improvement rate of spinal cord decompression was 67. 11％ in Group A and 70. 61％ in Group B. The final JOA score of Group A was ( 13. 29 ± 3. 68 ) points, which was significantlybetterthanthepreoperativeJOA[(5.61±2.74)points] (P <0.05). ThefinalJOA score in Group B [(14. 13 ± 3. 45) points] was also significantly better than the preoperative JOA [(7. 32 ± 2. 90)points] (P<0. 05). Improvement rate of JOA was 57. 31％ in Group A and 59. 91％in Group B. Conclusions Hyperextension MRI of cervical vertebra can effectively judge whether the anterior spinal cord is compressed after reduction of atlantoaxial dislocation. It has important clinical significance for decompression treatment during reduction and internal fixation of reducible atlantoaxial dislocation. At the same time, posterior atlantoaxial arch resection and decompression can effectively relieve the compression of the spinal cord after reduction of atlantoaxial dislocation.
ABSTRACT
ObjectiveTo discuss the clinical efficacy of hyperextension reduction with percutaneous kyphoplasty in treatment for osteoporotic vertebral compression fracture.MethodsTwenty-three patients with 23 vertebral compression fractures underwent hyperextension reduction with percutaneous kyphoplasty from September 2010 to October 2011.The vasual analogue scale(VAS) score and complications were recorded during followed up.Results All cases were successfully experienced the procedure using unilateral or bilateral percutaneous pedicle underwent hyperextension reduction.The operation time was (75 ± 45) minutes,the mean volume of cement injected into each vertebral body was(4.9 ± 1.9) ml.All patients had successful intervention without spinal cord injury,pulmonary embolism.Followed up(7.5 ± 6.5 ) months,the symptoms of the patients were improved,preoperative VAS score was (7.5 ± 0.7 ) scores,reduced to (3.4 ±0.4) scores at day 1 postoperatively,(2.7 ±0.5) scores at day 7 postoperatively and (2.3 ±0.5) scores at month 1 postoperatively,there was significant difference between preoperative and postoperative (P＜ 0.05).ConclusionsApplication of hyperextension reduction with percutaneous kyphoplasty can relieve pain and restore the vertebral body height,it may be an effective treatment method for patients with osteoporotic vertebral compression fracture.