HYPEREXTENSION TRAUMA IN PATIENTS WITH CERVICAL SPONDYLOSIS / Мэс засал

Introduction: Due to cervical spondylosispatients with cervical stenosis who hadhyperextension trauma developed spinalcord stress and contusions, tetraplegia anddisability and mortality. Cervical spondylosispatients with hyperextension traumatreatment management still not clearedout throughout the world and very fewresearch has been done in our country.We have been introduced our surgical andrehabilitation comparison research study ofcervical spondylosis trauma in 2015. Our goalis to develop treatment management forthe hyperextension trauma in patients withcervical spondylosis.1. To compare surgical treatmentresults between patients who hadhyperextension injury to the cervical spinewhich were treated at the Departmentof Spinal Surgery of the National Traumaand Orthopaedic Research Center ofMongolia.2. To study biomechanical effects after thesurgeryMaterial and methods: 42 cervicalspondylosis patients with hyperextensioninjury have been chosen retrospectively toevaluate the surgical, conservative, andrehabilitative treatments and results wereanalyzed by SPSS, EXCEL program who weretreated at the Department of Spinal Surgeryof the National Trauma and OrthopaedicResearch Center of Mongolia from 2012-September 2016. Over 20% canal stenosiscases were chosen for laminectomy andanterior discectomy and fusion surgeriesalong with conservative and rehabilitationtreatment. Up to 20% canal stenosis 10cases which is 23.8% of all patients weretreated by conservative treatment.Results: From 42 patients there was 10females and 32 males. Average ages were56±7.9. By the cause of injury 62% werecar accident, 23% motorcycle accident, 10%fall from horse riding and 5% were otherfalls respectively. All patients had neurologicdeficits according to the level of spinal cordinjury. 36 (85.7%) patients had C4-C5 andC5-C6 level injury and 15 (35.7) patients wererecovered from spinal shock after high dosesteroid treatment. According to the X-RAYall patients had cervical spondylosis signand 4 (9.5%) of them had facet fractureswith stable spine condition. After CT scanspinal cord injury located at C3-C4, C4-C5and C5-C6 levels and patients developedfacet arthrosis, ossification of ligaments andintervertebral discs. Clinical signs and CT scans were evaluated and 4 cervical spondylosispatients with hyperextension injury hadlaminectomy and 2 patient had anteriordiscectomy and fusion surgeries. Canalstenosis is decompressed after laminectomysurgery and cervical lordosis is reduced by 7degrees but after anterior discectomy andfusion surgery cervical lordosis is reducedby 3 degrees. Neurological deficit increasinglaminectomy cases had C5 palsy becauseof cord shift (2.4-4mm) which resulted bydenticulate ligament tethering.Conclusion: There were no significantstatistical (P≤.05) differences betweensurgical and rehabilitation treatmentsin cervical spondylosis patients withhyperextension injury who’s canal stenosiswere below 20% [1,2,3,4,5].In our practice itis essential to make laminectomy and anteriordiscectomy and fusion surgeries in 72 hoursafter trauma to help the patient recoverfrom the spinal shock and reabsorption ofcord contusion. For one or two level canalstenosis especially with the OPLL, artificialdisc replacement and ADF surgeries showedbetter results. In multiple level canal stenosiswith OLF and OPLL cases laminectomyand laminoplasty are choice for surgery. Incomparison to foreign study/ Biomechanicalinvestigation of spinal cord injury and diseasein cervical spine Batbayar.K Seoul.2016[2]/ our surgical treatment showed similarresults. Among cervical spondylosis patientswith hyperextension trauma cases whotreated in Spine Department of NationalTrauma and Orthopaedic Hospital, mortalityand disability is increasing and it is essentialto follow correct diagnostic and treatmentalgorithms.

Ossification of Spinal Ligaments

This authors reviewed the radiographs of 20,057 patients with spinl radiculomyelopathy from April 1983 August 1990. The incidence and distribtion of the ossification of the spinal ligaments were analized as following. 1) The overall incidence of spinal ligaments ossification was 3.6% among 20,057 patients. 2) The most frequently occurs at lumbar area(67.1%), and then cervical(27.5%) thoracic(0.4%) area as in orders. 3) The OPLL was most common type(2.19%) of these spinal ligaments ossification, and then OALL(0.7%), OLF(0.24%) as in orders. 4) OPLL (1) OPLL was most frequent at lumbar area(58.6%) and then cervical(37.0%), thoracic(0.4%) area as in orders. (2) The cervical OPLL was commonly found at C5 & C6 area and morphologically, the multiple segmented type was most common then continuous type, mixed type and single segmented type in orders. (3) The multiple segmented type was more frequently found at upper cervical area, but the continuous type was more frequent at lower cervical area. 5) OALL (1) OALL was most frequent at lumbar area(86.0%) but thoracic(1.4%) and cervecal area(5.3%) were relatively low in frequency. (2) Of the lumbar OALL, the L4/5 area was most frequent site(37.8%) but the L3/4(25.3%) and L5/S1 area(24.5%) also had relatively high occurance rate. 6) OLF (1) OLF was most frequent at lumbar area(92.7%), but the incidence of OLF was relativerly rare at cervical(2.1%) and thoracic area(5.2%). (2) Of the lumbar OLF, the L4/5 area was most common site(33.1), but L5/S1 area had also high occurance rate(27.2%).