Multivariate analysis of the operative effect on cervical spinal cord injury without fracture or dislocation / 中国骨伤

OBJECTIVE@#To explore the influencing factors of the operative effect on cervical spinal cord injury without fracture or dislocation.@*METHODS@#The clinical data of 69 patients with cervical spinal cord injury without fracture or dislocation from November 2010 to November 2016 who received operation were retrospectively analyzed. There were 37 males and 32 females, aged from 32 to76 years with an average of (51.6±7.3) years. The clinical data of 12 factors were selected, including age, gender, ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of the posterior longitudinal ligament (OPLL), intervertebral disc herniation, type of spine cord injury by MRI, time from injury to operation, treatment of high-dose methylprednisolone, operation time, intraoperative bleeding volume. In order to screen the main influencing factors of above items to prognosis, the single factor and multiple factor Logistic regression analysis were used in the clinical data by SPSS 22.0 statistical software.@*RESULTS@#Univariate analysis results showed that the factors including ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of longitudinal ligament, intervertebral disc herniation, the type of spine cord injury by MRI were associated with prognosis (<0.05). Multi factor analysis of the selected factors indicated that the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury were the main prognostic factors according to the influence intensity (<0.05).@*CONCLUSION@#The influencing factors of the operative effect on cervical spinal cord injury without fracture and dislocation were the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury, and the foremost were the type and length of spine cord injury by MRI. Compared with other patients, preoperative MRI showed the patient with spinal cord injury type with bleeding and edema, or the length of spine cord injury larger than 45 mm may be less effective, therefore, it is necessary to thoroughly communicate with the patients and their kin before surgery.

Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation

STUDY DESIGN: Retrospective case series. PURPOSE: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation. OVERVIEW OF LITERATURE: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. METHODS: To obtain a relatively uniform background, patients non-surgically treated for an acute C3-4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. RESULTS: There were no significant relationships between sagittal diameter of the CSF column at the C3-4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. CONCLUSIONS: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.

Posterior internal fixation and bone grafting fusion for atlantoaxial fracture or dislocation / 中国矫形外科杂志

[Objective]To evaluate the method and curative effect of posterior internal fixation and bone grafting fusion for atlantoaxial fracture or dislocation.[Method]Posterior internal fixation and bone grafting fusion were made on 26 patients with atlantoaxial fracture or dislocation in condition of tracheal intubation anesthesia.Occipitocervieal fixation(Aixs) and bone grafting fusion were performed on patients with fracture of vertebral lamina-arch.Vertebral lamina splint fixation (Apofix) was performed on patients without fracture of vertebral lamina-arch and decompression of vertebral canal.[Result]Followed up for 5 to 60 months(averaged,16.8 months),the vertebral artery and spinal cord injury were not occurred and clinical symptom was relieved in all patients.X ray examination showed screws in vertebral articular process and occipital condyle were normotopic without laxation and fragmentation.The bone grafting transformed into osseous fusion after 3 months.[Conclusion]Aixs fixation and bone grafting fusion and Apofix fixation are effective methods for atlantoaxial fracture or dislocation.