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Objective@#To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect.@*Methods@#From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed.@*Results@#The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05).@*Conclusion@#The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.
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Objective:To observe the relationship between cervical curvature and spinal drift distance after laminectomy with lateral mass screw fixation, and its effect on clinical outcome. Methods:From January, 2017 to October, 2018, a total of 117 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation, and 90 of them completed the follow-up. According to the patients' cervical curvature (CC), they were divided into three groups: those CC between 0° to 5° were in Group A (n = 28), 5° to 16.5° in Group B (n = 36) and CC > 16.5° in Group C (n = 26). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy were recorded and analyzed. Results:There were significant differences in CC and spinal drift distance (F > 152.119,P < 0.001), and no significant difference was found in laminectomy width and incidence of C5 palsy (P > 0.05) among three groups. The Japanese Orthopaedic Association (JOA) score significantly increased in all the groups post operation and at the last follow-up (t > 8.869,P < 0.001), and no significant difference was found among there groups at the same time (P > 0.05), as well as the incidence of C5 palsy (F = 0.472,P = 0.625). There was significant difference in the score of Visual Analogue Scale of axial symptoms among three groups (F > 34.800,P < 0.001), which was lower in groups B and C than in group A (t > 5.845,P< 0.001), and no significant differene was found between group B and group C. Conclusion:On the basis of the same laminectomy width, the greater the CC was, the more favorable the spinal drift went backwards. The loss of CC was related to the occurrence of axial symptoms, but was not correlated with the neurological recovery and C5 palsy.
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Background: Atlas, first cervical vertebra bears sulcus over posterior arch for third part of vertebral artery.Sometimes an osseous bridge converts the sulcus into a foramen called as Arcuate foramen. It is commonlycalled as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incompleteossification of the posterior atlanto-occipital membrane over the vertebral artery groove resulting in the formationof a foramen (Arcuate foramen) containing the vertebral artery and the posterior branch of the C-1 spinal nerve.This variation has been associated with vertebro-basilar insufficiency symptoms, various types of headaches,and acute hearing loss. The knowledge of this variant prevents complications during lateral mass screw fixation,posterior laminectomy and endovascular surgery.Aims: The aim of the present study was to analyze the percentage of incidence of arcuate foramen and to identifyits clinical significance.Materials and Methods: Hundred dried human atlas bones were used to study the presence of arcuate foramen inthe department of Anatomy at ESIC Medical College and PGIMSR, Rajajinagar, Bangalore.Results: We came across the presence of arcuate foramen in two out of hundred bones. In both the atlas bones,osseous bridge extending from posterior aspect of superior articular facet to the posterior arch of atlas on theleft side, forming arcuate foramen, posterior to foramen transversarium was observed.Conclusion: Arcuate foramen commonly called as Kimmerle’s anomaly where in a groove for vertebral artery isconverted into a foramen by ossification of the ligament. Awareness of osseous bridging is essential in performingcranio-cervical junction surgeries. It also serves as an anthropological data and also identifying the impact ofcomplete arcuate foramen on the signs and symptoms of vertebra-basilar insufficiency.
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Objetivos: Realizar un análisis morfométrico del atlas por tomografía computada, determinando los valores promedio, medianos, y de variabilidad de dicha vértebra para la correcta colocación de tornillos trans-masas laterales. Introducción: Existe una significativa variabilidad interpersonal en los aspectos morfológicos del atlas, y dada su proximidad a estructuras neurovasculares (arteria vertebral, médula cervical, raíz de C2), hacen mandatario un exhaustivo planeamiento prequirúrgico para la elección de la técnica de artrodesis, tipo de tornillos a utilizar, y su trayectoria. Material y métodos: Se realizó un estudio de diseño de tipo exploratorio, descriptivo, observacional, retrospectivo, transversal. Se revisaron 99 tomografías computadas de la columna cervical. Se midieron parámetros morfométicos y angulaciones desde un "punto de entrada" en la masa lateral de C1, que fueron llamados A, B, C, D, E, F, G y H. Las mediciones de los parámetros a estudiar fueron realizadas con el programa RadiAnt DICOM Viewer (64-bit) y posteriormente volcadas a una ficha de registro de datos. Discusión: La distribución según género fue de 34 varones y 65 mujeres. Se encontró una diferencia estadísticamente significativa no solo en lo referente al género (masculino vs femenino; parámetros A, B, C, D, F, G, H p-valor < 0,05) de los parámetros medidos, sino también según lateralidad (derecha vs izquierda; parámetros C, E, F, G p-valor < 0,05). La investigación propone además la generación de una base de datos con información morfométrica del atlas. Conclusión: Existe una diferencia estadísticamente significativa en las propiedades morfológicas del atlas, tanto en lo relativo al género (masculino vs femenino), como en la lateralidad (derecha vs izquierda). Es por ello que el presente estudio enfatiza en la importancia de la realización prequirúrgica de una tomografía computada de la columna cervical superior para garantizar una efectiva y segura instrumentación a éste nivel, según el largo, ancho y trayectoria de los tornillos a utilizar.
Objectives: To morphometrically analyze the atlas, using computed tomography, thereby defining mean, median and variability values of C1 for the correct placement of lateral mass screws. Introduction: Significant interpersonal variability exists among the various morphological characteristics of the atlas. Given the structure's close relationship to neurovascular structures like the vertebral arteries, cervical spinal cord, and cervical roots, exhaustive pre-surgical planning becomes mandatory. Such planning assists in the choice of arthrodesis technique, and the dimensions and trajectory of screws. Material and Methods: A retrospective, observational study was performed, for which the computed tomography (CT) scans of 99 cervical spines were reviewed. Morpho-metric parameters and angulations were measured from an "entry point" in the lateral mass at C1; these parameters were alphabetically labeled from A through H. The RadiAnt DICOM Viewer (64-bit) program was used to measure all parameters of interest, the values of which then were entered into a data collection file.Discussion: By gender, there were 34 men and 65 women. A statistically-significant difference was found between the two genders for all parameters except parameter E (all p-values < 0,05), and between the two sides (right vs. left) for parameters C, E, F, and G. Our results argue for the creation of a general database containing morphometric information on the atlas. Conclusion: Statistically-significant differences exist between men and women, and from right to left, among the morphometrical features of the atlas. This underscores the need for careful preoperative surgical planning, including the use of CT scanning to estimate optimum screw lengths and trajectories.
Subject(s)
Humans , Cervical Cord , Arthrodesis , Vertebral Artery , Tomography , Functional LateralityABSTRACT
OBJECTIVE: The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis. METHODS: From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted. RESULTS: Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered. CONCLUSION: Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.
Subject(s)
Humans , Male , Asian People , Cohort Studies , Congenital Abnormalities , Constriction, Pathologic , Follow-Up Studies , Hand , Orthopedics , Retrospective Studies , Spinal CordABSTRACT
PURPOSE: This prospective study was designed to investigate the outcomes of laminectomy and fusion with using lateral mass screw (LMS) fixation for the treatment of cervical myeolpathy. MATERIALS AND METHODS: We studied a series of 26 consecutive patients with cervical myelopathy and who were planned to undergo laminectomy and fusion with using LMS fixation. MRI was done to investigate the high signal intensity lesion (HSIL) in the cord on the T2 weighted sagittal images. The JOA score, the grip and release test, the finger escape sign, and Hoffman's sign were checked. We analyzed the clinical outcomes depending on the high signal intensity lesion in the cord, the preoperative kyphosis, and the preoperative instability. RESULTS: The indications for lateral mass screw fixation was kyphotic deformity, segmental instability or ossification of the ligament flavum (OLF). Patients with HSIL on the T2-weighted sagittal MRI was found in 17 patients. The JOA score, the grip and release test, and the finger escape sign were significantly improved after the operation and at the 2 year follow up. The patients with HSIL on the T2-weighted sagittal MRI or segmental instability had a significantly lower preoperative JOA score and a poor postoperative recovery as assessed by the JOA score. CONCLUSION: Laminectomy and fusion using lateral mass screw fixation for the surgical treatment of cervical myelopathy, which is associated with kyphotic deformity, instability or OLF, is considered a safe and effective treatment option to prevent postoperative kyphosis.
Subject(s)
Humans , Congenital Abnormalities , Fingers , Follow-Up Studies , Hand Strength , Kyphosis , Laminectomy , Ligaments , Prospective Studies , Spinal Cord Diseases , United NationsABSTRACT
STUDY DESIGN: Lateral mass was measured using MRI for lateral mass screw fixation. OBJECTIVES: To measure the lateral mass of cervical spine using MRI for lateral mass screw fixation and find out the ideal entry point and insertion angle and length of lateral mass screws. SUMMARY OF LITERATURE REVIEW: Two methods of screw placement are in common use. The original technique, described by Ray-mond Roy-Camille, places the screw in a more or less straight sagittal direction and angling the screw laterally 10 to 20 degrees. Margerl technique involves placing the screw parallel to the facet joint and angling the screw laterally 25 to 30 degrees. MATERIALS AND METHODS: Axial MR images of the cervical spine parallel to the facet joints were obtained from C3 to C6 of 10 patients. The mean age of the patients were 48.0 years. The patients consisted of 6 male and 4 female patients. Ideal entry points, insertion angle and length of the lateral mass for lateral mass screw fixation were measured on the axial MR images using PACS digital measuring instument . RESULTS: Ideal entry point of a lateral mass screw was center of lateral mass in sagittal plane, 16mm lateral to the midline of the cervical spine, ideal direction of the lateral mass screw was parallel to the facet joint and angling the screw laterally 25.3 degrees, and ideal length of lateral mass screw was 17.9mm. CONCLUSIONS: Based on the results of the study, there were some differences of measurements depending on the patients and the level of the cervical spine. Therefore, a preoperative measurement of lateral mass was recommended in each patient and each level of the cervical spine.
Subject(s)
Female , Humans , Male , Magnetic Resonance Imaging , Spine , Zygapophyseal JointABSTRACT
Fractures of C1 are not uncommon, constituting only 10% of all cervical spine injuries. There is a high prevalence of concomitant fractures of the second and first cervical vertebral complex. Surgical treatment is controversal. Mainstay of treatment is various combination of traction and cervical orthosis according to degree of displacement and location of fracture. We experienced unusual type of fracture, anterior arch fracture of C1 who had a history of total laminectomy of C1,2 due to cervical cord tumor(neurilemmoma arising from C2 root). We performed C1,2 lateral mass screw fixation with posterior fusion with good postoperative outcome.