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SUMMARY: Anatomical variation of the foramina transversaria (FT) is associated with vertebral neurovascular symptoms and can cause complications after lower spine surgery, especially cervical pedicle screw (CPS) insertion. FT variation has been documented and classified in various populations, as this information can help increase cervical stability in subaxial vertebral surgery. Although the morphometry of the upper cervical spine in Thai populations has been reported, there have yet been no studies examining the features of FT. The FT of dried cervical spines (C3-C7; left and right side; n = 107, male = 53 and female = 54) were examined for morphological variation, and their anteroposterior (AP) and transverse (T) diameters were measured using a digital vernier caliper. Morphometric data and variations were compared by sex and lateral side. It was that the C3-C6 FT in both sexes were round, and the C7 FT was elliptical with an oblique right side. FT diameters did not differ significantly by sex except for the AP diameters of C6-C7 and for T diameters of C4 and C7. The left AP diameters of C3-C6 were significantly longer than the right, as were the T diameters of C4 and C7 FT. Additionally, T diameter was significantly longer than that of the AP, except that of the left C6 in male spines, which did not differ from the AP. Most FT examined were round. These findings should be considered in the provisional diagnosis of vertebral neurovascular symptoms caused by FT variation as well as that of neurovascular damage after cervical pedicle screw placement.
La variación anatómica del foramen transverso (FT) se asocia con síntomas neurovasculares vertebrales y puede causar complicaciones después de la cirugía de columna cervical inferior, especialmente la inserción de tornillos pediculares cervicales (TPC). La variación del FT se ha documentado y clasificado en varias poblaciones, ya que esta información puede ayudar a aumentar la estabilidad cervical en la cirugía vertebral subaxial. Aunque se ha informado sobre la morfometría de la columna cervical superior en poblaciones tailandesas, aún no se han realizado estudios que examinen las características de FT. Se examinó la variación morfológica del FT de vértebras cervicales secas (C3-C7; lado izquierdo y derecho; n = 107, hombres = 53 y mujeres = 54), y se midieron sus diámetros anteroposterior (AP) y transverso (T) usando un pie de metro digital. Se compararon datos morfométricos y variaciones por sexo y lado. Los FT de C3-a C6 en ambos sexos eran redondos, y el FT C7 era elíptico con el lado derecho oblicuo. Los diámetros del FT no difirieron significativamente por sexo excepto para los diámetros AP de C6- C7 y para los diámetros transversos de C4 y C7. Los diámetros AP izquierdos de C3-C6 eran significativamente más largos que los del lado derecho, al igual que los diámetros transversos de C4 y C7. Además, el diámetro transverso fue significativamente mayor que el AP, excepto el C6 izquierdo en las vértebras de hombres, que no difirió del AP. La mayoría de los FT examinados eran redondos. Estos hallazgos deben ser considerados en el diagnóstico provisional de síntomas neurovasculares vertebrales causados por la variación del FT, así como en el de daño neurovascular tras la colocación de tornillos pediculares cervicales.
Subject(s)
Humans , Male , Female , Cervical Vertebrae/anatomy & histology , Anatomic Variation , Thailand , Sex CharacteristicsABSTRACT
OBJECTIVE@#Using the method of finite element analysis, to compare the biomechanical properties between the plate deviating from the long axis of the cervical spine and the standard placement of the plate in the anterior cervical fusion surgery.@*METHODS@#A healthy female volunteer was selected and CT scan (C@*RESULTS@#The lower cervical spine (C@*CONCLUSION@#Little effect on the mechanical stability of the cervical spine was anticipated when the anterior cervical plate was not perfectly aligned with the long axis of the cervical spine. If the tilt of the plate in clinical surgery is less than 20°, there is no need to readjust the position of the plate.
Subject(s)
Female , Humans , Biomechanical Phenomena , Cervical Vertebrae/surgery , Finite Element Analysis , Range of Motion, Articular , Reproducibility of Results , Spinal FusionABSTRACT
Objective To establish the three-dimensional finite element model of human lower cervical spine C3-7 motion segments after anterior cervical corpectomy and fusion (ACCF) surgery with titanium mesh and bone graft,and to analyze the stability of cervical spine and stress distribution of internal fixation devices after ACCF surgery.Methods The finite element model of cervical spine C3-7 segments after ACCF of C5 segment with titanium mesh,bone graft,plate and screw fixation was established,and C3-7 segment intact model of cervical vertebra was also constructed.The torque moment of 0.5,1.0,1.5,2.0 N · m was applied to the ACCF surgery model.The ROM,maximum stress in facet joint and stress distributions on internal fixation devices under flexion,extension,lateral bending and axial rotation movement were analyzed.Results ROM of reconstructed C5 segment increased with the torque moment increasing after ACCF surgery.In the case of 1.0 N · m tomue moment and 50 N preload,the ROM of reconstructed C5,C3-4,C6-7 and C3-7 segment was reduced by 81％,62％,58％ and 80％ compared with the intact model.The maximum stress in facet joint of reconstructed C5 segment reduced and the stress in adjacent segments significantly increased.The stress of titanium mesh was mainly distributed on the compression side of movement,and high stress was located in the roots of screws.Conclusions ACCF surgery can promote the stability of cewical spine,decrease the stress in facet joint of operation segment,and has better treatment effect on easing compression from spinal cord caused by cervical spondylotic myelopathy.The research results will provide some theoretical basis for clinical application of ACCF surgery.
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Objective To measure the circumferential cortical thickness of anterior entrance and anterior half of lower cervical pedicles on computed tomography (CT) images, providing a reference for accurate anterior cervical pedicle screws. Methods CT scanning was performed in 10 normal lower cervical vertebrae from fresh cadavers, and the coronal and sagittal reconstructed images were obtained. The images were then opened in AutoCAD-2007 software to perform quantitative measurement (accuracy was 0. 1 mm) using the “dimaligned function” of dimension menu, and measurement parameters included the thicknesses of superior, medial, inferior and lateral cortex of anterior entrance of pedicle (SAE. MAE. IAE and LAE. respectively), and thicknesses of superior, medial, inferior and lateral cortex of anterior half of pedicle (SPA, MPA, IPA and LPA, respectively). Results Average thicknesses of SAE. MAE. IAE. LAE, SPA, MPA. IPA, and LPA at left and right side from Q to C7 were (1. 9 + 0. 6) and (1. 9 + 0. 5) mm, (1. 9 + 0. 7) and (1.9+0. 4) mm. (2.4 + 0. 6) and (2. 4 + 0. 5) mm, (0. 9 + 0. 5) and (0. 9 + 0. 6) mm, (2. 3 + 0. 9) and (2. 3 +0. 7) mm, (2. 1 + 0. 5) and (2. 1 + 0. 6) mm, (2. 2+0. 8) and (2. 2+0. 7) mm, and (1. 0 + 0. 7) and (1. 0 + 0. 6) mm, respectively. There was no significant difference in same measurement parameter between left and right sides at same cervical level (P>0. 05). Single factor random block analysis of variance found LAE and LPA were significantly thinner than the other 6 parameters of the same side of same cervical vertebra (all P0. 05). Conclusion LAE and LPA are the thinnest among the 8 measurement parameters from C3 to C7, which suggests LAE and LPA have the weakest resistance to exotic force if resistance strength to exotic force is parallel to cortex thickness. We should avoid locating close to LAE when finding anterior entrance or close to LPA when inserting anterior cervical pedicle screws.
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Objective To establish the three-dimensional finite element model of human lower cervical spine C3-7 motion segments after anterior cervical corpectomy and fusion (ACCF) surgery with titanium mesh and bone graft, and to analyze the stability of cervical spine and stress distribution of internal fixation devices after ACCF surgery. Methods The finite element model of cervical spine C3-7 segments after ACCF of C5 segment with titanium mesh, bone graft, plate and screw fixation was established，and C3-7 segment intact model of cervical vertebra was also constructed. The torque moment of 0.5, 1.0, 1.5, 2.0 N﹒m was applied to the ACCF surgery model. The ROM, maximum stress in facet joint and stress distributions on internal fixation devices under flexion, extension, lateral bending and torsion movement were analyzed. Results ROM of reconstructed C5 segment increased with the torque moment increasing after ACCF surgery. In the case of 1.0 N﹒m torque moment and 50 N preload, the ROM of reconstructed C5, C3-4, C6-7 and C3-7 segment was reduced by 81%, 62%, 58% and 80% compared with the intact model. The maximum stress in facet joint of reconstructed C5 segment reduced and the stress in adjacent segments significantly increased. The stress of titanium mesh was mainly distributed on the compression side of movement, and high stress was located in the roots of screws. Conclusions ACCF surgery can promote the stability of cervical spine, decrease the stress in facet joint of operation segment, and has better treatment effect on easing compression from spinal cord caused by cervical spondylotic myelopathy. The research results will provide some theoretical basis for clinical application of ACCF.
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Objective To establish the three-dimensional finite element model of human lower cervical spine C3-7 motion segments after anterior cervical corpectomy and fusion (ACCF) surgery with titanium mesh and bone graft,and to analyze the stability of cervical spine and stress distribution of internal fixation devices after ACCF surgery.Methods The finite element model of cervical spine C3-7 segments after ACCF of C5 segment with titanium mesh,bone graft,plate and screw fixation was established,and C3-7 segment intact model of cervical vertebra was also constructed.The torque moment of 0.5,1.0,1.5,2.0 N · m was applied to the ACCF surgery model.The ROM,maximum stress in facet joint and stress distributions on internal fixation devices under flexion,extension,lateral bending and axial rotation movement were analyzed.Results ROM of reconstructed C5 segment increased with the torque moment increasing after ACCF surgery.In the case of 1.0 N · m tomue moment and 50 N preload,the ROM of reconstructed C5,C3-4,C6-7 and C3-7 segment was reduced by 81％,62％,58％ and 80％ compared with the intact model.The maximum stress in facet joint of reconstructed C5 segment reduced and the stress in adjacent segments significantly increased.The stress of titanium mesh was mainly distributed on the compression side of movement,and high stress was located in the roots of screws.Conclusions ACCF surgery can promote the stability of cewical spine,decrease the stress in facet joint of operation segment,and has better treatment effect on easing compression from spinal cord caused by cervical spondylotic myelopathy.The research results will provide some theoretical basis for clinical application of ACCF surgery.
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Objective To establish the three-dimensional finite element model of human lower cervical spine C3-7 motion segments after anterior cervical corpectomy and fusion (ACCF) surgery with titanium mesh and bone graft,and to analyze the stability of cervical spine and stress distribution of internal fixation devices after ACCF surgery.Methods The finite element model of cervical spine C3-7 segments after ACCF of C5 segment with titanium mesh,bone graft,plate and screw fixation was established,and C3-7 segment intact model of cervical vertebra was also constructed.The torque moment of 0.5,1.0,1.5,2.0 N · m was applied to the ACCF surgery model.The ROM,maximum stress in facet joint and stress distributions on internal fixation devices under flexion,extension,lateral bending and axial rotation movement were analyzed.Results ROM of reconstructed C5 segment increased with the torque moment increasing after ACCF surgery.In the case of 1.0 N · m tomue moment and 50 N preload,the ROM of reconstructed C5,C3-4,C6-7 and C3-7 segment was reduced by 81％,62％,58％ and 80％ compared with the intact model.The maximum stress in facet joint of reconstructed C5 segment reduced and the stress in adjacent segments significantly increased.The stress of titanium mesh was mainly distributed on the compression side of movement,and high stress was located in the roots of screws.Conclusions ACCF surgery can promote the stability of cewical spine,decrease the stress in facet joint of operation segment,and has better treatment effect on easing compression from spinal cord caused by cervical spondylotic myelopathy.The research results will provide some theoretical basis for clinical application of ACCF surgery.
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Objective To investigate the feasibility of the lower cervical spine (C3 -C7 ) laminar screw technique for fixing adult posterior cervical spine .Methods We chose 9 formalin fixed moist adult cervical specimens ,which consist of male 6 and female 3 of the age 38 to 63 years old .The average age is 51 .9 years old and the average height is 165 .6 cm .Then we measured the thickness and heightof C3 -C7 lamina ,the lamina length of L1 ,L2 ,and the lamina of axis and the sagittal plane angle .Results The thickness and height of C3 -C7 lamina ,and the lamina length of L1 and L2 of adult male is bigger than adult women .There was statistical sig-nificance between the thickness ,height ,lamina length difference of different genders lamina (P 0 .05) .The average lamina thickness of C2 ,C3 ,C4 ,C5 ,C6 ,C7 were respectively 4 .70 ,3 .87 , 3 .30 ,3 .84 and 5 .16 mm .The lamina thickness which was more than 4 .00 mm accounted for 54 .4% .The lamina thickness of C3 , C4 ,C6 ,C7 which was more than 4 .00 mm accounted respectively for 77 .8% ,61 .1% ,33 .3% ,and 88 .9% .Conclusion Crossing laminar screws in cervical spine is feasible in anatomy .The operation can make under direct vision ,and can accurately estimate the screw path length and entry angle .Patients with anatomic abnormalities can be used as an alternative fixation technique or as fixed in the fixed mode fails .So the results can provide a reference for clinical application .
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PURPOSE: To analyze the incidence and treatment outcomes of lower cervical spine injury since there is no long term, large Korean data available. MATERIALS AND METHODS: We analyzed 277 patients with lower cervical spine injury who underwent surgical treatments between May 1994 and October 2008. The injury types are based on Allen's classification, and neurologic injury was classified as complete, incomplete cord injury, root injury and no neurologic status. We analyzed postoperative complications, neurologic recovery and the relief of pain. RESULTS: Distractive-extension injury occurred most commonly in 140 patients (50.5%). Neurologic injury was detected in 232 cases (83.8%); 46 (16.6%) complete cord injury; 154 (55.6%) incomplete cord injury; and 32 (11.6%) root injury. Incomplete cord injury of distractive extension injury was poorly recovered. Clinical outcomes demonstrated improvement compared with the preoperative values in mean visual analogue scale. Complications were respiratory failure, neurogenic bladder, urinary tract infection and gastritis. CONCLUSION: This study showed the highest incidence of distractive extension injury and neurologic injury contrary to previous studies. This result was caused by the use of plain radiograph to establish Allen's classification in the past. Therefore, we suggest the use of magnetic resonance imaging for evaluating soft tissue injury with Allen's classification to achieve accurate assessment.
Subject(s)
Humans , Incidence , Magnetic Resonance Imaging , Postoperative Complications , Respiratory Insufficiency , Soft Tissue Injuries , Spine , Urinary Bladder, Neurogenic , Urinary Tract InfectionsABSTRACT
PURPOSE: To evaluate the relationship between the damage to anterior soft tissues and neurological deficit in distractive extension injury of the lower cervical spine. MATERIALS AND METHODS: Ninety-two patients who were treated surgically for distractive extension injury of the lower cervical spine were included in this study. Soft tissue swelling was evaluated on plain radiographs. Damage to the longus colli muscle, anterior longitudinal ligament, superior end plate, inferior end plate, annulus fibrosus, and posterior longitudinal ligament were intraoperatively checked and the relationship between these findings and clinical neurologic deficits was analyzed. RESULTS: Soft tissue swelling was increased to 92% in the retropharyngeal space and to 89% in the retrotracheal space but there was no significant difference. No relationship was found between the damage to the prevertebral fascia, longus colli muscle and neurological deficit. Injuries to the inferior end plate and annulus fibrosus showed a directly propotional relation with neurological deficit, but it was not significant. Injuries to the anterior longitudinal ligament (p<0.01), superior end plate (p=0.02), posterior longitudinal ligament (p=0.04) showed significant relations with neurological deficit. CONCLUSION: The distractive extension injury combined with the damage to the anterior longitudinal ligament, superior end plate or posterior longitudinal ligament showed high frequency of neurological deficit. Hence, these are regarded as the important structures for maintaining the stability of the lower cervical spine.
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Humans , Fascia , Longitudinal Ligaments , Muscles , Neurologic Manifestations , SpineABSTRACT
PURPOSE: This study examined the obstacles preventing a decrease in a facet joint fracture-dislocation of the lower cervical spine after skeletal traction to determine suitable treatment guidelines. MATERIALS AND METHODS: This study examined 19 fracture-dislocation cases of the facet joint in the lower cervical spine who failed closed reduction through skeletal traction. The following parameters were analyzed: obstacles preventing reduction, neurological recovery, complications and body to canal ratio of the injured site. RESULTS: The obstacles found on MRI were herniated discs in 17 cases and joint capsule in 2 cases. The surgical decision was based on an analysis of the size and location of the disc, the degree of spinal canal stenosis and damage of the posterior structures. Anterior reduction/fusion and posterior fusion after anterior reduction/fusion, anterior fusion after posterior reduction/fusion and posterior reduction/fusion was performed in 9, 2, 6 and 2 cases, respectively. There was significant neurological recovery at the final follow-up (p=0.000). The body to canal ratio also increased significantly after surgery (p=0.000). CONCLUSION: For the treatment of unreducible facet joint fracture-dislocation of the cervical spine, pre-reduction MRI is essential for a thorough evaluation of the various underlying pathologies. In addition the surgical methods should be determined according to not only the neurological status, obstacles and pathologic structures preventing reduction, but also the surgeon's experience.
Subject(s)
Constriction, Pathologic , Follow-Up Studies , Intervertebral Disc Displacement , Joint Capsule , Spinal Canal , Spine , Traction , Zygapophyseal JointABSTRACT
The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.
Subject(s)
Humans , Congenital Abnormalities , Spine , Spondylitis, AnkylosingABSTRACT
[Objective]To study the method of multi-spiral CT(MSCT) 3D reconstruction technique assisting cervical pedicle screw fixation(PSF) and double-door laminoplasty in the treatment of multilevel degenerative stenosis with traumatic instability(MDSTI) of lower cervical spine.[Method]From September 2006 to August 2007,PSF combined with double-door laminoplasty were performed in 9 patients with MDSTI of lower cervical spine.MSCT 3D reconstruction techniques,including volume rendering(VR) and multi-planar reconstruction(MPR),were used to assist preoperative diagnosis,plan and measurement to guide procedure.Postoperative MPR was used again:through coronal format,the degree of screws perforation was measured precisely and the different positions of pedicle screws were divided into three grades according to Richter's method;through axial format,the increase in sagittal diameter and canal area of every laminoplasty level were measured precisely.A comparison between pre- and postoperative ASIA scores was used to present neural function recovery.[Result]Nine patients with MDSTI of lower cervical spine underwent PSF and total 44 screws.According to the classification of Richter,grade 1 were 72.7%(32/44),grade 2 were 27.3%(12/44).No screw perforation occurred(grade 3) and no screws revision resulted from misplacement.No iatrogenic damage occurred.Double-door laminoplasty was performed in total 42 volumes.The postoperative cervical spinal canal sagittal diameter and traverse area were significantly improved(P
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[Objective]To study the stability function of Luschka Joint(LJ) of lower cervical spine.[Method]C_(3、4) and C_(5、6) as a funtional spinal unit(FSU) were taken from 16 fresh adult cadavers and randomly divided into experimental group,its LJ was cut out and in control group,LJ was maintained.The FSU of C_(3、4) and C_(5、6)was loaded and tested on the AG-10 AT automatic electronic versatile machine in normal,flexion ≤10? and extension ≤7.5? positions.Data of sigattal horizontal displacement(SHD),rotational angulation(RA) and coronary laterral displacement(CLD) were collected,counted and 3-dimesionally analyzed by computer.[Result]The SHD,RA and CLD of FSU experimental group were significantly different with that of control group(P
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[Objective]To investigate the possible etiological factors,pathogenesis,diagnostic criteria,clinic characteristics and the choice of treatment of the adolescent instability of lower cervical spine.[Method]The diagnosis,therapies and follow-up materials of the two typical cases were analyzed and researched with the available literatures.[Result]The two cases showed dissappearance of syndroms.The Roentgen film showed that the operative segments have gotten bone-fuse.Results were excellent according to Henderson-evaluation classification without any complications at 3 and 4 years follow-up.[Conclusion]The degeneration is probable one of the etiological factors causing adolescent instability of lower cervical spine.It is resemble on the pathogenesis,diagnostic criteria and the choice of treatment between the adolescent and the adult.But the each characteristic on the pathogenesis,pathologic process,clinical situation should be remarked.The growth potentiality and other correlated factors should be paid attention to for the choice of treatment.
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STUDY DESIGN: A retrospective clinical and radiological analysis. OBJECTIVES: To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injuries of the lower cervical spine. SUMMARY OF LITERATURE REVIEW: Surgical approaches for distractive-flexion injuries of the lower cervical spine have included the anterior approach, the posterior approach, and the combined anterior and posterior approach. However, which approach is the most useful remains a controversial issue. MATERIALS AND METHODS: We reviewed the outcomes of 30 patients, who were followed-up for an average of 16 months (range, 12-43 months) after undergoing fusions with anterior cervical plating for distractive-flexion injuries of the lower cervical spine from July 1995 to July 2004. The average age of these patients was 52.9 years (range 24-77 years) and male-to-female ratio was 26:4. Group A consisted of 19 cases that were composed of unilateral dislocations and Group B consisted of 11 cases that were composed of bilateral dislocations based on Allen s classification. Group A1 (9 cases) and B1 (8 cases) were composed of cases that had fractures on the superior end plates or facet joints of the lower cervical spine in each group. Group A2 (10 cases) and B2 (3 cases) were composed of cases without fractures in each group. Neurologic symptoms were evaluated by the Frankel classification; and the angle of lordosis, disc height, and duration of bony union were analyzed postoperatively and with the last follow-up roentgenograms. RESULTS: Clinically, 22 (73%) patients had neurologic deficits, which were composed of 9 (41%) cases of complete injury, 7 (32%) cases of incomplete injury, and 6 (27%) cases of nerve root injury. The nerve root injuries recovered in all cases and the incomplete injuries had an average 1.7 grade recovery by the Frankel classification. Radiologically, the loss of lordosis was 2.2+/-1.7degrees in group A, 3.1+/-2.8degrees in group B (p=0.359), 3.0+/-1.6degrees in group A1, 1.5+/-1.5degrees in group A2 p=0.048), 3.5+/-3.1degrees in group B1, and 2.1+/-1.7degrees in group B2. Loss of disc height was 1.7+/-1.1 mm in group A, 2.2+/-0.9 mm in group B( p=0.201), 2.2+/-0.9 mm in group A1, 1.2+/-1.0 mm in group A2 (p=0.046), 2.5+/-0.6 mm in group B1, and 1.2+/-1.1 mm in group B2. The duration for bony union was 12.9+/-2.8 weeks in group A, 14.1+/-2.7 weeks in group B (p=0.044), 13.9+/-2.1 weeks in group A1, 11.9+/-3.0 weeks in group A2 (p=0.046), 14.4+/-2.9 weeks in group B1, and 13.3+/-2.3 weeks in group B2. There was no graft displacement, nonunion or metal failure. CONCLUSION: Anterior cervical plating was an effective treatment modality for distractive-flexion injuries of the lower cervical spine. and more firm method was necessary to surgical treatment in case of fractures on superior end plate or facet joint.
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Animals , Humans , Classification , Joint Dislocations , Follow-Up Studies , Lordosis , Neurologic Manifestations , Retrospective Studies , Spine , Transplants , Zygapophyseal JointABSTRACT
PURPOSE: The purpose of this study was to evaluate diagnostic criteria using plain lateral radiography, the incidence of traumatic disc herniation and the degree of neurologic deficit in extension injury of the lower cervical spine. MATERIALS AND METHODS: We analyzed 28 patients with extension injury of the lower cervical spine, by measuring the retropharyngeal, retrotracheal space and the intervertebral space at the injured level in plain lateral radiography. We selected 40 patients as a control group for the prevertebral soft tissue space measurement. RESULTS: Widening was found in the retropharyngeal space (6.8 +/-2.9 mm) and in the retrotracheal space (15.2 +/-3.8 mm) compared with the control group (4.2 +/-0.7 mm, 12.6 +/-1.9 mm, p<0.05). No significant increase in the injured intervertebral space was observed with respect to the normal upper and lower disc space. Neurologic deficit occurred in 25 cases (89%); with root injury in 11 cases and cord injury in 14 cases. There were 19 posterior disc herniations (68%), which were associated with neurologic deficits in all cases. CONCLUSION: Extension injuries should be suspected in the presence of soft tissue injury of the anterior column without fracture or dislocation by the radiologic study of the lower cervical spine. Magnetic resonance imaging study is believed to be an essential diagnostic modality for the accurate evaluation and proper management of the lower cervical spine injuries.
Subject(s)
Humans , Diagnosis , Joint Dislocations , Incidence , Magnetic Resonance Imaging , Neurologic Manifestations , Radiography , Soft Tissue Injuries , SpineABSTRACT
PURPOSE: Recently, as traffic and industrial accidents increase year by year, so the incidence of fracture and dislocation of the cervical spine tends to increase. The treatment of this condition is controversial. However, there is increasing tendency to stabilize unstable cervical spine injuries surgically. This study was undertaken to retrospectively analyze the results of surgical treatment of lower cervical spine fracture and dislocation, and to suggest a rational treatment method comparing of surgical approach, bone union, neurologic recovery and clinical symptoms. MATERIAL AND METHODS: Authors studied the medical records and roentgenograms of 48 patients, who were treated surgically for acute fracture and dislocation of the lower cervical spine since January, 1993 to April, 1999. 21 patients were treated by anterior plating and 27 patients were by posterior wiring method. 33 male and 15 female with average age of 38.3 years comprised the group. The most common cause of the injury was traffic accident(35 cases-73%). The most common site of injuries was cervical spine 5-6(20 cases-41%). 6 cases were compressive-flexion(C-F) injuries, 4 cases were vertical-compression(V-C) injuries, 22 cases were distractive-flexion(D-F) injuries, 16 cases were distractive-extension(D-E) injuries according to Allen's Classification. RESULTS: 6 C-F injury patients were treated surgically by 4 anterior approach and 2 posterior approach. All 4 V-C injury patients were by anterior approach. 22 D-F injury patients were by 6 anterior approach and 16 posterior approach. 16 D-E injury patients were by 9 anterior approach and 7 posterior approach. There were 95% radiologic bone union rate in anterior approach and 96% in posterior approach. There was no neurologic recovery in complete spinal cord injury and average 1-2 grade of recovery in incomplete and nerve root injury by Frankel's Classification. The postoperative complication were screw loosening in 1 case, instability on near site of the operation in 2 cases, superficial infection in 1 case. SUMMARY AND CONCLUSION: In the treatment of lower cervical spine fracture and dislocation anterior plating and posterior wiring were same results in bone union rate, neurologic recovery and stability. In flexion injuries with posterior disc herniation, posterior wiring by posterior approach could compressing the spinal cord or nerve root thus anterior discectomy and rigid fixation by anterior approach was necessary. In extension injuries with reduced facet joint dislocation by preoperative traction, anterior approach was effective. In combined fracture of posterior arch of cervical spine, it is difficult to operate posterior approach thus anterior approach was effective. Unreduced posterior facet joint by preoperative traction, posterior approach was effective in reduction and fixation.
Subject(s)
Female , Humans , Male , Accidents, Occupational , Classification , Diskectomy , Joint Dislocations , Incidence , Medical Records , Postoperative Complications , Retrospective Studies , Spinal Cord , Spinal Cord Injuries , Spine , Traction , Zygapophyseal JointABSTRACT
PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Subject(s)
Humans , Male , Central Cord Syndrome , Classification , Decompression , Diskectomy , Joint Dislocations , Duodenal Ulcer , Immobilization , Incidence , Kyphosis , Medical Records , Neck Pain , Neurologic Manifestations , Pathology , Phylogeny , Pressure Ulcer , Spinal Cord , Spinal Cord Compression , Spinal Cord Injuries , Spine , Urinary Bladder, Neurogenic , Wound Infection , Zygapophyseal JointABSTRACT
The authors retrospectively reviewed the operative cases of 28 patients with lower cervical spine injury from August 1991 to July 1996. Data from charts were reviewed the following clinical parameters, e.g.) etiologies, neurologic findings, degrees of recovery, managements including operative treatments, and complications. The lower cervical injury was most common in men in the third decade. The most common cause, mechanism and site of lower cervical injury were motor vehicle accidents, flexion type injury and C5-6 respectively. The head trauma was frequently combined. In most cases operation for stabilization was done around two weeks after the trauma, but for decompression purpose it was done before two weeks. Three patients who had complete neural injuries died due to pneumonia, adult respiratory distress syndrome, and upper gastrointestinal bleeding. A neurological recovery rate was high in incomplete neural injury group. In conclusion, early reduction and decompression of spinal canal in incomplete neural injury group is favorable for good recovery. Careful attention should be paid on the patient with complete injury for the development of serious complications such as upper gastrointestinal bleeding, ARDS and pneumonia.