Comparison of the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability / 中国基层医药

Objective@#To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability.@*Methods@#From January 2016 to October 2017, 36 cases of Chiari I malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method, with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy, complications occurred within 1 year after operation, JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.@*Results@#The total effective rate of the observation group [94.44%(17/18)] was slightly higher than that of the control group [88.89%(16/18)] (χ2=1.957, P>0.05). The total effective rate of the observation group at 1 year after operation was 88.89%(16/18), which was significantly higher than that of the control group [72.22%(13/18)] (χ2=3.498, P<0.05). The incidence rate of complications of the observation group at 1 year after operation was 11.11%(2/18), which was significantly lower than that of the control group [38.89%(7/18)](χ2=11.685, P<0.05). The JOA scores at discharge[(15.97±1.25)point] and 1 year after operation[(15.53±1.19)point] of the observation group were significantly higher than those of the control group[(14.21±1.18)point, (14.06±1.15)point](t=3.815, 3.706, all P<0.05). The spinal cord cavity size at discharge [(2.13±0.64)mm] and 1 year after operation[(2.28±0.69)mm] of the observation group were significantly higher than those of the control group [(3.41±0.76)mm, (3.45±0.78)mm](t=5.743, 5.511, all P<0.05).@*Conclusion@#The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability is remarkable, the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low, which is worthy of popularization and application.

Comparison of the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability / 中国基层医药

Objective To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability.Methods From January 2016 to October 2017,36 cases of Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method,with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy,complications occurred within 1 year after operation,JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.Results The total effective rate of the observation group [94.44％ (17/18)] was slightly higher than that of the control group [88.89％ (16/18)] (x2 =1.957,P ＞ 0.05).The total effective rate of the observation group at 1 year after operation was 88.89％ (16/18),which was significantly higher than that of the control group [72.22％ (13/18)] (x2 =3.498,P ＜ 0.05).The incidence rate of complications of the observation group at 1 year after operation was 11.11％ (2/18),which was significantly lower than that of the control group [38.89％ (7/18)] (x2 =11.685,P ＜ 0.05).The JOA scores at discharge[(15.97 ± 1.25) point] and 1 year after operation[(15.53 ± 1.19) point] of the observation group were significantly higher than those of the control group [(14.21 ± 1.18) point,(14.06 ±1.15) point] (t =3.815,3.706,all P ＜ 0.05).The spinal cord cavity size at discharge [(2.13 ± 0.64) mm] and 1 year after operation [(2.28 ± 0.69) mm] of the observation group were significantly higher than those of the control group [(3.41 ±0.76)mm,(3.45 ±0.78)mm] (t =5.743,5.511,all P＜0.05).Conclusion The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability is remarkable,the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low,which is worthy of popularization and application.

Risk Factors for the Development and Progression of Atlantoaxial Subluxation in Surgically Treated Rheumatoid Arthritis Patients, Considering the Time Interval between Rheumatoid Arthritis Diagnosis and Surgery

OBJECTIVE: Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. METHODS: We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. RESULTS: The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was 13.6±7.0 years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). CONCLUSION: The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.

Artrodese na coluna cervical utilizando SICAP como substituto de enxerto ósseo / Artrodesis en la columna cervical utilizando SICAP como sustituto de injerto óseo / Cervical spine fusion utilizing silicated calcium phosphate bone graft substitute SICAP

OBJETIVO: Substitutos de enxerto ósseo autólogo foram desenvolvidos para evitar as complicações da retirada de enxerto ósseo autólogo. SiCaP (Actifuse, ApaTech EUA, Reino Unido) é um enxerto ósseo composto de cálcio-fosfato com um substituição de silicato na estrutura química, com uma estrutura tridimensional que parece osso natural. MÉTODOS: 19 pacientes foram submetidos à fusão óssea cervical e analisados retrospectivamente. A avaliação radiográfica e avaliação clínica foram realizadas utilizando o questionário Neck Disability Index e a escala análoga da dor (VAS) pré- e pós-operação. RESULTADOS: O período médio de acompanhamento pós-operatório foi de 14 meses ± 5 meses (7-30 meses). 11 pacientes foram submetidos à fusão via anterior; 5 pacientes via posterior e 3 pacientes via anterior e posterior. A revisão radiográfica mostrou 19/19 (100 por cento) de fusão óssea, nenhum caso apresentou subsidência, quebra ou soltura de material de implante ou movimento nos níveis fusionados. Nenhum exemplo de ossificação heterotópica ou de crescimento ósseo intracanal foi observado. Clinicamente, os escores médios do Neck Disability decresceram 13,3 pontos (media pré-op. de 34,5, pós-op. de 21,2, melhora de 39 por cento), a média da VAS para dor cervical decresceu 2 pontos (2,7 pré-op para 0,7 pós-op.; melhora de 74,1 por cento). Não foram observadas complicações como infecção, osteólise ou edema excessivo das partes moles. CONCLUSÃO: Os resultados preliminares obtidos nesta série foram encorajadores com o uso do SICaP como enxerto ósseo, com sólida fusão óssea obtida em todos os casos e sem formação de ossificação heterotópica ou crescimento de osso intracanal. SIcaP demonstra ser um substituto confiável para o enxerto ósseo autólogo na coluna cervical.

OBJECTIVE: Bone graft substitutes have been developed to obviate the need for autograft from the iliac crest and its resultant complications. SiCaP (Actifuse, ApaTech US, UK) is a calcium phosphate bone graft substitute with selective controlled silicate substitution in a patented 3-dimensional structure resembling natural bone. METHODS: 19 patients who underwent cervical spine fusion were retrospectively reviewed. Radiographic evaluation and clinical evaluation were performed using Neck Disability Index questionnaire and Visual Analog Scale (VAS) pre- and post-operatively. RESULTS: The mean post-operative follow-up was 14 ± 5 months, range 7-30 months. Eleven patients had an anterior approach, five patients had a posterior approach, and 3 had combined anterior-posterior approaches. Radiographic review showed 19/19 (100 percent) patients were considered fused, with no subsidence, hardware breakage, or hardware loosening. No instances of heterotopic bone formation or intracanal boney ingrowths were observed. Clinically, average Neck Disability scores decreased 13.3 points (pre-op 34.5, post-op 21.2, a 39 percent improvement); average VAS neck pain scores decreased 2.2 points (4.9 pre-op to 1.9 post-op; a 44.9 percent improvement; average VAS arm pain decreased 2.0 points (2.7 pre-op to 0.7 post-op, a 74.1 percent improvement). There were no complications such as infection, osteolysis, or abnormal swelling of soft tissues. CONCLUSIONS: Preliminary results from this series with the use of SiCaP bone graft substitute were encouraging, with solid fusion occurring in all subjects, and no heterotopic bone formation or intracanal bone ingrowths. SiCaP seems to be a reliable alternative to autograft on cervical spine fusion achieving solid fusion with no complications.

OBJETIVO: Sustitutos de injerto óseo autólogo fueron desarrollados para evitar las complicaciones de la recogida de injerto óseo autólogo. SiCaP (Actifuse, ApaTech EE.UU, Reino Unido) es un injerto óseo compuesto de calcio-fosfato con una sustitución de silicato en la estructura química, con una estructura tridimensional que parece hueso natural. MÉTODOS: 19 pacientes fueron sometidos a fusión ósea cervical y analizados retrospectivamente. La evaluación radiográfica y la evaluación clínica fueron realizadas utilizandose el cuestionario Neck Disability Index y la escala análoga del dolor (VAS) pre y postoperación. RESULTADOS: El período promedio de seguimiento postoperatorio fue de 14 meses ± 5 meses (7-30 meses). Once pacientes fueron sometidos a fusión vía anterior; 5 pacientes vía posterior y 3 pacientes vía anterior y posterior. La revisión radiográfica mostró 19/19 (100 por ciento) de fusión ósea, ningún caso presentó subsidencia, rotura o soltura de material de implante o movimiento en los niveles fusionados. Ningún ejemplo de osificación heterotópica o de crecimiento óseo intracanal fue observado. Clínicamente, el promedio de las puntuaciones del Neck Disability disminuyeron 13,3 puntos (promedio preop. de 34,5, postop. de 21,2, mejora de 39 por ciento), el promedio de VAS para dolor cervical disminuyó 2 puntos (2,7 preop. para 0,7 postop.; mejora de 74,1 por ciento). No fueron observadas complicaciones como infección, osteólisis o edema excesivo de las partes blandas. CONCLUSIÓN: Los resultados preliminares obtenidos en esta serie feuron estimulantes con el uso de SICaP como injerto óseo, con sólida fusión ósea obtenida en todos los casos y sin formación de osificación heterotópica o crecimiento de hueso intracanal. SIcaP demuestra ser un sustituto confiable para el injerto óseo autólogo en la columna cervical.

Radiological Considerations of Posterior Cervical Lateral Mass Fixation Using Plate and Screw

The aim of this study is to determine whether the posterior cervical fusion methods with the plate-screw system applied to the lateral mass of cervical spine are radiologically safe to patients. The lateral cervical X-rays and CT scans were done on 40 normal adults without cervical problem. Based on Roy-Camille and Magerl's method, the theological trajectory of screw was shown on films and the parameters were measured. The study based on Roy-Camille's method showed less than one percent chance of injury on the facet joint and the mean depth of the screw to be 10.5+/-1.4mm. On the other hand, Magerl's method showed the mean depth of screw to be 11.9+/-1.5mm which is slightly larger than that of Roy-Camille's method and no chance of facet injury occurred. A reduced lateral angle of screw (19.6+/-3.5 degrees) performed with the concept based on Magerl's method resulted a longer depth of screw (13.5+/-2.1mm). Both Roy-Camille and Magerl's methods seemed to be radiologically safe to normal persons. However, the authors recommend the reduced lateral angle (19.6+/-3.5 degrees) of screw based on the Magerl's method more than an original Magerl's methods.

Long-term Outcome of Posterior Cervical stabilization with Halifax Interlaminar Clamp

Posterior cervical fusion is still the procedure of choice in the cases of spinal instability caused by flexion injuries. Halifax interlaminar clamp system can be used whenever posterior cervical fusion is to be performed. Thirty-one consecutive patients were treated with Halifax interlaminar clamp for cervical instability from Jan. 1991 to Jan. 1995. We followed up all of the cases for more than one year. All of the twenty-six mid-and low-cervical fixations showed immediate and long-term stability and there were no neurological complications. Two cases among the five C1-2 fixations were failed due to loosening of clamps. Fifteen cases of mid-and low-cervical fixations showed facet sclerosis and interbody fusion on the plain X-ray films after more than one year.

A Case of Atlanto-axial Dislocation due to Os Odontoideum

A patient who had an atlanto-axial dislocation due to an os odontoideum is presented. She was operated on successfully with preliminary realignment of the dislocation by skeletal traction and subsequent posterior cervical fusion with wiring and iliac bone.

Acrylic Posterior Cervical Fusion

The principle of the treatment of cervical spine injury should be directed first toward relief of spinal cord compression and reduction of the deformity, then toward adequate immobilization. Until this time, posterior wire fusion, posterior bone graft with wire fixation, acrylic posterior fusion and external immobilization method have been used for the adequate immobilization. The authors experienced 3 cases of acrylic posterior cervical fusion. Two patients were the odontoid process fracture and one patient was a congenital occipito-atlantal assimilation. Authors thought this procedure is more simple and there is no problem of donor site pain and infection which can be possible in the posterior fixation with iliac bone and rib graft. The acrylic fusion offers certain advantage over other form of fixation or fusion because of its rapid and solid fixation, permitting immediate rehabilitation.

Acrylic Posterior Cervical Fusion

The principle of the treatment of cervical spine injury should be directed first toward relief of spinal cord compression and reduction of the deformity, then toward adequate immobilization. Until this time, posterior wire fusion, posterior bone graft with wire fixation, acrylic posterior fusion and external immobilization method have been used for the adequate immobilization. The authors experienced 3 cases of acrylic posterior cervical fusion. Two patients were the odontoid process fracture and one patient was a congenital occipito-atlantal assimilation. Authors thought this procedure is more simple and there is no problem of donor site pain and infection which can be possible in the posterior fixation with iliac bone and rib graft. The acrylic fusion offers certain advantage over other form of fixation or fusion because of its rapid and solid fixation, permitting immediate rehabilitation.