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Article in Chinese | WPRIM | ID: wpr-928291


OBJECTIVE@#To establish the fixation model of anterior cervical transpedicular system (ACTPS) after subtotal resection of two segments of lower cervical spine(C3-C7) in order to provide a finite element modeling method for anterior cervical reconstruction.@*METHODS@#The CT data of the cervical segment (C1-T1) of a 30-year-old adult healthy male volunteer was collected. Used Mimics 10.0, Rapidform XOR3, HyperMesh 10.0, CATIA5V19 and ANSYS 14.0 to establish the three-dimensional nonlinear complete model of lower cervical spine(C3-C7) as the intact group. The number of units and nodes of the complete model were recorded. After the effectiveness of the complete model was verified, the C5 and C6 vertebral subtotal resection was performed, and the ACTPS model was established as the ACTPS group. The axial force of 75 N and moment couple of 1N·m was loaded on the upper surface of C3 in intact group and ACTPS group, the range of motion(ROM)and stress distribution in states of flexion extension, lateral flexion, rotation was compared between two groups.@*RESULTS@#There were 85 832 elements and 23 612 nodes in the complete model of lower cervical spine(C3-C7) which was established in this experiment. The stress distribution of ACTPS internal fixation model was relatively uniform. Comparing with the intact group, the overall range of motion in ACTPS group was decreased in flexion extension, lateral flexion and rotation directions, and the corresponding compensation of adjacent C3,4 segment was increased slightly.@*CONCLUSION@#The stress distribution of ACTPS fixation system is uniform, there is no stress concentration area at the joint of screw and titanium plate, and the fracture risk of internal fixation is low. It is suitable for stability reconstruction after anterior decompression of two or more cervical segments.

Adult , Biomechanical Phenomena , Bone Screws , Cervical Vertebrae/surgery , Finite Element Analysis , Humans , Male , Range of Motion, Articular , Spinal Fusion
Article in Chinese | WPRIM | ID: wpr-928289


OBJECTIVE@#To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.@*METHODS@#From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation.@*RESULTS@#All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).@*CONCLUSION@#Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.

Cervical Vertebrae/surgery , Child , Child, Preschool , Decompression/adverse effects , Female , Humans , Male , Musculoskeletal Manipulations , Radiculopathy/surgery , Retrospective Studies , Spondylosis/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928283


OBJECTIVE@#To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.@*METHODS@#The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group, the C3-C6 whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.@*RESULTS@#There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).@*CONCLUSION@#Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.

Adult , Aged , Aged, 80 and over , Bone Screws , Case-Control Studies , Cervical Cord/surgery , Cervical Vertebrae/surgery , Female , Humans , Laminectomy/methods , Laminoplasty/methods , Male , Middle Aged , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-888343


OBJECTIVE@#To observe the change of cervical curvature and range of motion (ROM) on imaging at 6 months after Hybrid surgery.@*METHODS@#A total of 29 patients with cervical degenerative disease who underwent Hybrid surgery from January 2017 to July 2018 were retrospectively analyzed. Also, they all met the inclusion criteria and had complete preoperative and 6 months postoperative imaging data. There were 11 males and 18 females, aged from 34 to 76 (55.86±10.69) years, and the operation time was from 2 to 4(3.03±0.51) hours. The Cobb angle method was used to measure the changes of cervical curvature and ROM of C@*RESULTS@#There was no statistically significant difference in C@*CONCLUSION@#Hybrid surgery reconstructs the lordotic curvature of the entire cervical spine and the responsible segment, retains the ROM of the cervical replacement segment, and restores the biomechanical function of cervical spine.

Cervical Vertebrae/surgery , Diskectomy , Female , Humans , Male , Range of Motion, Articular , Retrospective Studies , Spinal Fusion
Article in Chinese | WPRIM | ID: wpr-888332


OBJECTIVE@#To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation.@*METHODS@#From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C@*RESULTS@#All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C@*CONCLUSION@#Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.

Cervical Vertebrae/surgery , Female , Humans , Male , Retrospective Studies , Spinal Cord Diseases , Spinal Fusion , Spondylosis , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879447


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.

Biomechanical Phenomena , Cervical Vertebrae/surgery , Female , Finite Element Analysis , Humans , Range of Motion, Articular , Reproducibility of Results , Spinal Fusion
Article in Chinese | WPRIM | ID: wpr-879443


OBJECTIVE@#To compare the clinical effects of different anterior surgical methods in treating single segment cervical disc herniation.@*METHODS@#The clinical data of 46 patients with single-segment cervical disc herniation underwent surgical treatment from September 2013 to September 2018 were retrospectively analyzed. The patients were divided into three groups according to different surgical methods. Among them, 23 patients in the anterior percutanousendomic cervical dissection (APECD) group, there were 8 males and 15 females, aged (47±3) years old, prominent segments were C@*RESULTS@#All 46 patients were followed up for 12 to 24 (17.57±3.15)months. The follow-up time of APECD, CDR, ACDF groups were (17.30±3.25), (17.80±3.16), (17.85±2.88) months, and operation time were (95.48 ±13.85), (58.50±7.09), (76.00±15.72) min, respectively, there were no significant differences in follow-up time and operation time between two groups(@*CONCLUSION@#The three anterior surgical approaches can achieve satisfactory clinical results for the treatment of single-segment cervical disc herniation. However, the improvement rate of the CDR group and the activity of the retained responsibility segment are better than those of the other two groups. APECD surgery may have recurrence.

Adult , Cervical Vertebrae/surgery , Diskectomy , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/surgery , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Total Disc Replacement , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879437


OBJECTIVE@#To compare the efficacy of microscope assisted anterior cervical discectomy and fusion with conventional surgical approach in the treatment of single-segment cervical spondylotic myelopathy.@*METHODS@#The clinical data of 89 patients with single-segment cervical spondylotic myelopathy treated from March 2015 to March 2019 were retrospectively analyzed. There were 55 males and 34 females, with an average of (52.00±11.36) years old. Among the patients, 34 cases were treated with conventional anterior cervical discectomy with fusion (conventional group), including C@*RESULTS@#Intraoperative blood loss and hospital stay in microscope group were less than those in conventional group (@*CONCLUSION@#Both methods can achieve satisfactory effect in treating single-segment cervical spondylotic myelopathy. However, microscope-assisted anterior cervical discectomy and fusion has advantages of clear vision, less bleeding and fewer intraoperative complications.

Adult , Cervical Vertebrae/surgery , Diskectomy , Female , Humans , Male , Middle Aged , Retrospective Studies , Spinal Cord Diseases/surgery , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879410


OBJECTIVE@#To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.@*METHODS@#From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared.@*RESULTS@#At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (@*CONCLUSION@#The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Adult , Aged , Cervical Vertebrae/surgery , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/surgery , Male , Middle Aged , Range of Motion, Articular , Retrospective Studies , Total Disc Replacement , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879408


OBJECTIVE@#To investigate the clinical efficacy of zero-profile anchored spacer (ROI-C) in treating cervical spondylosis with osteoporosis.@*METHODS@#From May 2013 to May 2018, a total of 145 patients with cervical spondylosis were treated by ROI-C through anterior cervical spine approach. Among them, 31 patients were aged ≥60 years and had osteoporosis by bone density measurement, and they were retrospectively analyzed. Including 9 males and 22 females, aged 60-84 years old with an average of (69.12±7.65) years. There were 23 cases of single-segment fusion, 6 cases of two-stage fusion, and 2 cases of three-stage fusion;and 41 devices of ROI-C fusion was placed in the patients. Operation time and intraoperative blood loss were recorded;Japanese Orthopaedic Association (JOA) scores and visual analogue scale(VAS) were respectively used to evaluate the neurological function and neck pain before and after operation. The cervical curvature (expressed as Cobb angle), the height of the intervertebral space at the surgical segment, and the intervertebral fusion were observed at postoperative and follow-up periods were observed by image data.@*RESULTS@#All patients were followed up for 12-24(15.6±4.4) months after operation. The operation time were from 75 to 113 (101.33±10.25) min and intraoperative blood loss were from 14 to 51 (33.18 ± 16.56) ml. Among these 23 patients with fusion of single segment, the operation time were 75 to 98 (85.47±8.70) min and intraoperative blood loss were 14 to 30(21.18±6.56) ml. JOA scores of all included patients were increased from 9.66±2.12 preoperatively to 14.36±1.24 at the final follow-up (@*CONCLUSION@#Anterior cervical approach with ROI-C for the treatment of elderly patients with cervical spondylosis and osteoporosis had reliable clinical effect, short operation time, less intraoperative blood loss, and can effectively restore cervical curvature and intervertebral space height, and has advantages of fewer complications and higher successful rate of fusion.

Aged , Aged, 80 and over , Cervical Vertebrae/surgery , Female , Humans , Male , Middle Aged , Osteoporosis , Retrospective Studies , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879404


OBJECTIVE@#To compare accuracy of anterior cervical pedicle screws between assist of rapid prototyping 3D guide plate and free-hand insertion, and evaluate the safety of two methods.@*METHODS@#Eight adult cervical cadaver specimens after formaldehyde immersion, including 4 males and 4 females, aged 32 to 65(40.3±5.6) years old. After X-ray examination to exclude bone damage and deformity, 4 of them (3D guide plate group) randomly selected were for CT scan to obtain DICOM format data, and the data was imported into Mimics software for model, designed the ideal entry point and nail path for anterior cervicaltranspedicular screw (ATPS). After obtaining the personalized guide plate of the nail channel, it was exported as STL data, and the individual guide plate was printed by rapid prototyping and 3D printing technology. In turn, with the assistance of 3D guide plates, one-to-one personalized ATPS screws were placed on the four lower cervical cadaver specimens. Another 4 (free-hand group) lower cervical cadaver specimens were implanted with ATPS screws using free-hand technique. All specimens were performed CT thin-layer scanning and three-dimensional reconstruction after operation. The Tomasino method was used to evaluate the safety of the screws on the CT cross-sectional and sagittal images, to determine whether there was a cortical puncture of the lower and inner edges of the pedicle. According to the CT rating results, gradeⅠandⅡwere safe, and grade Ⅲ- Ⅴ were dangerous.And the accuracy of screws was recorded and analyzed between two groups.@*RESULTS@#Two screws were inserted in each segment from C@*CONCLUSION@#The 3D printing rapid prototyping guide plate assisted insertion of the anterior cervical pedicle screw can significantly improve the accuracy and safety, and provide a theoretical basis for further clinical application.

Adult , Aged , Bone Plates , Cervical Vertebrae/surgery , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pedicle Screws , Printing, Three-Dimensional
Article in Chinese | WPRIM | ID: wpr-879402


OBJECTIVE@#To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P).@*METHODS@#A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020, including 21 in Key hole group (12 males and 9 females), followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females), and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length, intraoperative blood loss, operation time, length of hospital stay, and complications) were compared between two groups, and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine, visual analogue scale(VAS) of pain before and after surgery, Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy.@*RESULTS@#In Key-hole group and Zero-P group, the surgical incision length, intraoperative blood loss, operation time, final follow-up Cobb angle and immediate postoperative VAS score respectively were (1.2±0.2) cm, (5.3±0.3) cm;(35.3±9.7) ml, (120.2±13.5) ml;(56.4±11.3) min, (90.6±12.6) min;(3.2±3.9)°, (7.3±3.8)°;(2.8±1.2)points, (3.8±1.1) points;the Zero-P group was larger than the Key hole group, with statistical significance(@*CONCLUSION@#The cervical spine Key-hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key-hole technique has certain advantages in incision length, intraoperative blood loss, and operation time. It is a safe, effective and can be widely used cervical spine surgery method.

Case-Control Studies , Cervical Vertebrae/surgery , Female , Humans , Male , Radiculopathy/surgery , Retrospective Studies , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879400


OBJECTIVE@#To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification.@*METHODS@#Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females, aged from 29 to 74 years old with an average of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy, 6 cases of cervical spondylotic myelopathy, and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification, 17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protrusion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal, 14 cases were medial and lateral type, 5 cases were central type, and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation, clinical effect was assessed according to modified Macnab standard.@*RESULTS@#All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h, length of postoperative hospitalization was 2 to 7(4.1± 1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed, and 10 cases were left after operation, and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation (@*CONCLUSION@#For an experienced surgeon, percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.

Adult , Aged , Cervical Vertebrae/surgery , Diskectomy , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Osteogenesis , Retrospective Studies , Treatment Outcome
Chinese Medical Journal ; (24): 2816-2821, 2020.
Article in English | WPRIM | ID: wpr-877937


BACKGROUND@#The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.@*METHODS@#A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.@*RESULTS@#There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.@*CONCLUSIONS@#Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

Blood Loss, Surgical , Cervical Vertebrae/surgery , Decompression, Surgical , Humans , Laminoplasty , Retrospective Studies , Spinal Cord Diseases/surgery , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
Rev. Asoc. Méd. Argent ; 132(2): 12-14, jun. 2019.
Article in Spanish | LILACS | ID: biblio-1026330


Se revisan la fisiopatología y los mecanismos que producen la sofocación en el hematoma cervical y se determina que el único tratamiento con posibilidades de éxito vital es el inmediato drenaje del hematoma.

In this article are reviewed the physiopathology and the mechanisms that causes suffocation in the cervical hematoma. It is determined that the only treatment with possibilities of vital success is the immediate drainage of the hematoma.

Humans , Asphyxia/etiology , Drainage , Hematoma/physiopathology , Hematoma/therapy , Postoperative Complications , Asphyxia/physiopathology , Cervical Vertebrae/surgery , Neck/surgery
Rev. bras. ortop ; 54(1): 20-25, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003598


Abstract Objective High cervical spine fixation represents a challenge for spine surgeons due to the complex anatomy and the risks of vascular and medullar injury. The recent advances in 3-D printing have unfolded a whole new range of options for these surgeons. Methods In the present study, a guide for the placement of the lateral mass screw in the C1 vertebra was developed using 3-D printing. Eight real-size models of the high cervical spine and their respective screw guides were built using computed tomography (CT) scan images. The guidewires were inserted with the help of the printed guides and then the models were analyzed with the help of CT scan images. Results All of the guidewires in the present study obtained a safe placement in the models, avoiding the superior and inferior articular surfaces, the vertebral foramen, and the vertebral artery. Conclusion The present study demonstrated the efficiency of the guide, a reliable tool for aiding the insertion of guidewires for screws in lateral masses of the C1.

Resumo Objetivos A fixação de coluna cervical alta pode representar um desafio para os cirurgiões de coluna devido à anatomia complexa e aos riscos de lesão vascular e medular. Os recentes avanços com a tecnologia de impressão 3 D abriram um novo leque de opções para os cirurgiões. Métodos Desenvolveu-se umguia para a adaptação de parafusos demassa lateral em C1 comauxílio de impressão 3 D. Foram confeccionados oitomodelos em tamanho real de coluna cervical alta e seus respectivos guias com base em tomografias computadorizadas. Os fios-guia foram introduzidos com o auxílio dos guias; os modelos foram analisados com auxílio de tomografia computadorizada. Resultados Todos os fios-guia avaliados no estudo apresentaram um trajeto seguro nos modelos, respeitaram as superfícies articulares superiores e inferiores, o canal vertebral e a artéria vertebral. Conclusão O estudo demonstrou que o guia tem boa eficácia, é uma ferramenta confiável para auxiliar a adaptação de fios-guia para parafusos em massas laterais de C1.

Humans , Male , Female , Spinal Fusion , Cervical Vertebrae/surgery , Cervical Vertebrae/pathology , Spinal Fractures , Printing, Three-Dimensional
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 5(1): 64-69, jun. 2018. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088673


La neurofibromatosis es el síndrome neurocutáneo más frecuente, una enfermedad hereditaria con afectación multisistémica. Se distinguen tres formas clínicas de la enfermedad; la neurofibromatosis tipo 1 (NF-1) es la más frecuente. A las lesiones cutáneas, presentes en la mayoría de los casos, se pueden asociar tumores en cualquier localización. Los neurofibromas son característicos de la NF-1. El objetivo de esta comunicación es describir una complicación poco frecuente de la NF-1 que representa un desafío terapéutico debido a la topografía y frecuencia de recidivas. Se trata de una niña de 3 años con NF-1 con síntomas de mielopatía multisegmentaria de instalación progresiva de dos meses de evolución. La imagenología evidenció una tumoración cérvico-dorsal con compresión medular. La exéresis tumoral permitió confirmar neurofibroma intradural, extramedular. Los neurofibromas plexiformes se caracterizan por su comportamiento infiltrativo y diseminación paraespinal extensa. La resección de estas lesiones genera habitualmente morbilidad asociada al compromiso de estructuras críticas extraespinales y dificulta su resección completa tal como ocurrió en el caso clínico presentado. Se destaca la importancia de realizar un correcto seguimiento clínico y eventualmente imagenológico de los pacientes con NF-1 para detectar y abordar oportunamente los tumores, su complicación más importante.

Neurofibromatosis is one of the most frequent neurocutaneous syndrome. It is an inherited diseasewhich affects multiple systems. Three clinical presentations of the disease can be distinguished being type 1 neurofibromatosis the most common. Tumors at any body location can be associated to the usually presented cutaneous lesions. Neurofibromas are characteristic of type 1 neurofibromatosis. The aim of this study is to describe a less frequent complication of the disease which represents a therapeutic challenge due to its topography and frequency of recurrences. This is the case of a 3 year-old girl with type 1 neurofibromatosis with symptoms of multisegmental myelopathy. A cervical-dorsal tumor with medullary compression was shown in medical imaging. Tumor extraction allowed to confirm intradural, extramedullary neurofibroma. Plexiform neurofibromas are characterized by their infiltrative behavior and extensive paraspinal dissemination. Resection of these lesions usually generates morbidity associated with the involvement of extra-spinal critical structures and hinders their complete resection as occurred in the presented clinical case. It is important to perform a correct clinical and eventually imaging follow-up of patients with NF-1 to detect and treat tumors, its most important complication.

Neurofibromatose é a syndrome neurocutânea mais freqüente, uma doença hereditária com envolvimento multissistêmico. Três formas clínicas da doença são distinguidas. A neurofibromatose tipo 1 (NF-1) é a mais freqüente. As lesões cutâneas, presentes na maioria dos casos, podem ser associadas a tumores em qualquer localização. Neurofibromas são característicos de NF-1. O objetivo desta comunicação é descrever uma complicação rara de NF-1 que representa um desafio terapêutico devido à topografia e freqüência de recidivas. Trata-se de uma menina de 3 anos com NF-1 com sintomas de mielopatia multisegmentar de instalação progressiva de dois meses de evolução. A imagem mostrou um tumor cérvico-dorsal com compressão da medula espinhal. A excisão do tumor permitiu confirmar neurofibroma intradural, extramedular. Os neurofibromes plexiformes são caracterizados pelo seu comportamento infiltrativo e sua disseminação paraspinal extensa. A ressecção dessas lesões geralmente gera morbidade associada ao envolvimento de estruturas críticas extra-espinhais e dificulta sua ressecção completa, como ocorreu no caso clínico apresentado. Destaca-se a importância de realizar um acompanhamento clínico e, eventualmente, de imagens de pacientes com NF-1 para detectar e tratar oportunamente os tumores, sua complicação mais importante.

Humans , Female , Child, Preschool , Spinal Cord Neoplasms , Thoracic Vertebrae/pathology , Cervical Vertebrae/pathology , Neurofibromatosis 1/complications , Neurofibroma/surgery , Neurofibroma/diagnosis , Thoracic Vertebrae/surgery , Cervical Vertebrae/surgery , Neoplasm Recurrence, Local
Article in French | AIM | ID: biblio-1263807


Evaluer les résultats du traitement des traumatismes du rachis cervical chez l'adulte dans un service aux ressources limitées.Materiels et méthodes Il s'agissait d'une étude rétrospective. Du 1er janvier 2010 au 30 juin 2014, 57 patients ont été traités pour un traumatisme du rachis cervical. Le traitement était orthopédique (n= 33) et chirurgical (n=24). Le délai pré-opératoire moyen était de 25 jours. L'arthrodèse par greffon iliaque intersomatique associée à une ostéosynthèse par une plaque visée a été la technique chirurgicale la plus utilisée.Résultats La durée moyenne du séjour à l'hôpital de nos patients était de 39 jours. Le contrôle radiologique postopératoire a été satisfaisant avec une bonne décompression et un bon alignement du mur postérieur chez tous les opérés. L'évolution finale a porté sur 49 patients avec un recul moyen 6 mois. Il n'ya pas eu d'aggravation neurologique chez les patients traités orthopédiquement. L'évolution neurologique a été favorable (amélioration du score de Frankel) (n= 26), stationnaire (n=9), et défavorable (aggravation) (n=14). Les complications non neurologiques étaient une infection du site opératoire (n=2), des escarres (n=21), et une pneumonie (n=4). Quatorze patients tétraplégiques complets étaient décédés. Conclusion Le traitement des traumatisés du rachis cervical dans notre contexte était aussibien orthopédique que chirurgical. Les complications de décubitus étaient fréquentes. Nos résultats devraient être optimisés par l'amélioration des soins préhospitaliers, une prise en charge précoce, l'instauration d'une couverture sociale,et une amélioration de notre plateau technique, la création de centre de soins des blessés médullaires

Africa , Cervical Vertebrae/surgery , Developing Countries , Orthopedic Procedures , Outcome Assessment, Health Care
Rev. Asoc. Argent. Ortop. Traumatol ; 82(Supl): S22-S27, 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-982773


El plasmocitoma extradural a nivel cervical es una de las patologías menos frecuentes dentro de los tumores extramedulares del mieloma múltiple; así mismo, es infrecuente que cause compresión medular o de las raíces nerviosas. Se presenta este caso por su gravedad y baja frecuencia en un paciente con diagnóstico de mieloma múltiple en tratamiento, que concurre con síntomas neurológicos (parestesia y paresia braquial bilateral) en la semana posterior a la cirugía de liberación meningorradicular y artrodesis cervical (C6-C7), en el mismo nivel de aparición de un plasmocitoma intracanal, extradural diagnosticado por resonancia magnética y confirmado con el resultado de la biopsia intraquirúrgica. Se ha publicado un caso similar al presentado, pero con la diferencia de que el paciente debutó con cuadriparesia. Se conoce también un caso de plasmocitoma originado en la médula espinal de la región torácica. En nuestro paciente, al igual que en un caso reportado con mieloma múltiple asintomático con manifestación primaria de plasmocitoma extramedular, la evolución de la enfermedad fue rápida, y el paciente falleció en menos de un año desde el diagnóstico. Nivel de Evidencia: IV.

Epidural plasmacytoma at the cervical spine is one of the less common extramedullary tumors in multiple myeloma. Likewise compression of the spinal cord or the nerve roots is uncommon. The following case is presented due to its rarity and severity. A patient diagnosed with and being treated for multiple myeloma presented with neurological symptoms (paresthesia and bilateral upper extremity weakness) a week after decompression and C6-C7 fusion, at the same level of an intracanal, epidural plasmacytoma detected by magnetic resonance and confirmed by intraoperative biopsy. A similar case was published, however it differs in that the patient presented with quadriplegia. There is also a reported case of plasmacytoma originating in the thoracic region of the spinal cord. In our patient, similar to the previously reported case of asymptomatic multiple myeloma with primary manifestation of extramedullary plasmacytoma, progression of the disease was rapid and the patient died less than one year from diagnosis. Level of Evidence: IV.

Middle Aged , Cervical Vertebrae/surgery , Multiple Myeloma/complications , Multiple Myeloma/surgery , Plasmacytoma/surgery
Rev. Asoc. Argent. Ortop. Traumatol ; 82(3): 220-230, 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-869370


Introducción: la instrumentación de la columna cervical pediátrica ha ganado terreno en la última década. Las diferencias anatómicas y biomecánicas entre la columna cervical pediátrica y del adulto hacen que la cirugía requiera de una minuciosa preparación toda vez que se utilizan implantes diseñados para adultos. El objetivo de este estudio fue evaluar los resultados posoperatorios en una serie de niños <10 años sometidos a fusión cervical instrumentada, y describir la técnica quirúrgica y las complicaciones. Materiales y Métodos: Se evaluó a 28 pacientes con patología cervical tratados con fusión instrumentada utilizando las técnicas descritas por Roy-Camille y Magerl para masas laterales, de Goel-Harms para C1-C2, y las fusiones occipitocervicales con placas occipitales o rótulas. Los criterios de inclusión fueron: pacientes <10 años, cirugía primaria y un seguimiento mínimo de 2 años. Resultados: La muestra incluyó 17 niñas y 11 niños, con un seguimiento promedio de 3.8 años (rango 2-10). La edad promedio fue de 6.1 años (rango 1.6-10). La tasa promedio de complicaciones generales fue del 32,1%. Los pacientes que tuvieron más complicaciones sufrían: síndromes genéticos [6 casos (21,4%)] y displasias esqueléticas [3 casos (10,7%)]. Trece tenían <6 años, 7 de ellos presentaron complicaciones (53,8%). Conclusiones: La instrumentación cervical en pacientes <10 años demostró ser un procedimiento factible y seguro. Las displasias vertebrales, las anomalías congénitas y los síndromes genéticos, sumados al factor edad <6 años, son las principales variables asociadas a las complicaciones observadas.

Introduction: pediatric cervical spine implants and construction designs had rapidly evolved in the last decade. Anatomic and biomechanical differences between pediatric and adult cervical spine require a thorough preoperative planning, because these implants were originally designed for adults. The objective of this study was to assess the postoperative results of cervical instrumented fusion in children under 10 years old, and to describe the surgical technique and complications. Methods: Twenty-eight children with different cervical pathology treated with instrumented fusion were evaluated. The following procedures were used: Roy-Camille’s and Magerl’s techniques for lateral masses, Goel-Harms’ technique for C1-C2 fusion, and occipital-cervical fusion with occipital plates or screws. Inclusion criteria were: children under 10 years, no prior spine surgery, and minimum follow-up of 2 years. Results: Sample included 17 girls and 11 boys, with a mean follow-up of 3.8 years (range 2-10). Mean age was 6.1 years (range: 1.6-10). Overall complication rate was 32.1%. The highest complication rates were associated with: genetic syndromes [6 cases (21.4%)], skeletal dysplasias [3 cases (10.7%)]. Thirteen patients were <6 years, 7 of them had complications (53.8%). Conclusions: Cervical instrumented fusion in patients <10 years old proved to be a feasible and safe surgical procedure. Vertebral dysplasias, congenital, syndromic anomalies, and being younger than 6 years old are the main factors associated with high complication rates.

Humans , Child, Preschool , Child , Atlanto-Occipital Joint/surgery , Internal Fixators , Spinal Fusion/methods , Cervical Vertebrae/surgery , Postoperative Complications , Treatment Outcome