Application of Smith-Robinson approach for C2/3 cervical spine surgery / 第二军医大学学报

Objective: To summarize our experience in using Smith-Robinson approach (SRA) for 1 evel C2/3 cervical spine surgery. Methods: The clinical data of 36 patients receiving SRA for level C2/3 cervical spine surgery were retrospectively analyzed. The patients included 25 males and 11 females, with an average age of (47 ± 13. 5) years(range: 21-72 years). Thirty-five cases had Hangman fracture and one had traumatic disc herniation at C2/3. Combined injury included head injury (10 cases), soft tissue injury on the face (22 cases), fracture at lumbar spine (1 case), extremities fracture (6 cases) and injury of inner organs (2 cases). One patient had ankylosing spondylitis. Results: C2/3 discetomy procedures were performed satisfactorily in all the 36 cases, with cages plus anterior plate fixation used in 34 cases and iliac bone plus anterior plate fixation in 2 cases. The patients were followed up for (9. 1 ± 2. 8) months (ranging 6-32 months). One patient (2. 4%) had choking and trouble in swallowing liquids, and the symptom disappeared 3 months later without any treatment. Neurological dysfunction was observed in 10 cases before operation, with the average JOA scope being (13. 10 ± 3. 35) pre-operation and (15. 70 ± 1. 49) post-operation, showing an improving rate of (74 ± 23) %. Fusion was achieved in all cases during follow-up. Conclusion: SRA can be applied at level C2/3 cervical spine surgery; the procedure is simple, with clear surgical field and less complication. Patients with large chin or extremely strong muscle may not be indicated for this approach.

Effectiveness of the New Modified Smith-Robinson Bone Graft for Cervical Anterior Interbody Fusion / 대한정형외과학회잡지

PURPOSE: We attempted to evaluate the effectiveness of the new modified Smith-Robinson bone graft method for performing cervical anterior interbody fusion. MATERIALS AND METHODS: Forty-two patients had anterior interbody fusion on the cervical spine, using an anterior approach and the new modified Smith-Robinson's method (NMSR), between September 2001 and June 2006. There were 30 males and 12 females, with an average age of 51.2 years and the mean follow up period was 39.5 months. We measured the area from C4 to C6 in 32 cases. This was compared with the contact area of the bone graft of the NMSR method and the Original Smith-Robinson method (OSR). We also checked the time to bone union and changes of Cobb's angle at the final follow-up to evaluate the effectiveness of the NMSR. RESULTS: Bony fusion was obtained in all cases. The average size of the OSR were 169 and 152 mm2, in the males and females respectively, whereas those of the NMSR were 263, and 228 mm2. Therefore, the average size of the NMSR increased to 94 mm2 and 76 mm2 than those of the OSR method in the males and females. The average time to radiological bone union was 9.6 weeks and the changes of Cobb's angle at final follow-up were 2.5+/-2.6degrees. CONCLUSION: The NMSR technique was a very effective method for cervical anterior interbody fusion. It could enlarge the bone graft size about 50-56% compared with the OSR technique. It also shortened the period of bone union and also increased the bone union rate.

Comparative Efficacy Study between Monocortical and Bicortical Screws in Anterior Cervical Fusion

The purpose of the study was to assess the role of two types screws(bicortical screws with 3.5mm diameter and monocortical screws with 4.5mm diameter) in anterior cervical spinal fusion. Seventy patients surgically treated on the same surgeon was retrospectively reviewed. All patients were managed as the same technique(modified Smith-Robinson technique) and the same non-locking plate system(Top plate system), but the bicortical screws were used in 40 patients(Group 1) and the monocorical screws in 30 patients(Group 2). The overall fusion rate during the 3 months follow up at least was to be satisfied on the both groups. The complication from the Group 2 was never seen but Group 1 was observed in 5 patients; one as slip of grafted bone, 2 as screw loosening, 1 as psychologic intolerance and 1 as CSF leakage. The monocortical screw was considered to be superior than bicortical screw and was related to the screw diameter.

A Clinical Analysis of Treatment of Cervical Fracture and Dislocation

Recently, the authors experienced the thirty-one cases of cervical fracture and dislocation. Among them, nineteen cases underwent surgical treatment and remained conservative treatment. There are three ways in operation ; 1) anterior approach(Cloward, Smith-Robinson method). 2) posterior approach. 3) combined approach(modified Smith-Robinson and posterior fusion). We did a combined approach and the results were excellent.

Management of Cervical Ossification of the Posterior Longitudinal Ligament

The authors treatment 35 patients with ossification of the posterior longitudinal ligament(OPLL). Sixteen of these patients had surgery during the past 3 years between 1983 and 1985. In this paper wer present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indications of surgical treatment and the choice of operative methods. 1) The ages of the patients ranged from 31 to 79 with a mean of 55.4 years. 57.1% of the patients were in the sixth decade. The male to female ration was 28:7. 2) The cases were graded on the bases of symptoms. Grade I, no symptoms or mild neck pain, 1 case(2.9%) ; Grade II only radiculopathy, 14 cases(40.0%) ; Grade III, mild myelopathy but able to walk, 11 cases(31.4%) ; Grade IV, severe myelopathy and unable to walk alone, 7 cases(20.0%) ; Grade V, complete paralysis of one or more extremities, 2 cases(5.7%). 3) Lateral tomogram and CT scan were most useful for assesment of OPLL. 4) The pattern of OPLL was divided into a continuous type(25.7%), a multiple segmented type(31.4%), a single segmented type(20.0%), and a mixed type(22.9%). 5) In cases of a clinical grading of more than III, surgery must be considered In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 6) Extensive total laminectomies and foraminotomies were found to be advisable in cases of OPLL involving more than two vertebrae. 7) The modified Smith-Robinson approach showed the best surgical results in cases of single segmented OPLL.