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Objective To study the stress change characteristics of the cervical disc after removing different ranges of the uncinate process by establishing a three⁃dimensional finite element model of the C
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Objective: To measure anatomical parameters related to cervical uncovertebral joint and provide data support for the design of uncovertebral joint fusion cage. Methods: According to the inclusion and exclusion criteria, raw DICOM data of cervical CT scan in 60 patients (30 males and 30 females, aged 39-60 years) were obtained, then the three-dimensional cervical spine model was reconstructed for anatomical measurement by using the Mimics19.0 software. The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region were measured bilaterally from C3 to C7. The anterior and posterior distances between the uncinate processes were measured from C3 to C7. The height of the uncovertebral joint space, the central height of the intervertebral disc space, and the depth of the intervertebral disc space were also measured from C2, 3 to C6, 7. The mean, standard deviation, maximum, and minimum were calculated by using the SPSS22.0 statistical software for the design of uncovertebral joint fusion cage. Results: The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region of C3-C7 and the height of the uncovertebral joint space of C2, 3-C6, 7 showed no significant difference between two sides (P>0.05). The height of the uncovertebral joint space also had no significant difference between females and males (P>0.05). The anterior distances between the uncinate processes of C3-C7 were significantly larger than the posterior distances between the uncinate processes (P<0.05), the uncovertebral joint presented a posterior cohesive shape. The central height of the intervertebral disc space in male group was slightly higher than that in female group, and the differences were significant (P<0.05) at C2, 3 and C5, 6; the depth of the intervertebral disc space in male group was significantly higher than that in female group (P<0.05). The central height of the intervertebral disc space was (4.94±0.49) mm (range, 3.81-5.90 mm), the depth of the intervertebral disc space was (15.78±1.23) mm (range, 12.94-18.85 mm), the anterior and posterior distances between the uncinate processes were (17.19±2.39) mm (range, 13.39-24.63 mm) and (10.84±2.12) mm (range, 7.19-16.64 mm), respectively. According to the results of the anatomical research, the height of the uncovertebral joint fusion cage was designed as 5, 6, 7, and 8 mm; the depth of the uncovertebral joint fusion cage was designed as 12, 13, 14, 15, and 16 mm; the width of the uncovertebral joint fusion cage was designed as 14-18 mm; and the two wings are designed as arc-shape with 2 and 3 mm in width. Conclusion: There are certain differences in the anatomical parameters of the uncovertebral joint between different segments. The uncovertebral joint fusion cage that designed based on the results of anatomical research is suitable for most patients.
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We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.
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Humanos , Constricción Patológica , Discectomía , Radiculopatía , Extremidad SuperiorRESUMEN
Objectives: To study the morphological difference of luscka joints between Hirayama disease patients and non-Hirayama disease patients on CT scan and to provide a new possible mechanism of Hirayama disease. Methods: 32 patients(all males) with a mean age of 19.4±4.1(range 16-37 years) and with Hirayama disease were treated in our hospital from October 2006 to January 2012, the mean course of disease was 31.7±23.7 months(range, 1-120 months). 32 patients(all males) with a mean of age was 19.1±4.3 (range, 12-26 years) suffering from acute neck pain and having no Hirayama disease were reviewed as control. Both groups showed no age related difference. From the cervical CT coronal plane reconstruction images which passing through the transverse foramen center of C3-C7 in GE-PACS system, the following data were measured in both sides: ①The width of the uncinate process base: the distance between inner and outer margin of the uncinate process at the upper edge of the vertebral body. ②The height of the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. ③The distance between two uncinate processes: the distance between the tips of the bilateral uncinate processes. ④The inclination angle of the uncinate process: the angle between the uncinate process and the upper edge of the vertebral body. ⑤The inclination angle of the inferior endplate: the angle between the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. Results:There were no significant side-related differences on the width of the uncinate process base, the height of the uncinate process, the distance of the uncinate process, the inclination angle of the uncinate process and the inclination angle of the inferior endplate at the same segment from C3 to C7 in Hirayama disease patients(P>0.05). However, differences were found on the height of the uncinate process and the distance between two uncinate processes of C3-C7 (PC5>C7>C3>C4. The distance of the uncinate process gradually increased from C3 to C7. There were no significant differences on the width of the uncinate process base, the inclination angle of the uncinate pro-cess and the inclination angle of inferior endplate(except for C3) of C3-C7(P>0.05). Then, using the mean value of the left and right sides as the width of the base of uncinate process, the height of uncinate process, and calculating the sum of inclination angle of the uncinate process, the sum of inclination angle of inferior endplate of the upper vertebra and the difference between the sums (the sum of inclination angle of uncinate process - the sum of inclination angle of inferior endplate of the upper vertebra), then calculating the mean value and standard deviation. Compared with the non-Hirayama disease patients, there were no significant dif-ferences on the uncinate process base, the distance of the uncinate process and the sum of inclination angle of the uncinate process at the same segment of Hirayama disease patients (P>0.05), while the height of the uncinate process and the sum of inclination angle of uncinate process of Hirayama disease patients were sig-nificantly smaller than those of the control group, respectively(P<0.05), and the differences between the sums were larger than those of the control group (P<0.05). Conclusions: Hirayama disease patients may possess a dysplasia in the luscka joint, manifesting the nonuniform development of the uncinate indicators. Lower unci-nate process and smaller inclination angle of inferior endplate of the upper vertebra are common, The conse-quential cervical instability may play a significantly important role in the pathogenesis and progress of Hi-rayama disease.