Diagnosis and treatment for the injury of cervical disc and longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVES</b>To study the diagnosis and treatment for the injury of cervical disc and longitudinal ligament.</p><p><b>METHODS</b>From 2001 to 2005, the clinical data of sixty-three patients with cervical disc and longitudinal ligament injury were studied. Early treatment was done based on spinal cord injuries and spinal stabilities by X rays and MRI. Early operation was done in fifty-four cases and early non-operation in nine cases.</p><p><b>RESULTS</b>The follow-up time was six to forty-one months in all patients. The neurological recovery was found in two of eight complete SCI post-operation, thirty-one in thirty-nine incomplete SCI. Cervical collar or plaster orthotic were used in nine cases with four to six weeks. Evidence of instability was noted in four patients, who were operated with anterior decompression fusion. Neck chronic pain was found in two patients, anterior decompression and fusion was done in one with cervical spinal cord compression.</p><p><b>CONCLUSIONS</b>MRI examination is the most value measure for the diagnosis of cervical disc and longitudinal ligament injury. Early anterior decompression and fusion was an important approach for cervical disc and longitudinal ligament injury.</p>

Key points about atlanto-axial internal-fixation and fusion using Gallie's technique / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical problems about posterior atlanto-axial internal-fixation and fusion for atlanto-axial instability or dislocation.</p><p><b>METHODS</b>Surgical treatments of 138 cases with atlanto-axial instability or dislocation were reviewed. There were 62 cases of odentoid malformation, 54 cases of odentoid fracture or rupture of transverse ligament, 22 cases of subluxation and rotation. All cases were treated using Gallie's technique. Six cases were also fixed with transarticular screws, and protected with Philadelphia collar. Other patients were fixed with plaster paris brackets. The followed-up period was 1 to 12 years with an average of 3 year and 5 months.</p><p><b>RESULTS</b>According to Sumi's criteria, excellent 70 cases (50.7%), good 40 cases (29.0%), fair 15 cases (10.9%), poor 13 cases (9.4%). 9 cases with bone graft postponed fusion were cured by enhance external-fixation. 2 cases with nonunion were treated with revision surgery. Complication of cord injury happened in 1 case.</p><p><b>CONCLUSION</b>Gallie's fusion technique is an effective method to manage the atlanto-axial instability or dislocation. Skull distraction before operation and reliable external-fixation post operative are important assistant measures. Key points for successful operation are careful wiring or cable traversing, decortication of posterior arc of C1, and maintaining the physiological height between C1 and C2 posterior arc. Indications and objectives should be conformed before revision surgery for failure cases.</p>

Comparison of fixation strength of the locking and non-locking anterior cervical plate systems / 第二军医大学学报

Objective: To compare the prompt fixation strength and antifatigue strength of the locking and non-locking anterior cervical plating systems. Methods:AO Cervical Spine Locking Plate (CSLP), Danek Orion plate and AcroMed Acroplate were used on the lamb cervical spines. The CSLP and Orion were tested with screws locked and unlocked, and the Acroplate with unicortical and bicortical purchase. The fixation strength and pull-off strength of the screw-plate constructs were performed initially and after fatigue. Results: Locked CSLP and Orion constructs were more rigid than all unlocked unicortical systems initially and after cyclic loading. After fatigue testing, the strength of all unlocked constructs decreased significantly. There was no significant difference in pull-off strength between the CSLP, the Orion and the unicortical Acroplate. Conclusion: The locking mechanism significantly increases the prompt fixation strength and antifatigue strength of the tested screw-plate systems.

Evaluation of long-term outcome of surgical treatment for cervical spondylotic myelopathy / 第二军医大学学报

Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.

Comparison of fixation strength of the locking and non-locking anterior cervical plate systems / 第二军医大学学报

Objective: To compare the prompt fixation strength and antifatigue strength of the locking and non-locking anterior cervical plating systems. Methods:AO Cervical Spine Locking Plate (CSLP), Danek Orion plate and AcroMed Acroplate were used on the lamb cervical spines. The CSLP and Orion were tested with screws locked and unlocked, and the Acroplate with unicortical and bicortical purchase. The fixation strength and pull-off strength of the screw-plate constructs were performed initially and after fatigue. Results: Locked CSLP and Orion constructs were more rigid than all unlocked unicortical systems initially and after cyclic loading. After fatigue testing, the strength of all unlocked constructs decreased significantly. There was no significant difference in pull-off strength between the CSLP, the Orion and the unicortical Acroplate. Conclusion: The locking mechanism significantly increases the prompt fixation strength and antifatigue strength of the tested screw-plate systems.

Evaluation of long-term outcome of surgical treatment for cervical spondylotic myelopathy / 第二军医大学学报

Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.