RESUMO
Objective To study the indications and clinical outcome of the upper cervical spine via the high anterior cervical retropharyngeal approach in treatment of upper cervical spine injuries. Methods There were 41 patients including 32 males and 9 females, at age of 12-67 years. Of all patients, there were 21 patients with Hangman fractures, two with fracture of C2 vertebral body, 12 with irreducible atlantoaxial dislocation secondary to os odontoideum, four with C1,2 tuberculosis and two with C2 gaint cell tumor. All patients underwent the high anterior cervical retropharyngeal approach to expose C1C3. C2,3 fusion followed by self-locking plate was performed for Hangman fractures and C2 fractures. Ventral reduction plud posterior aflantoaxial fusion was done for irreducible atlantoaxial dislocation secondary to os odontoideum. Lesion was cleared for tuberculosis and the tumor was resected and reconstructed. The neurological funcation was evaluated according to the ASIA criteria, the JOA score and Odom' s criteria. Results Successful exposure of arch of atlas to C3 was achived in all 41 patients, with satisfactory reducation, decompression, fusion, lesion resection and reconstruction. The trauma patients with normal neurological function showed no neurological deficit postoperatively, but those with quadriparesis had partial recovery. While the patients with illness obtained marked recovery of neurological function, with the JOA score from preoperative 8.9 to 12.5 at final follow-up. The clinical success rate (excellent/good/fair) reached 94. % according to Odom' s Criteria. Hypoglossal symptom was found in three patients and facial nerve symptom in two, without wound infection. Conclusions Via the high anterior cervical retropharyngeal approach, the upper cervical spine can be thoroughly exposed to facilitate reduction, decompression and reconstruction and maximally restore physiological function of the cervical spine in treatment of the upper cervical spine injuries.
RESUMO
Objective To study the clinical result of the surgical treatment of upper cervical vertebra disease from high anterior cervical retropharyngeal approach.Methods Among 14 patients,there were 7 C_(2.3)disc hernia- rions combined with C_(2.3)dislocations,3 Hangman fractures,2 odontoid process fractures and 2 C_3 tumors.All patients underwent the high anterior cervical retropharyngeal approach.10 cases were given discectomy of C_(2.3)or focus clear- ance of C_3,iliac bone autograft or titanium cage filled and internal fixation with titanium plate.2 cases of odontoid process fractures were given anterior screw fixation.Results 14 cases got successful exposure.The decompression, reduction,lesion clearance and fusion with internal fixation were done in all patients.There were no important vascu- lar or nerve injuries.The surgical treatment could improve the spinal cord nerve function to a certain degree for the cases with compression of spinal cord.Conclusion Good exposure of upper cervical spine and effective surgical oper- ation could be achieved from high anterior cervical retropharyngeal approach,with minimal trauma and complication, and it was a favorable approach.