Unilateral short-segment screw fixation and bone graft fusion for special upper cervical spine injury / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical effect of posterior unilateral short segment screw fixation and bone graft fusion in the treatment of special upper cervical spine injuries.Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with upper cervical spine injury adrnitted to Shanxi Bethune Hospital from July 2012 to May 2017.There were nine males and six females,aged 10-69 years [(41.9±20.9)years].There were eight patients with traumatic atlantoaxial dislocation,one with congenital atlantoaxial dislocation,two with atlantoaxial dislocation with nonunion of odontoid process,three with Anderson type Ⅱ odontoid process fracture,and one with old odontoid process fracture.All patients had cervico-occipital pain to different degrees,slender unilateral pedicle and distinct stenosis of vertebral artery.All patients were treated with posterior unilateral screw fixation and bone graft fusion.The injury of spinal cord and vertebral artery,operation time and intraoperative blood loss were recorded.Visual analogue scale(VAS)was used to evaluate pain before and after operation,and Japanese Orthopaedic Association(JOA)score was used to evaluate spinal cord function and postoperative improvement rate before and at the last follow-up.The position of internal fixation and fusion of bone graft were ohserved by X-ray after operation.Results All 15 patients were followed up for 6-36 months [(20.4±8.6)months].All the screws were implanted successfully at the first time.Without spinal cord or vertehral artery injury.The operation time was 100-210 minutes [(131.3±32.0)minutes],and the intraoperative blood loss was 100-450 ml [(203.1±104.0)ml].Preoperative VAS score was(7.9 ±0.9)points.And postoperative VAS score was(3.7 ±0.8)points(P＜0.01).Preoperative JOA score was(12.1±4.4)points.And the JOA score at postoperative follow-up was(16.1±1.4)points.With the improvement rate of 68％.Postoperative X-ray showed good recovery of cervical spine sequence.One patient developed loosened internal fixation after the neck hrace protection was removed one month after surgery.And the patient recovered after timely second surgical fixation and fusion.The remaining 14 patients did not have loosened internal fixation.Fracture or loss of reduction.With bone fusion 6-12 months after surgery.Conclusion Posterior cervical unilateral short-segment screw fixation and bone graft fusion can restore cervical stability,relieve pain,and improve function recovery,which can he used as complementary procedure to treat upper cervical spine injury with anatomic structure variation.