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Sample records for anterior cervical discectomy

  1. Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy

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    Sun Qizhi

    2016-01-01

    Full Text Available Background: Noncontiguous cervical spondylotic myelopathy (CSM is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF with zero-profile devices for two noncontiguous levels of CSM. Materials and Methods: 17 consecutive patients with two noncontiguous levels of CSM operated between December 2009 and August 2012 were included in the study. There were 12 men and 5 women with a mean age of 60.7 years (range 45-75 years. Involved disc levels were C3/4 and C5/6 in 11 patients and C4/5 and C6/7 in six patients. Preoperative plain radiographs, computed tomography (CT with 3-D reconstruction and magnetic resonance imaging (MRI of the cervical spine were taken in all patients. All radiographs were independently evaluated by 2 spine surgeons and 1 radiologist. The outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA score, improvement rate, neck dysfunction index (NDI, swallowing quality of life (SWAL-QOL score, the cervical lordosis and complications. Results: The mean followup was 48.59 months (range 24-56 months. The average operative time and blood loss was 105.29 min and 136.47 ml, respectively. The preoperative JOA score was 8.35, which significantly increased to 13.7 at the final followup ( P 0.05. Cerebrospinal fluid leak, dysphagia and radiological adjacent segment degeneration occurred in one patient, respectively. Conclusion: The ACDF with zero-profile devices is generally effective and safe in treating two noncontiguous levels of CSM.

  2. Surgery in cervical disc herniation: anterior cervical discectomy without fusion or with fusion

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    Iencean Andrei Stefan

    2017-03-01

    Full Text Available The study included a group of anterior cervical microdiscectomy without fusion performed at one level (either C5-C6 level or at the C6-C7 level and a second group of patients with same single-level of anterior cervical discectomy with fusion. The kinematic analysis included the range of motion, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level the range of motion and the translation were minimal in the anterior cervical discectomy without fusion group, both for the C5-C6 and C6-C7 levels, and absent in the cervical discectomy with fusion group. The superior adjacent levels translations were greater in the ACDF group compared with the ACD group. The clinical results of both types of cervical discectomy were comparable. In cervical microdiscectomy without fusion the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. No need for anterior cervical discectomy with fusion to trait a single level cervical disc herniation than in selected cases.

  3. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature

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    Ajayi, Olaide O; Asgarzadie, Farbod

    2016-01-01

    Introduction & Background: The use of external cervical orthosis (ECO) after anterior cervical discectomy and fusion (ACDF) varies from physician to physician due to an absence of clear guidelines. Our purpose is to evaluate and present evidence answering the question, “Does ECO after ACDF improve fusion rates?” through a literature review of current evidence for and against ECO after ACDF.  Review: A PubMed database search was conducted using specific ECO and ACDF related keywords. Our search yielded a total of 1,267 abstracts and seven relevant articles. In summary, one study provided low quality of evidence results supporting the conclusion that external bracing is not associated with improved fusion rates after ACDF.  The remaining six studies provide very low quality of evidence results; two studies concluded that external bracing after cervical procedures is not associated with improved fusion rates, one study concluded that external bracing after cervical procedures is associated with improved fusion rates, and the remaining three studies lacked sufficient evidence to draw an association between external bracing after ACDF and improved fusion rates. Conclusion: We recommend against the routine use of ECO after ACDF due to a lack of improved fusion rates associated with external bracing after surgery. PMID:27555986

  4. Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating.

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    Mobbs, Ralph J; Rao, Prakash; Chandran, Nadana K

    2007-07-01

    The aim of this study is to analyse the differences in clinical and radiological outcome of anterior cervical discectomy and fusion for cervical degenerative disease, with and without the addition of an anterior cervical locking plate. Although disc arthoplasty is gaining popularity, the anterior cervical decompression and fusion procedure remains the gold standard. The outcome of 242 cases operated between 1991 to 1998 were analysed. Two groups of patients were operated on by the same surgeon. The only difference in technique between the two groups was the addition of an anterior cervical plate, with all other technical details matching, including the use of iliac crest autograft. The indications for surgery for both groups was identical. We made an attempt to study radiological fusion, clinical outcome and complications between the non-plated and plated groups. Our main finding is that the addition of an anterior plate reduces the number of poor clinical outcomes, but does not increase the number of excellent outcomes. Anterior discectomy and fusion with plating in our series had a significantly higher fusion rate; 98% fusion was noted in the plating group as compared to 93.5% in the non-plating group (Fisher's exact test, p=0.029). Union was faster in the plated group with no significant increase in surgical complications. Although clinical outcomes were superior in the plated group for the radiculopathy cohort, excellent outcomes were not significantly higher as compared to the non-plated group. The non-plated group had a significantly higher rate of poor outcomes, with 10% of patients requiring revision surgery for non-union, kyphosis, graft extrusion and graft collapse with foraminal stenosis. 1.8% of the plated group required revision surgery.

  5. Modifications to the transverse Caspar cervical retractor blades optimized for a single-level anterior cervical discectomy.

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    Geisler, F H; Tamargo, R J; Weingart, J D

    1993-02-01

    A modification of the transverse Caspar cervical soft-tissue retractor blades for their use in a single-level anterior cervical discectomy is presented. These modified retractor blades are similarly inserted into the elevated anterior mesial portion of the longus colli muscles. However, they allow a smaller skin incision, less soft-tissue dissection, and do not require use of the superior and inferior smooth retractor blades, while providing the same surgical vision and operative ability in the disc space as does the four-bladed Caspar retractor system.

  6. Discover cervical disc arthroplasty versus anterior cervical discectomy and fusion in symptomatic cervical disc diseases: A meta-analysis

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    Shangguan, Lei; Ning, Guang-Zhi; Tang, Yu; Wang, Zhe; Luo, Zhuo-Jing; Zhou, Yue

    2017-01-01

    Objective Symptomatic cervical disc disease (SCDD) is a common degenerative disease, and Discover artificial cervical disc, a new-generation nonconstrained artificial disk, has been developed and performed gradually to treat it. We performed this meta-analysis to compare the efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) for SCDD. Methods An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials that compared DCDA with ACDF for patients suffering SCDD. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval. Results Of 33 articles identified, six studies were included. Compared with ACDF, DCDA demonstrated shorter operation time (P 0.05). Subgroup analyses did not demonstrated significant differences. Conclusion In conclusion, DCDA presented shorter operation time, and better ROM at the operative level. However, no significant differences were observed in blood loss, NDI scores, neck and arm pain scores, JOA scores, secondary surgery procedures and adverse events between the two groups. Additionally, more studies of high quality with mid- to long-term follow-up are required in future. PMID:28358860

  7. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

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    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  8. Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series

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    Friedman Jonathan A

    2009-03-01

    Full Text Available Abstract Background Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P. Methods All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care. Results 64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14, older age (1, and patient preference (2. At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia. Conclusion In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.

  9. Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons

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    Spanos, Savvas L.; Siasios, Ioannis D.; Dimopoulos, Vassilios G.; Fountas, Kostas N.

    2016-01-01

    Background A web-based survey was conducted among Greek spinal surgeons to outline the current practice trends in regard to the surgical management of patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathology. Various practice patterns exist in the surgical management of patients undergoing anterior cervical discectomy for degenerative pathology. No consensus exists regarding the type of the employed graft, the necessity of implanting a plate, the prescription of an external orthotic device, and the length of the leave of absence in these patients. Methods A specially designed questionnaire was used for evaluating the criteria for surgical intervention, the frequency of fusion employment, the type of the graft, the frequency of plate implantation, the employment of an external spinal orthosis (ESO), the length of the leave of absence, and the prescription of postoperative physical therapy. Physicians’ demographic factors were assessed including residency and spinal fellowship training, as well as type and length in practice. Results Eighty responses were received. Neurosurgeons represented 70%, and orthopedic surgeons represented 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was 4 weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by 83.3% of the orthopedic surgeons. The majority of the participants recommended 4 weeks leave of absence. Conclusions The vast majority of participants considered ACDF a better treatment option than an ACD, and preferred an allograft. The majority of them employed a plate, prescribed an ESO postoperatively, and recommended physical therapy to their

  10. Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study

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    Hauerberg, J.; Kosteljanetz, M.; Bøge-Rasmussen, Torben;

    2008-01-01

    STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE: To compare 2 surgical methods in the treatment of cervical radiculopathy caused by hard or soft disc herniation; namely, simple discectomy versus discectomy with an additional interbody fusion with a Ray titanium cage. SUMMARY...... by fusion with a Ray titanium cage (40 patients) or to discectomy alone (46 patients). Clinical and radiologic follow-up was performed 3, 12, and 24 months after surgery. RESULTS: There was no statistically significant difference between the 2 groups concerning self-reported satisfaction or severity of pain...... in the neck and arm. Two years after the operation, 86.1% of the patients treated with cage stated a good outcome versus 76.7% in the discectomy group (P = 0.44). The rate of fusion was 83.3% in the cage group versus 81.0% in the discectomy group (P = 0.30). Furthermore, after 2 years, also the rates of new...

  11. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases: A Meta-Analysis.

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    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-05-01

    To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.

  12. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

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    Aria Fallah

    Full Text Available OBJECTIVE: To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA compared to anterior cervical discectomy with fusion (ACDF for patient-important outcomes for single-level cervical spondylosis. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS, archives of spine meetings and bibliographies of relevant articles. STUDY SELECTION: We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD, reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. DATA SYNTHESIS: We used random-effects model to pool data using mean difference (MD for continuous outcomes and relative risk (RR for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. RESULTS: Of 2804 citations, 9 articles reporting on 9 trials (1778 participants were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004 and improvement in the Neck pain visual analogue scale (VAS (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. CONCLUSIONS: There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to

  13. A simplified technique for anterior cervical discectomy and fusion using a screw-plate implanted over the Caspar distractor pins.

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    Fransen, Patrick

    2010-08-01

    The author presents a simplified technique for midline screw-plate fixation in fusion procedures after anterior cervical discectomy, in which the plate is introduced over the Caspar distractor pins. The Uniplate system used, with a single screw in each vertebral body, minimizes bone damage to the vertebral body as the screws can be fixed in the holes previously used for the Caspar distractor pins. This simplified version of the classical anterior cervical fusion technique saves surgical time, facilitates screw insertion, and obviates the need for manipulations to stabilize the plate before the screws are inserted. It provides immediate stability comparable to other plate systems. To the author's knowledge, this is the first report on cervical fusion with the Uniplate system with the plate being introduced over the Caspar distractor pins.

  14. The NEtherlands Cervical Kinematics (NECK Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

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    van den Akker Elske

    2010-06-01

    Full Text Available Abstract Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial

  15. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion

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    Rakesh Garg

    2010-01-01

    Full Text Available Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7% and two patients had postoperative hoarseness of voice (5.4%. All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve ′just seal′, with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  16. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion.

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    Garg, Rakesh; Rath, Girija P; Bithal, Parmod K; Prabhakar, Hemanshu; Marda, Manish K

    2010-07-01

    Anterior cervical discectomy and fusion is a commonly performed procedure for prolapse of cervical intervertebral disc. It involves retraction of soft tissue of neck for adequate exposure of anterior spinal canal. Increased cuff pressure with retractor application may affect the postoperative vocal cord function. Cuff pressures of tracheal tube were measured continuously in 37 patients using air-filled pressure transducer connected to the pilot balloon. Changes of pressure from baseline values were noted after application of cervical retractor. At the end of procedure, vocal cord movement was observed using fibreoptic bronchoscope. Significant increase in cuff pressure (168% of baseline values) and airway pressure of tracheal tube during cervical retraction was observed. The vocal cord function was assessed using fibreoptic laryngoscope. One patient developed right vocal cord palsy (2.7%) and two patients had postoperative hoarseness of voice (5.4%). All these complications improved over a period of time. It is suggested that the cuff of tracheal tube should be inflated to achieve 'just seal', with adequate cuff pressure monitoring. Intermittent release of cervical retraction may help to prevent laryngeal morbidities.

  17. The use of autologous cervical laminae as bone graft in anterior cervical discectomy and fusion in patients undergoing one-stage posteroanterior cervical surgery

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    Xu XIONG

    2015-04-01

    Full Text Available Objective To evaluate the effectiveness and radiographic outcomes of using autologous cervical laminae as bone graft in anterior discectomy and fusion (ACDF in patients with one-stage posteroanterior surgery for cervical spinal stenosis (cervical spondylotic myelopathy. Methods From January 2010 to June 2013, 37 patients with cervical spinal stenosis underwent surgical treatment in our hospital. Fifteen of them underwent one-stage posteroanterior cervical surgery using autologous cervical laminae as bone graft in ACDF (group A, and 22 patients underwent one-stage posteroanterior procedure using autologous iliac bone as bone graft in ACDF (group B. The operative time, intraoperative blood loss, fusion rate, VAS score, JOA score and height of intervertebral space were compared between the two groups. Results The operative time was 102.7±13.9 min in group A and 128.9±12.3 min in group B, showing significant difference between two groups (t=–6.031, P=0.00. The intraoperative blood loss was 170.3±25.7 ml in group A and 191.1±32.0 ml in group B, and also showing significant difference between them (t=–2.097, P=0.04. All the patients were followed up from 6 months to 42 months (mean, 17.4 months. At 6 months after the surgery, the fusion rate of bone graft was 94.4% (14/15 in group A and 100% (22/22 in group B, and no significant difference was found between two groups (χ2=1.507, P=0.220. The postoperative VAS score, JOA score and intervertebral height were significantly improved compared with those before surgery in both groups (P0.05. Conclusion In anterior cervical discectomy and fusion during one-stage posteroanterior cervical surgery, the use of autologous cervical laminae as bone graft is feasible. DOI: 10.11855/j.issn.0577-7402.2015.02.12

  18. PHYSICAL THERAPY FOLLOWING ANTERIOR CERVICAL DISCECTOMY AND FUSION: A STUDY OF CURRENT CLINICAL PRACTICE AND THERAPIST BELIEFS

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    Brian T. Swanson

    2015-04-01

    Full Text Available Background: Anterior cervical discectomy and fusion (ACDF is a commonly performed surgical procedure. However, there is substantial debate regarding the role of physical therapy following this procedure. Therefore, we sought to determine current physical therapy practice following ACDF surgery, as well as determine physical therapists beliefs regarding rehabilitation following ACDF. Methods: One hundred and eighty three licensed Physical Therapists were invited to participate in a descriptive internet based survey; a total of 53 (29% completed the survey. Physical Therapists were assessed for their current practice, asked to rate the clinical usefulness of various treatment modalities, and indicate their recommendations regarding post-operative physical therapy for subjects following anterior discectomy and fusion. Results were then assessed for frequency distributions, with chi-square analysis for association between demographic data and practice recommendations. Results: The results indicate that Physical Therapists believe patients achieve superior outcomes with the inclusion of post-operative physical therapy, with a low risk of harm. Specific treatments indicated as most useful included endurance exercise (60.4%, isometric strengthening (56.6%, and stretching (45.3%. Other treatment options are discussed in detail. Conclusion: Physical Therapists identified specific activities that they felt were most appropriate for rehabilitation following ACDF surgery. These findings may help to direct both appropriate therapy prescription following ACDF, as well as future research.

  19. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.

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    Brenda M Auffinger

    Full Text Available OBJECT: The concept of minimum clinically important difference (MCID has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF for cervical spondylotic myelopathy (CSM. METHODS: Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI, Visual-Analog Scale (VAS, and Short Form-36 (SF-36 Physical (PCS and Mental (MCS Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC, minimum detectable change (MDC and standard error of measurement (SEM. The Health Transition Item of the SF-36 (HTI was used as an external anchor. RESULTS: Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01 NDI (29.24 to 14.82, VAS (5.06 to 1.72, and PCS (36.98 to 44.22. The five MCID approaches yielded a range of values for each PRO: 2.00-8.78 for PCS, 2.06-5.73 for MCS, 4.83-13.39 for NDI, and 0.36-3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94. MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. CONCLUSION: SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.

  20. Comparison of rhBMP-2 versus Autogenous Iliac Crest Bone Graft for 2-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

    OpenAIRE

    2015-01-01

    Background Few studies have examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2-level anterior cervical discectomy and fusion (ACDF). The purpose of this study was to compare the outcomes in a series of patients with CSM treated with 2-level ACDF with or without rhBMP-2. Material/Methods The retrospective study included a total of 146 patients with CSM. The rhBMP-2 group consisted of 73 patients who underwent 2-level ACDF with rhBMP-2. A total of 73 patients...

  1. Design of the PROCON trial: a prospective, randomized multi – center study comparing cervical anterior discectomy without fusion, with fusion or with arthroplasty

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    Grotenhuis J André

    2006-11-01

    Full Text Available Abstract Background PROCON was designed to assess the clinical outcome, development of adjacent disc disease and costs of cervical anterior discectomy without fusion, with fusion using a stand alone cage and implantation of a Bryan's disc prosthesis. Description of rationale and design of PROCON trial and discussion of its strengths and limitations. Methods/Design Since proof justifying the use of implants or arthroplasty after cervical anterior discectomy is lacking, PROCON was designed. PROCON is a multicenter, randomized controlled trial comparing cervical anterior discectomy without fusion, with fusion with a stand alone cage or with implantation of a disc. The study population will be enrolled from patients with a single level cervical disc disease without myelopathic signs. Each treatment arm will need 90 patients. The patients will be followed for a minimum of five years, with visits scheduled at 6 weeks, 3 months, 12 months, and then yearly. At one year postoperatively, clinical outcome and self reported outcomes will be evaluated. At five years, the development of adjacent disc disease will be investigated. Discussion The results of this study will contribute to the discussion whether additional fusion or arthroplasty is needed and cost effective. Trial registration Current Controlled Trials ISRCTN41681847

  2. Technical arrangement of the Williams-Isu method for anterior cervical discectomy and fusion.

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    Kogure, Kazunari; Isu, Toyohiko; Node, Yoji; Tamaki, Tomonori; Kim, Kyongsong; Morimoto, Daijiro; Morita, Akio

    2015-01-01

    Anterior cervical fixation with autologous bone transplantation-without the need for harvesting bone from other sites, such as the ilium-was developed by Williams and modified by Isu et al. In recent intervertebral fusion procedures, after harvesting the cuboid bone from vertebral bodies, a hydroxyapatite block is placed between two harvested vertebral bones in the same way as in the sandwich method for intervertebral fixation. According to previous studies, this procedure has the following disadvantages: (i) as the corrective force for cervical kyphosis is insufficient, it could not be adapted for patients with preoperative kyphosis; (ii) special devices, including a microsurgical saw, are required for harvesting vertebral bones. In our modified method, we used a conventional high-speed drill instead of a microsurgical saw. Nevertheless, the results show that the operated spine can be stabilized to a greater extent by decreasing the height of the grafted bone, and this might help in reducing postoperative kyphosis.

  3. Anterior cervical plating

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    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  4. Bilateral posterior cervical cages provide biomechanical stability: assessment of stand-alone and supplemental fixation for anterior cervical discectomy and fusion

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    Voronov LI

    2016-07-01

    Full Text Available Leonard I Voronov,1,2 Krzysztof B Siemionow,3 Robert M Havey,1,2 Gerard Carandang,1,2 Frank M Phillips,4 Avinash G Patwardhan1,2 1Musculoskeletal Biomechanics Laboratory, Department of Research, Edward Hines Jr VA Hospital, Hines, IL, USA; 2Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA; 3College of Medicine at Chicago, University of Illinois, Chicago, IL, USA; 4Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA Introduction: Supplemental posterior instrumentation has been widely used to enhance stability and improve fusion rates in higher risk patients undergoing anterior cervical discectomy and fusion (ACDF. These typically involve posterior lateral mass or pedicle screw fixation with significant inherent risks and morbidities. More recently, cervical cages placed bilaterally between the facet joints (posterior cervical cages have been used as a less disruptive alternative for posterior fixation. The purpose of this study was to compare the stability achieved by both posterior cages and ACDF at a single motion segment and determine the stability achieved with posterior cervical cages used as an adjunct to single- and multilevel ACDF.Methods: Seven cadaveric cervical spine (C2–T1 specimens were tested in the following sequence: intact, C5–C6 bilateral posterior cages, C6–C7 plated ACDF with and without posterior cages, and C3–C5 plated ACDF with and without posterior cages. Range of motion in flexion–extension, lateral bending, and axial rotation was measured for each condition under moment loading up to ±1.5 Nm.Results: All fusion constructs significantly reduced the range of motion compared to intact in flexion–extension, lateral bending, and axial rotation (P<0.05. Similar stability was achieved with bilateral posterior cages and plated ACDF at a single level. Posterior cages, when placed as an adjunct to ACDF, further reduced range of motion in both

  5. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population.

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    Haghnegahdar, Ali; Sedighi, Mahsa

    2016-01-01

    Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13-131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

  6. Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

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    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available We aim to evaluate the impact of age and duration of symptoms on surgical outcome of the patients with cervical spondylotic radiculopathy (CSR who had been treated by single-level microscopic anterior cervical discectomy and fusion (ACDF. We retrospectively evaluated 68 patients (48 female and 20 male with a mean age of 41.2±4.3 (ranged from 24 to 72 years old in our Orthopedic Department, Imam Reza Hospital. They were followed up for 31.25±4.1 months (ranged from 25 to 65 months. Pain and disability were assessed by Visual Analogue Scale (VAS and Neck Disability Index (NDI questionnaires in preoperative and last follow-up visits. Functional outcome was eventually evaluated by Odom’s criteria. Surgery could significantly improve pain and disability from preoperative 6.2±1.4 and 22.2±6.2 to 3.5±2.0 and 8.7±5.2 (1–21 at the last follow-up visit, respectively. Satisfactory outcomes were observed in 89.7%. Symptom duration of more and less than six months had no effect on surgical outcome, but the results showed a statistically significant difference in NDI improvement in favor of the patients aged more than 45 years (P=0.032, although pain improvement was similar in the two groups.

  7. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

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    Ali Haghnegahdar

    2016-01-01

    Full Text Available Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1 study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2 recent (one week prior to the interview postoperative VAS for neck and upper extremity radicular pain; (3 Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ (standard Persian version; and (4 follow-up cervical Magnetic Resonance Imaging (MRI and lateral X-ray. Results. With mean follow-up time of 52.93 (months ± 31.89 SD (range: 13–131 months, we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

  8. The application of a zero-profile implant in anterior cervical discectomy and fusion.

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    Wang, Zhi-dong; Zhu, Ruo-fu; Yang, Hui-lin; Gan, Min-feng; Zhang, Shi-kai; Shen, Min-jie; Chen, Chao; Yuan, Quan

    2014-03-01

    We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p>0.05). The JOA score was significantly improved in the two groups (p0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p=0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p=0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.

  9. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials.

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    Yan Hu

    Full Text Available This study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA versus anterior cervical discectomy and fusion (ACDF for the treatment of 1-level or 2-level symptomatic cervical disc disease.Medline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant randomized controlled trials that reported mid- to long-term outcomes (at least 48 months of CDA versus ACDF. All data were analyzed by Review Manager 5.3 software. The relative risk (RR and 95% confidence intervals (CIs were calculated for dichotomous variables. The weighted mean difference (WMD and 95%CIs were calculated for continuous variables. A random effect model was used for heterogeneous data; otherwise, a fixed effect model was used.Eight prospective randomized controlled trials (RCTs were retrieved in this meta-analysis, including 1317 and 1051 patients in CDA and ACDF groups, respectively. Patients after an ACDF had a significantly lower rate of follow-up than that after CDA. Pooled analysis showed patients in CDA group achieved significantly higher rates of overall success, Neck Disability Index (NDI success, neurological success and significantly lower rates of implant/surgery-related serious adverse events and secondary procedure compared with that in ACDF group. The long-term functional outcomes (NDI, Visual Analog Scale (VAS neck and arm pain scores, the Short Form 36 Health Survey physical component score (SF-36 PCS, patient satisfaction and recommendation, and the incidence of superior adjacent segment degeneration also favored patients in CDA group with statistical difference. Regarding inferior adjacent segment degeneration, patients in CDA group had a lower rate without statistical significance.This meta-analysis showed that cervical disc arthroplasty was superior over anterior discectomy and fusion for the treatment of symptomatic cervical disc disease in terms of overall success, NDI

  10. Significant relationship between local angle at fused segments and C2-7 angle: Average duration of longer than 20 years after anterior cervical discectomy and fusion

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    T Nagata

    2011-01-01

    Full Text Available Background : The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF using autologous bone grafting. Materials and Methods : Among the patients who underwent ACDF with trans-unco-discal (TUD approach between 1976 and 1997, 22 patients (16 males and 6 females made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD, osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results : The duration after ACDF ranged from 13 to 34 years with an average of 21.3 ± 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5% were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions : Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

  11. Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models

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    Cao L

    2012-11-01

    Full Text Available Lu Cao,1 Ping-Guo Duan,1 Xi-Lei Li,1 Feng-Lai Yuan,3 Ming-Dong Zhao,2 Wu Che,1 Hui-Ren Wang,1 Jian Dong11Department of Orthopedic Surgery, Zhongshan Hospital, State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China; 2Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China; 3Affiliated Third Hospital of Nantong University, Wuxi, ChinaPurpose: The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC.Methods: Quasistatic nonconstraining torques (maximum 1.5 NM induced flexion, extension, lateral bending (±1.5 NM, and axial rotation (±1.5 NM on 32 sheep cervical spines (C2–C5. The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM was calculated from the load-displacement curves.Results: BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation.Conclusion: The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages.Keywords: biomechanics, cervical spine, cages, bioabsorbable, sheep

  12. Safety and Efficiency of Biomimetic Nanohydroxyapatite/Polyamide 66 Composite in Rabbits and Primary Use in Anterior Cervical Discectomy and Fusion

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    Hui Xu

    2014-01-01

    Full Text Available This study was conducted to validate the safety and efficiency of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA66 composite in animal model (rabbit and report its application in anterior cervical discectomy and fusion (ACDF for 4, 12, and 24 weeks. N-HA/PA66 composite was implanted into one-side hind femur defects and the control defects were kept empty as blank controls. A combination of macroscopic and histomorphometric studies was performed up to 24 weeks postoperatively and compared with normal healing. 60 cervical spondylosis myelopathy and radiculopathy patients who were subjected to ACDF using n-HA/PA66 and PEEK cage were involved in this study with six-month minimum follow-up. Their radiographic (cage subsidence, fusion status, and segmental sagittal alignment (SSA and clinical (VAS and JOA scales data before surgery and at each follow-up were recorded and compared. Nanohydroxyapatite/polyamide 66 composite is safe and effective in animal experiment and ACDF.

  13. Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings.

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    Lundine, Kristopher M; Davis, Gavin; Rogers, Myron; Staples, Margaret; Quan, Gerald

    2014-01-01

    Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis.

  14. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

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    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  15. Adjacent segment disease after anterior cervical discectomy and fusion: Incidence and clinical outcomes of patients requiring anterior versus posterior repeat cervical fusion

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    Mohamad Bydon

    2014-01-01

    Conclusions : Patients undergoing an anterior revision surgery for ASD after ACDF have higher rates of postoperative radiculopathy and redevelopment of ASD when compared with posteriorly approached patients. Patients receiving posterior revision surgery had higher intraoperative blood loss, hospitalizations, and postoperative complications such as wound infections and discharge to rehabilitation, but had a statistically lower chance of redevelopment of ASD requiring secondary revision surgery. This may be due to the fact that posterior revision surgeries involved more levels fused. This study provides one of the longest and most comprehensive follow-ups of this challenging patient population. Prospective studies comparing surgical approaches and techniques are needed to corroborate our findings.

  16. CSF Leaks and Their Management Following Anterior Cervical Discectomy and Fusion: A Report of 13 Cases and a Review of the Literature.

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    Syre, Peter; Bohman, Leif-Erik; Baltuch, Gordon; Roux, Peter Le; Welch, William C

    2014-05-13

    : Study Design. Retrospective chart review and literature review.Objective. To identify cases where a CSF leak occurred during an ACDF and to create a management algorithm based on the findings.Summary of Background Data. Anterior cervical discectomy and fusion (ACDF) is a commonly performed spinal operation. It is effective with very low complication rates. One rare complication of ACDF is a CSF leak. There is limited information on the management of CSF leaks following ACDF and management is on a surgeon-by-surgeon basis.Methods. We reviewed 3 surgeons' case logs and identified cases where a CSF leak was encountered during ACDF and reviewed the patients' medical records, operative reports and imaging to determine how these leaks were managed. We also performed a PubMed search for articles about the presentation and management of CSF leaks following ACDF.Results. Thirteen CSF leaks were identified in 1223 ACDFs, corresponding to a CSF leak rate of 1%. Of these, 9 were successfully treated with intraoperative repair. Postoperative lumbar drainage was used in the remaining 4 patients and was successful in 1 patient. Three patients underwent neck re-exploration and attempted delayed repair. Three patients, including one who was found to have hydrocephalus, ultimately required continuous CSF diversion via shunting. We identified 7 case reports of CSF leak in ADCF in the literature and 1 article that reviewed the prevalence and management of this complication.Conclusion. CSF leak following ACDF is an uncommon complication that can usually be repaired. We provide a stepwise management strategy for CSF leaks in ACDF.

  17. Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion.

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    Mayo, Benjamin C; Massel, Dustin H; Bohl, Daniel D; Narain, Ankur S; Hijji, Fady Y; Long, William W; Modi, Krishna D; Basques, Bryce A; Yacob, Alem; Singh, Kern

    2017-02-01

    OBJECTIVE Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF). METHODS A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014-2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed. RESULTS A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: -0.74, p 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each). CONCLUSIONS The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain

  18. Anterior Cervical Discectomy and Anterior Cervical Corpectomy for Multilevel Cervical Spondylosis%椎间盘切除和椎体次全切除术结合颈前钢板内固定联合治疗多节段脊髓型颈椎病

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    晏雄伟; 张洪燕; 鲁宏; 廉凯

    2011-01-01

    Objective To explore the the clinical outcomes of anterior cervical discectomy and anterior cervical corpectomy for multilevel cervical spondylosis. Methods 17 patients with multilevel cervical spondylosis treated surgically were included in this study. Results All patients were followed-up and showed the successful fusion. No pseudoarthrosis or implant failure occurred. The symptoms disappeared or improved obviousty. Conclusion Anterior cervical discectomy and anterior cervical corpectomy provides a reliable safety technique for multilevel cervical spondylosis, allows us directly to make the completely decompression and can ensure good outcome.%目的 探讨颈椎前路间盘切除和椎体次全切除术结合颈前钢板内固定联合治疗多节段脊髓型颈椎病的临床效果.方法 17例3个及3个以上的多节段脊髓型颈椎病患者,平均年龄55岁,行颈椎前路间盘切除和椎体次全切除结合颈前钢板内固定术.术后观察临床效果.结果 患者均获随访,无死亡,无脊髓、神经、气管及食道损伤等并发症,无Cage或植骨块移位及松动发生.患者的神经功能较术前有明显的改善.结论 颈椎前路间盘切除和椎体次全切除术结合颈前钢板内固定联合治疗充分地解除脊髓前方的压迫,手术效果明显,减少了并发症的发生,是治疗多节段脊髓型颈椎病的一种可行方法.

  19. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

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    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  20. Meta - analysis of clinical trails for postoperative effect of cervical disc replacement versus anterior cervical discectomy and fusion%系统综述颈椎间盘置换与椎间融合的临床疗效

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    郑章; 贾长青; 梁峰; 付勤; 于云祥

    2011-01-01

    [Objective] To make an assessment of postoperative effects in patients who received cervical disc replacement compared with those who received anterior cervical discectomy and fusion (ACDF) . [ Methods ] We searched in Pubmed, Medline, EBSCO, Springer, Ovid, CNKI, Cochrane Library, foreign journals integrations system. We collected the randomized controlled trials (RCTs) from 1995 -2010 about cervical disc replacement versus anterior cervical discectomy and fusion (ACDF) . The methodological quality of the included RCTs were assessed, and the data were extracted by two reviewers independently according to the Cochrand Hand book. The homogeneous RCTs were pooled using RevMan software, and the non -homogeneous studies were evaluted using descriptive qualitative analysis. The evaluation of the postoperative effect included neck disability index ( NDI) , visual analog seal (VAS) , range of motion ( ROM) of the related leveL [ Results] Eight RCTs involving 1 734 patients met the inclusion criteria. The results of meta - analyses showed that the combined Weighted Mean Difference (WMD) ofNDIwas -7.82 (95% CI, -8.73- -6. 91) 2 years after operation, (P<0.05) . The combined WMD of NDI was - 5. 92 (95% CI, - 9. 89 ~ - 1. 94) 4 years after operation, (P < 0.05) .The combined WMD of ROM was 4. 93 (95% CI, 2. 08 -6. 71) 1 years after operation, (P <0. 05) .The combined WMD of ROM was 7. 26 (95% CI, 6. 82 ~ 7. 69) 2 years after operation, (P < 0. 05) .The combined WMD of the neck VAS was - 7. 56 (95% CI, - 14. 20 ~ - 0.92) 2 years after operation, (P <0. 05) . The combined WMD of the arm VAS was -5. 26 (95% CI, - 10. 01 - -0. 51) 2 yearsafter operation, ( P < 0. 05 ) . [ Conclusion ] Our results indicate that cervical disc replacement is superior than ACDF in maintaining the clinical effect (NDI) within 2 years and 4 years, the ROM within 1 year and 2 years, the pain relief of neek and arm (VAS) within 2 years after operation.%[目的]系统评价多节段颈椎间盘置换术

  1. Clinical outcome of anterior cervical corpectomy with fusion versus anterior cervical discectomy with fusion for multilevel cervical spondylosis%椎体次全切除与椎间隙减压治疗多节段颈椎病的疗效比较

    Institute of Scientific and Technical Information of China (English)

    宋科冉; 袁文; 王新伟; 张颖

    2011-01-01

    Objective To compare the clinical effect and radiological results between anterior cervical corpectomy with fusion (ACCF) and anterior cervical discectomy with fusion (ACDF) in the treatment of nulttilevel cervical spondylosis.Methods A total of 118 patients with multilevel cervical spondylosis who underwent ACCF or ACDF from June 2002 to June 2007 were analyzed respectively. And the patients were divided into Group A (2-level treated with ACCF, n = 33), Group B (2-level treated with ACDF,n =30), Group C (3-level treated with ACCF, n=28), Group D (3-level treated with ACDF,n=27) The clinical outcomes were compared between Group A and Group B, and also between Group C and Group D.Results Compared with Group B, Group A had shorter operation time and a higher postoperative 3 months fusion rate, and the differences were statistically significant ( P <0. 05 ). Compared with Group D, Group C had more blood loss in operation lower fusion rate and lower increased height of fusion segment of postoperative 3 months, and the differences were statistically significant ( P <0. 05 ); but the postoperative curvature of fusion segment of Group C was better than that of Group D and the differences were statistically significant ( P < 0. 05). Tne differences of other datas between Group A and Group B or Group C and Group D were not statistially significant ( P > 0. 05 ). Conclusion For patients with 2-level cervical spondylosis, ACCF and ACDF are both effective operation types; but the ACCF has a better field of vision than ACDF. For patients with 3-level cervical spondylosis, both operation types can be used; and the postoperative curvature of fusion segment of ACDF was worse than ACCF, but cage subsidence maybe occur after ACCF.%目的 比较椎体次全切除减压植骨融合术(anterior cervical corpectomy with fusion,ACCF)和经椎间隙减压植骨融合术(anterior cervical discectomy with fusion,ACDF)治疗多节段颈椎病的临床疗效及影像学结果.方法

  2. 人工颈椎间盘置换与前路颈椎间盘切除融合后邻近节段椎间盘应力分布的有限元对比%Comparison of stress distribution of adjacent segments after artificial cervical disc replacement versus anterior cervical discectomy and fusion:a finite element analysis

    Institute of Scientific and Technical Information of China (English)

    刘雅普; 侯秀伟; 吴广良; 夏虹

    2016-01-01

    背景:通过前期的临床随访研究发现,前路颈椎融合后邻近节段椎间盘退变速度要快于人工颈椎间盘置换,人工颈椎间盘置换相较于前路颈椎融合可以保持良好的置换节段活动度,是否置换后邻近椎间盘的应力情况与融合之间存在着差异需要进一步研究。目的:对比人工颈椎间盘置换与前路颈椎间盘切除融合后邻近节段椎间盘的应力分布情况。方法:选择1名30岁健康男性志愿者,人工颈椎间盘和颈椎前路钢板实物进行薄层CT扫描,通过Mimics 10.01及Geomagic Studio.v11软件重建出三维图像,将以上三维数据导入Abaqus 6.9有限元分析软件中进行网格划分、赋值、应力分析。利用有限元方法分析模拟人工颈椎间盘置换及前路颈椎间盘切除融合后邻近节段椎间盘的应力变化。结果与结论:①在相同的预载荷条件下,前屈、后伸、侧屈等运动状态时前路颈椎间盘切除融合后邻近节段椎间盘的应力明显大于正常人相应节段椎间盘应力;而人工椎间盘植入后与正常人相比,在前屈、后伸、侧屈等运动状态时邻近节段椎间盘的应力差异无显著性意义;②前路颈椎间盘切除融合组与人工颈椎间盘置换组相比较,融合组术后邻近节段椎间盘的应力较置换组增大10.3%-51.6%;③有限元分析方法发现,前路颈椎间盘切除融合后邻近节段椎间盘应力大于人工颈椎间盘置换组,随着随访时间的延长,相较于传统前路减压融合,人工颈椎间盘置换可能将更好地发挥其对邻近节段椎间盘的保护作用。%BACKGROUND:Previous clinical fol ow-up study showed that disc degeneration of adjacent segment after anterior cervical discectomy and fusion was faster than that of artificial cervical disc replacement. Compared with the anterior cervical discectomy and fusion, artificial cervical disc replacement can maintain a

  3. A meta-analysis of clinical effects of Bryan cervical disc replacement versus anterior cervical discectomy and fusion%Bryan颈椎间盘置换与颈前路间盘切除植骨融合疗效的系统分析

    Institute of Scientific and Technical Information of China (English)

    李德毅; 张旭; 刘川; 吴继生

    2013-01-01

    BACKGROUND:Bryan cervical disc replacement and anterior cervical discectomy and fusion have a dispute in the treatment of cervical spondylosis. OBJECTIVE:To evaluate the clinical effects of Bryan cervical disc replacement and anterior cervical discectomy and fusion by meta-analysis, thereby providing clinical evidence for treatment strategy of cervical spondylosis. METHODS:The authors searched Medline, PubMed, EMBASE, OVID, CBM, CNKI and also searched manual y seven relevant Chinese orthopedic journals for articles pertinent to clinical research of Bryan cervical disc replacement and anterior cervical discectomy and fusion. Extracted data included the range of motion of the cervical spine, visual analog scale score, neck disability index, the Japanese Orthopaedic Association score. Meta-analysis and forest plots were conducted with RevMan4.2.2 Software. RESULTS AND CONCLUSION:There are eight articles in the meta-analysis, including 883 patients (430 patients receiving Bryan cervical disc replacement, and 453 patients receiving anterior cervical discectomy and fusion). Meta-analysis did detect statistical y significant differences in the range of motion of the cervical spine at 3 months and 24 months postoperatively between the two groups, but did not detect statistical y significant differences in visual analog scale score, neck disability index, the Japanese Orthopaedic Association score between the two groups. These findings indicate that Bryan cervical disc replacement is superior to anterior cervical discectomy and fusion in the range of motion of the cervical spine. However, the current literature offers no evidence to support superiority of the Bryan cervical disc replacement over the anterior cervical discectomy and fusion.%背景:Bryan颈椎间盘置换与颈前路间盘切除植骨融合治疗颈椎病的临床疗效存在争议。  目的:应用 Meta 分析方法,评价 Bryan 颈椎间盘置换与颈前路间盘切除植骨融合治疗颈椎病

  4. Anterior cervical discectomy combined with corpectomy treatment of multi-segmental cervical spondylotic myeiopathy%颈椎前路两种手术方式治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    巩陈; 申才良; 董福龙; 郑军; 汪卫兵

    2011-01-01

    Objective To evaluate of two different anterior cervical surgical treatment of multilevel cervical spondylotic myelopathy clinical efficacy. Methods Selected three or more segments accumulated of the spinal cord-type cervical spondylosis of 36 patients, of which 18 cases were treated with a single sub-segment corpectomy internal fixation + other disc excision alone bone graft and internal fixation( A group ), which was segmental decompression and bone graft fixation; 18 patients with two or more vertebral bodies and fusion with subtotal long segment plate fixation( B group ), which was long segment decompression and bone graft fixation. Two groups were compared with operative time , operative blood loss, hospital stay, fusion rate, neurological improvement rate and cervical physiological curvature of the situation. Results Operation time, blood loss, hospital stay in A group were lower than those in B group( P <0. 05 ). Internal fixations of both groups had not problem postoperative. Cobb’s angle compared with preoperative improvement between the two groups was statistically significant( P < 0. 05 ) ; B group anglec loss rate of postoperative follow-up was higher than that in A group( P <0. 05 ); Bone graft fusion occurred after 6 months in two groups, JOA scores had improvement in the two groups and there was no statistically significant ( P >0. 05 ). Conclusion Both methods attain good clinical results; Anterior cervical discectomy combined with corpectomy treatment of multi-segmental cervical spondylotic myeiopathy , with relatively less blood loss, shorter operative time,less trauma, retain more vertebral bone.which is a good operation method.%目的 评价颈椎前路分节段减压植骨内固定术和长节段减压植骨固定术治疗多节段脊髓型颈椎病的临床疗效.方法 选择累及≥3个节段的脊髓型颈椎病患者36例,其中18例采用分节段单个椎体次全切除植骨内固定+其它椎间盘单独切除植骨内固

  5. 颈前路多节段融合术后吞咽困难的原因分析%Analysis on the causes of dysphagia after multilevel anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    祁敏; 梁磊; 王新伟; 陈华江; 曹鹏; 袁文

    2013-01-01

    Objective To investigate incidence and related factors of dysphagia after fusion with an anterior cervical plate plus cage or a stand-alone cage (Zero-p cage) following anterior cervical discectomy procedure for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From September 2008to September 2011,226 patients with MCSM underwent anterior cervical discectomy and fusion using an anterior cervical plate plus cage (118 patients,P&C group) or a stand-alone cage (108 patients,Zero-p group).Neurological function was evaluated by Japan orthopedic association (JOA) scores before and after operation.Cervical X-rays were taken to assess the graft fusion,internal fixation related complications and the thickness of the prevertebral soft tissue.The Bazaz dysphagia score and Swallowing Quality of Life questionnaire were used to assess the incidence and degree of dysphagia.Results The average follow-up time was 2.4years (range,1.0 to 3.5 years).The incidence of dysphagia was 41.53% in P&C group,while 33.33% in Zero-p group at 2 days after operation.The thickness of the prevertebral soft tissue in P&C group was significantly thicker than that in Zero-p group at 2 days and 2 months after surgery.In Zero-p group,the incidence of dysphagia was 43.1% in patients who underwent operation from C3 to C6,while 22% in patients who underwent operation from C4 to C7.Conclusion Dysphagia is common after multilevel anterior cervical discectomy and fusion.The choice of implants and the extent of operation are important influencing factors of postoperative dysphagia.The use of stand-alone cage can decrease the incidence of dysphagia.The operation at higher levels has a higher incidence of dysphagia.%目的 比较多节段颈前路椎间盘切除减压融合术中采用传统钢板+cage和“零切迹”颈椎椎间融合器植入患者术后吞咽困难的发生情况,并分析其原因.方法 2008年9月至2011年9月,接受颈前路椎间盘切

  6. 前路三节段椎间盘切除减压治疗颈椎病的近期疗效分析%Three-level anterior cervical discectomy: radiographic and clinical results analysis

    Institute of Scientific and Technical Information of China (English)

    胡建华; 田野; 仉建国; 钱军; 李佳忆; 邱贵兴

    2009-01-01

    目的 分析颈前路三节段椎间盘切除减压术治疗颈椎病的临床与影像学结果.方法 2002年10月至2007年1月,对23例颈椎病患者行颈前路连续三节段椎间盘切除减压、自体髂骨植骨、钢板内固定术,男15例,女8例;年龄32~66岁,平均51.4岁.通过分析术前及随访时JOA评分,观察其改善率,并记录术后颈部症状及Odom分级.测量术前、术后1周及末次随访时颈椎侧位X线片,观察颈椎融合节段曲度(Cobb角).在末次随访时,观察融合节段的融合情况以及邻近节段退变情况.结果 随访时间11~48个月,平均19.8个月.20例脊髓型颈椎病患者术前JOA评分(11.1±1.0)分,术后3个月(14.6±1.0)分,两者比较差异有统计学意义,平均改善率62%.3例神经根型颈椎病患者末次随访时,2例症状全部消失,1例左侧三角肌肌力由术前2级恢复至4级.术后Odom分级:优15例,良4例,一般4例.术后17.4%(4/23)的患者颈部仍有症状.植骨融合率100%.术前Cobb角为3.7°,术后1周为10.8°,末次随访为10.4°.未观察到邻近节段病变.无神经系统及与内固定物相关的并发症.结论 颈前路三节段椎间盘切除减压、自体髂骨植骨融合、钢板内固定术可以获得很高的植骨融合率.%Objective Retrospective study of radiographic and clinical results for cervical spondylo-sis patients treated with three-level anterior cervical discectomy. Methods From October 2002 to January 2007, 23 cervical spondylosis patients (including 15 males, 8 females, with the mean age of 51.4 years) un-derwent three-level anterigr cervical discectomy, iliae crest autograft fusion and titanium plate fixation. Pa-tients wore collar braces for a period of 6 to 8 weeks post surgery. Radiographic and clinic follow-up data were collected respectively. Study parameters include the JOA score and its improvement rate, results were graded from excellent to poor using the Odom criteria and post operative assessment of

  7. Heterotopic ossification following single-level anterior cervical discectomy and fusion: results from the prospective, multicenter, historically controlled trial comparing allograft to an optimized dose of rhBMP-2.

    Science.gov (United States)

    Arnold, Paul M; Anderson, Karen K; Selim, Abdulhafez; Dryer, Randall F; Kenneth Burkus, J

    2016-09-01

    OBJECTIVE Heterotopic ossification (HO) has been reported following total hip, knee, cervical, and lumbar arthroplasty, as well as following posterolateral lumbar fusion using recombinant human bone morphogenetic protein-2 (rhBMP-2). Data regarding HO following anterior cervical discectomy and fusion (ACDF) with rhBMP-2 are sparse. A subanalysis was done of the prospective, multicenter, investigational device exemption trial that compared rhBMP-2 on an absorbable collagen sponge (ACS) versus allograft in ACDF for patients with symptomatic single-level cervical degenerative disc disease. METHODS To assess differences in types of HO observed in the treatment groups and effects of HO on functional and efficacy outcomes, clinical outcomes from previous disc replacement studies were compared between patients who received rhBMP-2/ACS versus allograft. Rate, location, grade, and size of ossifications were assessed preoperatively and at 24 months, and correlated with clinical outcomes. RESULTS Heterotopic ossification was primarily anterior in both groups. Preoperatively in both groups, and including osteophytes in the target regions, HO rates were high at 40.9% and 36.9% for the rhBMP-2/ACS and allograft groups, respectively (p = 0.350). At 24 months, the rate of HO in the rhBMP-2/ACS group was higher than in the allograft group (78.6% vs 59.2%, respectively; p rhBMP-2/ACS group compared with 9.8% in the allograft group. At 24 months, the rate of inferior-anterior adjacent-level Park Grade 2/3 HO was 11.9% in the rhBMP-2/ACS group compared with 5.9% in the allograft group. At 24 months, HO rates at the target implant level were similar (p = 0.963). At 24 months, the mean length and anteroposterior diameter of HO were significantly greater in the rhBMP-2/ACS group compared with the allograft group (p = 0.033 and 0.012, respectively). Regarding clinical correlation, at 24 months in both groups, Park Grade 3 HO at superior adjacent-level disc spaces significantly reduced

  8. Adjacent segment degeneration after anterior cervical discectomy and fusion follow-up%颈椎前路融合术后邻近节段退变情况的研究

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的通过观察分析前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)术后随访患者的影像学资料,探讨邻近节段病变的发生时间和发生率。方法分析2008年以来本科收治的94例施行 ACDF 手术并获得完整随访的患者,其中男性51例,女性43例;年龄28~70岁,平均50.5岁。融合节段:单节段42例,上节段30例,三节段22例。术前均常规行颈椎正、侧位 X 线、MRI 检查。术后评定患者神经功能恢复情况,根据 Kellgren 分级标准对临近节段颈椎间盘退变情况进行 X 线评价。结果94例患者随访时间12~45个月,平均随访时间为29.1月。术后患者神经功能改善明显,JOA 评分较术前提高5.8,改善率为64.3%,有效率为100%。临近节段颈椎间盘退变情况的 X 线评估显示,有19例发生临近节段的退变,其中12例有轻度退变表现,7例出现较严重退变表现,邻近节段退变发生率为20.2%。退变发生时间为术后5~40个月,平均为18.7±4.79个月。结论 ACDF 治疗颈椎间盘退行性疾病有良好的疗效,术后邻近节段发生退变时间为18.7±4.79月,随访29.1个月邻近节段退变发生率为20.2%。%Objective To study the clinical efficacy of anterior cervical discectomy and fusion(ACDF) for cervical spondylosis , also the rate and occurrence time of adjacent segment degeneration.Methods 94 cases (male: 51, female: 43, average age: 50.5, ranging from 28 to 70)of cervical spondylosis admitted to our department since 2008 were analyzed in this study.42 patients were performed with single-level ACDF, 30 patients with double-level ACDF,and 22 patients with three-level ACDF. The cervical anterior-posterior and lateral X-ray and MRI examination were performed before the operation.Neurological functional recovery was assessed after operation. X -ray was used to evaluate the degree of adjacent segment degeneration according to

  9. 人工颈椎椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的疗效分析%Comparison of artifical cervical disc replacement versus anterior discectomy and fusion for the treatment of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    杨兴; 薛峰; 盛晓文; 彭育沁; 陈兵乾

    2012-01-01

    目的 比较人工颈椎椎间盘置换术与颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)治疗脊髓型颈椎病的临床疗效.方法 回顾性分析本院收治的人工颈椎椎间盘置换术及ACDF治疗的脊髓型颈椎病病例.测量所有患者颈椎活动度(range of motion,ROM),置换节段及相邻节段的ROM,并行日本骨科学会(Japanese Orthopaedic Association,JOA)评分及Odom分级.结果 所有患者术后JOA评分和Odom功能评定均得到显著改善.置换组术后颈椎ROM、置换节段及其邻近间隙平均ROM无明显改变,差异无统计学意义(P>0.05).ACDF组患者中,术后颈椎ROM显著减小,邻近间隙ROM明显增大,差异有统计学意义(P<0.05).置换组术后邻近节段的ROM明显小于ACDF组,差异有统计学意义(P<0.01).结论人工颈椎椎间盘置换术能保持颈椎ROM,避免邻近节段退变,早、中期疗效满意,远期效果尚有待临床进一步研究.%Objective To compare the clinical outcome of artifical cervical disc replacement versus anterior cervical discectomy and fusion ( ACDF ) in the treatment of cervical spondylotic myelopathy. Methods A total of 50 cases of cervical spondylotic myelopathy treated by artifical cervical disc replacement ( n = 20 ) or ACDF ( n = 30 ) were involved. Among these cases , the range of motion ( ROM ) of the cervical vertebra, the implanted level and the adjacent segment were measured. The Japanese Orthopaedic Association ( JOA ) score and Odom' s grade were record and analyzed. Results All of these patients were followed-up, and JOA score and Odom' s grade of all patients were significantly improved. The ROM of the cervical vertebrae, the implanted levels and the adjacent segments were preserved in artifical cervical disc replacement group ( P >0. 05 ). In the ACDF group, the ROM of the cervical vertebrae decreased, but the adjacent segments of the fusion segment compensatory increased remarkably( P 0

  10. Complications of the anterior approach to the cervical spine

    Directory of Open Access Journals (Sweden)

    Marcelo Lemos Vieira da Cunha

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels and, the type of procedure performed: discectomy and placement of cage and plate (D+C+P, discectomy with placement of a cage (D+C or corpectomy with placement of cage and plate (C+C+P. All complications related to surgical approach were reported. RESULTS: We studied 34 patients, 70% male. The average age was 50 years and mean follow-up was 8 months. Eighteen percent of patients had complications, distributed as follows: dysphasia (33% and dysphonic (67%. Among patients who developed complications, most underwent to D+C+P (83% and no complications were found in patients where no cervical plate was used. Regarding levels, both complications were identified in patients operated to one or two levels. However, in patients operated on three levels, only dysphonia was identified. CONCLUSION: The most frequent complication was dysphonia. Patients who presented more complications were those undergoing discectomy and fusion with cage and anterior cervical plate. All cases of dysphonia were in this group. The number of accessible levels does not seem to have affected the incidence of complications.

  11. A minimum 2-year comparative study of autologous cancellous bone grafting versus beta-tricalcium phosphate in anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage.

    Science.gov (United States)

    Yamagata, Toru; Naito, Kentaro; Arima, Hironori; Yoshimura, Masaki; Ohata, Kenji; Takami, Toshihiro

    2016-07-01

    Although titanium stand-alone cages are commonly used in anterior cervical discectomy and fusion (ACDF), there are several concerns such as cage subsidence after surgery. The efficacy of β-tricalcium phosphate (β-TCP) granules as a packing material in 1- or 2-level ACDF using a rectangular titanium stand-alone cage is not fully understood. The purpose of this study is to investigate the validity of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP. This retrospective study included 55 consecutive patients who underwent ACDF with autologous iliac cancellous bone grafting and 45 consecutive patients with β-TCP grafting. All patients completed at least 2-year postoperative follow-up. Univariate and multivariate analyses were performed to examine the associations between study variables and nonunion after surgery. Significant neurological recovery after surgery was obtained in both groups. Cage subsidence was noted in 14 of 72 cages (19.4 %) in the autograft group and 12 of 64 cages (18.8 %) in the β-TCP group. A total of 66 cages (91.7 %) in the autograft group showed osseous or partial union, and 58 cages (90.6 %) in the β-TCP group showed osseous or partial union by 2 years after surgery. There were no significant differences in cage subsidence and the bony fusion rate between the two groups. Multivariate analysis using a logistic regression model showed that fusion level at C6/7, 2-level fusion, and cage subsidence of grades 2-3 were significantly associated with nonunion at 2 years after surgery. Although an acceptable surgical outcome with negligible complication appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP, cage subsidence after surgery needs to be avoided to achieve acceptable bony fusion at the fused segments. Fusion level at C6/7 or 2-level fusion may be another risk factor of nonunion.

  12. Leakage of cerebrospinal fluid and secondary intracranial infection induced by Cloward technique of cervical discectomy and fusion: presentation and treatment

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-bin; YANG Shu-xu; WANG Yi-rong

    2008-01-01

    @@ Cloward technique of cervical discectomy and fusion is a long and complex surgical proce dure and instrumentation, by which compli-cated infection is rare in an era of routine prophylactic antimicrobial agent, especially in procedures by anterior approach. A study in the journal of Spine suggested that the incidence of unintentional laceration of the dura mater during spinal surgery might be as high as 14%.

  13. A Meta-analysis of Cervical Disc Arthroplasty Compared to Anterior Cervical Discectomy and Fu-sion for Degenerative Cervical Disc Disease%颈椎间盘置换与融合治疗退变性颈椎间盘疾病的 Meta 分析

    Institute of Scientific and Technical Information of China (English)

    石青鹏; 朱永林

    2016-01-01

    Objective To systematically compare the outcomes of cervical disc arthroplasty with anterior cervical discecto-my and fusion in the treatment of single-level degenerative cervical disc disease. Methods The references concerning cervical disc arthroplasty and anterior cervical discectomy and fusion for the singel-level degenerative cervical disc disease were re-trieved through PubMed,Cochrane Library,Ovid,SpringerLink,the China Biological Medicine Database,Wafang Database and Weipu Database,as well as by manually searching the related journals and literature. The eligible trials were extracted accord-ing to the inclusion and exclusion criteria. The methodological quality of the included trials were evaluated. RevMan5. 1 soft-ware was used for data analysis. Results Eight randomized controlled trials were included in the final Meta-analysis. The re-sults of Meta-analysis showed that statistically difference between these procedures in the SF-36(MD = 0. 98,95% CI:- 0. 33~ - 2. 29,Z = 1. 46,P = 0. 14),complications(OR = 0. 60,95% CI:0. 34 ~ 1. 04,P = 0. 07),reoperation rate(OR = 0. 52, 95% CI:0. 26 ~ 1. 05,Z = 1. 83,P = 0. 07). There were no statistically difference in the neck disability index(MD = - 2. 74, 95% CI:- 4. 57 ~ - 0. 91,Z = 2. 93,P = 0. 003),neck VAS(MD = - 2. 84,95% CI:- 4. 85 ~ - 0. 84,Z = 2. 78,P = 0. 005) and arm pain VAS(MD = - 1. 84,95% CI:- 3. 07 ~ - 0. 61,Z = 2. 92,P = 0. 003). Conclusion In treatment of single-level degenerative cervical disc disease,cervical disc arthroplasty has better outcomes in the improvement of pain symptom and neck function,but no superiority in complications,reoperation rate and SF-36 scores.%目的:系统性评价颈椎间盘置换与颈椎间盘摘除和融合治疗单节段退变性颈椎间盘疾病的效果。方法计算机检索 PubMed、Cochrane Library、Ovid、SpringerLink、中国生物医学文献数据库、万方、维普等数据库,手工检索相关杂志及纳入研究的参考文献,制

  14. Endoscopic anterior decompression in cervical disc disease

    Directory of Open Access Journals (Sweden)

    Yad Ram Yadav

    2014-01-01

    Full Text Available Background: Although microscopic anterior cervical discectomy with or without fusion are common surgical procedures for treatment of cervical herniated discs, loss of disc height, pseudarthrosis, and adjacent disc degeneration are some of the problems associated with it. This study is aimed to evaluate results of endoscopic microforaminotomy in cervical disc diseases. Materials and Methods: A prospective study of 50 patients of mono segmental soft or hard disc causing myeloradiculopathy was undertaken. A visual analogue scale (VAS for neck and arm pain and functional outcomes using the Nurick grading system were assessed. There were 28, 12, 8, and 2 patients at C5-6, C6-7, C4-5, and C3-4 levels disc diseases, respectively. Patients with two or more level disc, instabilities, disc extending more than half vertebral body height, and previous operation at the same segment were excluded. Results: Age ranged from 21 to 67 years. Average postoperative reduction in disc height, operating time, and blood loss was 1.1 mm, 110 minutes, and 30 ml, respectively. Average pre-operative VAS score for arm pain and Nurick grading was 7.6 and 2.7, which improved to 1.9 and 0.82, respectively. All patients improved; 1, 2, 3 grade improvement was seen in 10, 27, and 10 patients, respectively. There was no significant complication or any mortality. Conclusion: Although longer follow up of large number of patients is required, endoscopic microforaminotomy is a safe and an effective alternative to microscopic anterior discectomy with or without fusion.

  15. Kinematic analysis of the cervical spine after anterior cervical discectomy and self-locking cage fusion ;at an adjacent level%颈前路零切迹减压融合术对邻近节段瞬时旋转中心及活动度的影响研究

    Institute of Scientific and Technical Information of China (English)

    李冬梅; 刘宝戈; 田宝朋; 崔维; 朱继超; 亢卫波; 张耀

    2016-01-01

    目的:探讨颈前路零切迹减压融合术对邻近节段瞬时旋转中心(instantaneous center of ro⁃tation, ICR)及活动度(range of motion, ROM)的影响。方法对2011年10月至2014年12月的122例采用颈前路零切迹自锁式椎间融合器行颈前路减压融合术(anterior cervical decompression and fusion, ACDF)的患者进行回顾性分析。收集患者术前及末次随访时的过伸、过屈位X线片,测量邻近节段的ICR、ROM以及颈椎整体ROM。采用疼痛视觉模拟量表(visual analogue scale, VAS)评分、日本骨科协会(Japanese Orthopaedic Association, JOA)评估治疗分数、颈椎功能障碍指数(neck disability index, NDI)评价治疗效果。结果随访3~21个月,平均6个月。无论是融合上方还是下方相邻节段的ICR,其术前与末次随访时的数值差异均无统计学意义(均P>0.05);对于颈椎整体和屈、伸位ROM,其术前与末次随访时的数值差异均有统计学意义(均P<0.05),但其上下方相邻节段手术前后的ROM比较,差异均无统计学意义(均P>0.05);本组手术前后的VAS评分、JOA评分及NDI的比较,差异均有统计学意义(均P<0.05)。结论采用颈前路零切迹减压融合术治疗颈椎病效果良好,对邻近节段的ICR和ROM未造成明显的影响。%Objective To evaluate the instantaneous center of rotation (ICR) and range of motion (ROM) of the cervical adjacent segment after anterior cervical discectomy and self⁃locking cage fusion. Meth⁃ods A retrospective analysis was conducted on 122 patients who underwent anterior cervical discectomy and self⁃locking cage fusion between October 2011 and December 2014. The flexion and extension cervical X⁃rays were obtained before surgery and the final post⁃surgery check up and the ICR, ROM of the cervical adjacent seg⁃ment were measured. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) Scores

  16. 人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病%Treatment on multilevel cervical spondylotic myelopathy by artificial cervical disc replace-ment combined with anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    游新茂; 叶秀益; 宋滇文; 贾连顺

    2014-01-01

    Objective To explore the clinical effects of artificial cervical disc replacement( ACDR) combined with anterior cervical discectomy fusion ( ACDF ) for the treatment of multi-segmental cervical spondylotic myelopathy ( CSM) . Methods 18 cases with multi-segmental CSM which were treated by ACDR combined with ACDF were re-viewed. The stability of artificial disc, internal fixation and bone fusion were evaluated by X-ray films before opera-tive, immediate postoperative and follow-up. The JOA scores was evaluated also at the same time. Results 18 pa-tients were followed up from 24 to 60 months ( averaged 36 ± 9. 6 months) . The range of motion of the replacement segment were 13. 8° ± 6. 5° at preoperative and 12. 5° ± 5. 3° at the final follow-up, and there was no significant difference between them(P>0. 05). The preoperative JOA scores was 9. 5 ± 1. 5, which was improved to 14. 2 ± 2. 2 in 4 months after operation; Preoperative neurological symptoms were obviously alleviated in most patients, and the improvement ratio of JOA was 62. 7% ± 11. 2%. The results were excellent in 9 patients, good in 5, fair in 2 and poor in 2. There were no patient with false of internal fixation, and the position of artificial disc was good. Conclu-sions ACDR combined with ACDF is a good procedure for multi-segmental cervical spondylotic myelopathy, it not only maintain the cervical spine alignment with saving more movement segments,but also reduce the incidence of ad-jacent segment degeneration.%目的:评价人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病的临床效果。方法采用人工颈椎间盘置换联合颈前路融合治疗18例多节段脊髓型颈椎病患者。根据术前、术后、随访时的颈椎X线片观察人工椎间盘、内固定、植骨融合以及JOA评分改善情况。结果18例均获随访,时间24~60(36±9.6)个月。置换间隙平均活动度术前为13.8°±6.5°,末次随访时为12.5°±5.3

  17. [Anterior cervical hypertrichosis: case report].

    Science.gov (United States)

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  18. Comparative study of artificial cervical disc replacement verus anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy%人工颈椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的对照研究

    Institute of Scientific and Technical Information of China (English)

    马晓勇; 陈涛平; 郭志学

    2012-01-01

    目的 比较人工颈椎间盘置换术与颈前路减压融合术治疗脊髓型颈椎病的疗效,评价其优缺点.方法 65例脊髓型颈椎病患者按照手术方式分为人工颈椎间盘置换术组(33例,行Bryan假体置换术)和颈前路减压融合术组(32例,行颈前路减压融合术).观察两组患者住院时间、术后颈部外固定时间以及术后恢复工作时间;两组患者于术前、术后3、6、12个月行日本矫形外科协会(JOA)评分,并行X线检测颈椎活动度(ROM);评价临床疗效及术后并发症.结果 人工颈椎间盘置换术组患者住院时间、术后颈部外固定时间以及术后恢复工作时间均显著短于颈前路减压融合术组(P < 0.01).两组术后12个月JOA评分均较术前明显提高(P < 0.05),两组差异无统计学意义(P > 0.05).人工颈椎间盘置换术组术后12个月单节段及双节段置换ROM较术前无显著改变(P > 0.05),颈前路减压融合术组术后12个月ROM较术前减小(P < 0.05或P < 0.01),且显著小于人工颈椎间盘置换术组(P < 0.05或P < 0.01).两组患者满意率无差异(P > 0.05).两组术后均无严重并发症发生.结论 人工颈椎间盘置换术治疗脊髓型颈椎病患者术后恢复快,住院时间短,颈部外固定时间短,使患者保持正常的颈椎活动度,临床疗效好,值得临床推广使用.%Objective To compare the efficacy of artificial cervical disc replacement verus anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy (CSM), and evaluate their advantages and disadvantages. Methods A total of 65 patients with CSM were divided into artificial cervical disc replacement group (33 patients) and ACDF group (32 patients). The hospital stay, postoperative cervical fixation time and postoperative time returning to work of the two groups were observed; the Japanese Orthopaedic Association (JOA) score and range of motion by X-ray before surgery, 3

  19. 两种颈椎前路减压融合术治疗脊髓型颈椎病的临床疗效分析%Clinical results of anterior cervical discectomy or corpectomy in 2-level cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    张伟; 陈德玉; 杨立利; 陈宇; 田海军; 缪锦浩; 马跃

    2011-01-01

    [目的]回顾性分析比较椎间盘切除减压融合术(ACDF)和椎体次全切除减压融合术(ACCF)在治疗相邻两个节段脊髓型颈椎病的临床疗效及影像学数据.[方法]2005年4月~2007年8月,采用ACDF和ACCF治疗相邻两个节段脊髓型颈椎病156例.临床疗效采用日本骨科学会评分系统(JOA评分)对术前、末次随访的临床疗效进行评价.比较两组患者I临床疗效及手术时间、住院大数、术中失血量、颈椎活动度、颈椎曲度及节段性高度.[结果]两组的临床改善优良率无显著性差异(P>0.05),ACDF组与ACCF组术中平均出血量及手术时间有显著性差异(P<0.01),ACCF较ACDF增加,而ACCF组术后的节段性高度及颈椎前凸角较ACDF组明显降低(P<0.01).[结论]ACDF与ACCF均能达到良好的手术疗效,然而ACDF在减少术中出血量、手术时间,改善和维持术后颈椎前凸角度及节段性高度较ACCF作用明显,但ACDF要求技术较高,有较长的学习曲线.%[ Objective] To investigate clinical and radiologic outcomes after surgical treatment for 2 -level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) .[ Methods] The sample included 156 patients who underwent ACDF and ACCF. Clinical symptoms were assessed based on the Japanese Orthopedic Association Scores (JOA) . All medical and surgical records were examined and analyzed, including pain - free interval, intraoperative blood loss, length of surgery, postsurgery hospital stay and radiologic parameters ( total cervical range of motion, segmental cervical range of motion, cervical lordosis, segmental height, fusion rate) . [ Results] The operation time (P <0. 01 ) and bleeding amount (P <0. 01 ) were significantly greater in the ACCF group, whereas segmental height ( P < 0.01 ) and postoperative cervical lordosis ( P < 0. 01 ) were significantly lower in the ACCF group. However, other

  20. Negative Pressure Pulmonary Edema Associated with Anterior Cervical Spine Surgery

    Science.gov (United States)

    Yoneda, Masana; Tanaka, Yasuhito

    2014-01-01

    We report a very rare case of negative pressure pulmonary edema (NPPE) that occurred immediately after anterior cervical discectomy and fusion (ACDF). The patient was a 25-year-old man who sustained a facet fracture-dislocation of C5 during a traffic accident. After ACDF, he developed NPPE and needed mechanical ventilation. Fortunately, he recovered fully within 24 hours. NPPE is a rare postoperative complication that may occur after cervical spine surgery. The aims of this report are to present information regarding the diagnosis and emergent treatment of NPPE, and to review the previous literature regarding this serious complication. PMID:25558327

  1. Anterior One-Level Corpectomy Plus Adjacent-Level Discectomy on Multilevel Cervical Spondylosis%颈前路经椎间隙减压加单椎体次全切除术治疗多节段颈椎病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈为民; 章筛林; 石志才

    2012-01-01

    目的:评价颈前路经椎间隙减压加单椎体次全切除术治疗多节段颈椎病的临床疗效.方法:2006年12月-2009年12月收治相邻三节段颈椎病患者31例,其中采用颈前路经椎间隙减压加单椎体次全切除植骨融合治疗19例(A组);采用两椎体次全切除植骨融合治疗12例(B组).比较两组患者的手术时间、术中出血量、日本整形外科学会(Japanese OrthopedicAssociation,JOA)评分的改善率、植骨融合情况.结果:所有患者均得到随访,随访12~30个月,平均20个月.A组手术时间、术中出血量评估都显著优于B组(P<0.05);术后3个月植骨融合率A组为100%,B组为91.7%,差异无统计学意义(P>0.05),术后6个月两组植骨融合率均为100%;两组JOA评分均有改善,术后6个月和末次随访时的JOA评分改善率在两组间的差异均无统计学意义(P>0.05).结论:颈前路经椎间隙减压加单椎体次全切除术治疗多节段颈椎病较两椎体次全切除更具优势.%Objective:To study the clinical effects of anterior one-level corpectomy plus adjacent-level discectomy on multilevel cervical spondylosis. Methods: From December 2006 to December 2009, 31 patients with multilevel cervical spondylosis of 3 consecutive segments underwent anterior one-level corpectomy plus adjacent-level discectomy and fusion (group A) or contiguous two-level corpectomy and fusion (group B). Operative time, blood loss, improvement of post-operative Japanese Orthopedic Association(JOA) score and graft fusion rate were compared between the two groups. Results: All the patients were followed up for 12 to 30 months (average 20 months) . The mean operative time and blood loss of group A were statistically less than those of group B (P<0. 05). At 3 months postoperatively Graft fusion rate of group A(100%) was higher than group B (91.7%), but the difference was not statistically significant (P>0.05). At 6 months postoperatively Graft fusion rates of

  2. Analysis the Clinical Effect of Single Level and Two Level Anterior Cervical Discectomy and Fusion%单节段与两节段颈前路椎间盘切除和融合术的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    赵亮; 曹竞; 谭洪宇; 宋瑞鹏; 王卫东; 刘屹林; 王利民

    2016-01-01

    Abstract]Objective To compare results of patients undergoing single level and two level anterior cervical discectomy and fusion. Methods 145 cases of patients who accept ACDF were selected. Grouped all the patients single level and two level. Through the two-year follow-up, postoperative clinical results of the two groups of patients were analyzed and compared.Results According to the inclusion criteria, 79 cases of single segments, two segments 66 cases.There was no significant difference in age, sex, BMI between two groups (P>0.05). Preoperative NDI index, JOA score was not statistically significant difference between two groups before the operation,but there has significant inprovement after the operation(P0.05).Conclusion ACDF has been an effective surgical intervention in patients with single level and two level, anterior cervical discectomy and fusion has good way.%目的分析比较颈前路椎间盘切除和融合术治疗单节段和两阶段颈椎病患者的临床效果。方法回顾性分析145例接受颈前路椎间盘切除和融合术的患者,根据手术节段的不同分为单节段组和两节段组。通过2年的随访,对两组患者的术后临床效果进行对比分析。结果根据纳入标准,单节段组79例,两节段组66例,年龄、性别、BMI差异无统计学意义(P>0.05)。两组患者术前NDI指数、JOA评分差异无统计学意义,术后均较术前提高(P<0.05),两组间差异无统计学意义(P>0.05)。结论对于单节段和两节段保守治疗无效的颈椎病患者,颈前路椎间盘切除和融合术是一种行之有效的手术方法。

  3. 颈椎间盘置换术与前路减压椎间融合术术后疼痛及残障指数比较的Meta分析%Comparison of postoperative pain and neck function between cervical disc replacement and anterior cervical discectomy and fusion: a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    李冰; 王沛; 李晖; 阮文东; 冯世庆; 马信龙

    2009-01-01

    目的 收集并分析有关颈椎间盘置换术与颈前路减压椎间融合术(anterior cervical dis-cectomy and fusion,ACDF)术后疗效比较的文献,对颈椎间盘置换术和ACDF术后疼痛及残障指数进行Meta分析.方法 检索Medline(1966年1月至2008年11月)、Embase(1966年1月至2008年11月)、AMED(1985年1月至2008年11月)和Cochrane Library等数据库中关于颈椎间盘置换术和ACDF术后疗效比较的随机对照研究,纳入符合标准的文献,提取相关数据输入Review Manager4.2软件进行统计学分析.臂部疼痛及颈部疼痛的视觉模拟评分(visual analogue scale,VAS)、颈部功能残障指数(neckdisability index,NDI)均采用权重均差(weighted mean difference,WMD)进行评价.结果共4篇文献符合纳入标准,经改良Jadad评分判定均为高质最研究.共纳入213例,干预组(颈椎间盘置换组)和对照组(ACDF组)术后6周臂部疼痛VAS合并WMD为-2.91[95%置信区间(-4.19,-1.62),P<0.05],术后6个月合并WMD值为-2.67[95%置信区间(-4.02,-1.33),P<0.05].干预组和对照组术后6周NDI合并WMD值为-11.93[95%置信区间(-15.66,-8.19),P<0.05],术后6个月合并WMD值为-11.2[95%置信区间(-14.74,-7.69),P<0.05].结论 颈椎间盘置换术后6周和6个月时患者臂部疼痛程度低于ACDF;颈椎间盘置换术后6周和6个月患者颈部功能恢复程度高于ACDF.%Objective To evaluate the postoperative pain and neck function of patients who under-went cervical disc replacement or anterior cervical discectomy and fusion (ACDF) by Meta-analysis. Meth-otis In Medline (1966.1-2008.11), Embase (1966.1-2008.11), AMED (1985.1-2008.11) and Cochrane Li-brary, the randomized controlled trails about the comparison between cervical disc replacement and ACDF were collected. Then extracted the data of arm pain visual analogue scale (VAS), neck pain VAS and neck disability index (NDI) in these researches and made a Meta-analysis using Review Manager 4.2. Weighted mean difference

  4. 颈前路减压cage融合术与自体髂骨块植骨钛板内固定术治疗脊髓型颈椎病的中期疗效%Anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for the cervical spondylotic myelopathy:a mid-term follow up results

    Institute of Scientific and Technical Information of China (English)

    贾龙; 郑燕平; 刘新宇; 王延国; 黎君彦

    2011-01-01

    目的:观察颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期临床疗效.方法:2001年1月~2006年4月128例脊髓型颈椎病患者按照手术方式分为A、B两组,A组61例患者采用前路减压单纯PEEK cage植骨融合术治疗,其中病变节段与手术节段均为单节段22例,双节段39例;B组67例采用颈椎前路减压自体髂骨块植骨融合钛板内固定术,其中单节段27例,双节段40例.观察手术前后JOA评分、椎间高度和颈椎曲度情况.结果:A组手术时间为58.1±1.4min,术中出血量为42.4±2.0ml,B组分别为72.0±5.3min、82.7±3.9ml,两组比较差异有统计学意义(P0.05).随访24~60个月,平均36个月,末次随访时A、B组椎间融合率分别为95.2%和96.3%,两组比较差异无统计学意义(P>0.05);末次随访时每组JOA评分、椎间高度和颈椎曲度与术后比较差异无统计学意义(P>0.05).术前、术后和末次随访时JOA评分、椎间高度和颈椎曲度两组比较差异无统计学意义(P>0.05).结论:颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期疗效均较好,但前者手术方法简单、近期并发症少.%Objective:To evaluate the mid-term clinical results of anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for cervical spondylotic myelopathy. Method : From January 2001 to April 2006,128 cases with cervical spondylotic myelopathy were divided into group A and B respectively.61 cases in group A underwent anterior cervical decompression and fusion (ACDF) with PEEK cage (22 single-level and 39 double-level),while 67 cases in group B underwent anterior decompression and fusion procedures with autogenous iliac crest graft (27 single-level and 40 double-level).The disc height and cervical lordotic alignment were assessed by radiographs,and JOA

  5. Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

    OpenAIRE

    Ezgi Akar; Mehmet Ufuk Akmil; Merih İş

    2015-01-01

    Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF) in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males) who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of inter...

  6. Analysis of adjacent segment degeneration of patients with anterior cervical discectomy and fusion%颈椎前路减压植骨融合术后邻近节段退变情况分析

    Institute of Scientific and Technical Information of China (English)

    邓志龙; 张晓星; 王令; 李邦春

    2011-01-01

    目的 分析颈椎前路减压植骨融合术后融合椎体邻近节段退变的影响因素.方法 选取250例行颈椎前路减压植骨融合内固定手术治疗的患者作为研究对象,观察术后邻近节段退变的发生情况,对退变患者组与无退变患者组各项观察指标进行统计学比较.结果 共72例(75个节段)(28.8%)发生术后邻近节段退变,椎间盘退变程度按评分,1分48例,2分21例,3分3例;退变组术前D值(1.26±1.30)mm、术后D值(3.76±3.10)mm,明显小于无退变组的(1.90±1.30)mm与(5.85±3.04)mm(P0.05).结论 颈椎前路减压植骨融合术后融合椎体邻近节段退变发生率较高;颈椎前凸程度较小、且手术对颈椎前凸程度改善较小是导致邻近节段退变发生的重要影响因素.%Objective To analyze the influeneing factors of adjacent segment degeneration of patients with anterior cervical discectolny and fusion. Methods Totally 250 cases of anterior cervical discectolny and fusion were selected for study. The incidence of adjacent segment degeneration was observed and the indexes of degeneration group and non-degeneration group were compared statistically. Results There were 72 cases (75 segment) of adjacent segment degeneration( 28.8% ) ,including 48 cases of degradation score of 1, 21 cases of degradation score of 2,3 cases of degradation score of 3. The preoperative D value of degradation group was ( 1.26 ± 1.30 ) mm, while ( 3.76 + 3.10) mm after operation, indicating significantly lower than that of non-degradation group ( P < 0.05 ).The postoperative D value of degradation group increased by ( 2.5 + 3.21 ) mm,notably lower than that of non-degradation group (3.95 ± 3.13) mm ( P < 0.05 ) . The age, gender distribution, JOA score and Cobb' s angle of the two groups had no statistical difference( P < 0.05). Conclusion The incident rate of adjacent segment degeneration in patients with anterior cervical diseectolny and fusion is high. The small degree of

  7. 颈前路零切迹自锁椎间融合器治疗三节段颈椎病的初期临床结果%Preliminary clinical outcomes of anterior cervical discectomy and fusion using zero-profile and self-locking cages for three-level cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    曾峥; 刘宝戈; 王磊; 王林; 杨江; 吴炳轩

    2015-01-01

    Objective To analyze the early outcomes of anterior cervical discectomy and fusion ( ACDF ) using zero-proifle and self-locking cages in the treatment of 3-level cervical spondylosis. Methods From December 2011 to June 2012, 35 patients with 3-level cervical spondylosis underwent ACDF with zero-proifle and self-locking cages. There were 23 males and 12 females, whose mean age was 46.7 years old ( range:35-72 years ) and mean course was 9.7 months ( range:3-32 months ). Study parameters included the visual analogue scale ( VAS ) score, Japanese Orthopaedic Association ( JOA ) score, neck disability index ( NDI ) and lordosis angle of the cervical spine. Results The operation was successfully performed in all the cases. The mean operation time was ( 118±19 ) min and the mean blood loss was ( 95±43 ) ml. The follow-up period was 6 months. When compared with the preoperative scores, the VAS scores of neck and upper limb pain, JOA scores and NDI were obviously improved at 1 week, 6 weeks, 3 months and 6 months after the surgery. There were statistically signiifcant differences among them ( P<0.05 ). The lordosis angle of the cervical spine was ( 7.4±3.5 ) ° preoperatively, which was increased to ( 15.6±3.1 ) °, ( 15.2±2.5 ) °, ( 14.9±3.5 ) ° and ( 14.9±3.9 ) ° at 1 week, 6 weeks, 3 months and 6 months after the surgery, and statistically significant differences existed ( P<0.05 ). Conclusions The early outcomes of ACDF using zero-profile and self-locking cages for 3-level cervical spondylosis is satisfactory and reliable, and the cervical alignment can be restored. The surgery has the advantages of small incision, less bleeding, clear surgery ifeld, high safety and little trauma.%目的:分析颈前路应用颈椎零切迹自锁椎间融合器治疗三节段颈椎病的早期疗效。方法2011年12月至2012年6月手术治疗三节段颈椎病患者35例,男23例,女12例,平均年龄46.7(35~72)岁,平均病程9.7(3~32)个月。比较患者

  8. Morphological character of cervical spine for anterior transpedicular screw fixation

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    Rong-Ping Zhou

    2013-01-01

    Full Text Available Background: Anterior cervical interbody grafts/cages combined with a plate were frequently used in multilevel discectomies/corpectomies. In order to avoid additional posterior stabilization in patients who undergo anterior reconstructive surgery, an anterior cervical transpedicular screw fixation, which offers higher stability is desirable. We investigated in this study the anatomical (morphologic characters for cervical anterior transpedicular screw fixation. Materials and Methods: Left pedicle parameters were measured on computed tomography (CT images based on 36 cervical spine CT scans from healthy subjects. The parameters included outer pedicle width (Distance from lateral to medial pedicle surface in the coronal plane, outer pedicle height (OPH (Distance from upper to lower pedicle surface in the sagittal plane, maximal pedicle axis length (MPAL, distance transverse insertion point (DIP, distance of the insertion point to the upper end plate (DIUP, pedicle sagittal transverse angle (PSTA and pedicle transverse angle (PTA at C3 to C7. Results: The values of outer pedicle width and MPAL in males were larger than in females from C3 to C7. The OPH in males was larger than in females at C3 to C6, but there was no difference at C7. The DIP and PTA were significantly greater in males than in females at C3, but there was no difference in the angle at C4-7. The PSTA was not statistically different between genders at C3, 4, 7, but this value in males was larger than females at C5, 6. The DIUP was significantly greater in males at C3, 4, 6, 7 but was non significant at C5. Conclusions: The placement of cervical anterior transpedicular screws should be individualized for each patient and based on a detailed preoperative planning.

  9. Initial curative effect comparision of ano-hydroxyapatite polyamide-66 cage and polyetheretherketone cage on anterior cervical intervertebral disc discectomy and fusion%n-HA/PA66与PEEK cage在颈前路椎间盘切除减压术后椎间隙重建的比较研究

    Institute of Scientific and Technical Information of China (English)

    刘显宏; 欧云生; 蒋电明; 权正学; 张乐; 陈鑫; 胡侦明

    2012-01-01

    目的 观察比较纳米羟基磷灰石/聚酰胺66颈椎融合器(n-HA/PA66 Cage)与聚醚醚酮颈椎融合器(PEEK Cage)在颈前椎间盘切除减压术后椎间隙植骨重建的初期疗效.方法 回顾性分析2008年6月~2011年6月手术治疗资料完整的57例颈椎病患者,行颈前路椎间盘切除减压Cage植骨融合钛钉板系统内固定治疗,其中31例采用n-HA/PA66 cage,26例采用PEEK cage.术后随访包括影像学及临床疗效评价,影像学评价包括术前、术后正侧位片、动力位片观察植骨融合率、塌陷率、颈椎曲度及手术节段椎间隙高度情况;临床疗效采用Odom标准评定.结果 n-HA/PA66组患者6月时获得97.7%植骨融合,PEEK组融合率100%,两组融合率无统计学差异(P> 0.05);n-HA/PA66组术后颈椎丢失的角度为(2.06±1.77)°较PEEK组(2.39±1.56)°稍低,两组数据无统计学差异(P=0.384);n-HA/PA66组与PEEK组术后平均椎间隙丢失高度无统计学意义(0.46 ±0.52 mm,0.41 ±0.18 mm,P=.599),其中n-HA/PA66组出现l例患者1个节段塌陷,塌陷率2.3%,与PEEK组塌陷率(0%)比较无统计学差异(P=0.372);PEEK组获得81%临床优良率对比n-HA/PA66组77%的优良率无统计学差异(P=0.757).结论 颈前路椎间盘切除减压后,n-HA/PA66与PEEK cage椎间隙植骨融合并内固定治疗颈椎病的初期临床疗效与影像学结果均较好且相似.%Objective To evaluate the preliminary efficacy using polyetheretherketone cage (PEEK Cage) and Nano-hydroxyapatite polyamide/66 cage (n-HA/PA66 Cage) composites for reconstruction following anterior cervical interveitebral discectomy and fusion (ACDF) in cervical spondylosis. Methods We performed a retrospective study of patients (57 cases, 3 leases in n-HA/PA66 group, 26 cases in PEEK group) with cervical spondylopathy who underwent ACDF by two different cages between June 2008 and June 2011. Cervical pathologies included cervial spondylotic myelopathy and cervical

  10. Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate Avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato

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    Marcelo Luis Mudo

    2009-09-01

    Full Text Available BACKGROUND AND OBJECTIVES: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. METHOD: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA. Odom and Nürick scales were used to evaluation of functional status before and after surgery. Cervical spine X-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. RESULTS: Excellent and good results (Odom I and II were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. Using the chi square test of independence (1% of significance, there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical X-rays. The presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. Two patients died: one cervical hematoma and other from graft migration with cord compression. CONCLUSIONS: Cervical alignment was more important than fusion to achieve good surgical results in CDD.TEMA E OBJETIVO: O tratamento cirúrgico da radiculopatia cervical com ou sem mielopatia é um tema controverso, embora a discectomia por via anterior seja uma das formas mais comuns de tratamento. MÉTODO: Apresentamos a avaliação da artrodese cervical e do alinhamento pós operatório em 48 pacientes com doença degenerativa cervical (DDC submetidos a discectomia por via anterior seguida da interposição de polimetilmetacrilato (PMMA. As escalas de Odom e de Nurick foram utilizadas para avaliar o status funcional dos pacientes antes e após a cirurgia. Radiografias da coluna cervical foram utilizadas para avaliar a artrodese e o alinhamento cervical, pelo menos 2 anos ap

  11. Early-term clinical outcome of a Zero-profile implant for anterior cervical discectomy and fusion for cervical spondylosis%零切迹颈前路椎间融合系统治疗颈椎病的早期疗效

    Institute of Scientific and Technical Information of China (English)

    薛旭红; 宋洁富; 荆志振; 梁庆元; 胡伟; 崔小平; 陈斌; 秦集斌

    2015-01-01

    Background:The role of anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylosis has been es-tablished. But anterior plating is associated with higher rates of postoperative dysphagia and quicker degeneration of neigh-boring segments. Zero-profile anterior cervical interbody fusion cage (Zero-P ACIFC) is an implant that can potentially lim-it these drawbacks, however, there has been few literatures on it. Objective:To evaluate the early outcome of ACDF using Zero-P ACIFC in patients with cervical spondylosis. Methods:Thirty patients who underwent ACDF with Zero-P ACIFC between June 2013 and May 2014 were included in this study. The average age of the patients was (58.3±4.6) years (range, 38-71 years). There were 5 patients with radiculopathy, 16 with myelopathy and 9 with myelopathy combined with radiculopathy. Clinical outcome was evaluated using Visual Analog Scale (VAS) score for radiculopathy and Japanese Orthopaedic Association (JOA) score for myelopathy. The Cobb angle of cervical lordosis was measured by the tangent of the posterior body line of C2 and C7 on X-ray lateral view. The incidence and duration of dysphagia were recorded. Abnormality of involved segment was observed on extension and flexion lateral X-ray. Results:The average operation time was (72 ± 17.3) min (range, 54-120 min). The average blood loss was (80 ± 25.2) ml (range, 50-170 ml). A total of 39 Zero-Ps were implanted in 21 patients with monosegmental disease and 9 with bisegmental diseases. The number of Zero-Ps implanted in the C3/4, C4/5, C5/6, C6/7 was 5, 11, 19, and 4, respectively. Dysphagia oc-curred within one week after surgery in 9 patients and the symptom disappeared 6 weeks postoperatively. All patients were followed up for (13.6±0.7) months on average (range, 12-15 months). The VAS score was 1.5±0.8, 1.42±0.8 and 1.4±0.9 at 6 weeks, 3 months and 12 months after surgery, respectively, which was significantly lower than preoperative one (7.1±1

  12. 颈前路减压零切迹椎间植骨融合内固定系统治疗颈椎病的早期疗效分析%Early outcome of anterior cervical discectomy and fusion using a Zero-profile interbody fusion and fixation device for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    缪锦浩; 匡勇; 陈德玉; 杨立利; 王新伟; 陈宇; 刘晓伟

    2012-01-01

    目的:分析颈前路减压零切迹椎间植骨融合内固定系统(Zero-P)治疗颈椎病的早期疗效.方法:2010年6月~10月39例颈椎病患者接受颈前路减压Zero-P植骨内固定手术,患者年龄33~71岁,平均50.3岁.神经根型颈椎病8例,脊髓型31例;单间隙14例,2个间隙18例,3个间隙7例.共置入Zero-P 71枚,C3/4、C4/5、C5/6、C6/7椎间隙置入Zero-P分别为8、19、30、14枚.术前、术后2个月及12个月对神经根型颈椎病患者行VAS评分、脊髓型颈椎病患者行JOA评分,在颈椎中立侧位X线片上测量颈椎Cobb角(C2和C7椎体后缘切线的夹角),观察术后吞咽不适的发生率以及症状持续时间.根据术后伸屈侧位X线片观察手术间隙有无异常活动.结果:手术时间48~130min,平均86min:术中出血量40~310ml,平均110ml.14例患者术后1周内出现吞咽不适,其中13例术后2个月内症状消失,1例(2.6%)症状持续至术后4个月消失.随访12~16个月,平均14.6个月.神经根型颈椎病患者术后2个月、12个月时的VAS评分分别为1.5士0.8分、1.3±09分,均低于术前的7.3+1.3分(P<0.05).脊髓型颈椎病患者术后2个月、12个月时的JOA评分分别为14.6±1.1分、15.0±1.2分,均高于术前的9.7±1.7分(P<0.05).术后2个月及12个月颈椎Cobb角分别为18.4°士9.6°、17.8°±9.2°,大于术前的9.0°±10.0°(P<0.05).术后12个月时的VAS评分、JOA评分和颈椎Cobb角与术后2个月比较无显著性差异(P>0.05).随访期间手术间隙无异常活动,内置物无移位.结论:颈前路减压Zero-P植骨内固定治疗颈椎病的早期疗效满意,稳定性可靠,可重建颈椎曲度,术后慢性吞咽不适发生率低.%Objectives: To analyze the early outcome of anterior cervical discectomy and fusion(ACDF) using a Zero-profile interbody fusion and fixation device (Zero-P) for interbody fusion in the treatment of cervical spondylosis. Methods: The study enrolled thirty-nine patients who

  13. Comparison of anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion for the treatment of multi-segmental cervical spondylotic myelopathy%前路椎间盘切除减压融合与椎体次全切除减压融合治疗多节段颈椎病疗效比较

    Institute of Scientific and Technical Information of China (English)

    吴畏; 朱天亮

    2014-01-01

    目的:比较前路椎间盘减压融合( ACDF)与前路椎体次全切除减压融合( ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间:观察组(128.3±32.4)min,对照组(163.2±43.6)min;术中出血量:观察组(161.4±122.5)ml,对照组(319.2±308.7)ml;以上指标观察组均少于对照组(P0.05)。术后颈椎曲度:观察组23.5°±7.4°,对照组16.1°±7.2°;椎间节段性高度:观察组5.6°±0.4°,对照组4.7°±0.8°;以上指标两组比较差异有统计学意义(P0. 05 ) . Postoperative cervical curvature: the observation group was 23. 5° ± 7. 4°, the control group was 16. 1° ± 7. 2°;intervertebral segmental height:observation group was 5. 6° ± 0. 4°, the control group was 4. 7° ± 0. 8°; between these indicators there were statistically significant differences between groups ( P <0. 05 ) . Conclusions Compared with ACCF, ACDF has shorter operative time, less blood loss, cervical physiological curvature and height of intervertebral segment recovered well, but there is no statistically significant differences on postoperative hospital stay time, postoperative JOA score and cervical total activity.

  14. Anterior cervical hypertrichosis: a sporadic case.

    Science.gov (United States)

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature.

  15. ANTERIOR OSTEOPHYTE IDENTIFICATION IN CERVICAL VERTEBRAE

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    A. T. Chougale

    2011-06-01

    Full Text Available Radiologist always examines X-ray to determine abnormal changes in cervical, lumbar & thoracic vertebrae. Osteophyte (bony growth may appear at the corners of vertebrae so that vertebral shape becomes abnormal. This paper presents the idea from Image processing techniques such as customised Hough transform which will be used for segmentation which should be independent of rotation, scale, noise & shape. This segmented image will be then used for computing size invariant, convex hull based features to differentiate normal cervical vertebrae from cervical vertebrae containing anterior osteophyte. This approach effectively finds anterior osteophytes in cervical vertebrae.

  16. Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis: A Case Report and Literature Review.

    Science.gov (United States)

    Ma, Litai; Yang, Yi; Gong, Quan; Ding, Chen; Liu, Hao; Hong, Ying

    2016-04-01

    Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA. A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (-), and Babinski sign (-). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior-inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment. Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other complex

  17. Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

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    Ezgi Akar

    2015-06-01

    Full Text Available Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of intervertebral disc space narrowing, sagittal alignment and range of motion (ROM using serial radiographs and magnetic resonance imaging. Results: The mean age of the 89 patients was 41.3 (24-76 years. The mean follow-up duration was 34.3 (12-64 months. Radiographic evidence of adjacent segment degeneration was observed in 12 patients (13.4%. Nine (75% patients had new complaints. Of the patients who had degenerative changes, 7 were (58% were male, 5 (42% were female; the mean age was 46 (30- 62 years. It was observed that the level of fusion and the number of fusion did not increase the adjacent segment degeneration. All of 12 patients were observed to have a non lordotic cervical spine and increased ROM. Conclusion: Development of degeneration at the level adjacent to region anterior cervical discectomy and fusion performed is higher compared to non-adjacent levels. The level of fusion and the number of fusion levels have no effect on the development of degeneration. (The Medical Bulletin of Haseki 2015; 53:120-3

  18. Biomechanical analysis of multilevel discectomy and excision of posterior longitudinal ligament: An in vitro study in sheep

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    Yilmaz Cem

    2009-01-01

    Full Text Available Aim: This experimental biomechanical study was performed to determine the effects of multilevel anterior cervical discectomy and excision of posterior longitudinal ligament (PLL to stabilize the cervical spine using an in vitro animal model. Materials and Methods: Fifty fresh cadaveric C3-C6 sheep spine specimens were divided into five experimental groups: Group A was the control group; Group B, one-level discectomy; Group C, two- level discectomy, Group D, three-level discectomy, and Group E, three-level discectomy and excision of PLL, respectively. The specimens were subjected to non-destructive loads cycled from zero to five Newton-meter for flexion, extension, right and left lateral bending, and axial rotation on an electrohydraulic test machine. Load displacement curves were obtained via collected data using strain gauges. The values were obtained for all five groups, statistical differences were determined respectively (P < 0.05, ANOVA. Results: One- level discectomy was less stable than the control group, two-level discectomy was less stable than one-level discectomy and three-level discectomy was less stable than two-level discectomy, respectively (P < 0.05. Excision of PLL did not seem to affect stability (P > 0.05. Conclusion: Our data suggested that cervical discectomy decreases stability of sheep spine pieces.

  19. Anterior cervical fusion and Caspar plate stabilization for cervical trauma.

    Science.gov (United States)

    Caspar, W; Barbier, D D; Klara, P M

    1989-10-01

    A technique for anterior cervical iliac graft fusion with standardized, commercially available screw and plate fixation (Caspar plating) has been developed. The step-by-step procedure, as well as the instruments designed to facilitate the procedure, are described in this report. Sixty cases of cervical trauma (fractures, subluxations, ligamentous instability, or a combination of these problems) were treated with Caspar plating. All patients obtained fusion, and stability was achieved immediately after surgery without external stabilization. No unusual surgical complications occurred, and the most dreaded complication of dural penetration by drilling or screw placement was not observed. This report details the neurological presentation, anatomical lesions, surgical therapy, and outcome of these patients. Caspar plating combines the advantage of an anterior surgical approach with immediate postoperative stabilization without external stabilization. This advantage persists even in the presence of posterior ligamentous instability. The technique is an important addition to the surgical treatment of cervical trauma.

  20. Bryan颈椎间盘置换术与颈前路减压椎间融合术术后疗效的系统评价%The systematic review of clinical trails for postoperative effect of cervical disc replacement compared with anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    李冰; 王沛; 李晖; 刘保华; 冯世庆; 马信龙

    2009-01-01

    目的:收集并分析SCI收录的关于Bryan颈椎间盘置换术与颈前路减压椎间融合术(anterior cervicaldiseectomy and fusion,ACDF)术后疗效比较的文献,对Bryan颈椎间盘置换术和ACDF术后疗效进行系统评价.方法:检索Pubmed、Medline、Embase、Ovid、Cochrane Library等数据库.入选文献均为临床研究;各研究的干预组(治疗组)术式为Bryan颈椎间盘置换术,对照组术式为ACDF;治疗组和对照组例数均不小于10;术后疗效评价包括颈部功能残障指数(neck disability index,NDI),相应节段运动范围(range of motion,ROM)等常见指标.结果:共4篇文献符合纳入标准.纳入人数共588人,干预组303例,对照组285例;术后2年内NDI合并权重均差(weiishted meBJl difference,WMD)为-0.39(95%CI,-1.56-0.78),P>0.05.术后2年内相应颈椎节段运动范围(ROM)合并WMD值为8.95(95%CI,7.01~10.89),P0.05.The combined WMD of ROM was 8.95(95%CI,7.01- 10.89) less than 2 years after operation,P<0.05.Conclusion:Our results indicate that Bryan cervical disc re- placement is superior than ACDF in maintaining the ROM less than 2 years after operation.No evidence sup- ports that Bryan cervical disc replacement is better than ACDF less than 2 years after operation.

  1. Adjacent Segment Pathology after Anterior Cervical Fusion.

    Science.gov (United States)

    Chung, Jae Yoon; Park, Jong-Beom; Seo, Hyoung-Yeon; Kim, Sung Kyu

    2016-06-01

    Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.

  2. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial.

    Science.gov (United States)

    Abbott, Allan; Halvorsen, Marie; Dedering, Asa

    2013-05-01

    Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n = 17) and without (n = 16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability.

  3. Dysphagia Secondary to Anterior Osteophytes of the Cervical Spine.

    Science.gov (United States)

    Egerter, Alexander C; Kim, Eric S; Lee, Darrin J; Liu, Jonathan J; Cadena, Gilbert; Panchal, Ripul R; Kim, Kee D

    2015-10-01

    Study Design Retrospective case series. Objective Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease involves hyperostosis of the spinal column. Hyperostosis involving the anterior margin of the cervical vertebrae can cause dysphonia, dyspnea, and/or dysphagia. However, the natural history pertaining to the risk factors remain unknown. We present the surgical management of two cases of dysphagia secondary to cervical hyperostosis and discuss the etiology and management of DISH based on the literature review. Methods This is a retrospective review of two patients with DISH and anterior cervical osteophytes. We reviewed the preoperative and postoperative images and clinical history. Results Two patients underwent anterior cervical osteophytectomies due to severe dysphagia. At more than a year follow-up, both patients noted improvement in swallowing as well as their associated pain. Conclusion The surgical removal of cervical osteophytes can be highly successful in treating dysphagia if refractory to prolonged conservative therapy.

  4. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ramnarain A

    2008-01-01

    Full Text Available Background: Subaxial cervical spine dislocations are common and often present with neurological deficit. Posterior spinal fusion has been the gold standard in the past. Pain and neck stiffness are often the presenting features and may be due to failure of fixation and extension of fusion mass. Anterior spinal fusion which is relatively atraumatic is thus favored using autogenous grafts and cages with anterior plate fixation. We evaluated fresh frozen fibular allografts and anterior plate fixation for anterior fusion in cervical trauma. Materials and Methods: Sixty consecutive patients with single-level dislocations or fracture dislocations of the subaxial cervical spine were recruited in this prospective study following a motor vehicle accident. There were 38 males and 22 females. The mean age at presentation was 34 years (range 19-67 years. The levels involved were C5/6 ( n = 36, C4/5 ( n = 15, C6/7 ( n = 7 and C3/4 ( n = 2. There were 38 unifacet dislocations with nine posterior element fractures and 22 were bifacet dislocations. Twenty-two patients had neurological deficit. Co-morbidities included hypertension ( n = 6, non-insulin-dependent diabetes mellitus ( n = 2 and asthma ( n = 1. All patients were initially managed on skull traction. Following reduction further imaging included Computerized Tomography and Magnetic Resonance Imaging. Patients underwent anterior surgery (discectomy, fibular allograft and plating. All patients were immobilized in a Philadelphia collar for eight weeks (range 7-12 weeks. Eight patients were lost to follow-up within a year. Follow-up clinical and radiological examinations were performed six-weekly for three months and subsequently at three-monthly intervals for 12 months. Pain was analyzed using the visual analogue scale (VAS. The mean follow-up was 19 months (range 14-39 months. Results: Eight lost to followup, hence 52 patients were considered for final evaluation. The neurological recovery was 1.1 Frankel

  5. Dysphagia Due to Anterior Cervical Spine Osteophyte: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Mashhadinezhad

    2010-07-01

    Full Text Available Introduction: Degenerative changes of the cervical spine are more common in elderly, but anterior cervical osteophytes that cause problems in swallowing are rare. The most common cause of this problem is DISH disease (diffuse idiopathic skeletal hyperostosis. Trauma is also suggested as a potential cause in osteophyte formation. Case Report: We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by cervical spine trauma in a car accident 4 years ago, treated with a cervical collar. Dysphagia was the initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4 level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and stomach also ruled out other disorders. Surgical osteophytectomy was performed. Conclusion: Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma.

  6. Transverse cervical skin incision and vertical platysma splitting approach for anterior cervical vertebral column exposure

    Directory of Open Access Journals (Sweden)

    Agrawal Amit

    2014-03-01

    Full Text Available Anterior surgical approaches provide direct access to symptomatic areas of the cervical spine, allow management of the vast spectrum of cervical spine pathologies and there are many articles in the literature that discussed these techniques in detail. Cosmesis is an important issue for patients who undergone surgeryon neck structures as an improperly placed incision attracting significant morbidity and few publications discuss this issue in details. The purpose of the present article is to describe our experience with transverse cervical skin incision and vertical platysma splitting approach for anterior cervical vertebral column exposure.

  7. One stage anterior-posterior approach for traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    WANG Chang-sheng; LIU Mou-jun; LIN Jian-hua; XU Wei-hong; LUO Hong-bin

    2011-01-01

    Objectives: To explore the clinical features of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury (CSCI), and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases.Methods: From March 2004 to September 2009, 16cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied.Results: All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association (JOA) scores ranged from 10to 16 one year postoperatively, 13.95±2.06 on average (improvement rate= 70.10% ). X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants' position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed.Conclusions: Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal

  8. Anterior cervical fusion with the Caspar instrumentation system.

    Science.gov (United States)

    Naito, M; Kurose, S; Oyama, M; Sugioka, Y

    1993-01-01

    We reviewed 106 consecutive patients who had undergone anterior cervical fusion with the Caspar instrumentation system between 1984 and 1989. Preoperative diagnoses were cervical spondylosis in 73 patients, a traumatic lesion in 12, ossification of the posterior longitudinal ligament in 9, cervical disc herniation in 6, and tumour or miscellaneous lesions in 6. In the 106 patients, 56 had two levels fused and 27 had three levels fused. At an average duration of follow-up of 4 years and 7 months, nonunion occurred in 3 of the 83 patients with multiple level fusions. Screw loosening occurred in 8 of the 106 patients, but there was no oesophageal perforation.

  9. Genetic studies in congenital anterior midline cervical cleft

    DEFF Research Database (Denmark)

    Jakobsen, L P; Pfeiffer, P; Andersen, M

    2012-01-01

    Congenital anterior midline cervical cleft (CAMCC) is a rare anomaly, with less than 100 cases reported. The cause of CAMCC is unknown, but genetic factors must be considered as part of the etiology. Three cases of CAMCC are presented. This is the first genetic study of isolated CAMCC. Conventional...

  10. Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte

    Directory of Open Access Journals (Sweden)

    Jae Jun Lee

    2017-02-01

    Full Text Available A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

  11. Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion.

    Science.gov (United States)

    Joseph, Jacob R; Smith, Brandon W; Mummaneni, Praveen V; La Marca, Frank; Park, Paul

    2016-09-01

    Anterior cervical fusion (ACF) after discectomy and/or corpectomy is a common procedure with traditionally good patient outcomes. Though typically mild, postoperative dysphagia can result in significant patient morbidity. In this study, we examine the relationship between postoperative dysphagia and in-hospital outcomes, readmissions, and overall costs. The University HealthSystem Consortium (UHC) database was utilized to perform a retrospective cohort study of all adults who underwent a principal procedure of ACF of the anterior column (International Classification of Diseases, Ninth Revision [ICD-9] procedure code 81.02) between 2013 and 2015. Patients with a diagnosis of dysphagia (ICD-9 78720-78729) were compared to those without. Patient demographics, length of stay, in-hospital mortality, 30-day readmissions, and direct costs were recorded. A total of 49,300 patients who underwent ACF were identified. Mean age was 54.5years and 50.2% were male. Dysphagia was documented in 3,137 patients (6.4%) during their hospital stay. Patients with dysphagia had an average 2.1 comorbidities, while patients without dysphagia had 1.5 (p<0.01). Mean length of stay was 6.38days in patients with dysphagia, and 2.13days in those without (p<0.01). In-hospital mortality was 0.10% in patients without dysphagia, and 0.61% in those with dysphagia (p<0.01). Direct costs were $13,099 in patients without dysphagia, and $21,245 in those with dysphagia (p<0.01). Thirty-day readmission rate was 2.9% in patients without dysphagia, and 5.3% in those with dysphagia (p=0.01). In summary, dysphagia in patients who undergo ACF correlates with significantly increased length of stay, 30-day readmissions, and in-hospital mortality. Direct costs are similarly increased as a result.

  12. Artrodese cervical anterior em três e quatro níveis com dispositivo intersomático não associado à placa cervical Artrodesis cervical anterior en tres y cuatro niveles con dispositivo intersomático no asociado a placa cervical Anterior cervical arthrodesis for three and four levels using stand-alone interbody cages without cervical plates

    Directory of Open Access Journals (Sweden)

    Marcel Luiz Benato

    2009-06-01

    en tercer y cuarto niveles; dolor axial y/o irradiada; con mínimo seis meses de postoperatorio. El criterio de exclusión fue la presencia de inestabilidad cervical traumática. Fueron evaluadas las tasas de consolidación, la presencia de síntomas, la tasa de complicaciones y la posición de los dispositivos intersomáticos (subsidente después de seis meses. RESULTADOS: todos los pacientes obtuvieron consolidación en tres meses, sin embargo, dos pacientes presentaron el fenómeno de subsidente, o sea, migración con consolidación en cifosis, sin alterar los resultados clínicos y la consolidación de la artrodesis a los seis meses de postoperatorio. Los pacientes presentaron mejoría del dolor preoperatorio y solo tres (15% presentaron dolor residual. No hubo complicaciones mayores. El tiempo de hospitalización fue de dos días. No fue utilizada inmovilización rígida en el postoperatorio. CONCLUSIÓN: fue obtenida consolidación con esta técnica en todos los casos. La técnica se mostró segura y promovió buenos resultados radiológicos y clínicos.evaluate the rates of fusion of the anterior cervical discectomy and arthrodesis for three and four levels using interbody cages (stand-alone without cervical plates six months after post-operative. METHODS: from November 2005 to July 2008, 20 patients were treated as proposed. The inclusion criteria were: cervical degenerative disease of three and four levels; axial and/or irradiated pain at least six months of follow-up. The exclusion criteria were: cervical traumatic instability. The fusion rate, clinical symptoms, rate of complications and the implant position were evaluated six months after post-operative. RESULTS: results were favorable in 100% of the patients, with residual pain in two cases. Fusion was found in 100% of the patients, except for two cases with minimum subsidence and fusion in a slight kyphotic position. There were not significant complications. The discharge of the hospital was performed

  13. Anterior cervical fusion versus minimally invasive posterior keyhole decompression for cervical radiculopathy

    Directory of Open Access Journals (Sweden)

    Richard M. Young

    2015-12-01

    Conclusion: ACDF has been demonstrated to be an effective surgical procedure in treating degenerative spine disease in patients with radiculopathy and/or myelopathy. However, in a population with isolated radiculopathy and radiological imaging confirming an anterolateral disc or osteophyte complex, the MIPKF can provide similar results without the associated risks that accompany an anterior cervical spine fusion.

  14. Three-level cervical disc herniation

    Directory of Open Access Journals (Sweden)

    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  15. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

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    Rodrigo Ramos-Zúñiga

    2015-01-01

    Full Text Available Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma; and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

  16. Long Segment Cervical Corpectomy versus Discectomy Combined with Corpectomy for Multilevel Cervical Spondylotic Myelopathy%前路不同术式治疗多节段颈椎病

    Institute of Scientific and Technical Information of China (English)

    储建军; 裴少保; 王涛; 李定滨; 李键

    2014-01-01

    Objective To explore the effect of two different anterior approaches in the treatment of multilevel cervical spondylotic myelopathy . Methods The clinical data of 40 cases of multilevel cervical spondylotic myelopathy treated in our hospital from February 2008 to October 2011 were retrospectively analyzed .Of the 40 patients, 20 patients were treated with one or more cervical corpectomy combined with titanium mesh fusion and internal fixation ( Long-segment group ) and the remaining 20 cases were treated with anterior cervical discectomy and anterior cervical corpectomy combined with bone grafting and internal fixation ( Separate-segmental group ). Results The operative time in Separate-segmental and Long-segmental group was ( 118.2 ±23.4 ) and (102.3 ±20.4) min, respectively;the blood loss was (182.4 ±35.8) and (164.1 ±23.6) ml, respectively; the hospital stay was (7.1 ±3.2) and (5.2 ±2.8) d, respectively.Significant differences were found between the two groups in the improvement rate of JOA at every time point (P0.05;q=0.854,P>0.05).Cobb angle were improved after operation in both groups (F=181.80,P=0.000;F=245.36,P=0.000).Angle loss rate at the 12-month postoperative follow-up in Long-segment and Segment group was (6.5 ±0.4)%and (5.1 ±0.3)%, respectively.Two cases in Long-segment group showed bone graft fusion 6 months after operation , and the remaining patients in both groups showed bone graft fusion 4 months after operation . Conclusion Both methods could obtain good clinical results in the treatment of multilevel cervical spondylotic myelopathy .%目的:探讨长节段椎体次全切钛网植骨融合钢板内固定术和椎间盘摘除联合椎体次全切植骨融合钢板内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析我院2008年2月~2011年10月累及≥3个节段的脊髓型颈椎病40例,其中20例采用≥1个椎体次全切除植骨融合钢板内固定术(长节段组),20例采用单个椎

  17. The Outcomes of Anterior Spinal Fusion for Cervical Compressive Myelopathy—A Retrospective Review

    Directory of Open Access Journals (Sweden)

    Tsz-King Suen

    2011-12-01

    Conclusion: Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years in predicting a favourable outcome of anterior spinal fusion for CCM.

  18. Adjacent level spondylodiscitis after anterior cervical decompression and fusion

    Directory of Open Access Journals (Sweden)

    Saumyajit Basu

    2012-01-01

    Full Text Available Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7 followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup.

  19. Follow-up radiographs of the cervical spine after anterior fusion with titanium intervertebral disc; Roentgen-Verlaufsuntersuchung der Halswirbelsaeule nach anteriorer Fusion mit Titaninterponaten

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    Biederer, J.; Hutzelmann, A.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie; Rama, B. [Paracelsus Klinik, Osnabrueck (Germany). Klinik fuer Neurochirurgie

    1999-08-01

    Purpose: We examined the postoperative changes of the cervical spine after treatment of cervical nerve root compression with anterior cervical discectomy and fusion with a new titanium intervertebral disc. Patients and Methods: 37 patients were examined prior to, as well as 4 days, 6 weeks, and 7 months after surgery. Lateral view X-rays and functional imaging were used to evaluate posture and mobility of the cervical spine, the position of the implants, and the reactions of adjacent bone structures. Results: Implantation of the titanium disc led to post-operative distraction of the intervertebral space and slight lordosis. Within the first 6 months a slight loss of distraction and re-kyphosis due to impression of the implants into the vertebral end-plates were found in all patients. We noted partial infractions into the vertebral end-plates in 10/42 segments and slight mobility of the implants in 14/42 segments. Both groups of patients showed reactive spondylosis and local symptoms due to loosening of the implants. The pain subsided after onset of bone bridging and stable fixation of the loosened discs. Conclusions: The titanium intervertebral disc provides initial distraction of the fusioned segments with partial recurrence of kyphosis during the subsequent course. Loosening of the implants with local symptoms can be evaluated with follow-up X-rays and functional imaging. (orig.) [German] Ziel: An Patienten mit zervikalen Kompressionssyndromen wurden Stellung und Funktion der Halswirbelsaeule nach Diskektomie und Fusion mit einem neuartigen Titaninterponat untersucht. Patienten und Methoden: Bei 37 Patienten (42 Segmente) wurden praeoperativ sowie 4 Tage, 6 Wochen und 7 Monate postoperativ mit seitlichen Uebersichts- und Funktionsaufnahmen Stellung und Mobilitaet der HWS beurteilt. Erfasst wurden Lageveraenderungen des Titaninterponates und die Reaktion der angrenzenden Wirbelkoerperabschlussplatten. Ergebnisse: Das Titaninterponat bewirkte postoperativ eine

  20. Biomechanics characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy:a finite element model study%有限元法分析多节段颈椎病4种颈前路修复方式的生物力学特点

    Institute of Scientific and Technical Information of China (English)

    李忠海; 林斌; 唐家广; 任东风; 李利; 吴闻文; 侯树勋

    2016-01-01

    models were developed from the fusion model, including anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical hybrid decompression and fusion and anterior cervical discectomy and fusion with Cage alone. Von Mises stresses on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. RESULTS AND CONCLUSION:(1) The C2/3 disc stress in flexion, extension, lateral bending and rotation condition was significantly higher than the C6/7 disc in 4 anterior cervical reconstructive techniques, and the adjacent disc stress (C2/3, C6/7) was lowest in the anterior cervical discectomy and fusion with Cage alone, and highest in the anterior cervical corpectomy and fusion. (2) The stress at the plate-screw interface was highest in the anterior cervical corpectomy and fusion, and lowest in the anterior cervical discectomy and fusion. (3) In conclusion, among the four anterior cervical reconstructive techniques for multilevel cervical spondylotic myelopathy, the anterior cervical discectomy and fusion with Cage alone makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment disease after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

  1. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

    Science.gov (United States)

    Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

    2014-02-01

    Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P < 0.001), advanced comorbidity (OR = 2.3 [2.0-2.6], P < 0.001), revision surgery (OR = 2.7 [2.3-3.1], P < 0.001), disc prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P < 0.001). Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P < 0.001), tracheostomy (OR = 2.3 [1.6-3.3], P < 0.001), gastrostomy (OR = 30.9 [25.3-37.8], P < 0.001), and speech therapy/dysphagia training (OR = 32.0 [15.4-66.4], P < 0.001). Aspiration pneumonia was significantly associated with in-hospital mortality (OR = 15.9 [11.0-23.1], P < 0.001). Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology

  2. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

    Science.gov (United States)

    Frati, Alessandro; Palmieri, Mauro; Vangelista, Tommaso; Caruso, Riccardo; Salvati, Maurizio; Raco, Antonino

    2017-01-01

    Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots. PMID:28163949

  3. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

    Directory of Open Access Journals (Sweden)

    Alessandro Frati

    2017-01-01

    Full Text Available Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots.

  4. Comparision between single-level cervical corpectomy and two-level discectomy in two-adjacent-level cervical spondylotic myelopathy%相邻两节段脊髓型颈椎病前路不同术式的比较

    Institute of Scientific and Technical Information of China (English)

    贾小林; 谭祖键; 杨阜滨; 杨明; 万革

    2012-01-01

    [Objective] To compare the outcomes of patients treated with either anterior cervical corpectomy with fusion ( ACCF) or anterior cervical discectomy with fusion ( ACDF) for two - adjacent - level cervical spondylotic myelopathy. [ Methods ] The case histories of 67 patients underwent surgical treatment for two - adjacent - level cervical spondylotic myelopathy from June 2006 to March 2010 were retrospectively reviewed. There were 36 with a single -level corpectomy and 31 with a two -level ACDF. The following were analyzed: ( 1) perioperative parameters (hospital stays, bleeding amounts, operative times, complications) , (2) clinical parameters (Japanese Orthopedic Association scores, Visual Analog Scale scores for neck and arm pain) , and (3) radiologic parameters (sagittal alignment, cervical lordosis, total cervical range of motion, segmental range of motion, anterior and posterior body height for the fused levels, fusion rate) . [ Results ] The mean durations of follow - up were 28. 96 ± 13. 21 (ACCF) and 26. 81 ± 11. 02 (ACDF) months. Of these above parameters, operative time, bleeding amount and complication rates were significantly greater in the ACCF group, whereas postoperative cervical lordosis and segmental height were significantly lower in the ACCF group postoperatively. However, other parameters were not significantly different between the 2 groups. All radiologic parameters occurred significantly more during the first 6 weeks after surgery than after 6 weeks. The loss of posterior body height for the fused levels significantly progressed after 6 weeks in Group ACCF, with no differences in Group ACDF. [ Conclusion] Our data suggest that the two procedures yield comparable results in terms of clinical outcomes for two -adjacent - level cervical spondylotic myelopathy. However, ACDF was found to be superior to ACCF in terms of operation times, bleeding amounts, complication rates and some radiologic results. The decision to perform either ACCF or ACDF

  5. 颈前路减压植骨治疗脊髓型颈椎病%Treatment of Anterior Cervical Decompression and Fusion with Cervical Spinal Cord

    Institute of Scientific and Technical Information of China (English)

    余润泽; 喻德富; 章杰斌; 陶学顺; 王家顺; 吕建军

    2011-01-01

    Objective To observe the cervical spinal column fusion anterior cervical decompression and clinical efficacy. Methods 21 cases of single or double in patients with cervical myclopathy were selected,Central Bank of antcrior cervical discectomy and decompression saws,implantation of autologous iliac bone fusion columnar neck immobilization were performed.The patients were followed up by cervical spine X-ray observations,fell,clinical functional evaluation of nerve function recovery.Results 21 patients were followed up for 12 to 24 months( mean 16 months ). Recovery after surgery,bone fusion,the basic life of patients were satisfactory, Some patients returned to work.Neurological function according to the Japanese Orthopacdic Association(JOA) evaluation system,excellent in 16 cases,good in 2 cases,in 2 cases,1 patient;JOA score improved from(9.3±2.1) points up to postoperative(15.4±1.6) points.Conclusion Anterior decompression and fusion was a single,double cervical myclopathy effective treatment,with complete decompression,shorter operation time,trauma,neurological recovery was good,and with low cost advantage.%目的 观察脊髓型颈稚病颈前路减压柱状植骨融合的临床疗效.方法 21例单或双节段脊髓型颈椎病患者,行颈前路环锯椎间盘切除减压,自体柱状髂骨植入融合,颈托外固定.术后随访观察颈椎X线片、自我感觉、临床功能评价、神经功能恢复情况.结果 21例患者全部获得随访,随访时间12~24个月(平均16个月).术后恢复满意,植骨全部融合,患者生活基本可自理,部分患者重返工作.神经功能改善依据日本矫形外科学会(JOA)评定标准,优16例,良2例,中2例,无效1例;JOA评分由术前(9.3±2.1)分上升至术后的(15.4±1.6)分.结论 前路减压植骨是单、双节段脊髓型颈椎病的有效治疗方法,具有减压彻底,手术时间短,创伤小,神经恢复好,费用低等优点;术后需较长期外固定.

  6. Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease.

    Science.gov (United States)

    Jang, Jae-Won; Lee, Jung-Kil; Lee, Jung-Heon; Hur, Hyuk; Kim, Tae-Wan; Kim, Soo-Han

    2014-10-01

    Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.

  7. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite

    DEFF Research Database (Denmark)

    Kim, Phong; Sarauw, Martin Toft; Sonnesen, Liselotte

    2014-01-01

    INTRODUCTION: Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. METHODS: One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were di...

  8. Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

    Institute of Scientific and Technical Information of China (English)

    Chengwei JING; Qin FU; Xiaojun XU

    2009-01-01

    This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45-68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6-24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.

  9. Cervical intradural disc herniation and cerebrospinal fluid leak

    Directory of Open Access Journals (Sweden)

    Ritesh Kansal

    2011-01-01

    Full Text Available Cervical intradural disc herniation (IDH is a rare condition and only 25 cases of cervical have been reported. We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. The patient underwent C5/6 discectomy through anterior cervical approach. Postoperatively, the patient improved in stiffness but developed cerebrospinal fluid leak and the leak resolved with multiple lumbar punctures.

  10. Treatment of cervical dislocation with locked facets

    Institute of Scientific and Technical Information of China (English)

    YU Ze-sheng; James J.Yue; WEI Feng; LIU Zhong-jun; CHEN Zhong-qiang; DANG Geng-ting

    2007-01-01

    Background Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets.Methods A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation.Results In this series, there was statistically significant difference (P<0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However,unilateral cervical locked facets dislocation can be reduced by posterior open reduction.Conclusions Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

  11. Cervical instability in Klippel-Feil syndrome:case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Aaron Wessell; Peter DeRosa; Abraham Cherrick; Jonathan H.Sherman

    2015-01-01

    Background: The authors present a case of cervical myelopathy and radiculopathy in the setting of multiple Klippel-Feil syndrome abnormalities treated surgically with a single-level C3-C4 anterior cervical discectomy and fusion.We discuss the clinical presentation, radiographic findings, and various treatment options for cervical spine abnormalities in Klippel-Feil syndrome.Case Presentation: This 22-year-old female with Klippel-Feil syndrome presented with intermittent neck pain, left upper extremity weakness, and paresthesias.Preoperative MRI, CT, and X-rays of the cervical spine revealed anterolisthesis at C3/4 with unstable movement on flexion and extension imaging.In addition, there were multiple segmental fusion abnormalities including hemivertebrae and other congenital fusion abnormalities.A C3-C4 anterior cervical discectomy and fusion was performed with intervertebral disc spacer.Adequate decompression was achieved with postoperative resolution of the patient's symptoms and improvement in neurological exam.Conclusions: Single-level anterior cervical discectomy and fusion can be utilized for treatment of cervical myelopathy and radiculopathy in the setting of multiple congenital Klippel-Feil syndrome abnormalities.

  12. Clinical application of anterior cervical decompression and fusion under METRx system

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yue; ZHANG Xia; WANG Wei-dong; LI Chang-qing; CHU Tong-wei; ZHANG Zheng-feng; WANG Jian; ZHENG Wen-jie

    2005-01-01

    Objective: To explore the feasibility and effect of anterior cervical decompression and fusion under METRx system. Methods: Between Nov. 2001 and Nov. 2003, totally 23 consecutive patients were performed anterior cervical decompression and fusion under METRx system. The clinical outcome was evaluated by Odom standard. Results: Decompression and fusion along with internal fixation was obtained in all the 23 patients with minimal tissue damage and operation-caused scar. There were no wound infection, neurological injuries, throat discomfort and other complications. The total rate of excellent and good outcome in patients with degenerative cervical diseases was 94%. Conclusion: Cervical decompression and fusion can be performed under METRx system with its own advantages, such as minimal tissue damage and operation-caused scar, less throat discomfort.

  13. Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Yurdal Gezercan

    2014-08-01

    Full Text Available Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient's clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed. [Cukurova Med J 2014; 39(4.000: 669-678

  14. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, Wilco; Willems, Paul C.; van Limbeek, Jacques; Bartels, Ronald; Pavlov, Paul; Anderson, Patricia G.; Oner, Cumhur

    2011-01-01

    Background The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. Objectives To determine which technique of anterior interbody fusion g

  15. Esophageal, pharyngeal and hemorrhagic complications occurring in anterior cervical surgery: Three illustrative cases

    Directory of Open Access Journals (Sweden)

    Víctor Rodrigo Paradells

    2014-01-01

    Conclusions: Anterior cervical spine surgery is a safe approach and is associated with few major esophageal/pharyngeal complications, which most commonly include transient dysphagia and dysphonia. If symptoms persist, patients should be assessed for esophageal/pharyngeal defects utilizing appropriate imaging studies. Notably, even if the major complications listed above are adequately treated, optimal results are in no way guaranteed.

  16. Anatomic Study of Anterior Transdiscal Axial Screw Fixation for Subaxial Cervical Spine Injuries.

    Science.gov (United States)

    Ji, Wei; Zheng, Minghui; Qu, Dongbin; Zou, Lin; Chen, Yongquan; Chen, Jianting; Zhu, Qingan

    2016-08-01

    Anterior transdiscal axial screw (ATAS) fixation is an alternative or supplement to the plate and screw constructs for the upper cervical spine injury. However, no existing literatures clarified the anatomic feasibility of this technique for subaxial cervical spine. Therefore, the objective of this study was to evaluate the anatomical feasibility and to establish guidelines for the use of the ATAS fixation for the subaxial cervical spine injury.Fifty normal cervical spines had radiographs to determine the proposed screw trajectory (the screw length and insertion angle) and the interbody graft-related parameters (the disc height and depth, and the distance between anterior vertebral margin and the screw) for all levels of the subaxial cervical spine. Following screw insertion in 8 preserved human cadaver specimens, surgical simulation and dissection verified the feasibility and safety of the ATAS fixation.Radiographic measurements showed the mean axial screw length and cephalic incline angle of all levels were 41.2 mm and 25.2°, respectively. The suitable depth of the interbody graft was >11.7 mm (the distance between anterior vertebral margin and the screw), but C2-C3, C3-C4, C4-C5, and C5-C6 levels, but impossible at C6-C7 due to the obstacle of the sternum. All screws were placed accurately. None of the screws penetrated into the spinal canal and caused fractures determined by dissecting the specimens.The anterior transdiscal axial screw fixation, as an alternative or supplementary instrumentation for subaxial cervical spine injuries, is feasible and safe with meticulous surgical planning.

  17. Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia after Anterior Cervical Fusion: A Case Report

    Directory of Open Access Journals (Sweden)

    Kingsley R. Chin

    2013-01-01

    Full Text Available Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF. We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4–6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200 mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms.

  18. Biomechanical comparison of different cervical spine anterior decompressions and reconstructive techniques%3种颈椎前路减压重建方式对稳定性影响的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    刘世敬; 张景僚; 袁国栋; 赵卫东; 钟世镇

    2011-01-01

    [ Objective] To study the biomechanical effects of different cervical spine anterior decompressions and reconstructive techniques in the management of multilevel cervical myelopathy. [ Method ] Eighteen human cadaveric cervical spines were randomly divided into three groups :1) anterior cervical discectomy and fusion (ACDF) and 2) anterior cervical hybrid decompression and fusion ( combined with eorpectomy and discectomy, ACHDF) and 3 ) anterior cervical corpectomy and fusion ( ACCF). Pure moments were applied to induce flexion,extension,lateral bending,and axial rotation. The motion of all direction was recorded stereophotogrammetrically while the load was applied to the specimens. Testing was first performed on the intact specimens, then after decompression,after grafted and after plated . [ Result] There was no difference of the ROM and NZ between the three groups of the intact specimens. When decompressed in different modes,the alteration of SPIROM was not significant in the three groups. But the difference of SP1NZ in all direction of ACCF was significant compared with ACDF. After grafted,the changes of SPINZ of ACCF in flexion - extention mode was significant. No significant difference was noted about SPIROM during all loading modes between the three groups. After additional anterior plate,ACDF and ACHDF was significantly more rigid in flexion - extention mode than ACCF about SPIROM. [ Conclusion ] The different anterior decompressions and reconstructive techniques could restore the stability of cervical spine on the instant. ACDF and ACHDF are superior to the ACCF in flexion - extention mode.%[目的]研究颈椎前路不同减压、植骨固定方式对生物力学稳定性的影响.[方法]18具新鲜人尸体颈椎标本,随机分为三组,分别采用前路3节段椎间盘切除植骨融合固定(ACDF)、分节段混合减压植骨融合固定(ACHDF)及椎体次全切除植骨融合固定(ACCF),采用脊柱三维运动试验机依次测定正常状态

  19. 颈椎前路不同方式减压固定对颈椎稳定性影响的生物力学研究%Biomechanical effects of different anterior decompressions on the stability of cervical vertebra

    Institute of Scientific and Technical Information of China (English)

    刘世敬; 袁国栋; 余正红; 赵卫东; 梁栋柱; 钟世镇

    2009-01-01

    Objectives: To study biomechanical effects of different anterior decompression and fusion on the stability of cervical vertebrae. Methods: 18 cadaveric specimens of cervical spine were divided into three group randomly: ①anterior cervical discectomy and fusion (ACDF); ②anterior cervical hybrid decompression and fusion(combined with corpectomy and discectomy (ACHDF) ; ③anterior cervical corpectomy and fusion (ACCF); Specimens of every group endured the movements of flexion, extension, lateral bending, and axial rotation. The range of motion of all directions was recorded stereophotogrammetrieally niter flexion-extension fatigue loading of 2000 cycles on the specimens of 3 groups. Results: Anterior plate made all of specimens more stable. After flexion-extension fatigue loading of 1200 cycles, there were no changes of ROM between ACDF and ACHDF groups, however, ROM of ACCF group increased. After 2000 cycles, SPIROM and SPINZ of ACDF and ACHDF groups had no difference, however, that of ACCF group decreased. Conclusions: Three kinds of anterior decompression and fusion technique could restore the stability of cervical vertebrae. Under the fatigue loading, the stability and tolerance of ACDF and ACHDF groups are superior to that of ACCF group.%目的:研究颈椎前路多节段病变不同减压、融合固定方式对生物力学稳定性的影响.方法:18具新鲜人尸体颈椎标本,分别行前路椎间盘切除植骨融合(ACDF)、分节段混合减压植骨融合(ACHDF)及椎体次全切除植骨融合(ACCF)术,依次测定正常状态、减压植骨后、钢板固定后、疲劳2000次后的三维活动度,计算稳定潜能指数(SPI),测定疲劳2000次后尾端螺钉和椎体间的活动度.结果:3种方式减压、植骨、钢板固定后,稳定性均明显提高;届伸疲劳1200次后,ACDF、ACHDF组标准化的螺钉-椎体间活动度曲线无变化,而ACCF组曲线升高;疲劳2000次后,ACDF组三维运动SPIROM及SPINZ无变

  20. Operative techniques for cervical radiculopathy and myelopathy.

    LENUS (Irish Health Repository)

    Moran, C

    2012-02-01

    The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970\\'s. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  1. Percutaneous endoscopic cervical discectomy: 16 years of experience and literature review Discectomía endoscópica percutánea cervical: 16 años de experiência y revisión de la literatura Discectomia endoscópica percutânea cervical: 16 anos de experiência e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Gun Choi

    2009-09-01

    Full Text Available The advancement of the percutaneous endoscopic lumbar discectomy (PECD and its clinical success have led to similar minimally invasive approaches to the cervical spine. The goal of PECD is the decompression of the cervical nerve root through a direct endoscopic visualization, removing the herniated mass and shrinking the nucleous pulposus with the use of microforceps and holmium: yttrium-aluminum-garnet (Ho:YAG laser. The senior author have performed PECD with cervical laser assisted endoscopy since 1993. The PECD is indicate to patients with constrained or unconstrained soft herniated cervical disc, positive provocative test, and no bony spur larger than 2 mm, regardless of the herniation size. The authors described the surgical technique of PECD and report their 16 years of experience in the endoscopic treatment of the herniated cervical disc.El avance en la discectomía endoscópica percutánea lumbar y su triunfo clínico llevaron a abordajes mínimamente invasivos en la columna cervical. El objetivo de la discectomía endoscópica percutánea cervical es descomprimir la raíz del nervio cervical, por una visualización endoscópica directa, eliminando el fragmento herniado y disminuyendo el núcleo pulposo, con el uso de fórceps y micro Holmio: itrio-aluminio-granada (Ho:YAG laser. La discectomía endoscópica percutánea cervical con laser ha sido utilizada desde 1993. Esta es indicada en pacientes con hernia discal contenida o no, test provocativo positivo, ausencia de osteofitos mayores que 2 mm, independientemente del tamaño de la hernia. Los autores describen la técnica quirúrgica de discectomía endoscópica percutánea cervical y relatan 16 años de experiencia en el tratamiento endoscópico de disco cervical herniado.O avanço da discectomia endoscópica percutânea lombar e seu sucesso clínico levaram a abordagens minimamente invasivas para a coluna cervical. O objetivo da discectomia endoscópica percutânea cervical é o de

  2. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy.

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    Rui Gao

    Full Text Available BACKGROUND: Results showed good clinical outcomes of anterior corpectomy and fusion (ACCF for patients with cervical spondylotic myelopathy (CSM during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate the incidence of adjacent segment disease (ASD. METHODS: This is a retrospective study of 145 consecutive CSM patients on ACCF treatment with a minimum follow-up of 5 years. Clinical data were collected from medical and operative records. Patients were evaluated by using the Japanese Orthopedic Association (JOA scoring system preoperatively and during the follow-up. X-rays results of cervical spine were obtained from all patients. Correlations between the long term clinical outcome and various factors were also analyzed. FINDINGS: Ninety-three males and fifty-two females completed the follow-up. The mean age at operation was 51.0 years, and the mean follow-up period was 102.1 months. Both postoperative sagittal segmental alignment (SSA and the sagittal alignment of the whole cervical spine (SACS increased significantly in terms of cervical lordosis. The mean increase of JOA was 3.8 ± 1.3 postoperatively, and the overall recovery rate was 62.5%. Logistic regression analysis showed that preoperative duration of symptoms >12 months, high-intensity signal in spinal cord and preoperative JOA score ≤ 9 were important predictors of the fair recovery rate (≤ 50%. Repeated surgery due to ASD was performed in 7 (4.8% cases. CONCLUSIONS: ACCF with anterior plate fixation is a reliable and effective method for treating CSM in terms of JOA score and the recovery rate. The correction of cervical alignment and the repeated surgery rate for ASD are also considered to be satisfactory.

  3. Anterior decompression, structural bone grafting, and Caspar plate stabilization for unstable cervical spine fractures and/or dislocations.

    Science.gov (United States)

    Garvey, T A; Eismont, F J; Roberti, L J

    1992-10-01

    Fourteen patients who sustained acute cervical spine fractures and/or dislocations with associated posterior ligamentous disruption had anterior decompressions, structural bone grafting, and anterior Caspar plate stabilization. With an average 30-month follow-up, no patient has had loss of fixation. Despite criticism raised from biomechanical testing, the Caspar anterior plate system (Aesculape, Tuttlingen, Germany) may be added to structural bone grafting of unstable cervical fractures and/or dislocations, yielding an in vivo solid construct, which obviates the need for simultaneous posterior stabilization.

  4. Cervical total disc replacement is superior to anterior cervical decompression and fusion: a meta-analysis of prospective randomized controlled trials.

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    Yujie Zhang

    Full Text Available Despite being considered the standard surgical procedure for symptomatic cervical disc disease, anterior cervical decompression and fusion invariably accelerates adjacent segment degeneration. Cervical total disc replacement is a motion-preserving procedure developed as a substitute to fusion. Whether cervical total disc replacement is superior to fusion remains unclear.We comprehensively searched PubMed, EMBASE, Medline, and the Cochrane Library in accordance with the inclusion criteria to identify possible studies. The retrieved results were last updated on December 12, 2014. We classified the studies as short-term and midterm follow-up.Nineteen randomized controlled trials involving 4516 cases were identified. Compared with anterior cervical decompression and fusion, cervical total disc replacement had better functional outcomes (neck disability index [NDI], NDI success, neurological success, neck pain scores reported on a numerical rating scale [NRS], visual analog scales scores and overall success, greater segmental motion at the index level, fewer adverse events and fewer secondary surgical procedures at the index and adjacent levels in short-term follow-up (P 0.05.Cervical total disc replacement presented favorable functional outcomes, fewer adverse events, and fewer secondary surgical procedures. The efficacy and safety of cervical total disc replacement are superior to those of fusion. Longer-term, multicenter studies are required for a better evaluation of the long-term efficacy and safety of the two procedures.

  5. A radiological evaluation of allografts (ethylene oxide sterilized cadaver bone and autografts in anterior cervical fusion.

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    Parthiban J

    2002-01-01

    Full Text Available Serial roentgenograms of 40 patients who had 70 cervical intervertebral spaces grafted with ethylene oxide sterilized cadaver bone and 28 patients who received 44 iliac crest auto grafts for anterior cervical spine fusion, were studied. The radiological evaluation was made on the basis of settlement of intervertebral spaces, fusion rate, delayed union, non-union, graft collapse and extrusion of the graft. Indigenous methodologies were designed for the assessment of settlement of grafted intervertebral spaces in percentage. Disc space settlement was more common in autografts (93% cases than in allografts (80% cases. The average percentage of settlement of intervertebral disc space (S% was 22 in autografts and 28 in allografts during the first four months. By the end of eight months, allograft disc spaces settle more. No significant difference was noted in fusion rate at the end of one year viz. allografts (90% cases and autografts (93% cases. Autograft and allograft (ethylene oxide sterilized cadaver bone are equally useful in anterior cervical spine fusions.

  6. Endotracheal tube cuff pressure increases significantly during anterior cervical fusion with the Caspar instrumentation system.

    Science.gov (United States)

    Sperry, R J; Johnson, J O; Apfelbaum, R I

    1993-06-01

    To determine whether endotracheal tube cuff pressure increases significantly with surgical retraction and cervical spine distraction during anterior cervical spine surgery with Caspar instrumentation, we prospectively studied 10 patients undergoing this procedure. The tracheas of all patients were intubated with a Mallinckrodt Hi-Lo endotracheal tube. Tracheal tube cuff pressures measured with a transducer system were 42.4 mm Hg +/- 7.0 mm Hg (SEM) after intubation and cuff inflation. Air was removed from the endotracheal tube cuff until the trachea was just barely sealed at a cuff pressure of 15.2 mm Hg +/- 1.6 mm Hg. The endotracheal tube cuff pressure was readjusted to "just-seal" pressure before the surgeons introduced the Caspar instrumentation. The cuff pressure with traction and distraction was 43.2 mm Hg +/- 5.0 mm Hg. This pressure was significantly increased from the "just-seal" pressure, and from the cuff pressure after instrumentation was discontinued (9.8 mm Hg +/- 2.3 mm Hg). We conclude that anterior cervical spine surgery with Caspar instrumentation is associated with a significant increase in endotracheal tube cuff pressure.

  7. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Gudinchet, F.; Chapuis, L. (University Hospital, Lausanne (Switzerland). Dept. of Radiology); Berger, D. (University Hospital, Lausanne (Switzerland). Dept. of Pediatric Surgery)

    1991-11-01

    A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography. (orig.).

  8. Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach.

    Science.gov (United States)

    Wang, Zhi-Jian; Zhu, Meng-Ye; Liu, Xiao-Jian; Zhang, Xue-Xue; Zhang, Da-Ying; Wei, Jian-Mei

    2016-06-01

    This study aimed to determine the therapeutic effect of radiofrequency combined with low-dose collagenase injected into the disc interior via an anterior cervical approach for cervical intervertebral disc herniation.Forty-three patients (26-62-year old; male/female ratio: 31/12) with cervical intervertebral disc herniation received radiofrequency combined with 60 to 100 U of collagenase, injected via an anterior cervical approach. The degree of nerve function was assessed using the current Japanese Orthopaedic Association (JOA) scoring system at 3 and 12 months postoperation. A visual analogue scale (VAS) was used to evaluate the degree of pain preoperation and 7 days postoperation. The preoperative and 3 month postoperative protrusion areas were measured and compared via magnetic resonance imaging (MRI) and picture archiving and communication systems (PACS).Compared with the preoperative pain scores, the 7-day postoperative pain was significantly reduced (P <0.01). The excellent and good rates of nerve function amelioration were 93.0% and 90.7% at 3 and 12 months postoperation, respectively, which was not significantly different. Twenty-seven cases exhibited a significantly reduced protrusion area (P <0.01) at 3 months postoperation. No serious side effects were noted.To our knowledge, this is the first study to demonstrate that the use of radiofrequency combined with low-dose collagenase injection into the disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation.

  9. Post laminoplasty cervical kyphosis—Case report

    Science.gov (United States)

    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  10. Effect of Cervical Collar Removal on the Fracture Load of Anterior Zirconia Crowns.

    Science.gov (United States)

    Campos, Fernanda; Cardoso, Mayra; de Melo, Renata Marques; Bottino, Marco Antonio; Souza, Rodrigo Oa

    The objective of this study was to assess the influence of the extension of collar and fatigue cycling on the fracture load of anterior zirconia crowns. A total of 60 anterior full-crown preparations (central incisor) were machined in glass fiber-filled epoxy resin. Zirconia copings were designed and milled using computer-aided design/computer-assisted manufacture (thickness: buccal = 0.62 mm, lingual = 0.65 mm, incisal = 0.72 mm). The cervical collars (occlusogingival height = 0.8 mm, buccolingual width = 1.0 mm) were totally or partially (buccal face) removed for modified copings. They were randomly allocated to six groups according to the type of cervical collar design and the presence (or not) of fatigue cycling (n = 10). The veneering ceramic layer was pressed, and the crowns were cemented with resin cement. The samples were tested until fracture in a universal testing machine and analyzed by stereomicroscopy. Data were statistically analyzed by two-way analysis of variance and Tukey test (5%). Removal of the cervical collar significantly affected the fracture strength of zirconia crowns (P = .000), whereas fatigue cycling did not (P = .428). The mean failure load was lower in the groups with no collar. The most frequent failure modes were cracking of the veneer porcelain in collarless crowns and catastrophic failure in the others. The authors concluded that removal of the vestibular collar of zirconia copings in anterior crowns does not reduce the fracture load of the crowns. However, removal of the entire collar reduces the fracture load and cannot be recommended.

  11. BMP-4 Polymorphisms in the Susceptibility of Cervical Spondylotic Myelopathy and its Outcome after Anterior Cervical Corpectomy and Fusion

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    Dawei Wang

    2013-07-01

    Full Text Available Background: To investigate the association between single nucleotide polymorphisms (SNPs of bone morphogenic proteins-4 (BMP-4 gene and the susceptibility of cervical spondylotic myelopathy (CSM and its outcome after surgical treatment. Method: A total of 499 patients with CSM and 602 healthy volunteers were recruited. 425 CSM patients received anterior cervical corpectomy and fusion (ACF and were follow-up until 12 months. The SNPs of BMP-4 were determined. Results: For 6007C > T polymorphism, the cases had a significant lower prevalence of TT genotype than controls. With the CC genotype as reference, the TT genotype carriages significantly influence the CSM risk. The T allele carriage represented a higher risk for CSM as well. The TT of 6007C>T polymorphisms is also associated with higher chance to gain improvement from ACF surgery. The T allele carriage of 6007C>T had markedly higher chance to have a better post-operative outcome compared with C allele carriage. The genotype and allele distributions of -5826G>A polymorphism did not show positive association with risk and outcome of CSM in this study. Conclusion: BMP-4 genetic polymorphisms may be used as a molecular marker for the CSM susceptibility and its postoperative outcome in those underwent surgical treatment.

  12. RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

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    Amado González Moga

    Full Text Available ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

  13. 颈椎前纵韧带损伤的诊断与治疗%Diagnosis and treatment of injury to cervical anterior longitudinal ligaments

    Institute of Scientific and Technical Information of China (English)

    叶添文; 陈雄生; 贾连顺; 周许辉; 宋滇文; 陈德玉; 袁文

    2008-01-01

    and low cervical spinal instability in 14 cases. Damaged ligaments showed gray or gray-white signals which broke sometimes on MRT1-WI, and sheet sagittal widen uneven high signals which were usually disrupted on MRT2-WI. Early surgery was done for 19 patients complicated with spinal cord injury (SCI) (15 anterior decompression fusion, 2 posterior decompression fusion, 2 anteropesterior decompression fusion). Of 27 patients with simple neck pain, early operation was done for 6, cervical plaster orthosis was applied for 5 and cervical collar for 16. Results The mean follow-up time was from 6 to 41 (average, 16. 7) months in 45 patients. Complete SCI was improved to incomplete one in 2 of the 5 patients with complete SCI. Incomplete SCI was improved in different degrees in 10 of the 14 patients with incomplete SCI. No kyphosis or chronic neck pain was found after early operation for the 6 cases of simple neck pain. Of the 21 patients who were treated by cervical plaster orthosis or cervical collar, 7 had evidence of instability on flexion-exteusion imaging and thus underwent anterior decompression fusion to release their chronic neck pain and discomfort Anterior surgery was done for other 2 patients 2 to 3 years after injury because of disc degeneration and extrusion. Other 3 patients had complaints of discomfort and another one was lost for follow-up. The rest 8 were good. Conclusions MRI is the most valuable measure for diagnosis of CALL injury. Decompression and fusion should be done early for CALL injury complicated with spinal cord compression or with severe vertebral iustability. Early anterior discectomy and fusion should be done for cervical disc and longitudinal ligament injury without spinal cord injury.

  14. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

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    Ali Sadrizadeh

    2015-03-01

    Full Text Available Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  15. Related factors to dysphagia after anterior cervical spine surgery%颈椎前路术后吞咽困难的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    陈智; 黄轩; 李凤宁; 张帆; 何平; 綦珂; 侯铁胜; 沈洪兴

    2012-01-01

    Objectives: To evaluate the related factors of dysphagia following anterior cervical spine surgery. Methods: 135 cases undergoing anterior cervical spine surgery from August 2008 to July 2010 were followed up. There were 82 males and 53 females, with a mean age of 58.2 years (range, 32 to 80 years). Of these 135 patients, 58 had cervical spondylotic myelopathy(CSM), 32 had cervical radiculopathy, 18 had cervical myeloradiculopathy, 27 had ossification posterior longitudinal ligament (OPLL). All cases were treated by the same surgical group including anterior cervical discectomy and fusion(ACDF), and/or anterior cervical compec-tomy and fusion(ACCF), and total disc replacement(TDR). 135 patients were reviewed retrospectively on their postoperative dysphagia. All cases with dysphgia accepted Methylprednisolone intravenously and correspondant therapy. Results: 135 cases were followed up, and 36(26.7%) of them had postoperative dysphagia, including 11 males and 25 females. The age of patients with dysphagia ranged from 42 to 80 years, average age was 59.6. The rest age ranged from 32 to 76, the average age was 52.3, which was more significant compared to the former(P0.05). There was no statistical significance in the surgical time, blood loss or hospital day(P>0.05). After 6 month follow-up, 35 cases (97.2%) had dysphagia cured or improved. While 1 case had improvement at 1 year follow-up. Conclusions: Female, elder, titanium plating and multiple surgical level numbers may be associated with postoperative dysphagia. As a result, clinicians should pay more attention to this complication and make proper intervention.%目的:探讨颈椎前路手术后发生吞咽困难的相关因素.方法:随访2008年8月~2010年7月收治的颈椎前路手术患者135例,其中男82例,女53例;年龄32~80岁,平均58.2岁;诊断为脊髓型颈椎病58例,神经根型颈椎病32例,混合型颈椎病18例,后纵韧带骨化症27例.入院后均由同一组医师治疗,手术方

  16. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

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    Ravindranath Kapu

    2012-01-01

    Full Text Available We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.

  17. Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

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    Shimada Takashi

    2013-01-01

    Full Text Available Abstract Introduction There have been few reports of patients with bilateral cervical facet dislocations that remain untreated for eight weeks or more. We report the case of a 76-year-old man with an old bilateral cervical facet joint dislocation fracture that was treated by posterior-anterior reduction and fixation. Case presentation A 76-year-old Asian man was involved in a road traffic accident. He presented with neck pain and arm pain on his right side, but motor weakness and paralysis were not observed. He was treated conservatively; however, instability and spondylolisthesis at the C5 to C6 joint increased eight weeks after the injury. We performed a posterior-anterior reduction and fixation. After surgery, bony union was achieved, and his neck pain and arm pain disappeared. Conclusion We recommend reduction and fixation surgery if a patient has an old bilateral facet joint dislocation fracture in the cervical spine.

  18. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute

    Science.gov (United States)

    Wagstaff, Marcus JD; Caplash, Yugesh

    2017-01-01

    Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis. Results: Implantation, integration, delamination, and split-skin graft application proceeded without complication, mirroring our previous experience in other wounds (including major burns). The result was a robust, supple, mobile, and well-contoured reconstruction over the deep tissues of the neck. The functional and cosmetic outcomes exceeded all expectation. Discussion: The wound environment created after necrotizing fasciitis infection and debridement is austere. In this particular case, reconstructive options were limited to large free flap repair, skin graft alone, and skin graft augmented by commercially available collagen/glycosaminoglycan dermal matrix. Each option was discarded for various reasons. Our previous success with NovoSorb BTM, developed at our center, prompted its use following regulatory approval. The patient was physiologically stronger after the temporization afforded by the biodegradable temporizing matrix over 4 weeks of integration. Conclusion: This is the first description of the successful use of an entirely synthetic biodegradable dermal substitute for the reconstruction of both necrotizing fasciitis and an anterior cervical defect. PMID:28197297

  19. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute.

    Science.gov (United States)

    Wagstaff, Marcus Jd; Caplash, Yugesh; Greenwood, John E

    2017-01-01

    Introduction: Although we have previously described the use of a novel polyurethane biodegradable dermal substitute in the reconstruction of 20 free flap donor sites, and extensive cutaneous defects, including a large area of exposed calvarium secondary to burn injury, our experience with this material now extends to 35 free flap donor site reconstructions and 13 major or complex burns. Methods: The polyurethane material (NovoSorb BTM; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) was recently employed in another complex wound scenario, implanted into a large anterior cervical cutaneous and soft-tissue defect remaining after serial radical debridement for necrotizing fasciitis. Results: Implantation, integration, delamination, and split-skin graft application proceeded without complication, mirroring our previous experience in other wounds (including major burns). The result was a robust, supple, mobile, and well-contoured reconstruction over the deep tissues of the neck. The functional and cosmetic outcomes exceeded all expectation. Discussion: The wound environment created after necrotizing fasciitis infection and debridement is austere. In this particular case, reconstructive options were limited to large free flap repair, skin graft alone, and skin graft augmented by commercially available collagen/glycosaminoglycan dermal matrix. Each option was discarded for various reasons. Our previous success with NovoSorb BTM, developed at our center, prompted its use following regulatory approval. The patient was physiologically stronger after the temporization afforded by the biodegradable temporizing matrix over 4 weeks of integration. Conclusion: This is the first description of the successful use of an entirely synthetic biodegradable dermal substitute for the reconstruction of both necrotizing fasciitis and an anterior cervical defect.

  20. Factors influencing surgical outcome after anterior stabilization of the cervical spine with heterogeneous material

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    Athanasios K. Petridis

    2012-05-01

    Full Text Available Intervertebral fusion through an anterior approach with polymethylacrylate is a wellestablished neurosurgical technique in the treatment of cervical spine degeneration. However, questions still remain concerning the post-surgical outcome. Factors influencing surgical outcome that could help to predict which patients need further post-surgical treatment and what to expect after surgery are the subject of numerous studies. In the present study, we retrospectively collected data from patients who had undergone intervertebral fusion and defined which pre-operative factors could influence the surgical outcome. Between 1993 and 1997, 379 patients were surgically treated with the ventral fusion technique in our hospital. In 2006, we sent a questionnaire to the patients and 164 responses were received. We identified pre-operative presence of severe pain, hypesthesia, palsy and gait disturbance as negative predictive factors, whereas age, body mass index, pre-operative physical strain and the cervical segment involved did not seem to influence prognosis. In conclusion, identifying preoperative factors which influence prognosis after intervetebral fusion will help predict postoperative outcome.

  1. Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.

    LENUS (Irish Health Repository)

    Heneghan, Helen M

    2009-01-01

    BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical

  2. Ultra-low-dose recombinant human bone morphogenetic protein-2 for 3-level anterior cervical diskectomy and fusion.

    Science.gov (United States)

    Pourtaheri, Sina; Hwang, Ki; Faloon, Michael; Issa, Kimona; Mease, Samuel J; Mangels, Daniel; Sinha, Kumar; Emami, Arash

    2015-04-01

    This study evaluated the safety of 3-level anterior cervical diskectomy and fusion (ACDF) with ultra-low-dose recombinant bone morphogenetic protein-2 (rhBMP-2). Thirty-seven consecutive patients with cervical spondylotic myelopathy who were treated with 3-level ACDF and rhBMP-2 were evaluated. Complications such as airway or cervical swelling or hematoma were not observed. The rate of dysphagia was no different at 1, 2, and 6 months postoperatively compared with reports in the literature without rhBMP-2. There were significant improvements in VAS neck/arm pain, Oswestry Neck Disability Index, and cervical lordosis. The use of ultra-low-dose rhBMP-2 for 3-level ACDF may be efficacious for surgically addressing 3-level spondylotic myelopathy.

  3. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  4. Anterior cervical fusion and osteosynthetic stabilization according to Caspar: a prospective study of 41 patients with fractures and/or dislocations of the cervical spine.

    Science.gov (United States)

    Goffin, J; Plets, C; Van den Bergh, R

    1989-12-01

    Between June 1984 and April 1988, 41 patients with severe posttraumatic lesions of the cervical spine between the C2-C3 and the C7-T1 level seen consecutively were treated by an anterior cervical fusion and osteosynthetic stabilization according to Caspar. These patients were prospectively studied. Seven patients had a bilateral facet dislocation, 5 a unilateral facet dislocation, 9 an anterior subluxation, 9 an anterior compression fracture, 5 a hangman's fracture, and 6 a hyperextension injury at a lower cervical level. From a neurological point of view, there were 12 patients with an initial complete transverse lesion and 14 with an incomplete transverse lesion, and the remaining 15 patients did not have any deficit initially. Four patients died during the first 3 months after the operation. In 38 patients good anatomical position was obtained, generally by the intraoperative use of the vertebral distractor of Caspar. In all patients excellent immediate postoperative stability of the spine was obtained, although in 2 patients a second operation was necessary a few days after the first one. Postoperatively all patients were "immobilized" by a soft collar for 3 months. Four patients with an initial complete transverse lesion showed some neurological recovery in the postoperative period, and all patients with an incomplete transverse lesion improved. There were no postoperative neurological disturbances in the group of patients who were neurologically normal from the beginning. The mean postoperative hospitalization time was 13.6 days. These results were compared to the results from the literature, concerning other conservative and operative treatments for posttraumatic lesions of the cervical spine.

  5. Safety and Efficacy of Bioabsorbable Cervical Spacers and Low-Dose rhBMP-2 in Multi-Level ACDF

    OpenAIRE

    2014-01-01

    Introduction Many options for interbody spacer and graft biologic exist for multilevel anterior cervical discectomy and fusion (ACDF). The objective of this study is to evaluate the safety and efficacy of a bioabsorbable cervical spacer (BCS) (Cornerstone HSR, Medtronic Sofamor Danek) filled with low-dose rhBMP-2 (INFUSE, Medtronic Sofamor Danek) in multilevel ACDF. Methods 72 consecutive patients treated with a multi-level ACDF using BCS and rhBMP-2 (dosage between 0.5 to 0.7 mg per level) a...

  6. Two-level cervical disc replacement: perspectives and patient selection

    Directory of Open Access Journals (Sweden)

    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  7. 颈椎人工椎间盘置换与颈前路减压融合术术后轴性症状的分析%The analysis of neck axial symptoms analysis after cervical artificial disc replacement and anterior cervical decompression and fusion

    Institute of Scientific and Technical Information of China (English)

    张杨; 王利民

    2013-01-01

    目的 对比人工椎间盘置换术和颈前路减压融合术术后的早期临床效果及轴性症状,探讨人工椎间盘对术后颈椎轴性症状(AS)的价值.方法 回顾性分析2010年8月至2012年2月间在郑州大学第一附属医院接受治疗的颈椎病患者86例,均为单节段病变.46例患者(ACDF组)行颈前路减压融合内固定术,其中男21例,女25例,平均年龄51.6岁.40例患者(ADR组)行颈椎人工椎间盘置换术,其中男18例,女22例,平均年龄49.1岁.观察两组患者术后随访时JOA评分、Odom评级情况、颈椎曲度指数(CCl)、颈椎总活动度(ROM)的变化情况,对比颈部AS的发生情况,并进行分析.结果 所有患者均获随访,随访时间6~ 24个月,平均15.2个月.术后两组患者JOA评分较术前均有明显改善(P<0.05);术后3、6个月和末次随访时ACDF组与ADR组Odom临床疗效评级优良率比较差异无统计学意义.颈椎曲度ACDF组术后较术前丢失明显(P<0.05),ADR组手术前后无明显变化(P>0.05);ACDF组ROM术前较术后有明显减少(P<0.05),而ADR组与术前相比差异无统计学意义(P>0.05).ACDF组AS发生率为47.83%,ADR组为20.00%,两组相比差异有统计学意义(P>0.05).结论 人工椎间盘置换术能保留颈椎生理曲度及颈椎ROM,未明显增加邻近节段的活动,且无需佩戴颈围领,可早期活动,从而能够有效减少AS的发生.%Objective To compare the early clinical effects and neck axial symptom (AS)after cervical artificial disc replacement and anterior cervical discectomy and fusion,and to explore the value of cervical artificial disc lower the incidence of the postoperative neck AS.Methods To analyse the 86 cases of cervical spondylosis who treated in the first affiliated hospital of Zhengzhou university from August 2010 to February 2012 retrospectively,all of the cases were single segmental lesions.Forty-six patients (ACDF group) underwent anterior cervical discectomy and fusion

  8. Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

    Science.gov (United States)

    Zhang, Yuan; Deng, Xu; Jiang, Dianming; Luo, Xiaoji; Tang, Ke; Zhao, Zenghui; Zhong, Weiyang; Lei, Tao; Quan, Zhengxue

    2016-05-01

    To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study.

  9. Clinical Effectiveness and Influence on Adjacent Segments Degeneration after Single-level Anterior Cervical Fusion%单节段颈椎前路减压融合术对邻近节段退变的影响及疗效观察

    Institute of Scientific and Technical Information of China (English)

    郑兆君; 邱玉金; 刘文华; 李军磊; 曹亮波

    2013-01-01

    Objective To evaluate the clinical effectiveness and influence on adjacent segments degenera-tion after single-level anterior cervical fusion.Methods A retrospective study was given to 40 patients who underwent single-level anterior cervical fusion from Aug.2007 to Dec.2010 and 40 patients with cervical spondylosis of the same age for the same period(imaging showed only a single segment lesions ) underwent conservative therapypatient .The disc degeneration were evaluated using intervertebral disc height and disc Pfirrmann MRI degeneration score .The clinical ef-fectiveness were evaluated using cervical JOA score ,the neck disability index(NDI) .Results The surgical group and conservative group had a statistically significant difference (P0.05) in cervi-cal JOA score and NDI than 1 week after that.Conclusion Anterior cervical discectomy and fusion can lead to degener-ation at the adjacent segment,but the clinical effectiveness are worthy of recognition .%  目的探讨单节段颈椎前路减压融合术对邻近节段退变的影响及手术疗效.方法回顾性分析2007年8月~2010年12月我科收治的40例行单节段颈椎前路减压融合术患者及同期同年龄段颈椎病(影像学显示仅单节段病变)且行保守治疗的患者资料.采用椎间隙高度及椎间盘Pfirrmann MRI退变评分作为评价椎间盘退变指标;采用颈椎JOA评分、颈椎功能障碍指数(NDI)作为手术疗效评价指标.结果术后24个月时,与对照组相比,手术组邻近节段椎间隙高度明显降低,差异有统计学意义(P0.05).结论颈椎前路减压融合术后邻近节段易发生退变,但疗效值得肯定.

  10. Application of anterior decompression and reconstruction using titanium mesh with locking plates in the management of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Maolin He; Zengming Xiao; Shide Li; Qianfen Chen

    2008-01-01

    Objective:To observe the clinical effect of anterior decompression and reconstruction using titanium mesh with locking plates in the treatment of cervical spondylotic myelopathy.Methods:One hundred and twenty patients with cervical spondylotic myelopathy were treated by anterior decompression and reconstruction using titanium mesh with locking plates.There were 66 men and 54 women ranges in age from 37 to 72 Years(mean age, 58.3 years).The mean Japanese orthopedic surgery association(JOA) scale was 9.6 points before operation.Patients were followed up clinically and radiographically.Results:Having stood surgery well, the operation time ranged between 60-100 min and bleeding during operation ranged between 20-200 ml.There were no case of postoperative infection, recurrent laryngeal nerve palsy, or esophageal or tracheal laceration or rupture.The average follow-up period was 14.3 months(range, 12 to 24 months) in 96 who were followed up.At the last follow-up visit the mean JOA scale had improved to 14.4 points, reflecting an improve ment of 4.8 points.The results were considered to be excellent in 87 patients, good in 25, fair in 6, and poor in 2.No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods.Stable bone union was observed in all cases and the average time required for fusion was 5.7 months.Conclusion:Titanium mesh filled with autologous bone graft can avoid the complications associated with harvesting bone from the iliac crest donor site.When combined with cervical anterior locking plate, it can obtain satisfatory clinical results for the treatment of cervical spondylotic myelopathy.

  11. Adjacent-level arthroplasty following cervical fusion.

    Science.gov (United States)

    Rajakumar, Deshpande V; Hari, Akshay; Krishna, Murali; Konar, Subhas; Sharma, Ankit

    2017-02-01

    OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1-3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2-7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow

  12. 颈前路环钻法减压珊瑚羟基磷灰石植入术%Anterior Cervical Discectomy with Coralline Hydroxyapatite Porous Implantation

    Institute of Scientific and Technical Information of China (English)

    倪斌; 贾连顺; 袁文; 孙为平

    2000-01-01

    目的单纯颈椎间盘切除术扰乱颈椎解剖关系,自体骨移植常引起供区并发症.本研究采用颈前路环钻法减压、珊瑚羟基磷灰石植入融合术以避免这些并发症.方法 23例颈椎间盘病变患者采用这一治疗,年龄34~69岁,其中单节段融合21例,双节段融合2例.结果对结果进行临床及颈椎X线检查评定.平均随访16.8个月,临床症状均得到改善,取得了坚强的骨愈合并能维持颈椎解剖关系,无局部及全身异常反应.结论颈前路环钻法减压珊瑚羟基磷灰石植入具有应用前景.

  13. Reduction and fixation by high anterior cervical approach for treatment of type II and type IIA Hangman's fractures%高位颈前入路复位固定治疗Ⅱ型及ⅡA型Hangman骨折

    Institute of Scientific and Technical Information of China (English)

    谢学义; 彭新生

    2014-01-01

    目的:评价高位颈前入路复位固定治疗Ⅱ型及ⅡA型Hangman骨折的临床疗效。方法对2005年1月至2013年5月中山大学第一附属医院收治的21例Ⅱ型及ⅡA型Hangman骨折患者行高位颈前入路C2~C3椎间盘切除、复位及融合固定手术。记录手术时间、术中出血量,测量术后1周及末次随访时C2~C3前凸角;观察复位及并发症发生情况。结果手术时间50~90 min(平均75 min);术中出血量20~100 mL(平均55 mL)。术中无神经血管损伤并发症,所有患者成功获得固定。19例C2前脱位患者中,16例获得完全复位;3例基本复位。术后1周C2~C3平均前凸角为(3.1±0.8)°,优于术前的(-9±2.5)°(P<0.05);19例患者获得平均3年3个月(6个月至7年)的有效随访,末次随访时C2~C3平均前凸角为(2.6±0.5)°,未有明显丢失。所有患者获得椎间融合,未出现内固定松动、脱出、断裂等并发症。结论高位颈前入路C2~C3椎间盘切除、复位及融合固定治疗Ⅱ型及ⅡA型Hangman骨折,复位理想,内固定牢靠,能有效纠正和维持患者的颈椎前凸,融合率高,疗效满意。%Objective To evaluate the clinical effects of reduction and fixation by high anterior cervical approach for treatment of type II and type IIA Hangman's fractures. Methods From January 2005 to May 2013, 21 patients with type II and type IIA hangman's fractures underwent C2-C3 discectomy, reduction and intervertebral fusion with internal fixation by high anterior cervical approach. The operative time and intraoperative estimate blood loss were recorded, C2-C3 lordosis angles at one week postoperatively and the final follow-up were determined respectively, and the reduction and complications were observed. Results The average operative time was 75 min (50-90 min), the intraoperative estimate blood loss was 20-100 mL, with the average of 55 mL. No intraoperative

  14. From less to maximally invasiveness in cervical spine surgery

    Science.gov (United States)

    Visocchi, M.; Conforti, G.; Roselli, R.; La Rocca, G.; Spallone, A.

    2015-01-01

    Introduction Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. Presentation of case We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4–C7 discectomy and, instrumentation and fusion with telescopic distractor “piston like”, anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery “one stage combined” an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. Discussion There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. Conclusion We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation. PMID:25734320

  15. The Treatment of Cervical Fracture Dislocation by Titanium Rete and Orion Anterior Cervical Plate System%钛网并Orion颈椎接骨板在颈椎骨折脱位中的应用

    Institute of Scientific and Technical Information of China (English)

    郑建平; 郭萍; 廉凯

    2011-01-01

    目的 探讨钛质外科网并Orion颈椎接骨板在颈椎骨折脱位手术治疗中的应用价值.方法 对32例前路减压术的临床资料进行回顾性分析,判断融合效果.结果 随访10 ~24个月,32例颈椎脱位完全复位,颈椎生理曲度保护良好,植骨全部融合,椎间高度维持良好,脊髓功能获得不同程度改善.结论 钛质外科网合并Orion颈椎接骨板治疗颈椎骨折脱位效果肯定.%Objective To investigate the value of titanium rete and the Orion anterior cervical plate system in the cervical fracture or dislocation. Methods The clinical data of 32 cases of anterior cervical surgeries were reviewed. The effects of surgery were evaluated. Results All patients were followed up for 10 to 24 months( mean, 18months ). The intervertebral space was totally restored and cervical iordosis were well protected in 32 cases,the bone graft fused well. No implants breakage and loosening was found. Conclusion It is an ideal way to apply the titanium rete and the Orion anterior cervical plate system in the cervical fracture or dislocation.

  16. The Postoperative Application of Percutanous Dilatational Tracheostomy for Patients with Serious Cervical Spinal Cord Injury Undergoing Anterior or Combined Anterior-posterior Cervical Spine Fixation%经皮扩张气管切开术在重度颈髓损伤颈椎前路或前后路联合手术后人工气道中的应用

    Institute of Scientific and Technical Information of China (English)

    李强; 安卫红; 白宇; 刘飞; 么改琦; 朱曦

    2013-01-01

    Objective To investigate the feasibility of percutanous dilatational tracheostomy on patients undergoing anterior and anterior-posterior cervical spine fixation.Methods A retrospective analysis was done on 17 patients with cervical spinal cord injury who were admitted to ICU of Peking University Third Hospital from January 2012 to March 2013,including 12 cases of anterior and 5 cases of combined anterior-posterior cervical spine fixation.All patients received percutanous dilatational tracheostomy after anterior or anterior-posterior cervical spine fixation.The duration between the percutanous dilatational tracheostomy and the anterior/anterior-posterior cervical spine fixation were 5 to 11 days.Results The procedure of percutanous dilatational tracheostomy was smooth in all 17 cases,with no intraoperative impairment to the vital organs,no postoperative heavy blood loss and no fistula infection.No concurrent anterior and anterior-posterior cervical incision infection occurred.Conclusions Percutanous dilatational tracheostomy is a safe and efficient way of building the artificial airway 5 days after the anterior and anterior-posterior cervical spine fixation.%目的 探讨颈椎前路和颈椎前后路联合颈椎切开复位内固定手术后行经皮扩张气管切开术的安全性. 方法 回顾性分析2012年1月~2013年3月颈脊髓损伤17例,行颈前路(12例)或颈前后路(5例)切开复位内固定手术,术后5 ~11d行经皮扩张气管切开术. 结果 17例经皮扩张气管切开术均过程顺利,无颈前部重要器官损伤、术后局部大量出血、造瘘区域感染、颈前路手术切口及切口深层感染. 结论 颈前路手术5日后行经皮扩张气管切开术是安全高效的建立人工气道的方法.

  17. 颈椎前路减压人工颈椎间盘置换术与融合术治疗单节段颈椎间盘突出症的短期疗效比较%Clinical outcome of Discover artificial cervical disc replacement versus anterior cervical decompression and fusion for single segment cervical disc herniation

    Institute of Scientific and Technical Information of China (English)

    卡哈尔·艾肯木; 楚戈; 王振斌; 陈继征; 顾文飞; 胡雅斌; 涂来勇; 赵疆; 项泽文

    2014-01-01

    Background: The curative effect of anterior cervical discectomy and fusion (ACDF) is satisfactory for the patients with symptomatic cervical disc herniation. However, it can result in stress increase in adjacent segments and speed up the degen-eration of adjacent segments. Artificial cervical disc replacement (ACDR), a typical non-fusion surgical treatment, may be an alternative to ACDF for cervical disc herniation. Objective:To compare the clinical outcomes between ACDR and ACDF for single segmental cervical disc herniation. Methods:From January 2009 to February 2012, 61 patients with single segmental cervical disc herniation were treated in our hospital. Of them, 26 received Discover ACDF (arthroplasty group) and 35 underwent single-level ACDF (fusion group). Visual analogue scale (VAS) neck/arm pain score, Japanese Orthopedics Association (JOA) score and flexion-exten-sion range of motion of operative and adjacent segments were evaluated preoperatively and 1 week and 3, 6, 12, and 24 months postoperatively. Complications and secondary treatment were recorded. Results:A total of 52 patients (29 in arthroplasty group and 23 in fusion group) were followed up. The average follow-up pe-riod was 15.3 months (range, 12-24 months). The VAS scores of neck pain and upper limb pain and JOA score were signifi-cantly improved during follow up as compared with preoperative ones in all patients (P0.05). In arthroplasty group, there was no significant difference in range of motion of opera-tive and adjacent segments before and after treatment (P>0.05). The rate of fusion achievement was 90.5%. In arthroplasy group, prosthesis antedisplacement (<3 mm) in 2 patients at 6 months after surgery, and cerebrospinal fluid leakage oc-curred 1 patient. In fusion group, adjacent segment disease occurred in one patient who underwent secondary operation. Conclusions:Discover cervical disc replacement is a feasible alternative to ACDF for patients with persistent symptomatic cervical disc

  18. Anterior cervical interbody Cage placement for treatment of multilevel cervical spondylotic myelopathy: Reconstruction of spinal function%椎前路Cage植入技术治疗多节段脊髓型颈椎病重建脊柱功能的效应

    Institute of Scientific and Technical Information of China (English)

    李建光; 苗军; 夏群

    2007-01-01

    目的:多节段脊髓型颈椎病患者行颈前路椎间盘切除、Cage植骨融合、钢板内固定术可获得良好的椎管减压,达到脊髓减压目的,对这种患者彻底减压很重要.观察此技术的的脊柱重建功能.方法:①选择2003-04/2006-02天津医院脊柱外科住院的多节段脊髓型颈椎病患者38例,男35例,女3例;年龄43~72岁,病程0.5~5年.患者均对治疗方案知情同意.②所有患者均行前路颈椎间盘切除、Cage植入手术治疗,合并失稳者进行钛板固定,无失稳者单纯植入Cage.所采用Cage为Intromed公司方形聚醚醚酮材料Cage,钛板为Sofarmor Danek公司的Zephir钛板.采用的方形聚醚醚酮材料Cage弹性模量与骨组织接近,可透X线,便于术后观察评价植骨融合情况.Cage外形设计带有一定的角度,能更好的恢复颈椎生理前凸;表面弧度与终板一致,吻合度较高,增大了植骨融合率;表面有锯齿样防滑设计,植入后即刻稳定性较好;弹性模量介于皮质骨与松质骨之间,减少应力遮挡,减少融合器下沉,具有良好的抗腐蚀性和生物相容性.③于术前,术后2,8,24周时采用日本骨科协会评分系统分为上肢运动功能(4分)、下肢运动功能(4分)、感觉(6分)、膀胱功能(3分)进行评估,分数越高表示功能越好.术后进行查体和颈椎正侧位X射线片及MRI检查.结果:多节段脊髓型颈椎病患者38例均进入结果分析.38例患者在术后数天内均感到神经症状有明显改善,下肢肌力增加,肢体较术前轻松灵活,且伴有双上肢感觉异常好转.JOA评分由术前(9.25±1.85)分,提高到术后2周(12.4±2.08)分、术后8周13.2±2.07分、术后24周(13.8±1.67)分.结论:多节段间盘切除Cage植入可明显改善多节段脊髓型颈椎病患者运动感觉功能、减轻症状.%AIM: Anterior cervical discectomy and Cage bone graft fusion followed by steel plate internal fixation can decompress the vertebral canal and

  19. Orion锁定型颈椎前路钢板系统的临床应用%Clinical application of Orion anterior cervical locking plate system

    Institute of Scientific and Technical Information of China (English)

    郭澄水; 蒋学金; 陈新良; 韩国华; 孔祥飞

    2001-01-01

    Objective To evaluate the clinical application of Orion anterior cervical locking plate system in cervical injuries and cervical spondylous myelopathy. Methods 3 cervical spinal fractures and 2 cervical spondylous myelopathy were treated by anterior decompression, autografting and Orion plate fixation. Results 5 cases were followed up for 4~12 months. Bone graft was completely fused without complications of broken plate or loosening screw. Conclusion Orion plate can offer cervical stability after anterior decompression and bone grafting. It is easy to apply and suitable for the treatment of cervical fractures with spinal cord injuries.%目的探讨Orion锁定型颈椎前路钢板系统对颈椎骨折和脊髓型颈椎病手术固定的效果。方法对3例颈椎骨折合并高位截瘫和2例脊髓型颈椎病患者施行颈椎前路减压植骨融合及Orion钢板内固定。结果术后随访4~12个月,植骨已完全融合,无钢板断裂、螺钉松动等情况发生。结论 Orion锁定型颈椎前路钢板系统方法简单、容易掌握,内固定牢固,尤其适用于颈椎骨折伴高位截瘫患者的内固定治疗。

  20. [Somatotopic Representation of the Anterior Horn within Cervical Enlargement: Reappraisal of Known Doctrine Based on Clinicopathological Findings Seen in Hirayama Disease].

    Science.gov (United States)

    Hirayama, Keizo

    2016-05-01

    Clinical features (weakness and amyotrophy of intrinsic hand muscles and obliquely distributed amyotrophy of forearm muscles, figure 1), needle electromyographic findings (distribution of neurogenic activities, figure 2), and pathological findings (ischemic necroses of the anterior horns between C6 and T1, figure 3) of Hirayama disease suggest that understanding of somatotopic representation of the anterior horn innervating arm muscles in the cervical enlargement of spinal cord differs from the known doctrine. Anterior horn cells of the intrinsic hand muscles are located between C7 and T1, those of forearm muscles and triceps brachii muscle as elbow extensor are, contrary to the known doctrine, located in C5 and C6, and those of elbow flexors such as biceps brachii and brachioradialis are located in C4 and above (figure 5). Development of dexterity in human hand may reflect development of cervical enlargement in accord with larger areas representing the hand and fingers on cerebral motor cortex.

  1. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-03-01

     Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  2. Biomechanical evaluation on the stability of anterior cervical pedicle screw fixation for osteoporosis%生物力学评价颈椎前路椎弓根螺钉植入骨质疏松椎骨内的稳定性

    Institute of Scientific and Technical Information of China (English)

    李振伟; 向阳明

    2015-01-01

    背景:前路颈椎间盘切除植骨融合是治疗颈椎病的有效术式,该术式能够提供坚强固定且植骨融合率相对较高。但是,对于2个节段以上同时受累的颈椎,由于植骨跨度较大,内固定和植骨块稳定性较差,容易产生植骨融合失败、假关节形成等并发症,影响疗效。  目的:观察颈椎前路椎弓根螺钉植入骨质疏松椎骨内的生物力学稳定性。  方法:纳入12具人颈椎骨,包括6具骨密度正常颈椎骨和6具骨质疏松颈椎骨,共60个椎骨标本资料进行分析,将30个骨质疏松椎骨标本植入颈椎前路椎弓根螺钉设为颈椎前路椎弓根螺钉组,将30个骨密度正常椎骨标本植入前路椎体螺钉设为前路椎体螺钉组。从上述两组中根据骨密度值抽取40个椎骨,分别设置为即时正常骨密度组、即时骨密度疏松组、疲劳正常骨密度组以及疲劳骨质疏松组,每组10个椎骨。采用双能X射线骨密度仪测定各椎体骨密度值,采用ElectroForce 3510材料试验机对两种螺钉进行生物力学指标测试。结果与结论:颈椎前路椎弓根螺钉组骨矿盐含量、椎体螺钉拔出力、椎体螺钉拔出刚度、椎弓根螺钉拔出力、椎弓根螺钉拔出刚度均显著高于前路椎体螺钉组(P<0.05)。颈椎前路椎弓根螺钉即时正常骨密度标本最大轴向拔出力、即时骨质疏松标本最大轴向拔出力、疲劳正常骨密度标本最大轴向拔出力、疲劳骨质疏松标本最大轴向拔出力均显著高于高于前路椎体螺钉(P<0.05)。结果证实,与颈椎前路椎体螺钉相比,颈椎前路椎弓根螺钉在骨质疏松椎骨内生物力学性能更加稳定。%BACKGROUND:Anterior cervical discectomy and bone graft fusion are effective method to treat cervical spondylosis. This method can provide firm fixation and the fusion rate is high. However, for cervical vertebra involved in more than two

  3. 两种颈前路减压重建术治疗多节段脊髓型颈椎病的疗效比较%Two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    李会明; 夏刚; 田融

    2016-01-01

    目的 探讨两种颈椎前路减压重建术治疗多节段脊髓型颈椎病的临床疗效.方法 我院2009至2013年采用颈椎前路单节段间盘切除、椎间融合器植骨融合钛板内固定术(A组)及颈椎前路椎体次全切除、钛网椎间植骨钛板内固定术(B组)治疗的多节段脊髓型颈椎病患者210例,根据手术方式分为两组,进行疗效分析.结果 术后7d、术后3个月、术后6个月、术后18个月各时间点,A组患者神经功能改善[日本骨科协会(JOA)评分]分别为(12.94±3.82)、(13.95±3.19)、(4.12±3.95)、(14.06±3.85)分和B组(12.73±3.53)、(13.39±3.95)、(14.09±3.53)、(14.11±2.98)分,两组JOA评分均较术前明显改善,两组比较JOA评分的差异无统计学意义(P>0.05);两组患者术后椎间隙高度比较差异无统计学意义(P>0.05),A组颈椎生理曲度深度(弧弦距)分别为(9.11±2.34)、(9.36±1.88)、(9.89±2.46)、(9.61±1.62) mm和B组(7.57±0.78)、(7.76±0.91)、(7.21±0.33)、(7.36±0.79) mm,A组均大于B组,A组植骨融合率为96.3%,B组为89.0%,A组高于B组.结论 两组术后神经功能恢复较好,两组术后均能保持椎间隙高度;但椎间融合器植骨融合率较钛网椎间植骨融合率高,而且椎间融合器组与钛网组比较能较好的维持颈椎生理曲度.%Objective To investigate the clinical curative effect of two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy.Methods In our hospital from 2009 to 2013 the anterior cervical single segmental discectomy,interbody bone graft fusion and titanium plate internal fixation (group A),and anterior cervical subtotal resection,titanium mesh cage bone and titanium plate internal fixation (group B) were used in 210 patients with multilevel cervical spondylotic cervical spondylosis.The efficacy was evaluated.Results On the 7th day,3rd month,6th month,and 18th month after the surgery,the scores of

  4. Cervicitis

    Science.gov (United States)

    ... much growth of normal bacteria in the vagina (bacterial vaginosis) can also cause cervicitis. ... under a microscope (may show candidiasis , trichomoniasis , or bacterial vaginosis) Pap test Tests for gonorrhea or chlamydia Rarely, ...

  5. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach.

    Science.gov (United States)

    Loret, Jean-Edouard; Francois, Patrick; Papagiannaki, Chrysanthi; Cottier, Jean-Philippe; Terrier, Louis-Marie; Zemmoura, Ilyess

    2013-07-01

    We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension.

  6. The role of cervical instability in sympathetic cervical spondylosis%颈椎不稳致交感型颈椎病的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    于泽生; 刘忠军; 党耕町

    2001-01-01

    目的 探讨交感型颈椎病的发病机制及有效的治疗方法。 方法 回顾了1989~1998年应用颈前路间盘切除加植骨融合术治疗的交感型颈椎病患者18例;分析了患者术前及术后颈椎伸、屈侧位X光片。 结果 18例患者术前均有颈椎不稳,不稳定节段为1个者6例,2个者9例,3个者3例;颈椎不稳主要发生于C3~C4和C4~C5,偶见于C5~C6和C6~C7。14例患者术前行颈椎高位硬膜外封闭,11例有效;于不稳定节段行颈前路间盘切除加植骨融合术,18例均获随访,平均随访时间为1年9个月,术后有效率为88.9%。 结论 颈椎不稳定是交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭具有重要的诊断价值;颈前路间盘切除加植骨融合术是治疗交感型颈椎病的有效方法。%Objective To investigate the etiology and treatment ofsympathetic cervical spondylosis. Methods Eighteen patients who underwent anterior cervical discectomy and fusion for sympathetic cervical spondylosis were reviewed retrospectively. Lateral views in flexion and extension of the pre- and postoperative cervical roentgenograms were analyzed to quantify cervical instability. Results Cervical instability was found at one level in 6 patients, two levels in 9 patients, and three levels in 3 patients. Cervical instability mainly took place at C3-C4 and C4-C5, occasionally at C5-C6 or C6-C7. Cervical epidural block was performed in 14 patients and it was effective in 11 patients. Cervical discectomy and fusion at unstable segement was carried out in all 18 patients. The effective rate was 88.9%. Conclusions Cervical instability in the upper cervical spine was an importmant factor in the etiology of sympathetic cervical spondylosis.Cervical epidural block may provide diagnostic information. Anterior cervical discectomy and fusion are effective to treat sympathetic cervical spondylosis.

  7. [Forestier-Rotes-Querol's disease. Ossification of the anterior cervical longitudinal ligament as a cause of dysphagia].

    Science.gov (United States)

    Alcázar, L; Jerez, P; Gómez-Angulo, J C; Tamarit, M; Navarro, R; Ortega, J M; Aragonés, P; Salazar, F; Del Pozo, J M

    2008-08-01

    Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology. It produces calcificationossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness). Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued.

  8. 下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性%Biomechanical stability of the lower cervical spine inter-fixation by anterior approach combined with posterior articular screws

    Institute of Scientific and Technical Information of China (English)

    康建平; 冯大雄; 王清; 钟德君; 李骏; 叶飞; 王松

    2011-01-01

    BACKGROUND: A simple anterior corpectomy or discectomy, or simple posterior open canal to expand a single trip cannot fully complete three-column spinal cord decompression and spinal stabilization in patients with degenerative cervical stenosis.OBJECTIVE: To study the biomechanical stability of the lower cervical spine inter-fixation by anterior approach combined with posterior srticular screws.METHODS: Ten cervical spine specimens were gained from cadavers. Every specimen was managed via two methods sequentially: The first method was by posterior C3-C7 open-door laminoplasty combined with posterior articular screw fixation andby anterior C5 subtotal corpectomy with bone granule graft in the titanium mesh and ORION fixation (test group); The second method was by posterior C3-C7 open-door laminoplasty and by anterior C5 subtotal corpectomy with bone granule graft in thetitanium mesh and ORION fixation (control group).RESULTS AND CONCLUSION: Compared with the control group, displacement angles of flexion, extension, left/right lateroflexion left/right rotation in the test group were lower (P < 0.001). The findings indicated that: ①The lower spine gained the excellent biomechanical stability in flexion, extension, lateroflexion and rotation via the treatment of anterior fixation combined posterior articular screw fixation. ②The treatment of anterior fixation combined with posterior articular screw fixation provided significant biomechanical stability to the lower cervi cal spine in flexion position.%背景:对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定.目的:探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性.方法:正常成人尸体颈椎标本,每具分别制作以下两种模型:①经后路C3~C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定

  9. Adjacent segment disease after anterior cervical decompression and fusion: analysis of risk factors on X-ray and magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    Zhao Yanbin; Sun Yu; Zhou Feifei; Wang Shaobo; Zhang Fengshan; Pan Shengfa

    2014-01-01

    Background Adjacent segment disease (ASD) is common after cervical fusion.The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).Methods Patients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion.A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments.Plate-to-disc distances (PDDs),developmental cervical canal stenosis on X-ray,cervical disc degeneration grading,and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.Results Thirty-four patients with complete radiographic data were included in the ASD group.The causative segments of ASD included nine cases of C3-4,18 cases of C4-5,three cases of C5-6,and four cases of C6-7.The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients.PDD distributions were similar between the ASD group and the control group.Developmental cervical canal stenosis was a risk factor for ASD,with an odd ratio value of 2.88.Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group.In the upper-level ASD group,the disc bulge impingement was (19.7±9.7)%,which was significantly higher than that of the control group of (11.8±4.8)%.Conclusions ASD was more likely to develop above the index level of fusion.Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.

  10. 颈椎前路手术20例并发症治疗分析%Treatment for Surgical Complications of Anterior Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    郑军; 杨效宁; 曹雷

    2011-01-01

    Objective To investigate the reasons of and prevention for surgical complications of anterior cervical spine. Methods The clinical data of 20 patients with surgical complications in 201 patients who underwent anterior cervical surgery from May 2000 to May 2009 were analyzed retrospectively. Results The patients with complications were followed up for 3 months to 10 years with an average of 5. 5 years. The rate of 11 patients with short-term complications was 15%, and the rate of nine patients with long-term complications was 4. 48%. Conclusion The key of a successful surgery for anterior cervical spine inludes full realization of type of cervical spinal cord injury, careful evaluation of the patient's general condition, skilled operation, and good post-operative care.%目的 探讨颈椎手术并发症原因及预防措施,以提高手术成功率.方法 对2000年5月-2009年5月实施颈椎前路手术的脊髓型颈椎病患者201例中20例发生并发症患者的临床资料及随访情况进行回顾性分析.结果 20例并发症患者获得随访时间3个月~10年,平均5.5年.近期并发症11例,发生率5.47%;远期并发症9例,发生率4.48%.结果 充分认识脊髓的损伤类型,仔细评估患者的全身情况,熟练的手术操作,良好的术后护理是手术成功的关键.

  11. Estudo experimental da influência da altura do enxerto ósseo intersomático na estabilidade da fixação monossegmentar anterior da coluna cervical Experimental study of the impact of intersomatic bone graft height on the stability of anterior monosegmental fixation of the cervical spine

    Directory of Open Access Journals (Sweden)

    Jorge Alfredo Léo

    2008-06-01

    Full Text Available OBJETIVO: Estudar experimentalmente a influência da altura do enxerto ósseo intersomático da coluna cervical na estabilidade mecânica da fixação cervical anterior. MÉTODOS: Foram realizados ensaios mecânicos utilizando a coluna cervical de suínos (C3-C4. Foram formados três grupos experimentais compostos por 20 segmentos da coluna cervical (C3-C4, de acordo com o grau de instabilidade produzido e a fixação do segmento vertebral. Grupo I: retirada do disco intervertebral e colocação de enxerto intersomático. Grupo II: retirada do disco intervertebral, colocação de enxerto intersomático e fixação anterior com placa. Grupo III: retirada do disco intervertebral, secção dos ligamentos posteriores e cápsulas articulares bilateralmente, colocação do enxerto intersomático e fixação anterior com placa. Cada grupo experimental foi dividido em dois subgrupos, de acordo com a altura do enxerto ósseo utilizado (3,0mm ou 6,0mm. Os segmentos vertebrais foram submetidos a ensaios mecânicos de flexão, flexão lateral e torção em máquina universal de ensaio. Os parâmetros analisados foram força máxima (N e o momento (Nm para produzir uma deflexão preestabelecida. RESULTADOS: Não foi observada em todos os grupos experimentais diferença estatística dos valores da força máxima (N e do momento (Nm, entre as diferentes alturas (3,0mm e 6,0mm do enxerto ósseo intersomático. Conclusões: A estabilidade mecânica imediata da artrodese cervical monossegmentar anterior não sofreu influência da altura do enxerto ósseo intersomático nos ensaios de flexão, flexão lateral e torção.OBJECTIVE: To perform an experimental study of the impact of intersomatic bone graft height of the cervical spine on the mechanical stability of anterior cervical fixation. METHODS: Mechanical assays were performed using swine cervical spine (C3-C4. Three experimental groups were formed with 20 cervical spine segments (C3-C4 according to the degree

  12. Resultados clínicos e radiológicos en serie de artrodesis cervical anterior con caja de fusión intersomática y placa Resultados clínicos e radiológicos em série de artrodese cervical anterior com dispositivo de fusão intersomática e placa Clinical and radiologica outcomes in series of anterior cervical fusion with intersomatic cage and plate

    Directory of Open Access Journals (Sweden)

    Lyonel Beaulieu Lalanne

    2012-06-01

    Full Text Available OBJETIVOS: Analizar los resultados clínicos e radiológicos de una serie de pacientes sometidos a artrodesis cervical anterior con caja de fusión intersomática (CAGE y placa. MÉTODOS: Análisis retrospectivo de serie de pacientes sometidos a artrodesis cervical anterior con caja de fusión intersomática y placa entre los años 2004 y 2009. Revisión de fichas clínicas y radiografías, registro de edad, sexo, diagnósticos, nivel operado, complicaciones, evolución clínica y radiológica. Técnica quirúrgica de Smith-Robinson. Las cajas de fusión intersomática fueron llenadas con sustitutos de huesos. Deambulación 12 horas después de la cirugía, alta a las 48 horas, collar cervical intermitente por 2 semanas. Evaluación clínica mediante criterios de Odom. Seguimiento 17 a 78 meses. RESULTADOS: Diagnósticos: Hernia del núcleo pulposo (HNP cervical, 44 (71%, mielopatía, 11 (17,7%, fracturas, 7 (11,3%. Nivel 1: 44 (71%, Nivel 2: 15 (24,2%, Nivel 3: (4,8%. El nivel C5-C6 incluyó 92% de los casos. Alivio del dolor radicular: 60 (97%. Recuperación del déficit neurológico: 59 (95,2%. Alivio de la mielopatía: 8/11 pacientes (73%. Alivio del dolor cervical: 56 (90%. Resultados clínicos: 91,9% excelentes y buenos. Complicaciones (12,9%: 4 disfagias transitorias (6,5%, 1 disfagia permanente (1,6%, 2 disfonías transitorias (3,3%, 1 subcidencia con aflojamiento del implante y fractura asintomática de placa (1,6%. No hubo pseudoartrosis. CONCLUSIONES: Esta serie presenta buenos resultados clínicos, com alivio del dolor y recuperación neurológica comparables con los hallazgos en la literatura. El uso de la caja de fusión intersomática evita complicaciones de la zona dadora y, cuando es asociado a placa cervical anterior permite fijación intersomática inmediata, dando soporte estructural adecuado, con buenos resultados y sin complicaciones a largo plazo.OBJETIVOS: Analisar os resultados clínicos e radiológicos de uma série de

  13. Influência do macheamento do orifício piloto nos parafusos cervicais anteriores Influencia del taladramiento del agujero piloto en tornillos cervicales anteriores Influence of tapping the pilot hole in anterior cervical screws

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    Patrícia Silva

    2013-01-01

    Full Text Available OBJETIVO: Analisar experimentalmente a influência do macheamento do orifício piloto nas propriedades mecânicas e na interface osso-implante do parafuso cervical anterior. MÉTODOS: Oito carneiros da raça Santa Inês deslanados foram utilizados no estudo. Nos segmentos vertebrais cervicais de C2-C7 foram realizados orifícios piloto de 2,5mm, de ambos os lados da vértebra. No lado direto da vértebra foi realizado o macheamento previamente a inserção do parafuso cortical de 3,5mm, e no lado esquerdo o implante foi colocado sem o macheamento do orifício piloto. Foram realizados ensaios mecânicos para avaliar a força de arrancamento dos implantes e estudo histomorfométrico da interface osso-implante na fase aguda e oito semanas após a colocação dos implantes. O torque de inserção foi mensurado durante a colocação dos implantes. RESULTADOS: O torque de inserção e a resistência ao arrancamento dos implantes foram maiores nos implantes colocados sem o macheamento do orifício piloto. A interface osso-implante apresentou maior área de contato ósseo e maior área óssea no interior da rosca do implante nos parafusos implantados sem o macheamento prévio. Não foi observado diferença na área óssea fora do passo de rosca do implante. CONCLUSÕES: O macheamento do orifício piloto reduz o torque de inserção e a resistência ao arrancamento do implante na fase aguda e crônica, e reduz a área de contato osso-implante e área de osso no interior do passo de rosca.OBJETIVO: Para estudiar experimentalmente la influencia del taladramiento del agujero piloto sobre las propiedades mecánicas y la interfaz hueso-implante del tornillo cervical anterior. MÉTODOS: Ocho ovejas Santa Ines fueron utilizadas en el estudio. En los segmentos vertebrales cervicales C2-C7 se hicieron agujeros pilotos de 2,5 mm en ambos lados de la vértebra. En el lado derecho de la vértebra el taladramiento se hizo antes de la inserción del tornillo cortical

  14. Anterior cervical locking plate combined with bone graft for cervical vertebral fractures%颈前路带锁钢板联合植骨手术治疗颈椎骨折

    Institute of Scientific and Technical Information of China (English)

    王家明

    2011-01-01

    目的探讨和评价颈前路带锁钢板联合钛网植骨治疗颈椎损伤的应用价值。方法自2003年6月至2009年5月经住院手术的13例颈椎骨折的患者行颈椎前路椎体次全切除术减压,同时带锁钢板内固定联合钛网植骨或自体髂骨植骨融合。结果全部病例得到随访,平均18个月,内固定牢靠无松脱,植骨融合,椎体高度无丢失。结论颈前路带锁钢板联合钛网植骨可即刻恢复节段高度,重建节段稳定性,手术操作简单,并发症少,解决了颈椎损伤重建的难题。%Objective To evaluate the efficacy of anterior cervical locking plate combined with bone graft for cervical vertebral fractures. Methods Totally 13 patients with cervical vertebral fracture hospitalized from June 2003 to May 2009 were treated with internal fixation of steel plate combined with fusion of titanium mesh or iliac bone autograft after the resection of anterior cervical vertebra. Results All cases were followed up for an average of 18 months. The internal fixation was stable, the bone graft fusion was well and the height of vertebra body was close to normal. Conclusion The operation can be used to recover the height and stability of vertebra body. It is an easy operation with few complications and it is conducive to the reconstruction of injured cervical vertebra.

  15. Descrição de técnica de redução cirúrgica das luxações facetárias da coluna cervical baixa por via anterior Descripción de la técnica quirúrgica para reducción de las luxaciones facetarias de la columna cervical baja por acceso anterior Description of surgical technique for reduction of facet dislocations of the lower cervical spine by anterior approach

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    André Rafael Hübner

    2012-12-01

    Full Text Available O trabalho descreve uma técnica cirúrgica de redução anterior das luxações facetárias da coluna cervical e discute as indicações para cirurgia por via anterior para as luxações da coluna cervical baixa. A técnica descrita neste artigo oferece excelentes resultados, conforme revisão bibliográfica e dos resultados do Serviço, tendo sido aplicada em até 95% dos casos de fraturas-luxações. Não será abordada a apresentação de resultados neste trabalho, apenas a descrição e discussão da técnica aberta por via anterior. Observações de quarenta e um pacientes tratados nos últimos dez anos por esta técnica demonstram bons resultados quanto a pós-operatório menos doloroso, recuperação funcional extremamente rápida e complicações pouco frequentes.El artículo describe una técnica quirúrgica para las luxaciones facetarias de la columna cervical y discute las indicaciones para la cirugía de luxación de la columna cervical baja por lo acceso anterior. La técnica descrita en este artículo proporciona excelentes resultados según la revisión de la literatura y los resultados del Servicio, después de haber sido aplicado a 95% de los casos de fracturas-luxaciones. No serán abordados resultados, sino que únicamente la descripción y discusión de la técnica de reducción abierta por acceso vía anterior. Las observaciones en cuarenta y un pacientes operados en los últimos diez años por esta técnica muestran resultados sorprendentes con respecto a un pos operatorio menos doloroso, con recuperación funcional extremadamente rápida y complicaciones menos frecuentes.This paper describes a surgical technique for anterior reduction of the spinal facets dislocations and discusses its indications for surgery of lower cervical dislocations by anterior approach. The technique described in this article provides excellent results according to literature review and the results of the Service, having been applied to 95% of

  16. Research progress on Hybrid surgery treating multilevel cervical degenerative disc diseases%Hybrid术式治疗多节段颈椎退行性疾病的研究进展

    Institute of Scientific and Technical Information of China (English)

    张耐洋(综述); 彭宝淦(审校)

    2016-01-01

    Nowdays, anterior cervical discectomy and fusion (ACDF) and cervical artificial disc replacement (CADR) are the most accepted procedure to treat multilevel cervical degenerative disc diseases. However, ACDF reduces the motion of the cervical spine and accelerates adjacent level degeneration. Strict indications and hyper-mobility of the operative levels may limit the application of multilevel CADR. Some experts put forward the method of Hybrid surgery incorporating ACDF and CADR. The purpose of this study is to review the progress of Hybrid surgery treating multilevel cervical degenerative disc diseases.%目前对于多节段颈椎退变性疾病的治疗术式中以颈前路减压植骨融合内固定术(anterior cervical discectomy and fusion,ACDF)和颈椎间盘置换术(cervical artificial disc replacement,CADR)为主,然而ACDF消除了颈椎融合节段的活动度,加速了颈椎临近节段的退变;CADR的适应证狭窄并且手术节段的活动度不理想。所以有学者提出在治疗多节段颈椎退行性疾病中将ACDF和CADR结合起来即Hybrid术式,笔者就目前Hybrid术式治疗多节段颈椎退行性疾病的研究进展做一综述。

  17. Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS insertion: an in vitro study.

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    Maoqing Fu

    Full Text Available BACKGROUND: With the properties of three-column fixation and anterior-approach-only procedure, anterior transpedicular screw (ATPS is ideal for severe multilevel traumatic cervical instabilities. However, the accurate insertion of ATPS remains challenging. Here we constructed a patient-specific biocompatible drill template and evaluated its accuracy in assisting ATPS insertion. METHODS: After ethical approval, 24 formalin-preserved cervical vertebrae (C2-C7 were CT scanned. 3D reconstruction models of cervical vertebra were obtained with 2-mm-diameter virtual pin tracts at the central pedicles. The 3D models were used for rapid prototyping (RP printing. A 2-mm-diameter Kirschner wire was then inserted into the pin tract of the RP model before polymethylmethacrylate was used to construct the patient-specific biocompatible drill template. After removal of the anterior soft tissue, a 2-mm-diameter Kirschner wire was inserted into the cervical pedicle with the assistance of drill template. Cadaveric cervical spines with pin tracts were subsequently scanned using the same CT scanner. A 3D reconstruction was performed of the scanned spines to get 3D models of the vertebrae containing the actual pin tracts. The deviations were calculated between 3D models with virtual and actual pin tracts at the middle point of the cervical pedicle. 3D models of 3.5 mm-diameter screws were used in simulated insertion to grade the screw positions. FINDINGS: The patient-specific biocompatible drill template was constructed to assist ATPS insertion successfully. There were no significant differences between medial/lateral deviations (P = 0.797 or between superior/inferior deviations (P = 0.741. The absolute deviation values were 0.82±0.75 mm and 1.10±0.96 mm in axial and sagittal planes, respectively. In the simulated insertion, the screws in non-critical position were 44/48 (91.7%. CONCLUSIONS: The patient-specific drill template is biocompatible, easy

  18. White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF: A “no reflow phenomenon”?

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    Giuseppe Roberto Giammalva

    2017-03-01

    Conclusions: Despite the pathophysiology of non-reflow phenomenon is not widely known, we suspect that an improper blood flow after the double-level discectomy could have led to the changes in medullar hemodynamics.

  19. Artificial cervical vertebra and intervertebral complex replacement through the anterior approach in animal model: a biomechanical and in vivo evaluation of a successful goat model.

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    Jie Qin

    Full Text Available This was an in vitro and in vivo study to develop a novel artificial cervical vertebra and intervertebral complex (ACVC joint in a goat model to provide a new method for treating degenerative disc disease in the cervical spine. The objectives of this study were to test the safety, validity, and effectiveness of ACVC by goat model and to provide preclinical data for a clinical trial in humans in future. We designed the ACVC based on the radiological and anatomical data on goat and human cervical spines, established an animal model by implanting the ACVC into goat cervical spines in vitro prior to in vivo implantation through the anterior approach, and evaluated clinical, radiological, biomechanical parameters after implantation. The X-ray radiological data revealed similarities between goat and human intervertebral angles at the levels of C2-3, C3-4, and C4-5, and between goat and human lordosis angles at the levels of C3-4 and C4-5. In the in vivo implantation, the goats successfully endured the entire experimental procedure and recovered well after the surgery. The radiological results showed that there was no dislocation of the ACVC and that the ACVC successfully restored the intervertebral disc height after the surgery. The biomechanical data showed that there was no significant difference in range of motion (ROM or neural zone (NZ between the control group and the ACVC group in flexion-extension and lateral bending before or after the fatigue test. The ROM and NZ of the ACVC group were greater than those of the control group for rotation. In conclusion, the goat provides an excellent animal model for the biomechanical study of the cervical spine. The ACVC is able to provide instant stability after surgery and to preserve normal motion in the cervical spine.

  20. Impact of graft height on zygapophyseal joint pressure and range of motion adjacent to segment following cervical anterior fusion%颈椎前路融合术中植骨块的高度对邻近节段关节突压力及椎间位移的影响

    Institute of Scientific and Technical Information of China (English)

    罗春山; 欧阳北平; 梁栋柱; 陆廷盛; 姚书耽; 赵国权

    2016-01-01

    Objective To discuss impact of graft height on zygapophyseal joint pressure and range of motion of adjacent segments following the cervical anterior fusion and to guide the choice of optimal graft height in clinic. Methods Eight fresh-frozen human cadaveric cervical spines were used in this series, specimens were tested in five conditions, normal(specimens with intact discs)and different graft height(120%, 140%,160%of mean height) after Smith-Robinson discectomy between the fifth and sixth cervical vertebrae. Each specimens were subjected to flexion-extension. Lateral bending and axial rotation in material test system (BOSE ELECTROFORCE) were adopted to measure zygapophyseal joint pressure and rotation of the fourth to fifth segments and the sixth to seventh segments. Finally, The data for each state was used to determine the statistical significance of differences. Results The height of bone graft had little effect on the zygapophysial joints pressure values in neutral position with no statistical significance noted among each groups(P>0.05); The zygapophysial joints pressure value was the highest increase in extension position,but 120%M increased minimum of zygapophysial joints pressure value, and statistical significance were noted among each groups(P0.05), and statistical significance were noted in others groups(P0.05). Conclusion The appropriate graft height after single discectomy may be 120%mean height.%目的:探讨颈椎前路融合术中植骨块的高度对邻近节段关节突压力及活动度的影响,为临床上选择适宜的植骨高度提供依据。方法采用8例新鲜成人尸体颈椎标本,对完整状态,C5/6节段椎间隙减压术后(100%M、120%M、140%M、160%M)5组,于BOSE机加载下行三维运动,并测量颈C4/5,C6/7关节突压力值及C4/5,C6/7三维运动范围;最后将结果行多重比较分析。结果中立位状态下,关节突压力值各组无显著差异,P>0.05;后伸状态下,关节突压力

  1. Adjacent segment degeneration after single-level anterior cervical decompression and fusion: disc space distraction and its impact on clinical outcomes.

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    Li, Jia; Li, Yongqian; Kong, Fanlong; Zhang, Di; Zhang, Yingze; Shen, Yong

    2015-03-01

    The purpose of this study was to find whether excessive distraction of the disc space for cage insertion was a risk factor for adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). One hundred and sixteen consecutive patients who underwent ACDF for single-level cervical disc herniation between June 2006 and November 2008 were retrospectively reviewed. Preoperative, postoperative and final follow-up disc height (DH), sagittal segmental alignment (SSA), and sagittal alignment of the cervical spine (SACS) were measured and compared between the ASD group and non-ASD group. In 116 patients, ASD was radiographically proven in 28 (24.1%) patients. The clinical outcomes were significantly improved compared to the preoperative scores in both groups. However, the postoperative and final follow-up DH of the ASD group were significantly higher than in the non-ASD group (p<0.05). In addition, the postoperative DH was significantly correlated with the postoperative or final follow-up SSA (p<0.05). However, postoperative DH was not found to significantly correlate with postoperative or final follow-up SACS (p=0.072 and p=0.096, respectively). Multivariate analysis showed that postoperative DH was the most significant risk factor for ASD. The clinical outcomes of ACDF for single-level degenerative cervical disc disease were satisfactory. Postoperative DH (the distracted distance) had the greatest impact on the incidence of ASD. Excessive disc space distraction is a considerable risk factor for the development of radiographic ASD.

  2. Clinical application of integrated anterior cervical plate cage benezech implant%颈椎前路一体化钢板融合器的临床应用

    Institute of Scientific and Technical Information of China (English)

    李晓林; 朱丹杰; 金永明; 杨迪; 陈锦平

    2008-01-01

    目的 评价颈椎前路一体化钢板融合器治疗颈椎间盘突出症的长期疗效. 方法 对54例症状性退行性颈椎间盘突出症和急性颈椎间盘突出症患者行前路椎间盘切除减压一体化钢板融合器置入术.术后行日本脊柱学会(JOA)评分,X线片观察融合情况.随访12~79个月,甲均53.2个月.结果 所有患者术中无并发症发生.随访显示椎间隙高度和脊柱前凸已恢复,无器械断裂、远期不稳定或假关节形成.1例急性椎间盘突出脊髓部分损伤患者和3例症状严重脊髓型椎间盘突出患者症状改善不明显,其余患者治疗效果良好.术后JOA评分为13~17分,平均16.1分,术后改善率为86.7%,融合率100%. 结论 颈椎前路一体化钢板融合器治疗颈椎间盘突出症有其生物力学优势,是颈椎前路融合固定一项可靠的技术.%Objective To evaluate the long term effect of the integrated anterior cervical plate cage benezech (PCB) implant in treatment of cervical intervertebral disc protrusion. Methods A total of 54 patients with retrogressive and acute cervical intervertebral disc protrusion were treated with anterior decompression and PCB devices of the proper sizes. The results were evaluated by Japanese Orthopaedic Association (JOA) and the fusion rate by X-rays. All patients were followed up for 12-79 months (mean 53.2 months). Results No complication occurred during the operation. The height of intervertebral space and the cervical curvature were regained postoperatively, with no implant breakage, cervical insta-bility or pseudoarticulation. All patients obtained satisfactory outcomes except for one patient with acute spinal cord injury and three with retrogressive cervical intervertebral disc protrusion. The JOA score was 13-17 points (mean 16. 1 points). All patients got fusion, with postoperative improvement rate of 86.7%. Conclusions The integrated anterior cervical PCB implant has the superiority over other im-plants in

  3. Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused.

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    Shunzhi Yu

    Full Text Available OBJECTIVE: The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. METHODS: A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients, the 3-level group (98 patients and the 4-level group (44 patients. The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA score, Neck Disability Index (NDI score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM, and complications were compared. RESULTS: At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05, and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05. The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05. CONCLUSIONS: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.

  4. Posterior endoscopic discectomy: Results in 300 patients

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    Mohinder Kaushal

    2012-01-01

    Full Text Available Background: Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system. Materials and Methods: A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab′s criteria after a minimum followup of 12 months and maximum up to 24 months. Results: Based on modified Macnab′s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months. Conclusion: Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.

  5. Cervical facet dislocation adjacent to the fused motion segment

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    Kunio Yokoyama

    2016-01-01

    Full Text Available This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B. Cervical computed tomography (CT indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D. In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.

  6. Cervical facet dislocation adjacent to the fused motion segment.

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.

  7. Anatomia microcirúrgica do nervo laríngeo recorrente: aplicações no acesso cirúrgico anterior à coluna cervical Microsurgical anatomy of the recurrent laryngeal nerve: applications on the anterior approach to the cervical spine

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    Aluízio Arantes

    2004-09-01

    Full Text Available OBJETIVO: Descrever a anatomia do nervo laríngeo recorrente (NLR bilateralmente, correlacionando-a com os prováveis mecanismos de lesão na abordagem cervical anterior. MÉTODO: Foram examinados 12 cadáveres de adultos provenientes do Laboratório de Microcirurgia da Faculdade de Medicina da UFMG. Os dados foram analisados em termos de freqüência, média e desvio-padrão. RESULTADOS: O NLR esquerdo teve comprimento total médio de 9,4 ± 1,6 cm. Penetra na laringe em 36,3% dos casos na altura de C5, 18,2% de C4, 18,2% de C5-C6, 18,2% de C6 e 9,1% de C4-C5. Recorre em 45,4% dos casos na altura de T3, 18,2% de T3-T4, 18,2% de T4 e 18,2% de T5. O NLR direito teve comprimento total médio de 5 ± 0,3 cm. Penetra na laringe em 44,4% dos casos na altura de C5, em 44,4% de C6 e 11,1% de C3-C4. Recorre em 60% dos casos na altura de T1, 30% de C7 e 10% de T2. CONCLUSÃO: O NLR direito encontra-se mais vulnerável a lesões operatórias por dois aspectos diferentes e complementares: trajetória e comprimento. Devido ao fato de apresentar trajetória mais oblíqua e desprotegida, não se relacionando de forma íntima com o sulco traqueoesofágico, existe maior possibilidade de ocorrerem traumas diretos, como a compressão por retratores ou a secção acidental, principalmente nas abordagens envolvendo níveis vertebrais mais baixos. Da mesma forma, o seu menor comprimento favorece o estiramento de suas fibras durante a tração per-operatória.OBJECTIVE: To present an anatomical description of the recurrent laryngeal nerve (RLN on both sides of the larynx as it relates to the possible lesion mechanisms in anterior cervical spine surgery. METHOD: Twelve adult cadavers were examined from the microsurgical laboratory at the School of Medicine at UFMG, MG, Brazil. The data collected were analyzed in terms of frequency, average and standard deviation. RESULTS: The left RLN had a total average length of 9.4 ± 1.6 cm entering the larynx in 36.3% of the

  8. MRI after successful lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Kelft, E. van de [Department of Neurosurgery, University of Antwerp, Edegem (Belgium); Biltjes, I.G.G.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hasselt, B.A.A.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hauwe, L. van den [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Parizel, P.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Schepper, A.M.A. de [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium)

    1996-05-01

    Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs.

  9. Treatment of self-locking stand-alone anterior cervical interbody fusion for patients with single level cervical spondylotic myelopathy%自锁式颈椎前路椎间融合治疗单间隙脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    徐灿华; 吴增晖; 张清顺; 刘才俊

    2013-01-01

    目的:探讨自锁式颈椎前路椎间融合器治疗单椎间隙脊髓型颈椎病(CSM)的近期临床疗效。方法2010年3月至2011年12月广州军区广州总医院采用颈椎前路椎间盘髓核摘除、减压、自锁式椎间融合器植骨融合术治疗单间隙CSM患者39例,其中C3/410例、C4/517例、C5/612例。记录手术时间、术中失血量、住院时间及并发症发生情况;评估术前及术后3、6、12个月患者视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分;同时测量手术前后融合节段Cobb角和椎间隙高度,判断椎间稳定性。结果手术时间(50±10)min,术中失血量(30±5)mL,住院时间(4.9±1.2)d,术后均未发现吞咽困难、伤口血肿、呼吸困难等并发症。39例患者获得随访,随访时间13~26个月(平均17.5个月)。术后3、6、12个月VAS评分、JOA评分、Cobb角及椎间高度均优于术前,差异有统计学意义(P<0.05)。按VAS评估标准,术后12个月随访时优27例、良10例、可2例,优良率95%(37/39);按JOA评分标准,术后12个月随访时优21例、良15例、可3例,优良率92%(36/39)。随访过程中未发现融合器移位、下沉、断裂,术后12个月颈椎过屈过伸位X线片判断椎间稳定率100%。结论自锁式颈椎前路椎间融合器具有良好的力学稳定性,可有效恢复颈椎生理曲度和椎间隙高度,治疗单间隙CSM具有手术创伤小、操作简单、并发症少、住院时间短等优点,椎管减压效果确切,临床症状获得有效改善。%Objective To explore short-term clinical efficacy of self-locking stand-alone anterior cervical interbody fusion (ACIF) cage for the treatment of single level cervical spondylotic myelopathy (CSM). Methods From March 2010 to December 2011, 39 patients with single level CSM (C3/4 in 10 cases, C4/5 in 17 cases and C5/6 in 12 cases) were performed anterior cervical discectomy

  10. Anterior subaxial cervical spine fixation using a plate with single screw per vertebral body: A simple and efficient construct - Clinical series and a cadaver study

    Directory of Open Access Journals (Sweden)

    Vannemreddy Prasad

    2009-01-01

    Full Text Available Objective: To report our experience with a novel construct for traumatic and nontraumatic cervical spine lesions that was validated by biomechanical studies of cadaver cervical spine. Study Design: Consecutive cases of anterior cervical spine fixation performed over six years reviewed for stability offered by a construct comprising of a plate fixed by a single screw to each vertebral body. Setting: A university hospital and a biomechanical lab. Materials and Methods: Data were coded and entered into a statistical worksheet for multivariate analysis. Cadaver spine models applied for biomechanical study of stability. Results: Total of 103 cases reviewed; 86 with single-level disease; traumatic in 66 (64% cases and degenerative in 33 (32% cases, including hard disks, OPLL, and spondylitis (4% with other causes. Fixation was with diskectomy in 59 and with corpectomy in 40. A bone graft was utilized for fusion in 87 and a bone-filled titanium spacer in 13. A single screw was placed in each vertebral body with a locking plate (having linear arrangement of holes. This construct remained strong in 95% of cases at the end of 6-24 months. Five cases failed requiring reoperation. Five patients with cervical spinal cord injury (SCI died. On statistical analysis, construct was stronger with diskectomy compared with corpectomy. Construct used on cadavers confirmed the biomechanical stability in short segment fixation (C5-6. Conclusion: A conservative construct utilizing a single screw per vertebral body and a one-holed plate system appears to be strong enough to afford stability in both traumatic and nontraumatic lesions of subaxial cervical spine, comparable to others.

  11. Avaliação do tratamento da discopatia degenerativa cervical pela artrodese via anterior utilizando placas associadas a cages ou cages em peek isoladamente Evaluación del tratamiento de la enfermedad degenerativa del disco cervical por la artrodesis anterior utilizando placas asociadas con jaulas o jaulas en peec, aisladamente Evaluation of cervical degenerative disc disease treatment by anterior arthrodesis using plates associated with cages or cages in peek alone

    Directory of Open Access Journals (Sweden)

    André Rafael Hübner

    2011-01-01

    Full Text Available OBJETIVOS: Avaliar comparativamente o tratamento da discopatia degenerativa cervical por discectomia e artrodese cervical via anterior utilizando placas associadas a cages ou cages em PEEK isoladamente. MÉTODOS: Foi realizado um estudo retrospectivo comparativo entre dois grupos de pacientes operados pela técnica de discectomia e artrodese cervical via anterior. Foram selecionados aleatoriamente 70 pacientes, 35 operados com o método de fixação com placas associadas a cages - denominado Grupo I - e 35 com o cage em PEEK isoladamente - Grupo II. Realizou-se anamnese, exame físico, escores de dor (escala visual e analógica da dor e função (critérios de Odom's, SF-36, Indice de incapacidade do pescoço o pré e pós-operatório e exames de imagem. RESULTADOS: Houve predominância de pacientes do sexo feminino em ambos os grupos, com média de idade de 55 anos no Grupo I e 47 no Grupo II. Ambos os grupos apresentaram distribuição semelhante quanto ao número de níveis operados, assim como nas complicações encontradas e escores de dor, cervicalgia e SF36 no pré e pós-operatório. Houve 97.1% de fusão com 94.3% de bons resultados no Grupo I e 100% de fusão, com 97 % de bons resultados no Grupo II. CONCLUSÕES: O estudo comparativo da utilização de placas com cages e cages em PEEK isoladamente apresentou resultados semelhantes e satisfatórios para os grupos estudados, não se constatando superioridade ou inferioridade de um método com relação ao outro.OBJETIVOS: Evaluar comparativamente el tratamiento de la enfermedad degenerativa del disco cervical por discectomía y artrodesis cervical vía anterior, utilizando placas asociadas con el uso de jaulas o estas en PEEK [Poliéster-Éter-Éter-Cetona], aisladamente. MÉTODOS: fue realizado un estudio retrospectivo comparativo de dos grupos de pacientes tratados con la técnica de discectomía y artrodesis cervical vía anterior. Se seleccionaron al azar 70 pacientes, 35 operados

  12. Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimizadeh

    2016-01-01

    Full Text Available The dropped head syndrome (DHS is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient’s neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels.

  13. CT value analysis and clinical significance before and after percutaneous lumbar discectomy

    Institute of Scientific and Technical Information of China (English)

    刘雷; 裴福兴; 宋跃明; 沈彬; 周宗科; 宋文锴; 张聪

    2002-01-01

    To provide theoretical basis for effect and mechanism of percutaneous lumbar discectomy in clinic. Methods: A total of 180 patients with lumbar intervertebral disc herniation were evaluated by CT on the fifth day before and after operation. Meanwhile, CT value was measured in the determined level and region. Results: After operation, CT value of the central and posterior determined point of herniated intervertebral disc was lower significantly than that before operation (P<0.01), but CT value of the anterior determined point was different insignificantly. The excellent and good results of the patients together were 83% postoperatively. Conclusions: The curative effect of percutaneous lumbar discectomy is achieved through reduction of lumbar intradiscal pressure.

  14. Cervicoplastia anterior Anterior cervicoplasty

    Directory of Open Access Journals (Sweden)

    Lucas Gomes Patrocínio

    2004-10-01

    Full Text Available Muitos pacientes buscam correção estética da frouxidão da pele do pescoço, depósito de gordura na região submentoneana ou bandas de platisma. Em grande parte dos casos a ação medial, via cervicoplastia anterior é necessária. OBJETIVO: Demonstrar a casuística e avaliar os resultados e complicações com a técnica de cervicoplastia anterior no Serviço de Otorrinolaringologia da Universidade Federal de Uberlândia. FORMA DE ESTUDO: Relato de série. PACIENTES E MÉTODOS: Quarenta e dois pacientes, entre 39 e 65 anos de idade, sendo 40 (95,2% do sexo feminino e 2 (4,8% do masculino, foram submetidos a cervicoplastia anterior. Retrospectivamente foram avaliados resultados e complicações. RESULTADOS: Destes, 34 apresentaram resultados satisfatórios, 4 apresentaram déficit estético notado somente pelo cirurgião, 3 apresentaram déficit estético notado somente pelo paciente e 1 apresentou déficit estético necessitando cirurgia revisional. Ao estudo fotográfico, todos os pacientes apresentaram melhora do perfil cervical, redução das bandas de platisma e da frouxidão da pele, estabilização da musculatura cervical e acentuação do ângulo cervicomental, em graus variados. Houve complicação em 2 casos (discreto serohematoma e cicatriz um pouco alargada. CONCLUSÃO: A cervicoplastia, associada ou não à tração lateral pela ritidoplastia, é uma técnica que produz resultados satisfatórios na grande maioria dos casos.Many patients look for aesthetic correction of the laxity of neck skin, submandibular fat deposit or platisma bands. In a large part of the cases, medial action, through anterior cervicoplasty is necessary. AIM: To demonstrate the casuistic and to evaluate the results and complications with anterior cervicoplasty technique in the Otorhinolaryngology Service of the Federal University of Uberlândia. STUDY DESIGN: Serie report. PATIENTS AND METHODS: Forty-two patients, between 39 and 65 years of age, being 40 (95

  15. Advances in cervical anterior transpedicular screw fixation technique%颈椎前路椎弓根螺钉内固定技术的研究进展

    Institute of Scientific and Technical Information of China (English)

    欧阳钧; 吴卫东

    2013-01-01

    Cervical posterior transpedicular screw technique was first introduced to clinic in 1994. Due to its good biomechanical stability and satisfactory fusion effect,it has become a major solution to some cervical spine diseases.However,most of the diseases involved in vertebral body and posterior transpedicular screw technique is complex and difficult,these factors prevent the technique be widely used in cervical spine surgery.In 2008,a new concept of cervical anterior transpedicular screw fixation technique was first proposed.This new technique inherited advantages of posterior transpedicular screw fixation,and of course,it also overcomes drawbacks of conventional anterior vertebral body screw fixa-tion.This review presents an overview of anterior transpedicular screw fixation technique on anatomical and biomechanical field.%颈椎后路椎弓根螺钉固定技术于1994年首次应用于临床,鉴于其稳定的固定融合效果,已成为多种颈椎疾病的主要治疗手段。然而,由于颈椎病灶的好发部位多位于前部,且颈椎后路椎弓根螺钉操作难度较大,在一定程度上限制了该技术的发展。2008年颈椎前路椎弓根螺钉固定技术的概念被首次提出,此技术继承了后路椎弓根螺钉生物力学性能卓越的优点,且克服传统颈椎前路椎体螺钉稳定性较差的缺点。本文主要就颈椎前路椎弓根螺钉固定技术的解剖学及生物力学研究进展进行综述。

  16. Analysis of cervix and shoulder pain after anterior cervical operation%颈前路术后颈肩痛分析

    Institute of Scientific and Technical Information of China (English)

    杜文君; 孙娟; 田融; 夏英鹏; 田成瑞; 江毅

    2001-01-01

    目的:观察了颈前路植骨融合术后颈肩痛患者的临床表现,对其原因进行了分析。方法:对28例因颈间盘[摘要]目的:观察了颈前路植骨融合术后颈肩痛患者的临床表现,对其原因进行了分析。方法:对28例因颈间盘突出症及颈椎病患者行“颈前路间盘和/或椎体次全切除取髂骨植骨融合术"后颈肩痛患者临床表现进行了分析,并行X-ray、CT及MRI等影像学检查,对其进行总结。结果:本组病例经证实有植骨块移位、植骨块假关节形成、伴发肩周炎及单纯颈托外固定过紧所致。骨块移位及假关节形成者二次手术复位或切除假关节,追加植骨,钢板内固定,肩周炎及卡压所致者对症治疗,效果均十分满意。结论:颈前路间盘和/或椎体次全切除取髂骨植骨融合术时应注意骨块大小、外固定松紧程度及合并症的早期诊断,为预防颈前路术后颈肩痛的关键。%Objective:The clinic of cervix and shoulder pain after anterior cervical operation has been observed, whose causes have been analysised. Methods: 28 patients with cervix and shoulder pain were analyzed who had been operated on anterior operation of cervical intervertibral disc resection and/ or vertebral body subtotal ectomy and implantation with iliac bone and analyzed their x-ray,CT,and MRI .Results:These patients' pain was caused by implanted bone shift, pseudarthrosis formation, supervention of scapulohumeral periarthritis and tenseness of extra-plastic-collar .The implanted bone shift and pseudarthrosis were operated again with reposition and excision, and implanted more bone, interior fixation with steel-board, expectant treatment with scapulthumeral periarthritis and tenseness of extra-plastic-collar were all satisfied .Conclusion: The anterior operation of cervical intervertibral disc resection and/or vertebral body subtotal ectomy and implantation with iliac bone are often applied to

  17. Cone beam computed tomographic evaluation of two access cavity designs and instrumentation on the thickness of peri-cervical dentin in mandibular anterior teeth

    Science.gov (United States)

    Varghese, Vinny Sara; George, John V.; Mathew, Sylvia; Nagaraja, Shruthi; Indiresha, H. N.; Madhu, K. S.

    2016-01-01

    Background and Objectives: The aim of the study was to determine the effect of two access cavity designs on the peri-cervical dentin thickness before and after instrumentation using cone beam computed tomography (CBCT). Materials and Methods: Sixty mandibular anterior teeth were divided into two groups of thirty teeth each: Group I: conventional access cavity preparation, where access was prepared just above the cingulum and Group II: incisal access cavity preparation, where access was prepared in proximity to the incisal edge. CBCT scans were taken preoperatively, following access cavity preparation and post instrumentation. 200 μm thick slices were obtained 4mm apical and coronal to the cemento-enamel junction. The peri-cervical dentin thickness was calculated on the facial, lingual, mesial, and distal for all the three obtained scans. Results: The analysis showed that access cavity preparation and instrumentation resulted in a significant loss of tooth structure in Group I on all surfaces, but in Group II, there was a significant loss of tooth structure only in the mesial, lingual, and distal surfaces (P < 0.05). Conclusion: Incisal access cavity preparation resulted in lesser loss of dentin in the peri-cervical region. PMID:27656065

  18. 颈椎前路锁定钢板治疗颈椎疾病的疗效观察%Effectiveness of Anterior Cervical Locking Plate System in Cervical Surgery

    Institute of Scientific and Technical Information of China (English)

    任云峰; 熊鹰; 赵烽; 张仲子

    2011-01-01

    目的 观察颈椎前路减压、取髂骨植骨结合锁定型钢板系统内固定治疗颈椎疾病的临床疗效.方法 2001年3月至2008年3月采用该方法治疗颈椎疾病34例,并进行12 ~24个月后随访.结果 术前Frankel分级A-D级31例中,25例有1 ~2级的改善,6例无明显改善.植骨块融合良好,无严重并发症发生.结论 该方法具有固定牢靠、植骨融合率高、手术操作简单、手术并发症少等优点,是一种治疗颈椎疾病的良好方法.%Objective To evaluate the effectiveness of anterior decompression, bone grafting combined with locking plate system internal fixation for cervical spinal desease.Methods From March 2001 to March 2008 34 patients were operated with anterior decompression, bone grafting and locking plate system fixation, all the patients were followed up for 12 to 24 months.Results 25 patients of Frankel's A-D were improved by to 2 degree after operation,6 patients had no obvious improvement.There was no plate or screw breaking and loosening; no dislocation of graft bone, all the bones were fusion in 6 months.Conclusion Anterior decompression , bone grafting combined with locking plate system internal fixation can provide reliable stability for the fixation segments with higher bony fusion rate,less complications,and the operation was much simple and safe.It was a good choice for treatment of cervical spinal disease.

  19. 三种颈前路减压术式治疗多节段脊髓型颈椎病的并发症比较%Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    祁敏; 王新伟; 刘洋; 梁磊; 陈华江; 杨立利; 袁文

    2012-01-01

    目的:分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异.方法:回顾性分析2006年1月~2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料,根据手术方式不同分为三组:前路椎间盘切除减压融合术(anterior cervical discectomy with fusion,ACDF) (A组)、前路椎体切除减压融合术(anterior cervical corpectomy with fusion,ACCF)(B组)和ACDF+ACCF“混合式”减压术(C组),其中A组男性69例,女性55例,平均年龄53.48±8.50岁;B组男性51例,女性43例,平均年龄54.36±7.82岁;C组男性61例,女性48例,平均年龄53.68±7.80岁,组间比较无统计学差异.对三种不同手术方式并发症情况进行比较.结果:平均随访时间3.5年(1.5~5年).共有69例在手术后出现多种并发症,包括植骨未融合11例,其中C组3例(2.75%),B组8例(8.51%),B组植骨不愈合发生率显著高于A组和C组(P<0.05);声音嘶哑12例,其中A组5例(4.03%),B组3例(3.19%),C组4例(3.67%);吞咽困难26例,其中A组11例(8.87%),B组7例(7.45%),C组8例(7.34%);C5神经根麻痹12例,其中A组2例(1.61%),B组5例(5.32%),C组5例(4.59%);脑脊液漏5例,其中A组3例,C组2例;切口感染3例,其中B组2例,C组1例.A组患者并发症发生率为16.94%,B组为26.60%,C组为21.10%,B组患者术后并发症的发生率显著高于其余两组(P<0.05).结论:多节段脊髓型颈椎病患者手术治疗中,ACDF的并发症发生率最低,ACCF术式应慎用,其并发症的发生率较高.%Objectives: Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy(CSM). Methods: This study retrospectively reviewed the postoperative complications in 327 patients with three-level CSM in whom the anterior cervical surgery was performed between January 2006 and August 2011. According to the decompression procedure, patients were divided into

  20. 颈椎间盘置换及前路椎间融合治疗单节段颈椎间盘突出症:谁更多影响邻近节段发生退变?%Anterior cervical disc replacement and anterior cervical decompression and fusion for treating single segment cervical disc herniation:which has greater effects on adjacent segment degeneration?

    Institute of Scientific and Technical Information of China (English)

    刘威; 盛伟斌; 张健; 邓强; 郭海龙

    2016-01-01

    背景:有研究表明,颈椎间盘置换及前路固定融合治疗颈椎病可以取得较好的临床效果,但是哪种术式在避免邻近节段退变方面更具优势尚无定论。目的:比较颈椎间盘置换与前路固定融合治疗单节段颈椎间盘突出症对邻近节段的近期影响。方法:收集2009年1月至2012年12月以“颈椎间盘突出症”为诊断收入院并行单节段颈椎间盘置换或颈前路椎间盘切除融合患者178例的临床资料,进行回顾性分析,其中前路固定融合组116例,颈椎间盘置换组62例。结果与结论:①评价:两组患者末次随访时目测类比评分、日本骨科协会评估治疗评分、颈椎功能障碍指数均较治疗前明显改善(P 0.05)。前路固定融合组术后3个月时手术节段基本融合,活动度丧失,末次随访时邻近上位节段活动度与邻近下位节段活动度明显增加,且上位节段活动度增加的度数较下位节段大(P 0.05). At 3 months after surgery, in the anterior cervical decompression and fusion group, surgical segment was confluent, and range of motion lost. During final fol ow-up, range of motion of adjacent upper segment and adjacent lower segment was significantly increased, and the increased range of motion in the upper segment was bigger than that of the lower segment (P < 0.05). (3) During final fol ow-up, X-ray films and MRI images revealed the number of degenerated adjacent segment was more in the anterior cervical decompression and fusion group than in the anterior cervical disc replacement group (P <0.05). The number of degenerated middle and upper segments was more than that of the lower segment in both groups (P < 0.05). (4) The findings confirmed that anterior cervical disc replacement or anterior cervical decompression and fusion for treating cervical disc herniation could effectively relieve nerve symptoms of patients. However, compared with the anterior cervical disc

  1. 颈椎前路内固定失败翻修一例报告%A case report of the revision after a failed anterior cervical internal fixation

    Institute of Scientific and Technical Information of China (English)

    陈志龙; 蔡林; 平安松; 张刚刚; 任斌; 鲍冲

    2012-01-01

    Objective To analyse the causes of the failure and the surgical approach of the revision after a failed anterior cervical internal fixation in 1 case. Methods Loose screws and steel plates were removed first. The decompression of the anterior cervical spinal cord was conducted. Afterwards a titanium mesh and a steel plate were again implanted for fixation. Finally, posterior screw-rod fixation system was employed to strengthen the fixation. Results The cervical spinal cord was decompressed. The height of cervical vertebrae and the physiological curve were restored in general. According to the American Spine Injury Association (ASIA) standard, the function of cervical spinal cord was recovered from Apreoperatively to C postoperatively 2 months after the surgery. Conclusions Primary anterior-posterior operation is a comparatively good choice for the cervical fracture and dislocation with spinal cord injury. The revision surgery should decompress the cervical spinal cord completely and restore the height of cervical vertebra and the physiological curve.%@@ 我科于2011年5月收治颈椎前路内固定术后钢板松动行翻修手术病例1例,现报道如下. 临床资料 患者,男,32岁,因"颈椎骨折并脊髓损伤术后8个月,发现内固定松动40余天"于2011年5月入院.患者2010年8月因头颈部外伤导致C5、C6椎体骨折并四肢瘫痪,在外院行C5、C6椎体切除钛笼植入前路钢板内固定手术.

  2. 颈前路减压融合内固定术治疗下颈椎损伤的疗效研究%Clinical effect of anterior cervical decompression and fusion with internal fixation on lower cervical spine injury

    Institute of Scientific and Technical Information of China (English)

    王宏

    2015-01-01

    Objective To compare the efficacy of anterior cervical decompression and fusion with internal fixation and posterior decompression and bone fixation on lower cervical spine injury. Methods Eighty patients underwent operation in the Second People’s Hospital of Jinzhong for treatment of lower cervical spine injury were selected as research objects. They were randomly divided into observation group and control group respectively,for anterior cervical decompression and fusion with inter-nal fixation and posterior decompression and bone grafting and fixation. The bleeding volume,operation time,postoperative com-plications,the atlanto odontoid front clearance,JOA scores,quality of life score before and after operation were observed. Re-sults The operation time,bleeding volume,postoperative complications incidence of the observation group were significantly lower than those in the control group. The two groups’preoperative atlanto odontoid front clearance,JOA,quality of life score were similar as that of before treatment;and the results improved significantly after operation than that before operation,there were significant differences(P ﹤0. 05),and the indexes of the observation group were significantly better than those in the con-trol group,the differences were significant(P ﹤0. 05). Conclusions The curative effect of anterior cervical decompression and fusion with internal fixation on cervical spine injury is significant,so it is worthy of promotion.%目的:比较颈前路减压融合内固定术与颈后路减压植骨固定术治疗下颈椎损伤的疗效。方法以80例于晋中市第二人民医院接受手术治疗的下颈椎损伤患者为研究对象,随机均分为观察组与对照组,分别行颈前路减压融合内固定术与颈后路减压植骨固定术治疗。观察术中出血量、手术时间、术后并发症、手术前后寰齿前间隙、日本骨科协会评估治疗分数(JOA)、生存质量评分。结果观察组手术

  3. Fusion of Adjacent Segment Degeneration after Anterior Portion Cervical Decompression%颈前路融合术后相邻节段退变120例

    Institute of Scientific and Technical Information of China (English)

    占蓓蕾; 叶舟

    2014-01-01

    目的:探讨颈椎前路减压融合术后相邻节段退变的因果关系。方法:对237例患者行前路椎间节段减压植骨融合术(87例),椎体次全切除减压植骨融合术(109例),椎间节段减压、椎体次全切除减压植骨融合术(41例)。通过影像学检查,观察不同手术方法术后相邻节段退变发生情况。结果:术后随访时间2.6~13年,平均6.8年;发生相邻节段明显退变的120例(50.6%),头侧相邻节段退变发生率明显高于尾侧邻近节段(P<0.05),其中27例(22.2%)需2次翻修手术。结论:颈椎前路融合术后可导致颈椎相邻节段的退变。%Objective To investigate the result of anterior cervical decompression and fusion of adjacent segment degeneration after causality. Methods among 237 patients(87 cases) weretreated with anterior decom-pression and interbody fusion intervertebral segments, 109cases with subtotal excision of the vertebral body with decompression and interbody fusion,and 41 cases with intervertebral segmental decompression, vertebral body subtotal resection decompression and interbody fusion.By imaging examination, different surgical methods and postoperative adjacent segment degeneration were observed. Results Postoperative follow-up at time of 2.6~13 years, averaging 6.8 years; showed significantly degeneration of adjacent segments in 120 cases (50.6%), the cranial adjacent segment degeneration rate significantly higher than that of the caudal adjacent segment (P<0.05), among them,27 cases (22.2%)needed 2 times of revision surgery. Conclusion The anterior cervical fu-sion surgery can lead to cervical vertebral adjacent segment degeneration.

  4. Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography.

    Science.gov (United States)

    Anderst, William

    2016-01-01

    Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.

  5. Effect of cervical instability in sympathetic cervical spondylosis%颈椎不稳在交感型颈椎病发病中的作用

    Institute of Scientific and Technical Information of China (English)

    于泽生; 刘忠军; 党耕町

    2002-01-01

    目的研究交感型颈椎病的病理因素及治疗方法.方法回顾分析了1988~2000年收治的20例手术治疗的交感型颈椎病患者.根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳. 结果 20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果.每例患者均于不稳节段行颈前路融合术,手术有效率为90%. 结论颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法.%Objective To investigate the etiology and treatment of sympathetic cervical spondylosis (SCS).Methods Twenty patients who with SCS had undergone operations for sympathetic cervical spondylosis were reviewed retrospectively from 1988 to 2000. Lateral views in flexion and extension of pre- and postoperative cervical X-ray were analyzed to quantify cervical instability.Results Cervical instability was detected at one level in seven patients, two levels in ten patients, three levels in three. Cervical instability mainly occurred at C3-C4 and C4-C5. Cervical epidural block had a short time effect in the greater part of patients. Cervical discectomy and fusion at unstable segement was carried out in all 20 cases. The effective rate was 90%.Conclusions Cervical instability at C3-C4 or C4-C5 maybe an importmant factor in the etiology of sympathetic cervical spondylosis. Cervical epidural block may provide diagnostic information. Anterior cervical fusion were effective to treat sympathetic cervical spondylosis.

  6. Quality of systematic reviews: an example of studies comparing artificial disc replacement with fusion in the cervical spine.

    Science.gov (United States)

    Tashani, Osama A; El-Tumi, Hanan; Aneiba, Khaled

    2015-01-01

    Cervical artificial disc replacement (C-ADR) is now an alternative to anterior cervical discectomy and fusion (ACDF). Many studies have evaluated the efficacy of C-ADR compared with ACDF. This led to a series of systematic reviews and meta-analyses to evaluate the evidence of the superiority of one intervention against the other. The aim of the study presented here was to evaluate the quality of these reviews and meta-analyses. Medline via Ovid, Embase, and Cochrane Library were searched using the keywords: (total disk replacement, prosthesis, implantation, discectomy, and arthroplasty) AND (cervical vertebrae, cervical spine, and spine) AND (systematic reviews, reviews, and meta-analysis). Screening and data extraction were conducted by two reviewers independently. Two reviewers then assessed the quality of the selected reviews and meta-analysis using 11-item AMSTAR score which is a validated measurement tool to assess the methodological quality of systematic reviews. Screening of full reports of 46 relevant abstracts resulted in the selection of 15 systematic reviews and/or meta-analyses as eligible for this study. The two reviewers' inter-rater agreement level was high as indicated by kappa of >0.72. The AMSTAR score of the reviews ranged from 3 to 11. Only one study (a Cochrane review) scored 100% (AMSTAR 11). Five studies scored below (AMSTAR 5) indicating low-quality reviews. The most significant drawbacks of reviews of a score below 5 were not using an extensive search strategy, failure to use the scientific quality of the included studies appropriately in formulating a conclusion, not assessing publication bias, and not reporting the excluded studies. With a significant exception of a Cochrane review, the methodological quality of systematic reviews evaluating the evidence of C-ADR versus ACDF has to be improved.

  7. Application of anatomical measurement to anterior cervical decompression surgery%解剖学测量在颈椎前路减压手术中的应用

    Institute of Scientific and Technical Information of China (English)

    胡明华; 陈傲; 唐顺胜; 陈世杰; 袁宪宇

    2015-01-01

    Objective To explore the value of anatomic measurement applied to anterior cervical decompression surgery.Methods One hundred and twenty patients with cervical spondylotic myelopathy were divided into research group and control group based on random number table,with 60 cases in each group.Eighteen specimens of adult vertebrae cervicales were measured and the related data of C3 -C7 were collected before the surgery.The data included the distance between the adjacent transverse foramina,the distance between adjacent tips of uncus of vertebral body,the distance between bilateral posterior margins of uncus of vertebral body,the distance between bilateral anterior margins of uncus of vertebral body,the anteroposterior diameter of uncus of vertebral body,spinal canal transverse diameter and vertebral sagittal diameter.The anterior cervical decompression surgery was performed in the research group according to the measurement results, while the routine anterior cervical decompression surgery was performed in the control group.The surgical efficacy,operative duration and intraoperative blood loss were compared between two groups.Results There was no significant difference in the distance between bilateral posterior margins of uncus of vertebral body among C3 -C7(P>0.05).There was significant difference in the distance between bilateral anterior margins of uncus of vertebral body and the maximum spinal canal diameter among C3 -C7(P0.05).The JOA score of research group was significantly higher than that of control group 6 months after surgery(P<0.05).Conclusion The efficacy of anterior cervical decompression surgery is better when the data of cervical anatomical measurement are applied to the surgery.%目的:探讨颈椎解剖学测量在颈椎前路减压手术中的应用价值。方法120例脊髓颈椎病患者,按随机数字表法分为研究组和对照组,每组60例。术前测量18具成年人颈椎标本C3~C7相关数据:横突孔间距离、钩突尖

  8. Avaliação da dor e morbidade local da retirada do enxerto ósseo da crista ilíaca para artrodese cervical anterior Evaluación del dolor y morbilidad local del injerto extraído de la cresta ilíaca para artrodesis cervical anterior Evaluation of the pain and local morbidity of the insertion taken out from the iliac crest to the anterior cervical arthrodesis

    Directory of Open Access Journals (Sweden)

    Rafael Barreto Silva

    2010-12-01

    Full Text Available OBJETIVO: avaliar as possíveis complicações associadas à retirada de enxerto da crista ilíaca anterior em cirurgia para artrodese cervical anterior, em especial a dor residual. MÉTODOS: foi realizado estudo retrospectivo com análise de prontuários e aplicação de questionário via telefone com 20 pacientes no período compreendido entre Agosto de 2008 e Novembro de 2009. Todos os pacientes foram submetidos à mesma técnica cirúrgica para extração do enxerto, sendo operados pela mesma equipe no Hospital de Clinicas da Unicamp (HC Unicamp. As variantes analisadas foram dor residual, taxa de infecção, lesão neurológica ou vascular e ocorrência de fratura da asa do ilíaco. Os dados foram colocados em uma tabela e as médias e porcentagens foram calculadas. RESULTADOS: dos 20 pacientes, 12 homens e 8 mulheres, com média de idade de 51,75 anos (29-74 e follow-up médio de 11,83 meses (2-29, não houve nenhuma lesão grave, como fratura, lesão arterial ou neurológica. Houve um caso de infecção superficial (5% e 25% dos pacientes queixaram-se de desconforto leve e dificuldade para deambular não incapacitante. CONCLUSÃO: a retirada de enxerto da crista ilíaca anterior está associada a muitas complicações, sendo importante o conhecimento de outras opções de enxerto e exposição ao paciente das possíveis complicações. Por meio deste levantamento, não verificamos nenhuma complicação grave, e o percentual de pacientes com dor residual acompanha os achados na literatura, podendo ser diminuído com uma dissecção cuidadosa da crista ilíaca.OBJETIVO: evaluar las posibles compilaciones asociadas a la retirada del injerto de la cresta ilíaca anterior en cirugía para artrodesis cervical anterior, principalmente los dolores residuales. MÉTODOS: fue realizado un estudio retrospectivo con análisis de prontuarios y con aplicación de cuestionario por teléfono para 20 pacientes entre agosto de 2008 y noviembre de 2009

  9. CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae.

    Directory of Open Access Journals (Sweden)

    Chun Chen

    Full Text Available BACKGROUND: Accurate placement of pedicle screw during Anterior Transpedicular Screw fixation (ATPS in cervical spine depends on accurate anatomical knowledge of the vertebrae. However, little is known of the morphometric characteristics of cervical vertebrae in Chinese population. METHODS: Three-dimensional reconstructions of CT images were performed for 80 cases. The anatomic data and screw fixation parameters for ATPS fixation were measured using the Mimics software. FINDINGS: The overall mean OPW, OPH and PAL ranged from 5.81 to 7.49 mm, 7.77 to 8.69 mm, and 33.40 to 31.13 mm separately, and SPA was 93.54 to 109.36 degrees from C3 to C6, 104.99 degrees at C7, whereas, 49.00 to 32.26 degrees from C4 to C7, 46.79 degrees at C3 (TPA. Dl/rSIP had an increasing trend away from upper endplate with mean value from 1.87 to 5.83 mm. Dl/rTIP was located at the lateral portion of the anterior cortex of vertebrae for C3 to C5 and ipsilateral for C6 to C7 with mean value from -2.70 to -3.00 mm, and 0.17 to 3.18 mm. The entrance points for pedicular screw insertion for C3 to C5 and C6 to C7 were recommended -2∼-3 mm and 0-4 mm from the median sagittal plane, respectively, 1-4 mm and 5-6 mm from the upper endplate, with TPA being 46.79-49.00 degrees and 40.89-32.26 degrees, respectively, and SPA being 93.54-106.69 degrees and 109.36-104.99 degrees, respectively. The pedicle screw insertion diameter was recommended 3.5 mm (C3 and C4, 4.0 mm (C5 to C7, and the pedicle axial length was 21-24 mm for C3 to C7 for both genders. However, the ATPS insertion in C3 should be individualized given its relatively small anatomical dimensions. CONCLUSIONS: The data provided a morphometric basis for the ATPS fixation technique in lower cervical fixation. It will help in preoperative planning and execution of this surgery.

  10. Caspar型颈椎撑开器在颈椎间减压手术中的应用研究%The research of Caspar distractor for anterior cervical discectomy

    Institute of Scientific and Technical Information of China (English)

    袁峰; 杨惠林; 张志明; 殷骏; 姚飞荣

    2004-01-01

    目的:探讨使用Caspar型颈椎撑开器在颈前路椎间减压手术中对颈椎椎间角度、椎间孔大小的影响.方法:取10具C2~C7成人颈椎标本,将Caspar型颈椎撑开器的2枚固定螺钉分别在C4、C5椎体正中相互平行置人,按照Smith-Robinson手术方法进行C4/5间隙减压,用颈椎撑开器加压2mm和撑开2mm、4mm,分别在CR机上摄颈椎侧、斜位片,Pacsout程序软件测量C4/5椎间孔L面积和椎间角度,SAS 6.12软件包进行统计分析.结果:颈椎撑开器压缩2mm,椎间孔面积无明显改变,椎间角度减小39.7%;撑开2mm时,椎间孔面积增加28.3%,椎间角度增加67.6%;撑开4mm时,椎间孔面积增加33.3%,椎间角度增加136.8%.结论:颈椎撑开器撑开椎间隙时扩大了椎间孔面积,同时也增加了椎间角度;提示不应强求使用颈椎撑开器过度撑开椎间隙的方法来增加椎间孔面积.

  11. Evaluation of anterior cervical reconstruction with titanium mesh cages versus nano-hydroxyapatite/polyamide66 cages after 1- or 2-level corpectomy for multilevel cervical spondylotic myelopathy: a retrospective study of 117 patients.

    Directory of Open Access Journals (Sweden)

    Yuan Zhang

    Full Text Available OBJECTIVE: To retrospectively compare the efficacy of the titanium mesh cage (TMC and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage for 1- or 2-level anterior cervical corpectomy and fusion (ACCF to treat multilevel cervical spondylotic myelopathy (MCSM. METHODS: A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28 ± 12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy and cage type used (TMC or n-HA/PA66 cage. Clinical and radiological parameters were used to evaluate outcomes. RESULTS: At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01, and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01. Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. CONCLUSION: The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.

  12. 上颈椎不稳前路内固定方式的选择%Surgical strategy for upper cervical vertebrae instability through the anterior approach

    Institute of Scientific and Technical Information of China (English)

    黄卫兵; 蔡贤华; 陈庄洪; 黄继锋; 刘曦明; 魏世隽

    2013-01-01

    Objective:To explore the choice and effect of internal fixation in treating upper cervical vertebrae instability through anterior approach.Methods:From March 2000 to September 2010,83 patients with upper cervical vertebrae instability were treated with internal fixation through anterior approach.There were 59 males and 24 females with a mean age of 42 years old (ranged,20 to 68).Among these patients,36 patients were treated with odontoid screw fixation,16 patients with C1,2 transarticular screw fixation,23 patients with C2,3 steel plate fixation,5 patients with odontoid screw and transarticular screw fixation,2 patients with odontoid screw and C2,3 steel plate fixation,1 patient with C1,2 transarticular screw and C2,3 steel plate fixation.Results:One patient with completely cervical vertebrae cord injury died of pulmonary infection after C1,2 transarticular screw fixation.Other patients were followed up from 8 to 36 months with an average of 15 months.Upper cervical vertebrae stability were restored without vertebral artery and spinal cord injury.Thirty-six patients were treated with odontoid screw fixation and 5 patients were treated with screw combined with transarticular screw fixation obtained bone union in the dentations without bone graft.Among the 16 patients treated with C1,2 transarticular screw fixation,13 patients obtained bone union after bone graft ; 1 patient died of pulmonary infection after surgery ; 1 patient with comminuted odontoid fracture of type Ⅱ C and atlantoaxial anterior dislocation did not obtain bone union after bone graft,but the fibrous healing was strong enough to maintain the atlantoaixal joint stability ; 1 patient with obsolete atlantoaxial anterior dislocation were re-treated with Brooks stainless steel wire fixation and bone graft through posterior approach,and finally obtained bone union.Conclusion:It could obtain satisfactory effects depending on the difference of cervical vertebrae instability to choose the correctly

  13. Segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy: Comparison of fusion rates among three methods%颈前路分节段减压植骨融合术治疗多节段颈椎病:3种方法移植骨融合率的比较

    Institute of Scientific and Technical Information of China (English)

    袁文; 徐盛明; 王新伟; 张涛; 刘百峰

    2007-01-01

    -level corpectomy with fusion group(long-segmental decompression group,n =11):There were 4 cases grafted with long-titan net,and 7 cases grafted with autologous iliac bone. Sub-total two-level corpectomy with fusion was performed. ②segmental decompression group(n =16):including 12 cases of titan net+cage graft,4 cases of autologous bone+cage graft. One-level decompression and sub-total single corpectomy with fusion were performed. ③three-level decompression group(n =9):Only discectomy without corpectomy was performed. After complete decompression,3cages were used to fill artificial bone or grafted with autologous bone.MAIN OUTCOME MEASURES:Cervical anteroposterior and lateral radiographies,flexion and extension radiograph were reexamined within 1 week and at 3,6 and 12 months postoperatively. The neurological function was assessed using the Japanese Orthopaedic Association(JOA) scoring method preoperatively and 3 months postoperatively. The total score was 17 points,the higher the score,the better the neurological function. The duration of operation,perioperative bleeding amount,length of stay,cost of hospitalization,graft fusion at 3 months postoperatively,improved JOA score at 3 months postoperatively were recorded in the three groups. The occurrence of postoperative complications was observed by means of return visit.RESULTS:All the 36 patients with multilevel cervical myelopathy were involved in the analysis of results. The mean duration of operation,mean perioperative bleeding amount and mean length of stay in the segmental-decompression group and three-level decompression group were obviously fewer or shorter than those in the long-segmental decompression group(P < 0.05),and the average cost of hospitalization was obviously higher than that in the long-segmental decompression group(P < 0.05). The postoperative improved JOA score and graft fusion rate were close among the groups(P > 0.05).CONCLUSION:Segmental anterior cervical decompression is a recommendable

  14. The study of anterior cervical pedicle screw channel in the lower cervical spine%下颈椎前路椎弓根螺钉内固定解剖学测量及临床应用

    Institute of Scientific and Technical Information of China (English)

    徐荣明; 赵刘军; 马维虎; 朱彦昭

    2011-01-01

    Objective To investigate application of the anterior cervical pedicle screw in the lower cervical spine.Methods Twenty disarticulated human vertebrae (C3-C7) were evaluated with computed tomography for pedicle morphometry Parameters included vertebral body height,vertebral body depth,vertebral body width,outer pedicle width,outer pedicle height,pedicle axis length,transverse section angle,sagittal section angle,transverse intersection point distance and sagittal intersection point distance.On the basis of these data,the screw channel was determined and the screws were inserted in the specimen.Five patients underwent surgical reconstruction using anterior pedicle screw fixation.After surgery,physical examination and roentgenograms and CT scans were performed in all patients.Results The transverse section angle increased from C3(45.7°±4.0°) to C5(52.1°±5.9° ),but decreased from C6(47.8°±6.7°) to C7(44.4°± 8.3°).The sagittal section angle gradually increased from C3 (93.4°±7.2°) to C6( 112.1°±6.2°) but decreased a little to C7(102.7°±8.5°).The distances in transverse section was about 1.97-3.98 mm and in sagittal section was 3.4-7.5 mm.Anterior pedicle screws were inserted successfully in all specimens without critical pedicle wall perforations.Patients were permitted to ambulate the next day after surgery with a cervical collar.Postoperative neurological improvement was observed in all cases.Postoperative radiographic evaluation confirmed proper insertion of anterior pedicle screws without pedicle perforaton.The average follow-up time was 10.6 months.No anterior pedicle screw breakage and loosening was observed.Conclusion The entry point in anterior pedicle screw should located in 5mm to upper endplate and near anterior median line.The transverse section angle should be 45.7°-52.1°and the sagittal section angle should be 93.4°-112.1°.The lengths of the screw should be about 32 mm.%目的 通过解剖学测量和临床应用,探讨下颈椎

  15. 颈椎复合骨块融合的生物力学基础与疗效观察%Biomechanical basis and clinical aplication of combined bone graft in anterior cervical fusion

    Institute of Scientific and Technical Information of China (English)

    王春; 郭卫中; 刘成招; 郑立槟; 王以进

    2001-01-01

    目的 探讨颈椎前路复合骨植骨块融合的生物力学基础,为临床手术提供理论依据。方法 利用6具颈椎新鲜标本,采用复合骨块与常规髂骨块制成颈前路减压植骨融合标本,以实验应力分析手段观察和评定颈椎的三维稳定性及术后颈椎强度等生物力学指标的变化。并对临床运用复合骨块行颈椎植骨融合21例进行回故并与常规植骨融合病例对照。结果 复合骨块融合组的生物力学性能均优于常规髂骨融合组。(P<0.01)结论 颈椎前路复合骨块融合方便、稳定。是目前较好的植骨融合方法之一。%Objective To understand the biomechanical basis and evaluate clinical application of combined bone graft in anterior cervical fusion.Methods The cervical speciments of 6 cadavers prepared from decompressing and transplanting fusion anterior with combined iliac bone graft.It was evaluated that the cervical stability and intensity by stress determination.21 patients with combined bone graft in anterior cervical fusion were analyzed.The comparision of the cervical aligment and hight on disc space between the combine bone graft and the biomechanical standard.Result The patient with combine bone graft was significantly greater at cervical height of disc space and stability than routine iliac bone graft.Conclusion The combine bone graft is better method in anterior cervical fusion.

  16. Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

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    FengNing Li

    2015-01-01

    Full Text Available To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM with either anterior cervical discectomy and fusion (ACDF or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A and 21 patients received SCF. Japanese Orthopaedic Association (JOA score, Neck Disability Index (NDI score, and Cobb’s angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.

  17. 颈椎前路减压植骨钛板内固定治疗颈脊髓损伤%Treatment of Cervical Spinal Cord Injury by Anterior Decompression, Bone Graft and Titanium Plate Internal Fixation

    Institute of Scientific and Technical Information of China (English)

    沈宁江; 王先安; 林庆彪; 林明侠; 陈建

    2013-01-01

    Objective To evaluate the clinical efficacy of anterior decompression, bone graft and internal fixation for cervical spine fracture with cervical spinal cord injury. Methods 215 cases of cervical spine fracture with cervical spinal cord injury had been treated by the method of anterior decompression,iliac bone graft and cervical locking titanium plate fixation. X-rays were taken regularly after surgery and recovery of spinal cord function were recorded. Results 184 cases were followed for an average time of 3. 5 years. Bone graft union was achieved 3 months after surgery. The cervical intervertebral height and the physiological curvature maintained satisfactory without implant complications. Nerve function of 172 patients improved 1 to 2 degree. Only 12 cases with stage A nerve function obtained no recovery. Conclusion Patients of cervical fracture with cervical spinal cord injury should undergo surgery of anterior decompression,bone graft and plate fixation as soon as possible. It is good to spinal cord function recovery. The injured segments can obtain instant and firm stability, which makes care and functional exercises easier.%目的 评价颈椎前路减压植骨内固定治疗颈椎骨折合并颈脊髓损伤的临床疗效.方法 对215例颈椎骨折合并颈脊髓损伤的患者施行颈椎前路减压、自体髂骨植骨和颈椎带锁钛板内固定术.术后定期复查X线片,判定脊髓功能恢复情况.结果 随访184例患者,平均随访时间3.5年.术后3个月植骨块获得骨性愈合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,172例患者神经功能提高1~2级,仅12例A级患者神经功能无恢复.结论 颈椎骨折合并颈脊髓损伤应尽早行前路减压、植骨、钛板内固定术,有利于脊髓功能恢复,能使损伤节段获得即刻、坚强的稳定,方便护理和功能锻炼.

  18. The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA: a meta analysis of randomized controlled trials.

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    Baohui Yang

    Full Text Available BACKGROUND: Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. METHODOLOGY: We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1 Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA with anterior cervical discectomy and fusion (ACDF as controls; 2 A minimum of two-year follow-up using imaging and clinical analyses; 3 Definite diagnostic evidences for "adjacent segment degeneration" and "adjacent segment disease"; 4 At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled. RESULTS: No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant. CONCLUSIONS: Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due

  19. Corpectomia cervical anterior e fixação com placa: análise retrospectiva Corporectomía cervical anterior y fijación con placa: un análisis retrospectivo Anterior cervical corpectomy and plate fixation: a retrospective analysis

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    Marcos André Sonagli

    2012-09-01

    Full Text Available OBJETIVO: Avaliar os resultados clínicos e radiográficos de pacientes submetidos à corpectomia e fixação com placa cervical, com seguimento de dois anos. MÉTODOS: Análise retrospectiva de 2003 a 2009. Avaliaram-se o tipo de fratura (classificação AO, o grau de déficit neurológico (inicial e após dois anos - escala de Frankel, a taxa de complicações e a taxa de incorporação do enxerto ósseo (de acordo com radiografias dois anos depois da cirurgia. RESULTADOS: Vinte e um pacientes foram avaliados. De acordo com a classificação AO, 14 eram grupo A, 3 B e 4 C. Ao todo, sete pacientes apresentaram déficit neurológico inicial completo (Frankel A e permaneceram com o déficit neurológico completo após dois anos. Dos seis pacientes que apresentaram déficit neurológico inicial incompleto (Frankel B, C e D, 33% (2 de 6 apresentaram melhora de um nível na escala de Frankel e 50% (3 de 6 deles evoluíram para recuperação completa (Frankel E. Os oito pacientes que não apresentaram lesão neurológica inicial (Frankel E permaneceram sem déficit neurológico após dois anos. Três complicações clínicas foram verificadas: uma fístula esofágica, uma soltura asséptica do implante e uma infecção no sítio doador de enxerto. Todos os pacientes obtiveram consolidação do enxerto ósseo. CONCLUSÃO: A corpectomia cervical no tratamento da fratura-explosão permite a recuperação neurológica nos pacientes com lesão neurológica incompleta e apresenta baixos índices de complicações.OBJETIVO: Evaluar los resultados clínicos y radiográficos de los pacientes sometidos a corporectomía y fijación con placa cervical con dos años de seguimiento. MÉTODOS: Análisis retrospectivo desde 2003 hasta 2009. Se evaluó el tipo de fractura (Clasificación AO, el grado de déficit neurológico (inicial y después de 2 años - escala de Frankel, la tasa de complicaciones y la tasa de incorporación del injerto óseo (de acuerdo a los

  20. Surgical efficacy of minimally invasive thoracic discectomy.

    Science.gov (United States)

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach.

  1. 纳米羟基磷灰石/聚酰胺66椎体支撑体在下颈椎骨折脱位前路手术重建中的应用%Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation

    Institute of Scientific and Technical Information of China (English)

    吕超亮; 屠重棋; 段宏; 宋跃明; 刘浩; 刘立岷; 龚全; 李涛; 曾建成; 孔清泉; 裴福兴

    2012-01-01

    Objective To initially evaluate the application of artificial vertebra of n-HA/PA66 in anterior reconstruction of lower cervical spine fracture and dislocation.Methods In this study,84 patients with lower cervical spine fracture and dislocation received anterior cervical discectomy, spinal canal decompression or subtotal corpectomy, spinal canal decompression and reconstruction by n-HA/PA66composite artificial vertebral body combined with plate instrumentation.Neurological function was followed up by improvement rate of Frankel and situations of the supporting body was observed by X ray and 3D-CT in 3,12,24 months postoperatively.The intervertebral height,physical arc (reflected by Cobb angle) and the locations and fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients underwent operation successfully and were followed up for 6 to 24 months with an average of 12 months.The preoperative symptoms were improved to varying degrees. Imaging studies showed that in all cases graft fusion were achieved, and cervical alignments,iutervertebral height,cervical spine stability and the locations of the artificial vertebral body were well maintained. No displacement and subsidence of the artificial vertebral body occurred.Postoperative immediate intervertebral height (2.4 ± 0.2 ) cm,preoperative intervertebral height ( 1.9 ±0.1 ) cm,comparisons of the two groups was statistically significant ( q =2.48,P < 0.001 ).The immediate,3 month,1 year,2 year period follow-up group intervertebral height was not statistically significant (P >0.05 ).Preoperative Cobb angle was 9.8 ° ± 1.2 °,postoperative immediate Cobb angle was 16.6° ± 1.2 °comparisons of the two groups was statistically significant (q =14.25,P < 0.001 ). The immediate,3 month,1 year,2 year period follow-up group Cobb angle was not statistically significant (P > 0.05).Conclusions n-HA/PA66 artificial

  2. 颈椎前路手术中相关神经损伤并发症的常见原因及治疗%Causes tar and management of in anterior cervical surgery related nerve injuries

    Institute of Scientific and Technical Information of China (English)

    卢旭华; 袁文; 陈德玉; 倪斌; 王新伟; 郭永飞

    2011-01-01

    Objective To review the relevant causes for and treatment of nerve injuries in the anterior cervical surgery. Methods From January 2008 to December 2009,859 cages of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma were treated by anterior cervical surgery.This study retrospectively analyzed the clinical data of seven cases who were with worsened symptoms of spinal cord injury and related nerve injury. Results Of 859 cases,five cases(0.58%)were with spinal cord injury,one(0.12%)with recurrent laryngeal nerve injury and one (0.12%)with laryngeal nerve injury.Hematoma occurred in four cases after surgery caused spinal cord injury and all the four patients recovered to normal after removal of the hematoma and timely treatment with mythylprednisolone and hyperbaric oxygen.Cervical spine trauma was worsened in one patient after the anterior cervical surgery.The patient restored to its original level of spinal cord gradually through some measures such as tracheotomy,ventilator support,hormone therapy and hyperbaric oxygen treatment.Laryngeal nerve injuries in two cases recovered to normal after conservative treatment with hormone,dehydration and other drugs within three months after surgery. Conclusions Anterior cervical surgery of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma are likely to induce the related nerve damage.The good prognosis can be obtained under timely prevention and treatment.%目的 回顾颈椎前路手术中相关神经损伤的常见原因及治疗方法.方法 2008年1月-2009年12月手术治疗859例颈椎病、颈椎后纵韧带骨化症及颈椎外伤行颈椎前路手术患者,对术后出现脊髓损伤症状加重及相关神经损伤的7例患者的临床资料进行回顾性分析.结果 859例患者中共5例发生脊髓损伤,发生率为0.58%;1例发生喉返神经损伤,发生率为0.12%;1例发生喉

  3. Titanium cages subsidence following anterior cervical decompression and fusion%颈椎前路减压融合术后钛笼下沉临床分析

    Institute of Scientific and Technical Information of China (English)

    马永刚; 刘世清; 李亚明; 周小锐

    2011-01-01

    目的:探讨颈椎前路减压融合术治疗脊髓型颈椎病术后影响钛笼下沉的相关因素.方法:回顾性分析2005年6月~2009年6月我院收治的104例行颈椎融合钛笼植骨患者的颈椎平片和手术资料,分析撑开程度、钛笼直径和安放部位与钛笼下沉的相关性.结果:104例手术患者中,术后6个月复查时发现16例(15.4%)钛笼发生下沉.46例钛笼直径10mm者中9例发生下沉(19.6%),而58例直径12mm者中7例发生下沉(12.1%),差异有显著性(P<0.05).钛笼前缘与椎体前缘距离在1mm以内者89例,距离大于1mm者15例,发生下沉例数分别为13例和3例,差异有显著性(P<0.05).开槽节段相邻椎体终板延长线成角,其中角度在20°~30°者82例,成角大于30°者22例,两组发生下沉例数分别为11例和5例,发生率有显著性差异(P<0.05).结论:椎间撑开程度、钛笼直径和安放部位可能是影响钛笼下沉的重要因素.%Objective:To investigate the factors of titanium cage subsidence following anterior cervical decompression and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).Method: 104 patients with CSM underwent ACDF from June 2005 to June 2009.All patients were followed up for 6 months. The subsidence associated factors,including space dsitraction,position and the diameter of cage,were reviewed retrospectively.Result:Titanium cage subsidence was noted in 16(15.4%) patients 6 months after surgery. Of 46 cases with cage diameter less than l0mm,9 suffered subsidence,while of 58 cases with cage diameter over 12mm,7 suffered subsidence,which showed significant difference (P<0.05).Of 89 cases with the distance between anterior edge of cage and anterior edge of vertebral body less than lmm,13 had cage subsidence;while of 15 cases with the distance over lmm,3 had cage subsidence which showed significant difference(P< 0.05).Of 82 cases with intervertebral distract angle between 20°and 30°and 22 cases with the angle

  4. Single anterior approach surgery for old cervical spine subluxation%单纯前路手术治疗无明显后方压迫的陈旧性颈椎半脱位

    Institute of Scientific and Technical Information of China (English)

    赵必增; 袁文; 徐建广

    2008-01-01

    Objective To implore the feasibility of using single anterior approach surgery for old cervical spine subluxation. Methods From May 2004 to July 2006,16 cases of old cervical spine subluxation underwent cervical spine surgery through anterior approach at least 2 months after injury. During operation, we managed to reconstruct the cervical vertebral body alignment through a special anterior approach decompression, application of retractor instrument, titanium mesh and plate manipulation. Results Follow-ups averaged 8.5(6 to 11) months. The cervical vertebral body alignment Was obtained in all the 16 cases. The osseous fusion was assured in all cases with no instrument failure. The JOA neurological scores were improved from 13.4 preoperatively to 15.9 postoperatively. Conclusion If there is no posterior compression and the posterior structure has a fibrous fusion, the single anterior approach is good enough for the old cervical spine subluxation to maintain alignment and obtain stability, and posterior reduction is not necessary.%目的 探讨无明显后方压迫的陈旧性颈椎半脱位行单纯前路手术减压内固定的可行性及手术方法.方法 2004年5月至2006年7月收治陈旧性颈椎半脱位患者16例,受伤至手术时间均超过2个月,行前路减压,术中试图通过撑开螺钉及钛网钢板同定的运用,以获得减压固定、恢复正常序列.结果 16例患者术后均恢复正常颈椎序列及椎间隙高度,随访6-11个月,平均8.5个月,无植骨未融合及钛板螺钉松动、断裂病例.所有患者症状均得到改善,JOA评分由术前的平均13.4分恢复为最后随访时平均15.9分,改善率为69.4%.结论 对于陈旧性颈椎半脱位,后方结构已纤维愈合稳定,而且无明显后方脊髓压迫,前路减压技术完全能达到减压融合重建颈椎序列的目的 .

  5. Polymethylmethacrylate-assisted ventral discectomy: Rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years

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    Maier-Hauff Klaus

    2011-06-01

    Full Text Available Abstract Background Polymethylmethacrylate (PMMA assisted ventral discectomy has been criticized for high rates of graft migration and pseudarthrosis when compared with various other fusion procedures for the treatment of cervical degenerative disc disease (DDD, therefore rendering it not the preferred choice of treatment today. Recently however spine surgery has been developing towards preservation rather than restriction of motion, indicating that fusion might not be necessary for clinical success. This study presents a long term comparison of clinical and radiological data from patients with pseudarthrosis and solid arthrodesis after PMMA assisted ventral discectomy was performed. Methods From 1986 to 2004 416 patients underwent ventral discectomy and PMMA interposition for DDD. The clinical and radiological outcome was assessed for 50 of 127 eligible patients after a mean of 8.1 years. Based on postoperative radiographs the patients were dichotomized in those with a pseudarthrosis (group A and those with solid arthrodesis (group B. Results Pseudarthrosis with movement of more than 2 of the operated segment was noted in 17 cases (group A. In 33 cases no movement of the vertebral segment could be detected (group B. The analysis of the clinical data assessed through the neck disability index (NDI, the visual analogue scale (VAS of neck and arm pain and Odom's criteria did not show any significant differences between the groups. Patients from group B showed a trend to higher adjacent segment degeneration (ASD than group A (p = 0.06. This correlated with the age of the patients. Conclusions PMMA assisted discectomy shows a high rate of pseudarthrosis. But the clinical long-term success does not seem to be negatively affected by this.

  6. INTERLAMINAR ENDOSCOPIC DISCECTOMY: MINIMALLY INVASIVE PROCEDURE, A SERIES REPORT

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    Somashekar

    2014-04-01

    Full Text Available BACKGROUND: The upright posture of humans throws enormous stress on spine, particularly during flexion and is responsible for many structural causes of backache such as lumbar disc prolapsed. Various modalities of surgical management are available for intervertebral disc prolapsed, but posterior interlaminar endoscopic approach has minimal stripping of paraspinal muscles, enhanced visualization due to better magnification and illumination, shorter hospital stay, and faster recovery time. METHODS: Total of 64 patients with lumbar intervertebral disc herniation were operated between 2008and 2013with endoscopic discectomy after localization of symptomatic level. The results were evaluated by Oswestry Disability index score. RESULTS: At final follow-up results were, excellent 60%, Good20%, Fair 16.7% and Poor in 3.3%. CONCLUSION: Open discectomy has been standard procedure of choice. Interlaminar endoscopic discectomy is a safe supplement for open discectomy which offers minimal trauma, better visualization intra operatively with less hospital stay and early mobilization and early return to work.

  7. 颈椎前路蝶形钢板内固定系统的研制及临床应用%Design and preliminary clinical application of anterior cervical butterfly-like locking plate fixation system

    Institute of Scientific and Technical Information of China (English)

    金大地; 瞿东滨; 陈建庭; 江建明; 王吉兴; 朱青安

    2001-01-01

    Objective To evaluate the biomechanical stability and the preliminary clinical efficacy of self-designed anterior cervical butterfly-like locking plate fixation system. Methods The anterior cervical fixation system is composed of one butterfly-like plate and three types of screw made of titanium alloy(TC4,Ti6Al4V) on the basis of unicortical screw fixation and point contact plate fixation principle. Biomechanical stability analyses of the system and Orion locking plate system (Sofamor - Danek Corp) were performed in fresh cervical spine specimens from fourteen young male cadavers. 61 patients with cervical disorders were stabilized with the fixation system. The mean age of the patients during surgery was 48.2 years (range 18 to 68 years). The diagnosis included spondylosis in 26 cases, cervical intervertebral disk protrusion 14, fracture and/or dislocation 18 and tuberculosis 3. Results This anterior butterfly-like cervical plate fixation system holds similar biomechanical stability effects as Orion system. Of 61 cases received the plate fixation system after anterior decompression and autologous interbody fusion, 48 were followed-up for six to ten months, and showed solid interbody fusion in three to four months. No early complications such as implant loosening or failure related to the fixation system were noted. Conclusion The anterior cervical plate fixation system can provide sufficient biomechanical stability to cervical spine after anterior decompression surgery.%目的研制颈椎前路蝶形钢板内固定系统,评价其生物力学稳定性,并进行临床初步应用观察.方法该系统包括蝶形钢板及三种不同用途的螺钉,采用单皮质螺钉固定及点接触原理,由医用钛合金材料(TC4)制成.采用14具青年男性尸体的新鲜颈椎标本,利用脊柱三维运动分析系统,比较蝶形钢板固定与Orion钢板固定对失稳颈椎的稳定作用.临床上应用于颈椎患者的治疗61例,其中颈椎病26例,颈椎间

  8. Biomechanics control study of goat cervical model implanted with anterior cervical-adjustable fusion fixator%颈椎可调控式融合固定器山羊模型的生物力学对照研究

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    郭永飞; 陈宇; 陈德玉; 张竞; 刘岩; 王以进; 袁文

    2010-01-01

    Objective To compare the biomechanics difference among anterior cervical-adjustable fusion fixator (AC-AFF) and other cervical implant systems. Methods Eighteen experimental goats, respectively implanting the AC-AFF and titanium mesh or autogenous iliac bone combined cervical plate after corpectomy, were randomly divided to three groups and fed subsequently. Biomechanics control study of the goat cervical models was carried out 6 months later. Applied load was 0-150 N, loading rate was 1.4 mm/ min. The cervical spine deformation, displacement, strength, stiffness and ultimate mechanical properties were tested under the movement of cervical flexion, extension, lateral bending and rotation. Results Under the same load, the strain of AC-AFF group was least, less 2% -4% (P > 0.05) and 10% -16% (P 0.05) , and 16% -24% less than the iliac bone combined plate group (P < 0.05). It was statistically shown that the level shearing stiffness, axial stiffness and bending stiffness were maximum in AC-AFF group. Ultimate destruction of experiments showed that the limit load in AC-AFF was 1107 N, 998 N in titanium mesh combined plate group, and 879 N in iliac bone block combined plate group. Conclusion AC-AFF is more superior to titanium mesh or autogenous iliac bone combined cervical plate in the biomechanical stability.%目的 利用山羊颈椎模型分析比较颈椎可调控式融合固定器(AC-AFF)与其他内固定方式的生物力学差异.方法 将18只山羊随机分为3组,椎体次全切除后分别植入AC-AFF、钛网+钢板或髂骨块+钢板,人工饲养6个月后羊颈椎模型经处理再进行生物力学测试,施加载荷为0~150N,加载速率为1.4mm/min,测试的运动工况包括颈椎前屈、后伸、侧屈及旋转,测量指标包括颈椎的变形与位移、强度和刚度及极限力学性能.结果 三种重建方式中,AC-AFF组在相同载荷作用下应变最小,较钛网+钢板组、髂骨块+钢板组分别小2%~4%(P>0.05)及10%~16

  9. 人工椎间盘置换术治疗跳跃型多节段颈椎病的中期疗效%Comparison of the mid-term follow-up results between treatment of Bryan cervical artificial disc replacement and ante-rior cervical decompression and fusion for"skip"cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    尚子琨; 张英泽; 张迪; 丁文元; 张为; 孟宪中; 王林峰; 申勇

    2014-01-01

    Objective To retrospectively analysis and compareabout Bryan artificial cervical disc arthroplasty with ante-rior cervical decompression and fusion (ACDF) on the clinical efficacy for“Skip”cervical spondylosis. Methods From February 2002 to May 2012, 49 cases were treated with Bryan artificial cervical disc arthroplasty (artificial cervical disc replacement surgery group, 18 cases) or anterior cervical decompression and fusion (ACDF group, 31 cases), 29 males and 20 females. Each case was evaluated at the moment of preoperatively, 3 months, 6 and 12 months and last follow-up after surgery by the Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Visual Analog Scale (VAS), Cervical sagittal curvature, the total cervical spine range of motion(ROM),middle segments of motion. MRI was also used to assess to adjacent segment disc degeneration, spinal cord compression and signal change situation. Results All patients were followed up for more than 24 months. The score of the JOA, NDI, VAS in the two groups of patients improved significantly after surgery than before surgery. In addition, the VAS score in last follow-up were significantly different between the two groups, but other index each time in the two groups showed no significant difference. In last follow-up, the result of artificial cervical disc arthroplasty group were better than ACDF group on the incidence of axial symptoms, the total cervical spine range of motion (ROM) and middle segments of motion. The incidence of axial symptoms in artificial cervical disc arthroplasty group were 11.1%,ACDF group were 45.2%. ROM in arti-ficial cervical disc arthroplasty group were 35.5°±5.9°,ACDF group were 24.5°±6.2°. Middle segments of motion in artificial cer-vical disc arthroplasty group were 7.3°±1.4°,ACDF group were 10.1°±1.6°. The above comparison of the datas were statistically different. There are two cases of adjacent segment degeneration in ACDF group without need to surgery

  10. 微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病%Transcorporeal anterior cervical microforaminotomy for cervical radiculopathy

    Institute of Scientific and Technical Information of China (English)

    崔虎山; 李光浩; 郑炳周; 金成镇

    2014-01-01

    目的:探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法:2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位:C5/64例,C6/75例,C7/T13例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数(NDI)及病变水平椎间盘高度。结果:手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分(7~10分),末次随访时为1.4±0.2分(0~3分),两者比较有显著性差异(P0.05)。术后满意度为100%。结论:微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。%Objectives: To investigate the effectiveness of transcorporeal anterior microforaminotomy for cervi-cal radiculopathy. Methods: Between July 2008 and July 2010, 12 patients underwent transcorporeal anterior microforaminotomy due to cervical radiculopathy. Among them, there were 7 males and 5 females, with a mean age of 49 years(range, 35-68 years). The levels included C5/6 in 4 cases, C6/7 in 5 cases and C7/T1 in 3 cases. The pathogenesis included soft nucleus pulposus herniation in 3 cases, uncovertebral joint osteo-proliferation in 7 cases and the calcification of protruded nucleus pulposus in 2 cases. During surgery, after soft tissue dissection, the

  11. Tratamento cirúrgico por via anterior na mielopatia cervical espondilótica com seguimento mínimo de dez anos Tratamiento quirúrgico por vía anterior en la mieolopatía cervical espondilótica con seguimiento mínimo de diez años Anterior decompression and fusion for spondilotic cervical mielopathy with a minimal ten-year follow-up

    Directory of Open Access Journals (Sweden)

    Rui Peixoto Pinto

    2010-06-01

    Full Text Available OBJETIVO: a mielopatia cervical espondilótica (MEC é uma causa frequente de disfunção da medula espinhal na população adulta. O tratamento implica em descompressão cirúrgica precoce. O objetivo foi apresentar um estudo retrospectivo da descompressão anterior e artrodese para MEC com um seguimento mínimo de dez anos. MÉTODOS: pacientes operados entre Janeiro de 1990 e Dezembro de 1994 foram avaliados por sexo, idade, número de níveis operados, avaliação funcional pela escala de Nurick pré-operatória um ano após cirurgia e após a revisão final que ocorreu em 2004, evidência de consolidação e complicações. RESULTADOS: foram avaliados 91 pacientes, 69 do sexo masculino, 22 do sexo feminino, com uma média de idade de 56,6 anos (42-86 e um seguimento médio de 11,9 anos. Ocorreram cinco óbitos: três pacientes no pós-operatório imediato, um no primeiro ano e um durante o restante período. Em média, foram operados 2,7±1,0 níveis por paciente (1-4. O valor médio de Nurick pré-operatório foi de 3,8±0,9. Houve uma melhoria significativa do estado neurológico um ano após a cirurgia (2,2±1,1; pOBJETIVO: la mielopatía cervical espondilótica (MEC es una causa frecuente de disfunción de la médula espinal en la población adulta. El tratamiento implica una descompresión quirúrgica precoz. El objetivo es presentar un estudio retrospectivo de la descompresión anterior y artrodesis para MEC con un seguimiento mínimo de diez años. MÉTODOS: pacientes operados entre Enero de 1990 y Diciembre de 1994 fueron evaluados según el sexo, la edad, el número de niveles operados, la evaluación funcional por la escala de Nurick pre operatoria un año después de la cirugía y después de la revisión final que fue en el 2004, evidencia de consolidación y complicaciones. RESULTADOS: fueron evaluados 91 pacientes, 69 del sexo masculino, 22 del sexo femenino, con un promedio de edades de 56.6 años (42 a 86 y un seguimiento

  12. A biomechanical study of the cervical posterior longitudinal ligament in anterior cervical decompression and fusion%颈前路椎间盘切除植骨融合术中后纵韧带的生物力学作用

    Institute of Scientific and Technical Information of China (English)

    陈向东; 张烽; 徐舒洋

    2011-01-01

    目的 比较颈前路椎间盘切除减压植骨融合中后纵韧带切除前后颈椎的即刻稳定性变化.方法 14具新鲜小牛颈椎标本(C3~T1)随机平分为单节段(1)组和双节段(2)组.每组又分为正常对照组(N组)、椎间盘切除植骨组(A组)、椎间盘切除植骨内固定组(B组)、椎间盘切除植骨后纵韧带切除组(C组)和椎间盘切除植骨后纵韧带切除内固定组(D组).使用万能材料实验机分别测试各组在轴向压缩、前屈、后伸、侧屈状态下的应变、载荷-位移关系、刚度及抗扭转性能.结果 (1)应变:A1组较N组在轴向压缩、前屈、后伸、侧屈状态应变增大(P<0.05);C1组平均应变大于A1组(P<0.05).(2)载荷-位移关系:A1、A2组的平均位移比N组位移大(P<0.05),C1比A1组平均位移增大11%,前屈状态增大20%(P<0.05);C2组的平均位移比N组增大15%(P<0.05),加用内固定后B2比C2平均位移小18%(P<0.05).(3)刚度:在100N生理载荷作用下,N组的平均轴向刚度为(25.38±1.78)N/nn,A1、A2组分别比N组下降8%、12%;平均轴向刚度B1组、B2组高于N组;D1、D2组颈椎的轴向刚度与同节段B组无差异(P>0.05).(4)各组的扭转力学性能高低依次为B组>D组>N组>A组>C组.结论 颈椎后纵韧带的完整性对维持颈椎的稳定性起重要作用.单、双节段颈前路椎间盘切除减压操作中后纵韧带的切除将显著降低标本的即刻生物力学稳定性.植骨、内固定能有效地增强术后标本的即刻稳定性.%Objective To compare immediately biomechanical stability between reservation and resection of the cervical posterior longitudinal ligament(PLL) when performing anterior cervical decompression and fusion. Methods Fourteen fresh frozen calf cadaveric cervical spine specimens(C3-T1 ) were equally divided into two groups of l(single segment) and 2(two segments). Each group was subdivided into groups of N(normal control), A(cervical disc resection

  13. Success and safety in outpatient microlumbar discectomy.

    Science.gov (United States)

    Best, Natalie M; Sasso, Rick C

    2006-07-01

    Currently, many spine surgeons perform microlumbar discectomies on an outpatient basis. Yet, it is often customary for patients to have a 1-night stay in the hospital. Many studies have shown the efficacy of microlumbar discectomy (MLD) and its preference among surgeons for the treatment of lumbar disc herniation. It has also been shown to be safe, successful, and cost-effective. However, a large comprehensive study of this magnitude, gauging safety, success, and patient satisfaction for these procedures on an outpatient basis has not yet been done. One thousand three hundred seventy-seven MLD procedures have been done from 1992 to 2001 by 1 surgeon. A retrospective chart review was done on all procedures. Patients were then contacted by either telephone or mail to complete an outcome questionnaire. Seven hundred thirteen patients (53.9%) completed the questionnaire. Follow-up questionnaires were not completed due to deaths, incorrect contact information, and refused responses. Out of all MLD procedures, 55 (4.0%) were done with a hospital stay-only 24 of these (1.7%) were originally intended outpatient procedures. Of those that were done on an outpatient basis, 8.6% had a complication, including 6.4% who had a recurrent disc herniation. When asked, 81.6% said they would undergo the procedure again as an outpatient. In 82.1% the surgery's outcome was good, very good, or excellent. MLD is a routine procedure that can be performed on an outpatient basis safely, successfully, and with high patient satisfaction.

  14. The clinical application of zero notch anterior cervical fusion plate (Zero-P) on anterior cervical decompression and bone fusion%零切迹颈前路融合钢板(Zero-P)在颈椎前路减压植骨融合内固定中的应用

    Institute of Scientific and Technical Information of China (English)

    程俊杰; 代杰; 马原; 田慧中

    2015-01-01

    背景:近年来,内固定系统和技术不断改进,行颈椎前路减压植骨的同时行前路钢板内固定已被大多数学者所接受,但与之有关的并发症也不断出现。鉴于此,零切迹椎间植骨融合钢板(Zero-P)被批准应用于临床治疗颈椎退行性疾病。  目的:探讨Zero-P在颈椎前路减压植骨融合内固定中的早期应用效果。  方法:2014年2至12月采用零切迹颈前路融合钢板对22例颈椎病患者行颈椎前路减压植骨融合内固定治疗。C3-4,C4-5,C5-6分别置入Zero-P为1,3,18枚。治疗后应用目测类比评分和JOA评分来评价疼痛及神经功能改善情况,并拍摄颈椎正侧位及过伸过屈侧位线片,根据测量治疗后颈椎侧位X射线片上钢板头、尾侧相邻椎间隙与椎体高度的比值(R)及相邻节段骨质增生情况来判断相邻节段退变情况。根据治疗后伸屈侧位X射线片观察手术间隙有无异常活动。  结果与结论:22例患者随访10-28个月,2例患者分别于治疗后第4天和第5天出现吞咽困难(均为轻度),均于治疗后2周内症状消失。所有患者治疗后的目测类比评分均低于治疗前(P0.05)。钢板头侧相邻椎间隙中3例(均为1级)椎体出现骨质增生,尾侧有1例(1级)出现;头、尾两侧骨质增生差异无显著性意义(P >0.05)。头、尾侧R值治疗前后差异无显著性意义(P>0.05),随访期间手术间隙无异常活动,内置物无移位。提示Zero-P修复单节段椎间盘病变效果显著,能有效改善颈椎曲度,建立良好的颈椎稳定性,治疗后吞咽困难发生率低,早期不增加相邻节段的退变。%BACKGROUND:In recent years, with the continuously improving of the fixation systems and technology, conducting anterior cervical decompression bone graft accompanying with anterior plate fixation have been accepted by most scholars, however, the complications related to this also

  15. Percutaneous lumbar foraminoplasty via posterolateral approach and transforaminal endoscopic discectomy%经皮侧后路腰椎间孔成形与经椎间孔完全内镜下腰椎间盘摘除术

    Institute of Scientific and Technical Information of China (English)

    李振宙; 侯树勋

    2014-01-01

    Conventional open discectomy is a standard surgical method for lumbar disc herniation. But iatrogenic injury to paraspinal muscle and facet joint may cause postoperative chronic low back pain and segamental instability, which can lead to reoccurence of lumbar disc herniation. Epidural scarr fomation arised from flavum resection in open discectomy is inavoidable with 10%of it leading to failed back sugery syndrome. Transforaminal endoscopic discectomy can be performed without iatrogenic injury to paraspinal muscle, facet joint and flavum ligament. Foraminoplasty is a technique that enlarge the low part of intervertebral foramen with different tools so that working channel and endoscope can be introduced into epidural space anterior to dura sac where protruted disc tissue can be targeted resected and nerve root complete decompressed. It can be treated as an alternative surgical technique for lumbar disc herniation.

  16. Evaluación del uso de collar cervical de inmovilización después de la descompresión y fusion cervical por acceso anterior: Revisión sistemática

    OpenAIRE

    Alberto Ofenhejm Gotfryd; Regina El Dib; Ricardo Vieira Botelho; Patrícia Rios Poletto

    2013-01-01

    This study aims to evaluate safety and effectiveness of the use of orthesis in postoperative degenerative disorders of the cervical spine. Although widely used, there are not defined criteria for the use of cervical collars, and their importance on cervical arthrodesis. A systematic literature review was undertaken and a multicentre controlled clinical trial comprising 32 specialized services, with a total of 257 patients who met the inclusion criteria of the review. Clinical and radiographic...

  17. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.

    Science.gov (United States)

    Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

    2008-12-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P PCN procedure. There was no significant difference in stability either preoperatively or

  18. Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion.

    Directory of Open Access Journals (Sweden)

    Sheng Shi

    Full Text Available Cervical disc arthroplasty (CDA with Discover prosthesis or anterior cervical discectomy and fusion (ACDF with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM. However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM.A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA score and Neck Disability Index (NDI. For radiographic assessment, the overall sagittal alignment (OSA, functional spinal unit (FSU angle, and range of motion (ROM at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded.Both treatments significantly improved all clinical parameters (P 0.05. Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05. However, significant differences occurred in prosthesis migration in CDA group.The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the postoperative early-term follow-up.

  19. 颈椎间盘置换与颈前路椎间盘切除减压植骨融合治疗退变性颈椎病的Mela分析%Meta analysis of cervical disc replacement versus anterior cervical discectomy and fusion for degenerative cervical syndrome

    Institute of Scientific and Technical Information of China (English)

    唐文; 刘志礼; 舒勇

    2010-01-01

    背景:颈前路减压植骨融合是目前治疗退变性颈椎病手术方案中的"金标准".但是,随着颈前路减压植骨融合技术使用的增加和随访资料的不断丰富,一些不良结果开始暴露出来.近20年来,人工颈椎间盘置换技术在国外和国内逐步推广并广泛应用于临床,文献报道治疗效果令人满意.目的:系统评价颈椎间盘置换与传统的颈前路减压植骨融合治疗退变性颈椎病治疗效果的差异.方法:计算机检索Medline(1966/2009-06),荷兰医学文摘(EMbase1966,2009-06),Cochrane 图书馆(2009年第2期)、Cochrane协作网背痛专业试验数据库、中国生物医学文献数据库(CBM 截止2009-06),CNKI(截止2009-06),手工检索中文文献,收集颈椎间盘置换与颈前路减压植骨融合比较治疗退变性颈椎病的随机、半随机对照试验,进行严格的质量评价,利用RevMan4.2.2软件对纳入研究结果进行Meta分析.结果与结论:共纳入15个研究,Meta分析结果显示:颈椎间盘置换与颈前路减压植骨融合术比较平均出血量、手术时间、住院时间及术后并发症差异无显著性意义:术后2年再手术率颈椎间盘置换组低于颈前路减压植骨融合组;手术满意率两组差异无显著性意义;颈椎间盘置换组术后颈部功能异常指数较颈前路减压植骨融合组明显改善,术后SF-36评分改善显著优于颈前路减压植骨融合组;术后手术节段运动幅度颈椎间盘置换组显著大于颈前路减压植骨融合组,术后邻近节段运动范围颈前路减压植骨融合组明显较颈椎间盘置换组增大.但上述结果可能存在各种偏倚,因此需要更多高质量的临床随机对照试验来得出更为可靠的结论.

  20. Análise de fatores associados à lesão do nervo laríngeo recorrente em cirurgias de discectomia cervical via anterior Análisis de factores asociados a la lesión del nervio laríngeo recurrente en cirugías de discectomía cervical por vía anterior Analysis of factors associated with laryngeal nerve injury in anterior disc herniation surgery

    Directory of Open Access Journals (Sweden)

    Erasmo Abreu Zardo

    2011-01-01

    Full Text Available OBJETIVO: Estudar os possíveis fatores associados com lesão do NLR após cirurgia de hérnia discal cervical com abordagem anterior. MÉTODOS: No período de junho/2009 a junho/2010, avaliamos 30 pacientes submetidos a tratamento cirúrgico de hérnia discal via anterior no Hospital São Lucas da PUC-RS. No pré-operatório, foi realizada a medida da circunferência cervical (ao nível da cartilagem cricóide e da altura cervical (do ângulo da mandíbula à borda superior da clavícula. No perioperatório, avaliamos o tempo e a dificuldade de entubação, o tempo cirúrgico, o lado da abordagem, o número de níveis operados, bem como o tipo de incisão (transversa/longitudinal e o uso de halo craniano. Realizou-se uma avaliação videoendoscópica da laringe (VEL, em busca de lesão do NLR, no pré-operatório e no décimo dia após a cirurgia. Pacientes que apresentaram resultado anormal na VEL foram considerados com lesão do NLR e submetidos à reavaliação mensal até a recuperação espontânea ou no período máximo de seis meses quando a lesão foi considerada definitiva. RESULTADOS: Encontramos 3/30 (10% casos de lesões não definitivas do NLR que se recuperaram em até 120 dias pós-operatórios. Os pacientes com lesão do NLR apresentaram uma maior circunferência do pescoço, tempo cirúrgico e número de níveis operados em relação aos pacientes sem lesão do NLR. Também, pacientes com lesão do NLR apresentaram um menor comprimento do pescoço. Duas lesões ocorreram na abordagem pelo lado direito e uma pelo lado esquerdo. Todos os pacientes com lesão tiveram incisão transversa e não fizeram uso de halo craniano. CONCLUSÃO: A abordagem pelo lado direito apresentou maior índice de complicações com o NLR. Apesar de o número limitado de pacientes não permitir conclusões estatisticamente significativas, fatores anatômicos intrínsecos do paciente como pescoço curto e diâmetro do pescoço aumentado, bem como tempo

  1. 15例 Hangman 骨折前路融合钛板固定分析%Anterior Cervical Fusion with Titanium Plate Fixation for Hangman’s Fracture:An Analysis of 15 Cases

    Institute of Scientific and Technical Information of China (English)

    江海亮; 潘剑成; 张宗明; 林阳; 杨文超; 贺立新

    2014-01-01

    ABSTRACT:Objective To investigate the efficacy and value of anterior cervical fusion with tita-nium plate fixation for the treatment of hangman’s fracture.Methods Fifteen patients with hangman’s fracture underwent anterior cervical fusion with titanium plate fixation from March 2003 to March 2011.Patients were followed up for an average of 12 months (range,10 to 18 months).Results Clinical symptoms were relieved and cervical lordosis was maintained with blurry C2 vertebral arch fracture line in all patients after operation.Bone graft fusion rate reached 100% 6 months after operation.No loosening and fracture of fixation system were found in all patients.Conclusion Anterior cervical fusion with titanium plate fixation can result in immediate stability,prevent graft dislodgement,avoid plaster immobilization,maintain cervical lordosis,pro-mot fracture healing and increase bone graft fusion rate in the treatment of hangman’s fracture.%目的:探讨前路融合钛板内固定术治疗 Hangman 骨折的疗效和应用价值。方法2003年3月至2011年3月,对15例 Hangman 骨折患者行颈椎前路融合钛板内固定术。术后进行10~18个月随访,平均随访12个月。结果术后症状明显恢复。全部病例颈椎生理前凸维持良好,C2椎弓骨的线模糊。术后6个月植骨融合率达到100%。无内固定系统松动及断裂现象存在。结论应用颈前路植骨融合内固定术治疗不稳定性 Hangman 骨折,具有术后上颈椎即时稳定,防止植骨块移位,无须石膏固定,维持生理前凸,促进骨折愈合和植骨融合率高等优点。

  2. Post laminoplasty cervical kyphosis—Case report

    Directory of Open Access Journals (Sweden)

    D.E. Dugoni

    2014-01-01

    CONCLUSION: The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability.

  3. A review on the clinical advances of artiifcial cervical disc replacement%人工颈椎间盘置换术的临床疗效研究进展

    Institute of Scientific and Technical Information of China (English)

    陈佳海; 阮狄克; 王德利; 胡学昱; 叶斌; 伍耀宏

    2016-01-01

    Anterior cervical discectomy and fusion ( ACDF ) is one of the commonest operative methods in the treatment of cervical intervertebral disc diseases. It needs to remove the degenerated disc and ifx the upper and lower vertebral bodies together, but in this way, the disc loses the motion and the stress of the adjacent segments might increase. Therefore, non-fusion method begins to attract extensive attention in clinical practice. Artiifcial cervical disc replacement is a new operation, which has become popular gradually in recent years and its short term clinical outcomes are reported to be satisfactory. However, whether it can really sustain the range of motion persistently and decrease the degeneration of the adjacent segments is unknown. It is still controversial whether its clinical outcomes are better than ACDF. All of these problems need to be proved by mid-long term clinical efifcacy. In this paper, we summarize the clinical efifcacy and application prospect of artiifcial cervical disc replacement based on the latest literature.

  4. Rastreamento anterior para câncer de colo uterino em mulheres com alterações citológicas ou histológicas Previous screening for cervical cancer among women with cytological and histological abnormalities

    Directory of Open Access Journals (Sweden)

    C Rama

    2008-06-01

    Full Text Available OBJETIVO: Analisar a história de rastreamento citológico anterior em mulheres que apresentaram alterações citológicas e confirmação histológica para câncer cervical. MÉTODOS: Estudo transversal com 5.485 mulheres (15-65 anos que se submeteram a rastreamento para o câncer cervical entre fevereiro de 2002 a março de 2003, em São Paulo e Campinas, SP. Aplicou-se questionário comportamental e foi feita a coleta da citologia oncológica convencional ou em base líquida. Para as participantes com alterações citológicas indicou-se colposcopia e, nos casos anormais, procedeu-se à biópsia cervical. Para investigar a associação entre as variáveis qualitativas e o resultado da citologia, utilizou-se o teste de qui-quadrado de Pearson com nível de significância de 5%. RESULTADOS: Dentre os resultados citológicos, 354 (6,4% foram anormais, detectando-se 41 lesões intra-epitelial escamosa de alto grau e três carcinomas; em 92,6% revelaram-se normais. De 289 colposcopias realizadas, 145 (50,2% apresentaram alterações. Dentre as biópsias cervicais foram encontrados 14 casos de neoplasia intra-epitelial cervical grau 3 e quatro carcinomas. Referiram ter realizado exame citológico prévio: 100% das mulheres com citologia compatível com carcinoma, 97,6% das que apresentaram lesões intra-epiteliais de alto grau, 100% daquelas com confirmação histológica de carcinoma cervical, e 92,9% das mulheres com neoplasia intra-epitelial cervical grau 3. A realização de citologia anterior em período inferior a três anos foi referida, respectivamente, por 86,5% e 92,8% dessas participantes com alterações citológicas e histológicas. CONCLUSÕES: Entre as mulheres que apresentaram confirmação histológica de neoplasia intra-epitelial cervical grau 3 ou carcinoma e aquelas que não apresentaram alterações histológicas não houve diferença estatisticamente significante do número de exames citológicos realizados, bem como o tempo

  5. Papel da videoendoscopia da laringe no diagnóstico de lesão do nervo laríngeo recorrente na abordagem cervical anterior Papel de la videoendoscopía de laringe en el diagnóstico de lesión del nervio laríngeo recurrente en el abordaje cervical por vía anterior The importance of larynx videoendoscopy in diagnosis of recurrent laryngeal nerve injury after anterior approach

    Directory of Open Access Journals (Sweden)

    Alexandre Coutinho Borba

    2010-12-01

    Full Text Available INTRODUÇÃO: o reconhecimento da lesão do nervo laríngeo recorrente (NLR após tratamento cirúrgico de hérnia discal cervical via anterior é importante na evolução clínica do paciente e, em especial, nos casos de reintervenção. O real papel da videoendoscopia da laringe (VEL de rotina no pós-operatório não tem sido completamente estudado. OBJETIVO: identificar a prevalência de lesões do NLR em pacientes sintomáticos ou não através da VEL após cirurgia de hérnia cervical via anterior. MÉTODOS: no período de Junho de 2009 a Julho de 2010 selecionamos 30 pacientes submetidos a tratamento cirúrgico de hérnia discal no Hospital São Lucas da PUC-RS. Realizou-se avaliação por VEL no pré-operatório e no décimo dia após a cirurgia. Pacientes que apresentaram um resultado anormal da VEL foram considerados com lesão do NLR e foram reavaliados mensalmente até a recuperação espontânea, ou no período máximo de seis meses, quando a lesão foi considerada definitiva. RESULTADOS: encontramos evidência de lesão do NLR em 3/30 (10% dos pacientes, sendo que todos se apresentavam assintomáticos no momento do exame. Dentre as lesões, 2/30 (66,6% ocorreram após abordagem cirúrgica pelo lado direito e 1/30 (33,3% pelo lado esquerdo. Não encontramos nenhuma lesão definitiva, sendo o período máximo de recuperação de 120 dias. CONCLUSÃO: a avaliação por VEL no período pós-operatório pode ser útil para diagnosticar lesões do NLR, principalmente em pacientes assintomáticos. A falta de suspeita clínica não exclui a possibilidade de lesão do LNR.INTRODUCCIÓN: el reconocimiento de la lesión del nervio laríngeo recurrente (NLR después del tratamiento quirúrgico de hernia de disco cervical por la vía anterior es importante en la evolución clínica del paciente y, principalmente, en los casos de reintervención. El real papel de la videoendoscopía de laringe (VEL de rutina en el postoperatorio no ha sido

  6. Change of cervical balance following single to multi-level interbody fusion with cage.

    Science.gov (United States)

    Lin, Hung-Lin; Cho, Der-Yang; Liu, Yu-Fang; Lee, Wen-Yuan; Lee, Han-Chung; Chen, Chun-Chung

    2008-12-01

    Postoperative limitation of cervical movement and adjacent disc degeneration are major causes of postoperative neck pain after anterior cervical discectomy and interbody fusion (ACDF). We present a retrospective study of dynamic radiographic change following ACDF with cages. We performed ACDF in 50 patients with cervical degenerative diseases, divided into three groups based on the level of interbody fusion (Group A: one-level; Group B: two-level; Group C: three-level). Preoperative and postoperative flexion-extension X-rays were acquired and cervical range of motion (ROM), lordosis, fusion rate, cage subsidence rate, postoperative neck pain as evaluated by visual analogue scale (VAS) and upper adjacent level segmental movement were evaluated. The average following time was 14.6 months. The mean change in lordotic curve was -2.31 +/- 9.53 degrees for Group A, 5.60 +/- 6.96 degrees for Group B, and 3.23 +/- 7.50 degrees for Group C (p value = 0.03). The mean change in flexion angle was -5.46 +/- 8.69 degrees for Group A, -10.2 +/- 7.38 degrees for Group B, and -13.86 +/- 10.33 degrees for Group C (p value = 0.039). The mean change in total cervical ROM was -3.85 +/- 18.74 degrees for Group A, -12.73 +/- 10.31 degrees for Group B, and -16.95 +/- 10.57 degrees for Group C (p value = 0.02). Follow-up cervical MRI for patients with persistent neck pain showed no evidence of adjacent level degeneration. There were no significant differences between the three groups with respect to postoperative change in cervical extension angle, upper adjacent level segmental movement, neck pain VAS, fusion rate or cage subsidence rate. The further decrease in total cervical ROM and flexion movement after multi-level ACDF was observed. However, a more long-term follow-up was needed to assess the actual aetiologies of upper adjacent level degeneration.

  7. 生物活性颈椎椎间融合器在颈椎融合术中不同固定方式的生物力学研究%Biomechanical study of bioactive cervical fusion cage with different types of fixation in cervical spinal fusion

    Institute of Scientific and Technical Information of China (English)

    胡孔和; 吴强; 段扬; 包拥政; 靳安民; 赵卫东

    2012-01-01

    目的 探讨由羟基磷灰石和左旋聚乳酸复合研制的新型生物活性颈椎椎间融合器在颈椎融合术中不同固定方式的生物力学特性.方法 制备新鲜人颈椎标本6个(尸体均为合法捐赠,由南方医科大学解剖学教研室提供),模拟临床术式行前路C5~6减压椎间分别植入髂骨、生物活性颈椎椎间融合器和生物活性颈椎椎间融合器加钢板内固定,通过脊柱三维运动实验机测量C5~6节段的运动范围.结果 生物活性颈椎椎间融合器加钢板固定后稳定性增加,在各个状态的运动范围均明显小于其他各组(P <0.005).单纯生物活性颈椎椎间融合器组在后伸状态下运动范围(6.25±0.29)度较正常组(5.76±0.40)度增大,稳定性下降,但差异无统计学意义(P>0.05);在除后伸外的其他各种状态下的运动范围均小于髂骨组,较髂骨组稳定,差异有统计学意义(P<0.005).结论 新型生物活性颈椎椎间融合器具有良好的生物力学性能,加钢板内固定后各个方向稳定性好,能重建颈椎稳定性.%Objective To investigate the biomechanical characteristics of different types of fixation with bioactive cervical fusion cage made of hydroxyapatite and poly L-lactic acid in cervical spinal fusion.Methods Iliac crest bone,bioactive cervical fusion cage and bioactive cervical fusion cage with plate fixation were used for anterior interbody implants after anterior discectomy across C5-6 in six fresh human cervical spine specimens respectively,and the range of motion of the cervical vertebrae interbody fusion were measured through the motional stability test.Results After discectomy,Bioactive Cervical Fusion Cage with plate fixation exhibited a significant increase in stability and a decrease of range of motion in angular motion than others in all motional directions ( P < 0.005 ). Bioactive cervical fusion cage exhibited a decrease in stability and an increase of range of motion (6.25

  8. 前路内固定治疗复杂枢椎损伤%Anterior surgical treatment of complex axis fractures

    Institute of Scientific and Technical Information of China (English)

    蔡贤华; 王威; 康辉; 徐峰; 刘曦明; 黄勇; 赵继

    2014-01-01

    目的 探讨复杂枢椎损伤的损伤机制、临床诊断及应用前路有限内固定术治疗的疗效.方法 自2006年1月至2011年12月收治22例复杂枢椎损伤患者,男15例,女7例;年龄29~68岁,平均41.5岁.根据枢椎骨折情况及C1-2、C2-3稳定程度分别予以前路齿状突螺钉+C2-3椎间盘切除植骨融合钢板螺钉内固定术(11例),前路C2-3椎间盘切除植骨融合钢板螺钉内固定术(8例),前路齿状突螺钉+ C2前路钢板螺钉内固定(2例),前路C2-3椎间盘切除植骨融合钢板螺钉内固定+前路经寰枢关节螺钉内固定术(1例).合并脊髓损伤者予以充分减压.术后头颈胸石膏或支具外固定保护3个月,并对患者颈椎活动度、疼痛情况及并发症、神经功能改善情况进行随访分析. 结果 所有患者术后获6 ~36个月(平均13.0个月)随访,均获骨性愈合,无一例出现椎体位移和成角畸形,X线片示颈椎稳定性良好,除C1-2融合固定者头颈部旋转部分受限外,其他患者颈椎功能活动恢复满意.脊髓损伤患者术后神经功能得到不同程度的改善,术后根据Mayo(McGrory)颈椎创伤评分标准进行临床评价:优16例,良4例,可2例,优良率为90.9%. 结论 复杂枢椎损伤的发生机制通常与逐渐增加的屈曲和伸展载荷联合旋转或剪切载荷有关,临床结合X线片、CT及三维重建、MRI可明确诊断;采用前路手术进行有限内固定治疗疗效可靠,对于尽量保留上颈椎功能是一种行之有效的方法.%Objective To investigate the injury mechanism,clinical diagnosis and anterior surgery of complex axis fractures.Methods From January 2006 to December 2011,22 patients with complex axis fracture were treated in our department.According to the fracture type and the stability of C1-2 and C2-3 levels,11 patients received anterior odontoid screw fixation + C2-3 discectomy + bone grafting + anterior cervical plating,2 patients anterior odontoid screw fixation

  9. Cervical disc replacement and anterior interbody fusion in the repair of middle-aged patients with cervical spondylosis:cervical function and range of motion%颈椎间盘置换与前路椎间植骨融合修复中年颈椎病:颈椎功能及活动度比较

    Institute of Scientific and Technical Information of China (English)

    蒋新祥; 徐海栋; 路晓

    2015-01-01

    BACKGROUND:The development of spinal non-fusion technology promoted movement function protection of adjacent segment and operating segment. In the treatment of cervical spondylosis surgery, non-fusion technology has been widely carried out. For middle-aged patients with cervical spondylosis, the demand for spinal joint movement function is high. Non-fusion technology can improve the postoperative quality of life and slow down the risk of adjacent segment degeneration. OBJECTIVE:To evaluate the clinical efficacy of anterior cervical different implant materials (fusion or non-fusion) in the treatment of single segment of the intervertebral disc degeneration of cervical spondylosis in middle-aged patients. METHODS:This study enrol ed 10 cases of single segmental radiculopathy and cervical myelopathy after cervical intervertebral disc replacement from June 2011 to June 2013. Simultaneously, 10 cases were randomly selected from patients with anterior interbody fusion as the control group. Before treatment, at 1 and 3 months, and 1 year after treatment, changes in range of motion of cervical vertebra were observed using imaging results. Therapeutic effects were assessed using Japanese Orthopaedic Association Scores, Visual Analog Scale and The Neek Disability Index in both groups. RESULTS AND CONCLUSION:Al patients did not suffer from incision fat liquefaction, infection and delayed healing, and had finished fol ow-up for more than 1 year. Results revealed that Japanese Orthopaedic Association Scores and Visual Analog Scale scores were improved at 1 and 3 months, and 1 year after treatment (P0.05). In the analysis of range of motion of cervical vertebra and The Neek Disability Index, there were significant advantages in non-fusion treatment group (P  目的:评价在中年颈椎病患者人群中,采用颈椎前路不同植入材料(融合与非融合)治疗单节段椎间盘退变性颈椎病的临床效果。  方法:纳入2011年6月至2013年6月收

  10. Avaliação do uso de imobilização externa após descompressão e fusão cervical por via anterior: Revisão sistemática

    Directory of Open Access Journals (Sweden)

    Alberto Ofenhejm Gotfryd

    2013-01-01

    Full Text Available Este estudo tem como objetivo avaliar a efetividade e a segurança do uso de órteses no pós-operatório de afecções degenerativas da coluna cervical. Apesar de amplamente utilizados, não existem critérios definidos para a aplicação de colares cervicais e sua relevância na artrodese cervical. Foi realizada uma revisão sistemática da literatura, além de um estudo multicêntrico controlado, composto por 32 serviços, com um total de 257 pacientes que satisfizeram os critérios de inclusão da revisão. Foram comparados desfechos clínicos e radiográficos de pacientes operados em um único nível anatômico que fizeram uso ou não de colar cervical rígido por 6 a 12 semanas após a cirurgia. As evidências disponíveis na literatura, apesar de fracas, sugerem que o uso do colar cervical diminui os escores clínicos nas primeiras semanas após o procedimento cirúrgico. Além disto, não altera a taxa de fusão quando utilizado concomitantemente à placa e aos parafusos por acesso anterior, em doenças degenerativas cervicais em um único nível anatômico.

  11. Double-hook retractor for microlumbar discectomy and foraminotomy

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    Parthiban J

    2004-01-01

    Full Text Available Aiming to achieve better results in microlumbar discectomy and foraminotomy, a double-hook retractor has been designed to retract lumbar paraspinal muscles away from the spinous process. A double-hook retractor obviates the limitations of single-hook systems.

  12. Results of arthrospine assisted percutaneous technique for lumbar discectomy

    Directory of Open Access Journals (Sweden)

    Mohinder Kaushal

    2016-01-01

    Full Text Available Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years. The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3, L2-L3 (n = 2, L3-L4 (n = 8, L4-L5 (n = 90, and L5-S1 (n = 47. Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90% patients had excellent to good, 12 (8% had fair, and 2 patients (1.3% had poor results. The complications observed were discitis in 3 patients (2%, dural tear in 4 patients (2.6%, and nerve root injury in 2 patients (1.3%. About 90% patients

  13. Gabapentin for analgesia after operation of cervical spine anterior cervical observation%加巴喷丁用于颈椎前路颈椎手术后镇痛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    蔡兵; 文传兵; 牟玲

    2012-01-01

    目的 探讨加巴喷丁用于经前路颈椎手术的超前镇痛作用.方法 选择ASAⅠ~Ⅱ级40例择期经前路颈椎手术患者,随机分成两组,G组(n =20)于手术开始前2h口服加巴喷丁胶囊300mg,C组(n=20)于手术开始前2h口服维生素E胶囊.所有患者在手术结束后1h、4h、8h、12h及24h时进行疼痛视觉模拟评分(VAS)情况;采用Ramsay镇静评分评价患者的镇静情况;观察可能出现的恶心、呕吐、嗜睡、眩晕、呼吸抑制等不良反应.结果 G组术后1h、4h及8hVAS评分均低于C组(P<0.05);与C组比较,G组术后恶心、呕吐发生率更低(P<0.05);嗜睡、眩晕及呼吸抑制的发生率在两组相似.结论 加巴喷丁超前镇痛可以增强经前路颈椎手术后的镇痛效果,能降低术后恶心呕吐发生率的作用.%Objective To evaluate the efficacy of preemptive analgesia with gabapentin for oral use in anterior approaches for cervical spondylotic myelopathy. Methods 40 patients ASA Ⅰ ~ Ⅱ grade aged 21 ~ 70 undergoing laparoscopic cholecystec-tomy were randomly divided into two groups(n =20) : Group 1 ,the gabapentin group (G) and group 2, the C group. The G group were given a bolus of 300mg gabapentin for oral use 2 hours before operation while the C group were given a bolus of vita-mine E for oral use 2 hours before before operation. The pain scores VAS (visual analog scale) , Ramsay sedation score, nausea, vomiting, drowsiness, giddiness, Respiratory depression and other adverse reactions were recorded inl , 4,8,12, and 24 hour postoperation respectively. Results In group G , the VAS score were lower than group C at the 1 hour postoperation,4 hour posto-peration and 8 hour postoperation ( P < 0. 05 ) . The complaint of nausea, vomiting in group G were lower than group C (P < 0. 05). There were no differences in complaint of drowsiness, giddiness, Respiratory depression between the two groups. Conclusion Preemptive analgesia with gabapentin via

  14. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation : A prospective randomised controlled trial [ISRCTN51857546

    NARCIS (Netherlands)

    M.P. Arts (Mark); W.C. Peul (Wilco); R. Brand (René); B.W. Koes (Bart); R.T.W.M. Thomeer (Raph)

    2006-01-01

    textabstractBackground: Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows ea

  15. Prevalence of complications after surgery in treatment for cervical compressive myelopathy

    Science.gov (United States)

    Wang, Tao; Tian, Xiao-Ming; Liu, Si-Kai; Wang, Hui; Zhang, Ying-Ze; Ding, Wen-Yuan

    2017-01-01

    Abstract Purpose: We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan. Methods: An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3. Results: A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%). Conclusions: Based on our meta

  16. 颈椎前路手术前后康复护理工作要点%Nursing notes of rehabilitation before and after anterior cervical operation

    Institute of Scientific and Technical Information of China (English)

    孙彩霞; 何冰

    2003-01-01

    @@ BACKGROUND:The operation of anterior vertebrae often cause the injury of superior laryngeal nerve and inferior laryngeal nerve and it is important of enough preoperative preparations and postoperative care for pationts.

  17. The Mobi-C cervical disc for one-level and two-level cervical disc replacement: a review of the literature

    Directory of Open Access Journals (Sweden)

    Alvin MD

    2014-11-01

    Full Text Available Matthew D Alvin,1,2 Thomas E Mroz1,3,41Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; 4Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USABackground: Cervical disc arthroplasty (CDA is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures.Purpose: To critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA.Methods: All clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded.Results: Fifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF. Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO. Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies.Conclusion: One-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients

  18. 显微镜辅助下颈前路精细化减压治疗多节段脊髓型颈椎病的研究%Elaborative decompression under microscope through anterior cervical approach for treatment of multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    邵进; 杨铁毅; 刘树义; 张岩; 吴亮; 黄国华; 宋超; 范鑫斌

    2015-01-01

    目的:探讨显微镜辅助下颈前路精细化椎间隙减压内固定治疗多节段脊髓型颈椎病的临床效果。方法2011年1月~2014年1月,第二军医大学附属上海市浦东新区公利医院骨科52例多节段脊髓型颈椎病患者给予了显微镜辅助下精细化减压治疗。摄颈椎正侧位X线片,测量颈椎曲度,运用日本矫形外科学会(JOA)评分标准进行神经功能评价。结果所有52例患者均获得随访,术前、术后3 d、术后6个月和术后12个月颈椎生理曲分别为(14.92±2.81)º、(19.85±3.37)º、(19.57±2.69)º、(19.49±3.05)º,日本矫形外科学会(JOA)评分分别为(9.82±3.32)、(13.72±3.23)、(13.63±3.17)、(13.56±3.24)分,术后3 d、6个月和术后12个月颈椎生理曲度较术前均明显恢复、JOA评分较术前均明显提高(P<0.01);末次随访示植骨融合。除1例患者术后10 d发生血肿致呼吸困难,即刻清除血肿后恢复正常外,未发生切口感染、钛板断裂、螺钉松动以及融合器下沉或移位等并发症。结论显微镜辅助下颈前路手术,具备视野清晰、配合默契、彻底精细减压、术后即刻功能恢复等优势,显著提高颈椎前路手术优良率。%Objective To investigate the clinical efficacy of elaborative decompression under microscope through anterior cervical approach for treatment of multilevel cervical spondylotic myelopathy. Methods From January 2011 to January 2014, a total of 52 patients of multilevel cervical spondylotic myelopathy was carried out elaborative decompression under microscope through anterior cervical approach. The cervical curvature was measured by anterior-posterior and lateral X-ray of the cervical vertebrae, and the neurological function was evaluated using JOA score. Results All the 52 patients were followed up. The cervical curvature of preoperation, 3 days, 6 months and 12 months was (14.92±2.81)o, (19.85±3.37)o, (19.57±2.69)o, (19.49±3.05)orespectively. The JOA

  19. Mobi-C人工颈椎间盘在颈前路手术的临床应用%Clinical study of Mobi-C cervical prosthetic disc in cervical anterior route operation

    Institute of Scientific and Technical Information of China (English)

    严力生; 罗旭耀; 钱海平; 梁伟; 鲍宏伟; 宫峰

    2011-01-01

    目的 探讨观察Mobi-C人工颈椎间盘置换技术治疗颈椎病、颈椎间盘脱出症的临床疗效.方法 自2008-10-2010-03,应用Mobi-C人工颈椎间盘置换术治疗颈椎病8例13个椎间隙、颈椎间盘脱出症5例6个间隙,对手术操作、术中出血、术后影像学检查及临床疗效等进行了分析.结果 患者手术后1周均感到上胸部紧缩感及手指麻木等神经症状明显好转,手指持物及下肢肌力增加.术后1周X线片检查显示:椎间隙高度、位置良好.随访6~23个月,根据JOA评分:从手术前的平均9.5分增加到随访时16.5分,术后改善率93.4%.X线摄片示无椎间隙的高度丢失、椎体后缘自发骨化及后凸畸形,动力性摄片未见不稳、假体移位、松动征象.术后未出现喉头水肿、伤口血肿、切口感染、声音嘶哑等并发症.结论 Mobi-C人工颈椎间盘置换术治疗颈椎病、颈椎间盘突出症能获得优良的近期疗效.%objective To observe the clinic effecl of Mobi-C artifitial cervical disc prosthesis on treating cervical spondylotic myelopathy and cervical disc protrusion. Methods From October 2(X)8 to March 2010,8 cases(13 spacs )of cervical spondylotic myelepathy anrl 5 cases(6spacs)of cervical disc protrusion were treated surgically by cervical arthroplasty using Mobi-C disc prosthesis. The material include the surgery procedures, operative time,blood loss,radiological examinations,clinical effect and complications were analyzed. Results The neurologic symptoms were relieved obviously within one week postoperative in all patients. Low limb muscle strength increased, upper limb abnormal sensation disappeared and limb moved more agile. Cervical X-ray film showed cervical curve anil position of Mobi-C prosthesis resumed normal. The intervertebral space height were maintaining original height in all cases. Followed up average 15 months (6~23 months). The average JOA score increased from 9.5 preoperative to 16.5 at followed up

  20. The sugery for adjacent segment degenerative disease after previous anterior cervical corpectomy and fusion%颈前路椎体次全切除融合术后邻近节段病的手术治疗

    Institute of Scientific and Technical Information of China (English)

    张海龙; 贺石生; 丁悦; 顾广飞; 李忠海; 溪铁胜

    2012-01-01

    颈前路椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)是治疗神经根及脊髓型颈椎病的有效方法,但随之而来的邻近节段退变问题成为广泛关注的焦点.既往文献报告引起症状的邻近节段退变的发生率达7%~17%,部分患者需要手术干预[1].1997年8月~2007年8月对42例ACCF后邻近节段退变性疾病患者行再手术治疗,总结如下.

  1. 颈椎椎前筋膜的解剖特点及其与周围结构的关系%Anatomic features office prevertebral fascia and its significance in the anterior cervical approach

    Institute of Scientific and Technical Information of China (English)

    单建林; 姜恒; 李放

    2011-01-01

    目的 观察颈椎椎前筋膜的解剖特点及其与周围结构的关系,优化颈前手术入路.方法 成人厂J体标本22具.在环状软骨下缘水平横形切断气管、食管.观察椎前筋膜在椎体前方的移行,观察右侧喉返神经、甲状腺F动脉穿出椎前筋膜处与颈椎椎体水平的对应关系和与颈动脉鞘的位置关系.在同水平横行切开椎前筋膜、颈动脉鞘及其内容.横断面观察椎前筋膜的层次、质地、各层次向两侧的移行及与颈动脉鞘的关系,观察颈动脉鞘的形态及体验游离椎前筋膜的难易.结果 颈椎椎前筋膜分为深、浅两层,浅层致密,深层薄弱,二层容易相互分离,颈动脉鞘内侧直接与椎前筋膜浅层相移行.右侧喉返神经均在胸1椎体水平自颈动脉鞘内缘穿出椎前筋膜,甲状腺F动脉约在颈6椎体水平自颈动脉鞘内缘穿出椎前筋膜.结论 颈椎椎前筋膜的解剖特点及其与周围结构的关系可被利用使颈前手术入路更合理和安全.%Objective To make the anterior cervical approach more reasonable and safer by means of investigating the anatomic features of the prevertebral fascia and its anatomic relationships to surrounding organs. Methods Twenty-two embalmed cadavers were dissected. At the level of cricoid cartilage the trachea and esophagus were divided and pulled aside to observe the lateral transition and continuation of the prevertebral fascia and observe the location and corresponding level to the cervical vertebra where the inferior thyroid artery and the fight recurrent laryngeal nerve exit from the prevertebral fascia and its location relationship to the carotid sheath. At the same level the carotid sheath and its content and the prevertebral fascia were cut transversely to observe the layers and texture of the prevertebral fascia and transition of each layer, the morphology of the carotid sheath and its relationship to each layer of the prevertebral fascia were observed

  2. Clinical Effect of Anterior Disc Excision with Bone Graft Fusion and Bryan Artificial Cervical Disc Replacement%颈前路减压植骨融合与Bryan人工颈椎间盘置换疗效比较

    Institute of Scientific and Technical Information of China (English)

    陈昆; 蔡惠民; 陈荣滋

    2014-01-01

    目的:探讨颈椎前路减压植骨融合术( anterior cervical decompression and fusion,ACDF)与Bryan人工颈椎椎间盘置换术( artificial cervical disc replacement,ACDR)两种手术方式用于治疗脊髓型颈椎病及神经根型颈椎病的近期和远期疗效。方法系统分析我院2010年11月至2012年11月70例(70个节段)脊髓型或神经根型颈椎病患者病例资料,将70例(70个节段)脊髓型或神经根型颈椎病患者,通过随机数字表法随机分为ACDF组(35例)及Bryan组(35例)。通过分析术前及术后随访12个月的Odom′s标准评分、活动度( range of motion,ROM)、日本骨科协会( Japa-nese orthopaedic association,JOA)、健康调查简表( the MOS item short from health survey,SF-36)及颈椎残障功能指数( neck disability index,NDI)观察指标的差异,同时对随访12个月的上述各项指标进行两组间比较,比较两者疗效,分析两种术式的优点及他们产生的问题。结果两种手术方式都能取得明确疗效,治疗后患者症状明显缓解( P0.05);JOA评分及SF-36评分两者差异性不显著( P>0.05);而在12个月随访ROM评估及NDI比较有差异,Bryan组数据优于 ACDF组,差异具有统计学意义( P0. 05). JOA score and SF-36 scale had no significant differences(P>0. 05). There was difference between ROM and NDI in the evaluation of 12 month follow-up. Data of Bryan group were better than ACDF group(P<0. 05). Conclusion Bryan artificial cervical disc re-placement(ACDR)is superior to the anterior cervical decompression and fusion(ACDF)in reducing the adjacent segment degeneration of cervical vertebra. Its short-term and mid-term curative effect is superior to the ACDF. But Bryan artificial cervi-cal disc replacement( ACDR)coexist the complications such as incomplete decompression and heterotopic ossification,the long-term curative effect is inferior than ACDF.

  3. 颈椎前路融合与置换体外生物力学实验的新观点%Advances in research on anterior cervical fusion and replacement in vitro biomechanical experiment

    Institute of Scientific and Technical Information of China (English)

    吕聪伟; 蒲婷; 廖振华; 刘伟强

    2013-01-01

    背景:传统“金标准”颈前路减压植骨融合及近年来迅速发展的人工颈椎间盘置换是临床上常见的治疗颈椎病的方式。大量科研工作者和临床医生希望通过颈椎体外标本实验研究脊柱生物力学,为临床治疗提供指导数据。  目的:对现有颈椎体外标本生物力学实验研究进展进行综述,并对未来的研究方向进行展望。  方法:以“Cervical Spine, Fusion, Replacement, Hybrid, Biomechanics, In vitro, Adjacent-level Degeneration, Review”为英文检索词检索Pubmed数据库,以“颈椎,融合,置换,混合术,生物力学,体外,相邻节段退变,综述”为检索词检索CNKI数据库和万方数据库,检索2007年1月至2013年3月有关颈椎前路融合与置换体外生物力学实验研究进展的文献,主要整理近3年来相关研究,排除陈旧文章和重复性工作,最后对40篇文献进行归纳与讨论。  结果与结论:文章对现有的颈椎体外标本融合、置换实验进行总结,集中体现在手术多节段、运动控制条件差异化、颈椎耦合运动测试和新型植入器械4个方面,对比总结融合与置换治疗对邻近节段运动范围、关节内压力、髓核内压力和椎间孔形态的影响,探讨融合、置换后存在的问题。最后结合临床的需求,展望颈椎体外标本实验的发展趋势及应用前景。%BACKGROUND:Traditional“gold standard”of anterior cervical decompression with fusion and artificial cervical disc replacement rapidly developed in recent years are common clinical methods for the treatment of cervical spondylosis. A large number of researchers and clinicians hope to research the biomechanics of spine through cervical specimen in vitro experiments, which provide guidance for clinical surgery. OBJECTIVE:To review the cervical specimen in vitro experiments and to prospect the future research. METHODS:The PubMed database

  4. 前路减压植骨可吸收螺钉内固定治疗颈椎病%The anterior decompression and bone grafting with bio-absorbable screw fixation for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    王栋; 贺西京; 李浩鹏; 张健; 徐思越; 杨平林; 王国毓

    2009-01-01

    Objective:To observe the early clinical effect of the cervical spendylosis treated by the fixation with bio-absorbable screw after cervical anterior decompression and bone grafting.Method:26 cases suffered from cervical spondylosis who were treated by anterior compression,bone grafting and fixating with 2 bio-ab-serbable screws from Mar. 2007 to Sep. 2008,including 16 males and 10 females with an average age of 49.4 years (38-70 years ).There were 11 cases with cervical spondylotic myelopathy,5 with cervical spendylofic radieulopathy and 10 with mixed type of cervical spondylosis.Clinical data of these patients was analyzed ret-rospectively.One intervertebral space involvement was in 8 cases,and two spaces involvement in 18 cases.All patients underwent anterior decompression and bone grafting,in which the grafted bone was fixated by 2 bio-absorptive screws (PLLA,diameter:2.7mm) from the midline of graft bone to the bone surface of upper and lower vertebrae in 45°.Cervical collar was commonly used for 4-6 weeks after operation.All cases were fol-lowed-up every month in outpatient department to observe the improvement of symptoms and evaluate the fu-sion of bone graft.Neurological function recovery was observed by JOA score.Result:Operations of all cases were finished and screws were placed successfully.The operative incisions healed well.The excellent and good rate of symptom improvement was 84.2%,the graft fusion time was 3.3±0.6 months (range,3.2-4.6 months).No obvious complications were found.Conclusion:The cervical spendylosis with one or two-level involvement can be effectively treated by anterior decompression and bone grafting with bio-absorbable screw fixation.This operative method is safe and can avoid the complications induced by metal implants.%目的:观察颈椎前路减压植骨可吸收螺钉内同定治疗颈椎病的初步临床疗效.方法:2007年3月~2008年9月我院应用颈椎前路减压植骨可吸收螺钉

  5. Measurement and clinical significance on anatomic landmark of anterior cervical decompression%颈椎前路减压手术解剖标志定位测量及其临床意义

    Institute of Scientific and Technical Information of China (English)

    林永绥; 王万明; 张发惠; 郑和平; 王春

    2014-01-01

    Objective The primary purpose of the current study is to provide more scientific landmarks for safe and efficient decompression within limited operating field in cervical anterior decompression. Methods Relative data were observed and measured at C3~7 of 15 adult cadaveric specimens and some data were calculated basing on above data:the ratio of anterior crus of uncinate process-medial border of longus colli muscle distance and medial border of longus colli muscle-median sagittal plane distance(AULD/MLPD), the ratio of anterior crus of uncinate process- medial border of foramen transversarium distance and anterior crus of uncinate process-medial border of longus colli muscle distance (AUTD/AULD), the ratio of anterior crus of uncinate process-lateral border of dural sac perpendicular distance and posterior crus of uncinate process-lateral border of dural sac distance(AUDD/PUDD), and the ratio of the nearest point of uncinate process and nerve root-anterior crus of uncinate process perpendicular distance and anteroposterior crus of uncinate process perpendicular distance(UNAD/APUD). Results AULD/MLPD averaged 0.83 at C3, 0.55 at C4, 0.20 at C5, 0.34 at C6, and 0.27 at C7. AUTD/AULD averaged 2.71, AUDD/PUDD averaged 0.28, and UNAD/APUD averaged 0.34. Conclusion Anterior crus of uncinate process is a consistent anatomic landmark at anterior border of cervical vertebrae, which could serve as a stationary and reliable landmark in cervical anterior decompression, and facilitate the location of dural sac, cervical nerve root and vertebral artery during operation according to the ratios of AUDD/PUDD, UNAD/APUD and AUTD/AULD.%目的:为颈椎前路减压手术在有限显露术野中达到安全、有效减压提供更科学的减压标志。方法在15具成人尸体标本上,解剖观测C3~7节段相关解剖数据,以所测量的数据为基础,计算:(1)椎体钩前脚至颈长肌内侧缘的距离/颈长肌内侧缘至正中矢状面的距离(AULD/MLPD);(2

  6. Cervical spine disc herniation at C2-C3 level: Study of a Clinical Observation and Literature Review

    Directory of Open Access Journals (Sweden)

    Oka Dominique N'Dri

    2015-12-01

    Full Text Available Cervical C2-C3 herniated disc is rare. It is characterized by its clinical polymorphism. Several surgical approaches have been described for the discectomy of a herniated disc. This work aims at discussing through personal observations and literature review clinical semiology and surgical treatment.

  7. Anterior cervical Cage-assisted fusion combined with locking titanium plate internal fixation for the treatment of extension-type cervical fracture%颈前路Cage融合锁定钛板置入内固定治疗伸直型颈椎骨折

    Institute of Scientific and Technical Information of China (English)

    吴剑; 刘艳西; 秦星星; 郑勇; 石振; 鲍同柱

    2013-01-01

    BACKGROUND:There is no literature about the treatment according to the mechanism of cervical spine injury classification, especial y for the treatment of extension type cervical fracture/dislocation with merger cases of posterior composite structure damage, whether simple anterior approach can meet the needs of the treatment has no detailed elaboration. This article may analyze from the aspect of cervical spine injury mechanism. OBJECTIVE:To observe the short-term effect of anterior cervical Cage-assisted fusion combined with locking titanium plate internal fixation for the treatment of extension type cervical fracture. METHODS:A retrospective analysis was performed in 15 extension type cervical spine fracture dislocation patients treated with decompression anterior cervical intervertebral disc resection plus bone graft with cage-fusion locking titanium plate internal fixation from June 2006 to March 2011 in the Department of Orthopedics, Xianning Central Hospital, including 10 cases of single segment injury and treatment, and five cases of multiple segment injury and treatment. Japanese Orthopaedic Association score and the neck disability index were compared before and after treatment;the cervical flexion and height were measured according to the antersposterior X-ray film taken before fixation, 1 week after fixation and final fol ow-up.RESULTS AND CONCLUSION:The patients were fol owed-up for 8-37 months. One case had Cage mild sinking and shift, and there was no internal fixation breakage or loosening in al the patients. Transient pharyngeal discomfort was observed in 11 patients. Compared with the preoperation, the Japanese Orthopaedic Association score, neck dysfunction index, fusion segment cervical flexion and fusion segment intervertebral disc height were significantly improved at 1 week after fixation and final fol ow-up (P0.05). The short-term effect of decompression anterior cervical intervertebral disc resection plus bone graft with cage-fusion locking

  8. Endoscopic anatomy and features of lumbar discectomy by Destandau technique

    Directory of Open Access Journals (Sweden)

    Keyvan Mostofi

    2017-03-01

    Full Text Available Minimally invasive spine surgery prevents alteration of paraspinal muscles and avoids traditional open surgery, so in the majority of cases, recovery is much quicker and patients have less back pain after surgery. The authors describe an endoscopic approach to lumbar disc herniation by the Destandau's method originated in Bordeaux. Destandau designed ENDOSPINE for discectomy will be inserted, and the procedure will continue using endoscopy. The Endoscopic approach to lumbar disc herniation by Destandau's method offers a convenient access to lumbar disc herniation with less complications and negligible morbidity. It gives maximum exposure to the disc space with maximal angles and minimal cutaneous incision. Contrary to other minimally invasive approaches, the visual field in discectomy by Destandau technique is broad and depending on the workability of ENDOSPINE an adequate access to lumbar disc herniation is possible.

  9. Influence of cervical disc replacement versus anterior cervical discectomy and fusion on the in-vivo kinematics of the adjacent segments: a meta-analysis%颈椎人工间盘置换与前路融合对相邻节段在体运动影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    李宏达; 夏群; 刘佳男; 魏冬; 胥鸿达

    2016-01-01

    [目的]比较颈椎间盘置换和前路融合两种不同手术方式对相邻节段在体运动影响.[方法]计算机检索Coehrane library、Pubmed、Ovid、ELSEVIER Science Direct、Springerlink、中国期刊全文数据库、万方数据库、中国生物医学文献数据库(时间截至2014年10月),手工检索相关杂志,纳入有关人工颈椎间盘置换和前路融合术后相邻节段在体运动学研究的文献,利用RevMan5.3(下载于Cochrane Library)进行Meta分析,选取手术部位相邻上下节段矢状面运动范围、C2~7整体矢状面运动范围等指标进行比较分析.[结果]经过筛选,16篇文献符合纳入标准,共1 666例.Meta分析结果显示:前路融合术后手术部位上方相邻节段矢状面运动范围增大:随机对照组[MD=-1.34,95%CI(-2.39,-0.30),P=0.01],非随机对照组[MD=-1.38, 95%CI(-1.61,-1.14),P<0.00001];下方相邻节段矢状面运动范围也增大:随机对照组[MD=-1.23, 95%CI(-1.63,-0.82),P<0.000 01],非随机对照组[MD=-1.85,95%CI(-2.82,-0.89),P=0.000 2];颈椎整体矢状面运动范围随机对照组示两种术式无差异[MD=1.70, 95% CI(-3.29,6.69),P=0.50],而非随机对照组示间盘置换术后颈椎整体运动范围比前路融合组大[MD=8.31,95%CI (3.63,13.00),P=0.000 5].[结论]颈椎前路融合术后相邻节段的活动范围比椎间盘置换增大,从一个侧面可能解释颈椎融合后相邻节段疾病发生率比人工颈椎间盘置换高的临床现象.

  10. 不稳定Hangman骨折前路减压融合内固定术后颈椎矢状面形态的影像学研究%Sagittal cervical alignment in unstable Hangman fracture patients undergoing anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    王强; 吴寅良; 周波; 李法年; 陈亮; 江龙

    2016-01-01

    目的 评估不稳定Hangman骨折行C2、3前路减压融合内固定术后的矢状面形态.方法 对自2011-03-2015-02在本院接受C23前路减压融合内固定术且有完整术后随访资料的19例不稳定Hangman骨折进行回顾性分析.比较术前、术后以及末次随访时的C2、3局部后凸角(LK)、C2椎体前移距离、上颈椎角(Co~2)、下颈椎角(C2.)、颈椎矢状面平衡(C2~7 SVA).结果 19例术后平均随访10(6~24)个月.术中均未出现脊髓及神经损伤.术后仅1例ASIA C级,脊髓及神经功能改善.术后及末次随访时的LK、C2椎体前移距离、上颈椎角、下颈椎角、C2~7 SVA均较术前明显改善,差异有统计学意义(P<0.05);且术后及末次随访时比较差异均无统计学意义(P>0.05).结论 C2、3前路减压融合内固定术可矫正不稳定Hangman骨折后C2成角及前移,恢复颈椎局部及整体矢状面平衡,是一种良好的手术方法.

  11. 下颈椎前路椎弓根螺钉配套钢板系统的生物力学性能研究%Biomechanical characteristics of anterior pedicle screw-plate system in the lower cervical spine

    Institute of Scientific and Technical Information of China (English)

    赵刘军; 柴波; 蒋伟宇; 徐荣明; 祁峰

    2014-01-01

    目的 探讨下颈椎前路椎弓根螺钉配套钢板系统在颈椎病患者的生物力学性能.方法 采集新鲜颈椎标本16具,分解为C3/4、C4/5、C5/6、C6/7共32个运动节段(FSU),其中C3/4、C4/5、C5/6、C6/7各8个.将其按照不同节段随机分成A、B两组,将所获标本椎间盘切除后模拟植骨、分别植入我们自行设计生产的下颈椎前路椎弓根螺钉配套钢板系统和普通颈椎前路椎体螺钉钢板系统,比较两组固定系统的生物力学性能:(1)两组下颈椎三维生理运动范围(ROM);(2)两组稳定性指数;(3)两组螺钉的抗拔出力.结果 A、B两组各有16个FSU(其中C3/4、C4/5、C5/6、C6/7节段各4个),A组植入下颈椎前路椎弓根螺钉配套钢板系统16套,B组植入普通颈椎前路椎体螺钉钢板系统16套.经生物力学测试发现:(1)A组固定的颈椎节段前屈/后伸平均运动值为(12.78±1.32)°,左右侧弯(9.25±0.94)°,左右旋转(22.82 ±2.42)°;而B组分别为(16.24±1.64)、(12.08±1.32)、(28.44± 2.78)°.A组优于B组,差异有统计学意义(P<0.05).(2)A组稳定性指数(Sf)在屈伸、侧屈、旋转时分别为111%、110%、112%,而B组分别为87%、84%和88%,两者比较差异有统计学意义(P<0.05).(3)抗拔出力测试结果显示,A组最大抗拔出力为(604.68±48.76)N,而B组为(488.24±32.42)N,A组优于B组,两者比较差异有统计学意义(P<0.05).结论 下颈椎前路椎弓根螺钉配套钢板系统在生物力学性能方面优于普通颈椎前路椎体螺钉钢板系统,适用于需要颈椎前路坚强固定的患者.%Objective To explore the biomechanical characteristics of anterior pedicle screw-plate system in the lower cervical spine,and to provide basic data for clinical application.Methods Sixteen fresh cervical cadavers were collected and dissected into 32 different FSUs (8 separately in C3/4,C4/5,C5/6,and C6/7).After disectomy and intervertebral body bone graft,the subjects were randomly

  12. LONG-TERM OUTCOMES OF FENESTRATED DISCECTOMY FOR LUMBAR DISC

    Institute of Scientific and Technical Information of China (English)

    PAN Yu-tao; CAO Peng; LIANG Yu; GONG Yao-cheng; ZHENG Tao; ZHANG Xing-kai; WU Wen-jian

    2008-01-01

    Objective To evaluate the long-term outcomes of fenestrated discectomy for lumbar disc herniation and analyze the correlative influence factors.Methods Eighty-two cases of lumbar disc herniation, from February 1996 to May 1999, were retrospectively studied. All patients were treated with simple fenestrated discectomy. The average follow-up time was 8 years and 7 months (from 7 years to10 years and 3months). There were 13, 38 and 31 cases at L3-L4, L4-L5 and L5-S1 level, respectively.Results The average scales before operation were as following: Japanes Orthopaedics Association (JOA) scale 6.5 (5-9), visual analysis scale (VAS) of low back pain 4.8 (0-8), and VAS of sciatica 7.2 (4-10). At the final follow-up, the above parameters were 13.2 (10-14), 1.8 (0-10) and 1.2 (0-7), respectively. The average increase ratio of JOA scale was 78.8%. The average disc-vertebra height ratio (Mochida method) was 80.2%. At the final follow-up, 7 cases reoccurred disc herniation. The final clinical satisfaction rate was 80% (modified Macnab method).Conclusion With appropriate surgical indications, the successful long-term outcomes could be expected with fenestrated discectomy. Discectomy improves sciatica to a greater extent than low back pain. The occurrence of low back pain is related to intervertebral disc height, segment stability, disc degeneration, and lumbar muscle disability.

  13. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

    Directory of Open Access Journals (Sweden)

    Kanthila Mahesha

    2017-01-01

    Full Text Available Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab′s criteria, visual analog scale, and Oswestry Disability Index. Results: The mean followup period was 2 years (range 18 months - 3 years. Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

  14. 颈椎动态稳定器置入非融合颈椎的生物力学分析%Biomechanical study on anterior decompression and non-fusion with dynamic cervical implant

    Institute of Scientific and Technical Information of China (English)

    侯振扬; 徐耀增; 顾叶; 周峰; 钱忠来; 姜为民; 杨惠林

    2011-01-01

    背景:颈椎动态稳定器的解剖型设计与正常椎间盘应具有相似的生物力学特点,其动态性设计具有轴向顺应性以及震荡吸收功能,而前缘倒齿嵌入上下椎体可获得足够的轴向稳定性.目的:比较颈椎前路融合内固定和颈椎动态稳定器置入非融合后颈椎相关生物力学指标变化.方法:将6具新鲜人C2~C7颈段脊柱标本随机分为3组,在完整颈椎测试后分别行C5、6前路减压颈椎动态稳定器DCI置入,C5、6前路减压单纯Cage融合内固定,C5、6前路减压颈椎前路一体化钢板椎间融合器融合内固定.检测各组标本前屈、后伸、左右侧屈不同生理运动工况并施加2.0 N·m纯力偶矩,颈椎标本C5~6上下邻近节段手术前后活动度大小.结果与结论:3种内固定后C5~6上下邻近节段较正常颈椎标本前屈、后伸和左右侧屈关节活动度值均有所增加,且表现出良好的即时稳定性,但颈椎动态稳定器置入组最接近正常值;3组间C5~6上下邻近节段关节活动度差异无显著性意义.表明颈椎动态稳定器置入后对邻近节段椎体活动度无明显影响或影响甚小,在一定程度上减小假体与其邻近椎体轴向应力,有效地维持颈椎活动.%BACKGROUND: The anatomical design of the dynamic cervical implant (DCI) has similar biomechanical characteristics to the normal disc The dynamic design has axial compliance and shock absorption And the front teeth down fitting into the upper and lower vertebral bodies can get sufficient axial stabilityOBJECTIVE: To compare the change of related cervical biomechanical properties between DCI non-fusion and anteriorMETHODS: A total of 6 adult human fresh cervical spinal specimens (C2-7) were randomly divided into A, B, C groups Following intact specimens analysis, specimens in groups A, B, C were sequentially reconstructed at Cs-s segment with DCI, Cage and integrated anterior cervical plate cage benezech (PCB) implant

  15. Comparison of the mid-term follow-up results between Bryan cervical artificial disc replacement and anterior cervical decompression and fusion for cervical degenerative disc disease%Bryan人工间盘置换与前路减压融合治疗颈椎退行性疾病的中期随访研究

    Institute of Scientific and Technical Information of China (English)

    田伟; 阎凯; 韩骁; 于杰; 靳培浩; 韩晓光

    2013-01-01

    Objective To evaluate the mid-term tollow-up results of cervical artificial disc replacement (CADR) for cervical degenerative disc disease,and to explore whether it can reduce the occurrence of adjacent segment degeneration (ASD).Methods A prospective comparative study of 93 patients who underwent CADR or anterior cervical decompression and fusion (ACDF) for cervical degenerative disc disease were conducted.All patients were followed up for more than 6 years.The Japanese Orthopaedic Association (JOA) score,neck disability index (NDI),Odom's scale,X-rays and magnetic resonance imaging (MRI) were used to evaluate the clinical and radiologic results.Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data.At final follow-up,the JOA score and NDI improved significantly in both groups.Between the two groups,there was no significant difference in terms of JOA score,NDI and Odom's scale.The sagittal alignment was well maintained in both groups.The total cervical spine range of motion (ROM) had no significant change for the CADR group,whereas,it significantly decreased for the ACDF group.The ROM at the replacement level of CADR patients decreased from 9.5° ± 3.7° before operation to 7.0° ± 3.0° 3 months after operation,and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease.Lateral radiographs and T2-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group.Conclusion The six-year follow-up results of CADR are basically satisfactory.Compared with ACDF,it could better preserve physiological motion and biomechanics of cervical spine,and reduce the incidence of ASD.%目的 评价人工椎间盘置换术治疗颈椎退行性疾病的中期疗效,并探讨其是否可以减少邻近节段退变的发生.方法 前瞻性对比分析接受颈椎人工间盘置换术(置换组,45例)与颈椎前路减压融合术(融合组,48例)治疗的颈椎

  16. 经前路颈椎椎体次全切除钛网置入融合后相邻节段的退变%Adjacent segment degeneration after anterior cervical corpectomy and fusion

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    翟鹏飞; 刘伟; 孙志明; 张学利

    2016-01-01

    BACKGROUND:In recent years, the researchers have studied the adjacent segment degeneration after cervical fusion. Several studies concerned the adjacent segment degeneration after anterior cervical corpectomy and fusion. OBJECTIVE:To evaluate the correlative factors of adjacent segment degeneration after anterior cervical corpectomy and fusion. METHODS:122 patients were included in the study from 126 patients who underwent anterior cervical corpectomy and fusion that operated by the same treatment team and involved a single vertebral body and the two plates between February 2009 and February 2012. The final fol ow-up period was 3 years. According to the degeneration progress of adjacent segment degeneration, these patients were divided into non-progression group and progression group. The gender, age, preoperative adjacent segment degeneration, cervical range of motion, upper and lower vertebral range of motion, surgical segment, titanium mesh subsidence, plate-to-disc distance, and cervical curvature index were compared between two groups. Logistic regression analysis was applied to analyze the correlative factors of adjacent segment degeneration. RESULTS AND CONCLUSION:(1) There were significant differences in preoperative adjacent segment degeneration, postoperative cervical range of motion, postoperative upper and lower vertebral range of motion, and postoperative cervical curvature index (P  目的:探讨经前路椎体次全切除钛网椎间置入融合后相邻节段退变的相关因素。  方法:纳入2009年2月至2012年2月行经前路椎体次全切除钛网椎间置入融合的患者共126例,其中资料完整的122例纳入研究。均由同一治疗组完成,且手术均涉及单个椎体及2个间盘。终末随访期为3年。根据术前及术后相邻节段退变程度,分为非相邻节段退变进展组和相邻节段退变进展组,比较2组患者的性别、年龄、术前相邻节段退变、颈椎活动度、术椎

  17. 后前入路治疗下颈椎骨折脱位伴双侧关节突绞锁%Decompression via posterior-anterior approach and anterior fixation in treatment of fracture-dislocation of the lower cervical spine with bilateral facet joints dislocation

    Institute of Scientific and Technical Information of China (English)

    李鹏; 雪原; 王沛; 马信龙; 赵华健; 赵晓涛; 卢旭亚

    2011-01-01

    Objective To evaluate the surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of the lower cervical spine with bilateral facet joints dislocation. Methods This study retrospectively reviewed 37 cases of lower cervical spine fracture with bilateral joints dislocation. There were 21 males and 16 females with an average age of 42 years (19-58). Distraction-flexion stage 3(DFS 3) were found in 24 cases and DFS 4 in 13 cases. All the cases were diagnosed by X-ray, CT and MRI and confirmed during the surgery. Decompression via posterior-anterior approach and anterior fixation had been adapted as the surgical strategy. The NASCIS and IMSOP standard were applied to definite the level of cervical spinal cord injury. The ASIA grading was used for evaluation the spinal cord function and the recovery rate. The X-ray and CT were used to observe reduction and bone fusion. Results The mean operative time was (4.5:±0.5) h, and the mean amount of blood loss was 360 ml (200-500 ml). All the incision healed. The two segments fixation was used in 23 cases, 3 segments fixation in 13 cases, and 4 segments fixation in 1 case. The mean follow-up period was 32 months (16-45 months).Postoperative X-ray and CT showed that bone fusion was achieved in all patients within 4-8 months, without graft displacement, or failure of implants. Spinal cord function did not aggravate, and sensory recovery ranged from 7 to 20 levels (averaged, 12.7). The ASIA grade were improved with an average of one grade. Conclusion To treat fracture-dislocation of the lower cervical spine with bilateral facet joints dislocation, the posterlor-anterior approach and anterior fixation/fusion was benefit to preservation the cervical spinal cord function and reconstruction biomechanical stability of the cervical spine.%目的 探讨后前路减压、前路固定治疗下颈椎骨折脱位伴双侧关节突绞锁的可行性及临床效果.方法 2000

  18. Non-fusion segment disease after the anterior cervical arthrodesis:a retrospective study%颈椎前路融合术后非融合节段退变性疾病的回顾性研究

    Institute of Scientific and Technical Information of China (English)

    郭炳路; 宋科冉; 陈巧灵; 陈增海; 王大鹏; 王慧; 金培; 唐家广

    2016-01-01

    Objective To investigate the incidence and causes of non-fusion segment disease ( NFSD ), both adjacent and non-adjacent to the fused segment, after the anterior cervical arthrodesis.Methods This is a retrospective cohort study. Between January 1998 and January 2011, 171 patients who had anterior cervical decompression and fusion for the intervertebral disc herniation and cervical spondylosis were followed clinically. There were 97 males and 74 females, and the average age at the operation was ( 51.90 ± 9.28 ) years ( range: 31 - 72 years ). We evaluated the correlation between the incidence of symptomatic non-fusion segment disease and the following clinical parameters ( age at the operation, fusion levels ) and radiological parameters ( preoperative and postoperative cervical spine alignment, Pavlov’s ratio at the C5 level, and preoperative existence of a non-fusion segment degeneration on magnetic resonance imaging ).Results Of the 171 patients reviewed, 16 patients had non-fusion segment disease ( 9.36% ), 12 patients had adjacent segment disease and 4 had non-adjacent segment disease. Postoperative cervical lordosis in the non-fusion segment disease group was signiifcantly smaller than that of the disease-free group [ ( 7.38 ± 12.37 ) ° vs. ( 17.26 ± 9.75 ) °,P < 0.001 ]. Fusion levels in the NFSD group were 1.63 whereas 2.27 in disease-free group (P = 0.002 ). The incidence of disc degeneration in non-fused segments was more severe in the NFSD group than in the disease-free group [ ( 2.63 ± 0.62 )vs. ( 1.62 ± 0.99 ), P = 0.008 ].Conclusions The incidence of symptomatic non-fusion segment disease after the anterior cervical arthrodesis has multifactorial causes. Postoperative cervical lordosis, disc degeneration in non-fusion segments, and the number of fusion levels are all factors in the incidence of NFSD.%目的:探讨颈椎前路减压融合术后非融合节段病变( non-fusion segment disease,NFSD )的发生率和

  19. Halo-vest辅助下前路手术治疗严重颈椎结核伴后凸畸形%Halo-vest Assisted Anterior Approach for the Treatment of Cervical Spinal Tuberculosis Complicated with Kyphosis

    Institute of Scientific and Technical Information of China (English)

    杨成伟; 屈涛; 王世勇; 张军华

    2013-01-01

    Objective: The purpose of this study is to explore the surgical method and clinical effects of Halo-vest assisted anterior approach operation for the treatment of cervical spine tuberculosis complicated with kyphosis. Methods: 12 patients suffered from cervical spine tuberculosis complicated with kyphosis were managed in our department from October 2004 to September 2010. The preoperative Cobb angle was 34° (range from 20°to 42°). Before operation, all patients accepted anti-tuberculosis chemotherapy for 2-4 weeks. The patients with cervical kyphosis were treated by Halo-vest and the spinal deformity was corrected before operation. All patients were treated by anterior debridement and fusion with internal fixation. Anti-tuberculosis chemotherapy was performed for 12 to 24 months. Results: The average duration of follow-up was 26 months (range from 12 to 48 months). All the patients stood surgery well. The kyphosis deformity was corrected and the normal cervical lordosis was maintained without associated complication. The neural symptoms were improved. All cases had bony fusion in 3-6 months. There were no plates and screws complications and Halo-vest associated complications. No recurrence of tuberculosis was noted at final follow-up. Conclusion: Application of Halo-vest can correct the cervical kyphosis and maintain normal cervical lordosis. When kyphosis was corrected, the risk of spinal cord injury in the operation can be reduced. Anterior debridement and internal fixation assisted with Halo-vest is a safe and effective method for treatment of the cervical tuberculosis complicated with kyphosis.%目的:探讨使用halo-vest支具牵引复位并通过前路手术治疗严重颈椎结核并后凸畸形的方法和疗效.方法:通过对2004年10月至2010年9月在我科住院治疗的14例严重颈椎结核并后凸畸形的患者进行回顾性研究.本组患者中男8例,女6例,术前颈椎后凸Cobb角24-42°,平均34°.术前使

  20. Clinical evaluation of gingival composite resin restoring cervical defects in anterior teeth%应用龈色树脂修复前牙颈部缺损的临床评价

    Institute of Scientific and Technical Information of China (English)

    赵奇; 薛世华; 吴艳; 王世明

    2011-01-01

    Objective : To evaluate the clinical effects of gingival composite resin used for restoring cervical defects in anterior teeth. Methods: Eighty cervical defects of anterior teeth were involved. Firstly, they were restored with simulated restorations using only tooth colored composite resin. Then, the simulated restorations were removed and the defects were restored with simulated restorations using gingival composite resin combined with tooth colored composite resin. Visual analogue scale ( VAS) was employed to survey the patient satisfaction with the esthetic results of the two methods. The defects were filled with gingival composite resin and tooth colored composite resin. Then, longitudinal clinical evaluation were made at 1-week, 6-month, 1-year and 2-year recalls respectively using modified United States Public Health Service ( USPHS) criteria. Results : Simulated restorations made of gingival composite resin and tooth colored composite resin obtained more satisfaction in overall impression, gingival position and tooth contour than simulated restorations simply made of tooth colored composite resin ( P < 0. 1 ) . In the longitudinal clinical evaluation, no significant differences among the recalls were found in color match , restoration morphology, marginal adaptation, marginal discoloration, secondary caries or pulp sensitivity ( P > 0. 1 ) . Conclusion : Using gingival composite resin in restoring cervical defects in anterior teeth achieved not only satisfactory treatment effect but also ideal esthetic results.%目的:评价采用龈色树脂修复前牙颈部缺损的临床效果.方法:选择北京大学口腔医院第一门诊部 2007年6月至2008年10月前牙唇侧颈部缺损患者80例,先单纯使用牙色树脂模拟充填,然后用龈色树脂配合牙色树脂按照前牙美学标准模拟充填.采用视觉模拟评分法,由患者从整体印象、龈位置和牙齿轮廓3个方面对两种充填方法的美学效果满意度分别进行

  1. The Correlation between Relation of Anterior Cervical Plate Position and Adjacent Level Degeneration%颈前路钢板固定位置与相邻节段退变之间关系的研究

    Institute of Scientific and Technical Information of China (English)

    冯虎; 马志兵; 齐祥如; 袁峰; 郭开今

    2011-01-01

    Objective To study adjacent level degeneration after anterior cervical spine fusion with a plate and its relation to the plate position.Methods Totally 165 patients were received anterior cervical spine fusion with plates months, who had a bony fusion wholly.The cephalad and caudal plate to disc distance(PDD) was measured on thepostoperative lateral radiograph and was used to divide the patients into two groups. In group A the PDD was<5mm, and in group B it was>5mm. The severity of the ossification at the two adjacent disc space was classified on a scale ranging from grade 0(no ossification ) to grade 2(complete bridging ). Preoperative, immediate postoperative and 6 to 46 months follow-up radiographs were taken, measured the height of cephalad and caudal adjacent intervertebral and adjacent vertebral body, and then calculated the ratio of intervertebral height to vertebral body height (R), besides, calculated the angle(α)of upper and down endplate gradient of two adjacent disc. Results In cephalad adjacent disc, group A had 53.7% levels developed ossification and 29.8% in group B; compared to caudal adjacent disc, group A and B was 38.5% and 19.7%, respectively. The rate of ossification was higher in group A than in group B, both at two adjacent disc (P<0.05). There was no significant difference between preoperative and postoperative both R ratio and angle α in group A of cephalad adjacent disc (P>0.05), but it was significant decreased when followed up comparing to preoperative and postoperative (P<0.05). The result of R ratio of caudal adjacent disc was similar with cephalad adjacent disc in group A, but angle α was not. There was no significant difference among preoperative, postoperative and following up time both R ratio and angle α in group B of cephalad and caudal adjacent disc (P>0.05).Conclusion Adjacent segments degeneration was one of the common complications after anterior cervical spine fusion. The incidence could be affected

  2. 颈椎人工椎间盘置换术与颈前路减压融合内固定术手术疗效比较%Comparing the effects of Bryan cervical Disc arthroplasty with anterior cervical decompres-sion and fusion

    Institute of Scientific and Technical Information of China (English)

    张涛; 王弘; 徐宏光; 李从明

    2016-01-01

    目的:比较颈椎人工椎间盘置换术( cervical disc arthroplasty ,CDA)与颈前路减压融合内固定术( anterior cervical de-compression and fusion ,ACDF)的手术疗效。方法:回顾分析2012年8月~2015年1月收治的退变性颈椎病50例,随机给予CDA(n=23),或者ACDF(n=27)治疗,术后12个月门诊随访。结果:两组术前性别、年龄、手术节段活动度(range of motion, ROM)、VAS( visual analogue scale )及JOA( Japanese orthopaedic association )无统计学差异,CDA组比ACDF组手术时间短,出血量少,具有明显统计学差异( P<0.01),两组住院时间无明显统计学差异。术后12个月,两组手术节段ROM差异具有统计学意义( P<0.01),CDA组ROM较术前得以维持,ACDF组降低。两组JOA及VAS无统计学差异。结论:CDA较ACDF能维持手术节段的活动度,CDA有望取代ACDF。%Objective:To compare curative effects of Bryan cervical disc arthroplasty ( CDA) with those of anterior cervical decompression and fusion ( AC-DF).Methods:A total of 50 patients with cervical spondylotic myelopathy treated in our hospital between August 2012 and January 2015 were randomly as-signed to two groups.One group were treated with CDA (n=23) and another with ACDF(n=27).Two groups of patients were postoperatively followed on outpatient basis for 12 months.Results:The two groups were not significantly different regarding the gender,ages,range of cervical motion(ROM) and sco-ring on visual analogue scale(VAS) and Japanese Orthopedic Association(JOA).CDA group had shorter operative time and intraoperative blood loss than ACDF group,the difference was significant( P<0.01) .The length of hospital stay remained similar for the two groups ,yet the two groups were different con-cerning the ROM 12 month after operation(P<0.01).Postoperative ROM was maintained in patients in CDA group,whereas was decreased in ACDF group. There was no

  3. Biomechanical evaluation of anterior multifunctional cervical plate system made of a new type of titanium-alloy%新型钛合金颈椎前路接骨板的三维稳定性试验

    Institute of Scientific and Technical Information of China (English)

    韩秀鑫; 朱悦; 吴亚俊; 郝玉琳; 赵卫东

    2012-01-01

    Background: To date, anterior surgery for the cervical spine has been performed in spinal fractures, spinal tumors, and degenerative cervical disorders. Objective: Anterior multifunctional cervical plate (MCP) was designed and made by a new type of titanium-alloy. Flexibility test was made to analyze the characteristics of the MCP. Methods: Totally 24 porcine specimens (C3-C7) (median age 6 months) were collected and randomly divided into 4 groups with 6 specimens in each group. Each specimen was loaded in vitro with pure moments of ±2.0 Nm in flexion/extension, lateral bending, and axial rotation. Range of motion (ROM) and neutral zone (NZ) were measured in the intact state, with anterior cervical corpectomy in C4-C6 without plating, after addition of either a MCP or C-mark plate (CMP) and after 2000 cycles of axial torsion. Results: All the segments in all loading directions of ROM, no differences were found among MCP fixed state, MCP fatigue state, CMP fixed state and CMP fatigue state. But there were significant differences between the above states and the intact and grafted states (P<0.01). In flexion and lateral bending of ROM, significant difference was found between the intact and grafted states (.P<0.01). In the NZ of flexion/extension, no differences were found among MCP fixed state, MCP fatigue state, CMP fixed state and CMP fatigue state. But when the above states compared with the intact and grafted state, significant differences were found (P<0.01). In the lateral NZ, significant difference was found between the intact state and other states, but no significant differences were found among other states. In the rotational NZ, no significant differences were found among all the states. Conclusions: MCP can provide three-dimensional stability of the cervical spine in the flexibility test. After the torsional fatigue test, the MCP can still provide enough stability.%背景:目前,颈椎前路接骨板已经广泛应用于颈椎创伤、畸形、退行

  4. 喉返神经在颈椎前入路手术中的应用解剖学研究%Applied Anatomy Research of Recurrent Laryngeal Nerve in Anterior Cervical Approach Operation

    Institute of Scientific and Technical Information of China (English)

    骆明炎; 范伟杰; 谢兴国; 吴亚琼; 唐芳; 周可为

    2015-01-01

    Objective To provide anatomical basis for anterior approach to cervical spine surgery protecting the re-current laryngeal nerve. Methods Forty formalin-fixed adult cadavers (23 male/ 17female) were dissected bilaterally to expose the path of the recurrent laryngeal nerve ( RLN) . The starting point,the first branch and the entering tracheoesopha-geal groove point were observed corresponding with vertebral body level. Results The right RLN looped around the sub-clavian artery at the level of T2. It crossed the prevertebral fascia from the carotid sheath medial border at T1 level,entered the tracheoesophageal groove at C7-T1 level and entered the larynx at C6. The left RLN looped around the aortic arch at T4 level,entered the tracheoesophageal groove at T2 level and entered the larynx at C6 level. The RLN traveled superiorly, slightly anterior to the tracheoesophageal groove and its diameter tapered. The first branch diameter minimum value is 0. 02mm. The starting point of RLN diameter maximum value is 4. 76mm. Conclusions The left RLN anatomical structure is relatively more constant than the right side. The left or right anterior approach to cervical spine surgery at or superior to C7 level is safe,but inferior to C7 level the left anterior approach is better. Mastering the anatomical characteristics of RLN is important to reduce the iatrogenic injury.%目的:为临床颈椎前入路手术保护喉返神经提供解剖学依据。方法取成人尸体标本40具(男23,女17),共80侧。在颈动脉鞘与气管食管间的颈根部找到喉返神经,测量各侧喉返神经起点、入气管食管沟点和入喉第一分支点各部横径及其与颈椎对应的位置关系。结果右侧喉返神经在T2椎体水平绕右锁骨下动脉上行,T1椎体水平自颈动脉鞘内侧缘穿出椎前筋膜,C7T1椎体水平向内、上、前进入气管食管沟;左侧喉返神经在T4椎体水平绕主动脉弓上行,在T2椎体水平进入气管食管沟,在沟内行

  5. One-stage removal of a large dumb-bell-shaped cervical neurinoma without laminectomy or interbody fusion in a child.

    Science.gov (United States)

    Ryu, H; Nishizawa, S; Yamamoto, S

    1999-12-01

    A 12-year-old boy had a large dumb-bell-shaped cervical neurinoma originating at the C5 spinal root that was removed in a one-stage operation through the enlarged C4/5 intervertebral foramen. This technique required no laminectomy, discectomy or interbody fusion, which may frequently produce spinal deformity in children.

  6. Applie danatomy on the landmark of anterior decompression surgery in cervical vertebrae%颈椎病前路手术减压范围标志的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    韩伟峰; 林欣; 李小光; 崔维; 熊英

    2009-01-01

    Objective: To explore the suitable anatomic marks as safe border of transverse decompression in anterior border of cervical vertebral surgery. Methods: Anatomic data of vertebral artery were measured on 12 adult embalmed cadavers (44 sides), for locating vertebral artery during three-dimensional CT reconstructing. Under the microscope, the distance between bilateral medial borders of longus colli muscles was measured, while the features of vertebral artery, nerve root, uncinate joint were observed and analyzed. Results:The distances between horizontal tangent of anterior vertebral body and anterior transversal foramen, bilateral root of anterior wall of transversal foramens, and bilateral medial borders of iongus colli muscles gradually decreased from downside to upside. The distance between anterior angle oftmcinate process was (17.3±2.92) mm averagely, and dural sac width (16.5±0.42)mm. The distance between the medial border of iongus colli muscles and medial margin of the vertebral artery, medial border of longns colli muscles and median sagittal plane had no significant difference at C4~6 level, however, which had significant difference at C3 and C7 level (P<0,05). Hyperplasia of uncinate joint can be found in senile cadavers, with the most serious case of which covering the vertebral artery completely and pushing it posterolaterally. Conclusions: For anterior approach, it is necessary to analyze image data carefully before the surgery, make sure operation process individually, and consider about the hyperplasy of uncovertebral joint.%目的:探讨颈前路手术减压范围及安全界限的解剖标志.方法:对12具成人尸体标本进行三维CT重建,并测量定位椎动脉所需解剖数据,在显微镜下测量颈长肌内侧缘间距等数据,并观察椎动脉、神经根、钩椎关节及其对应关系.结果:椎体前缘与横突孔前缘水平切线间距离、双侧横突孔内侧壁距离及颈长肌内侧缘间距由下端至上端逐渐

  7. Microendoscopic discectomy for treatment of lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    ARJUN Sinkemani; WU Xiao-tao

    2015-01-01

    A lumbar microendoscopic discectomy ( MED ) is a minimally invasive surgical technique performed through a tubular device which is designed for the pain relieve caused by herniated discs pressing the nerve roots . In 1997, a new minimally invasive surgical approach for the management of symptomatic lumbar disc herniation , MED was introduced .This technique uses a tubular retractor system and a microendoscope for visualization rather than the operating microscope .However , recent literature suggests that MED is an effective microendoscopic system which has a fine long-term outcome in treating lumbar disc herniation .This article describes the operative tech-niques and outcomes reported in the literature for MED .

  8. Multivariate prognostic modeling of persistent pain following lumbar discectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2013-03-04

    Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined.

  9. Lumbar percutaneous discectomy. Initial experience in 28 cases

    Energy Technology Data Exchange (ETDEWEB)

    Faubert, C. (Saarland Univ., Homburg/Saar (Germany). Neuroradiological Inst.); Caspar, W. (Saarland Univ., Homburg/Saar (Germany). Dept. of Neurosurgery)

    1991-10-01

    Since November 88, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. A short-term follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. (orig./GDG).

  10. The effect of single anterior approach for pinching cervical spondylotic myelopathy%单纯前路手术治疗“钳夹型”颈椎病的疗效

    Institute of Scientific and Technical Information of China (English)

    张颖; 王新伟; 陈华江; 杨立利; 徐盛明; 吕碧涛; 张竞; 袁文

    2012-01-01

    目的 探讨单纯前路手术治疗“钳夹型”颈椎病的疗效及影响疗效的因素.方法 回顾性分析自2003年1月至2009年12月采用前路减压植骨融合治疗“钳夹型”颈椎病且影像学、随访资料完整的82例病历资料,男43例,女39例;年龄33~79岁,平均(54.4±8.6)岁.正中矢状位MRI测量手术前后的椎管总占位率、前方占位率(anterior occupying rate,AOR)及后方占位率(posterior occupying rate,POR).对术前占位率、椎间隙高度、术后影像学改变与神经功能改善情况进行相关性分析.结果 患者均获得9~72个月随访,平均(25.8±10.6)个月.术后日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA),AOR、POR及椎间隙高度术后测量值较术前均有明显改善.术前POR平均为29.0%+10.5%,术后平均为19.9%±11.6%,POR改善率平均为9.0%±6.1%.统计分析显示术前椎间高度丢失与术前POR无相关性,术前POR与POR改善率有相关性.术前POR在20%~40%的病例术后JOA评分改善明显,术前POR≥40%的病例前路间接减压效果较差.结论 通过前路减压撑开、植骨融合固定重建颈椎曲度和椎间隙高度,可达到间接后方减压的目的.术前POR在20%~40%的患者后方间接减压效果较好.%Objective To investigate effect of single anterior decompression and fusion for pinching cervical spondylosis myelopathy.Methods 82 patients with pinching cervical spondylosis myelopathy,treated with single anterior decompression and fusion,were analyzed,including 43 males and 39 females,with an average age of 54.4 years (range,33-79 years).Occupying rate,anterior occupying rate and posterior occupying rate were measured on pre- and post-operative midsagittal MRIs.Multiple regression analysis was performed between preoperative occupying rate,intervertebral space height,postoperative imaging changes and neural function recovery.Results All patients were followed up for an average of

  11. Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

    Institute of Scientific and Technical Information of China (English)

    YANG Shuhua; HU Yong; ZHAO Jijun; HE Xianfeng; LIU Yong; XU Weihua; DU Jingyuan; FU Dehao

    2007-01-01

    This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing).Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°) 3.42° (2.6°-4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

  12. Anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction injury: anatomic study%颈椎前路钢板并轴向螺钉固定治疗屈曲牵张型损伤的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    瞿东滨; 邹琳; 杨勇; 徐准; 程勇泉

    2012-01-01

    Objective To study the anatomical flexibility of anterior cervical plating plus axial screw fixation for treating cervical flexion-distraction. Methods Fifty cases of digital lateral X-ray films from adult healthy volunteers aged 24-48 years, with mean 28 years, were measured directly in the JW-PACS picture system. Measuring parameters included vertebral body height, intervertebral disc height and disc depth. The line started from anteroinferior point of the inferior vertebrae to posterosuperior point of the superior vertebrae was drawn to mimic the axial screw fixation in the lateral film. The maximal screw length, screw cephalic inclination angle and the distance between screw and anterior vertebral margin at disc level was recorded. Simulated anterior cervical plating and axial screw fixation was carried out in one preserved human specimen under the guidance of C-arm X-ray fluoroscope. Results The maximal length of anterior cervical axial screw was (41.18+3.92 )mm, and the axial screw inclination angle (25.21±3.58)°. The suitable depth of interbody graft was more than (11.69±1.63)mm, but less than (17.09±1.50)mm of disc depth. Simulated procedure in the preserved specimen demonstrated that axial screw fixation could be successfully completed at C2/3, C3/4, C4/5, and C5/6 levels, but difficult be performed at C6/7 due to obstacle of sternum. Conclusions The flexibility of axial screw fixation plus anterior cervical plating is confirmed from this study for managing of cervical flexion-distraction injuries.%目的 提出一种联合颈椎前路钢板固定治疗屈曲牵张型颈椎损伤的新术式—颈椎轴向螺钉固定术,进行解剖学可行性研究.方法 随机调取50例正常成年志愿者的颈椎侧位片.年龄22~48岁,平均28岁.通过JW-PACS图像系统,测量C2~6椎体高度;C2/3~C5/6椎间盘高度以及椎间盘矢径;并模拟轴向螺钉固定,即下位椎体前下缘至上位椎体后上缘的连线,测量轴向螺钉最大

  13. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk

    2014-04-01

    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  14. 单节段颈椎人工椎间盘置换与前路椎间融合内固定:维持颈椎活动度和稳定性的比较%Single level artificial disc replacement versus anterior cervical fusion:range of motion and stability of cervical vertebra

    Institute of Scientific and Technical Information of China (English)

    王威; 王利民; 王卫东; 谭洪宇; 刘屹林; 张书豪

    2014-01-01

    BACKGROUND:Fusion treatment for single segment cervical spondylosis can induce complications such as abnormal enlargement of range of motion in adjacent segments and degenerative manifestations. Recently, scholars began to explore and to use non-fusion technique to replace traditional fusion therapy. Cervical artificial disc replacement as a new anterior non-fusion program has been greatly used in the clinic, not only obtained good clinical therapeutic effects, but also made cervical vertebrae near physiological stability, delayed adjacent segment degeneration and reduced complications. OBJECTIVE:To compare the clinical effects of the single level artificial disc replacement and the anterior cervical decompression and fusion for cervical spondylosis. METHODS:A total of 59 patients with single segment cervical spondylosis, whose clinical signs and symptoms were accorded, were enrol ed from the First Affiliated Hospital of Zhengzhou University, China from May 2011 to May 2013. Imaging revealed that single segment of cervical disc degeneration compressed spinal cord or nerve root. Owing to different surgeries, these patients were divided into artificial disc replacement group (replacement group;n=32) and anterior cervical decompression and fusion group (fusion group;n=27). They were fol owed up at 5 days, 3, 6 and 12 months after treatment. Japanese Orthopaedic Association scores, neck pain, upper extremity pain visual analog scale scores were measured. The range of motion of the replacement segment and its effects on adjacent segments were observed. RESULTS AND CONCLUSION:The postoperative Japanese Orthopaedic Association Scores were improved compared with preoperative scores (P0.05). Range of motion of the replacement segment after treatment was (11.6±3.0)° in the replacement group, showing no significant differences as compared with before surgery (8.8±2.7)° (P>0.05). No significant activity was found at 3 months after treatment in the fusion group. During fol

  15. 前路减压植骨融合术后颈椎相邻节段生物力学变化%Biomechanical changes of the adjacent segments after anterior cervical decompression and fusion

    Institute of Scientific and Technical Information of China (English)

    尹飞; 郭丽; 朱庆三; 赵东旭; 巩固; 李然; 赵昆池; 王迎智

    2013-01-01

    Objective To study the biomechanical changes of the adjacent segments after anterior cervical decompression and fusion (ACDF).Methods EB composite resin was used to mimic the fuion effect after anterior cervical decompression.The motion range and biomechanical changes of the adjacent segments were measured.Results Under the same torque of 2.0 Nm,the motion range of the adjacent segments was from 4.3 to 8.0 degrees,which was not significantly different from that before fusion (P >0.05).Increasing the torque gradually to let the samples reach their normal range of motion,the range of motion of the adjacent segments increased significantly.There are significant differences of them after and before fusion (P < 0.05).Conclusion If people keep the normal range of motion of cervical spine after ACDF,their adjacent segment's movement will increase significantly.This might be the main cause of the degeneration after fusion.By limiting the neck movement can reduce,or even avoid postoperative degeneration.%目的 观察颈椎前路减压植骨融合术后相邻节段生物力学变化.方法 采用EB复合树脂黏合的方法模拟颈椎前路减压植骨术后融合的效果,检测颈椎融合前、后相邻节段运动范围及生物力学的变化.结果 在2.0 Nm力矩不变的情况下,融合节段相邻间隙的运动范围为4.3°~8.0°,与融合前比较差异无统计学意义(P>0.05);加大力矩使融合后的颈椎尽量达到术前正常运动范围时融合节段相邻间隙运动范围明显增加,与融合前比较差异有统计学意义(P<0.05).结论 颈椎融合术后如果仍要达到术前正常的运动范围,其相邻节段的运动范围明显增加,这可能是造成其退变的主要原因.限制颈部术后活动可以减少、甚至避免术后退变的发生.

  16. 前路根治性减压治疗严重颈椎后纵韧带骨化症%Anterior radical decompression for severe ossification of the posterior longitudinal ligament in the cervical spine

    Institute of Scientific and Technical Information of China (English)

    王新伟; 袁文; 陈德玉; 张颖; 陈雄生; 陈宇; 汤俊君; 张竞

    2008-01-01

    Objective To report the outcome of anterior radical decompression for the treatment of severe ossification of the posterior longitudinal ligament(OPLL)with an average occupying ratio exceeding 50% in the cervical spine.Methods From July 2002 to February 2006,26 patients with cervical OPLL occupying ratio of the spinal cord exceeding 50% underwent anterior decompression and fusion. There were 18 males and 8 females.The average age was 59 years(ranged from 43 t0 73 years)and the mean occupying ratio was(65±20)%;Before operation,the JOA score was 8.7±2.8,and the saggital diameter of spinal cord was(25±7)%.The ossified ligament was classified into two groups,the base-open group and the base-closed group. The occupying ratio was measured on 3-D CT scans,and the sagital diameter of the deformed spinal cord was measured at the narrowest level on sagittal T2-weighted MR. All patients received anterior decompression with the ossified ligament removed completely. Among them,10 cases underwent one level corpectomy combined with one level disectomy,3 cases underwent 2 level corpectomy,and the other 13 patients underwent one level corpectomy. The decompressed segments were reconstructed either with a tricortieal iliac crest strut or a titanium cage,and an anterior locking plate was implanted to prevent graft extrusion in every patient. All patients were monitored with ECP during decompression. Results The occupying ratio decreased to(10±5)%,the saggital diameter of spinal cord increased to(75±15)%,and the average diameter of spinal cord at the narrowest site increased 3 times after operation.The JOA score was 14.2±2.5,with an average improvement ratio of(61±24)%.Three patients accompanied with diabetes presented with temporarily neurological deterioration.There were two cases complicated with cerebrospinal fluid leaks but cured within 2 weeks after surgery. One case acccompanied with diabetes underwent a second emergency reexploration for hematoma in the spinal canal

  17. Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2013-01-01

    Full Text Available Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.

  18. Treatment of multi- level cervical spondylosis by anterior decompression and autograft fusion with introfixation%多节段颈椎病前路减压植骨内固定临床效果评价

    Institute of Scientific and Technical Information of China (English)

    马原; 高帅; 阎朝辉; 田慧中; 余光宇

    2012-01-01

    [Objective] To evaluate the clinical effects of anterior decompression and autograft fusion with internal - fixation in treating multi -level cervical spondylosis. [Methods] Between April 2008 and May 2011 , 46 patients with multi -level cervical spondylosis were treated with anterior decompression, auiograft fusion, and internal fixation. There were 32males and 14 females with an average age of 58 years ( range, 49 -73 years) . Consecutive 3 segments of C-3、4 , C4、5, and C5、6h involved in 30 cases and C4、5s , C5、6 , and C6、 7 in 16 cases. All patients suffered sensory dysfunction in limbs and trunk, hyperactivity of tendon reflexes of both lower extremities, walking with limp, and weakening of hand grip. Cervical MRI showed degeneration and protrusion of intervertehral disc and compression of cervical cord. The disease duration were 7 to 29 months ( 13. 5 months on avera -ge) . Japanese Orthopedic Association (JOA) score system was adopted for therapeutic efficacy evaluation. JOA scores were recorded preoperatively, 1 week, 3 months, and 12 months postoperatively. [Results] No cerebrospinal fluid leakage was observed after operation. All the incisions healed by first intention. All cases were followed up for 12 to 24 months. No injury or recurrent laryngeal nerve injury occurred. The nervous symptoms in all cases were improved significantly within 1 week after operation. Lower limb muscle strength increased, upper limb abnormal sensation disappeared, and limb moved more agile. The internal fixatro was in appropriate situation, and the fusion rate were 100% . The JOA -score increased from 8. 1 ±0. 3 preoperatively to 14. 6 ± 0. 4 at 12 months posloperatively with an improvement rate of 69. 8% ± 0- 29% , showing significant difference (P <0. 05) . NDI at final follow up (7.8% ±2.2%) was significant lower than preoperative ( 19. 0% ± 3. 4% ) (P < 0. 05 ) . Radiograph analysis indicated that the average angle of lordosis was corrected from 8. 8° ±1

  19. Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine%下颈椎前路椎弓根螺钉最佳进钉点和进钉方向的影像学研究及其临床运用

    Institute of Scientific and Technical Information of China (English)

    赵刘军; 徐荣明; 华群; 马维虎; 蒋伟宇; 朱彦召

    2012-01-01

    Objective:To explore the best entry point and trajectory of anterior cervical screw in the cervical screw by radiological studies,and provide reference for clincal application. Methods:From January 2008 to December 2010,50 patients were scanned by cervical CT and confirmed no obvious defect of lower cervical spine. Of them, 27 cases were males and 23 were females,ranged the age from 38 to 83 years ( mean 58.5 years). On horizontal axis,the camber angle of C3-C7 anterior lower cervical pedicle of vertebral arch axis (α) and distance between (axial length, AL) of anterior cervical pedicle axial line was measured from C3 to C7- Vertebral were divided into four areas, and from measured side of pedicle of vertebral began to record, orderly 1 to 4, the area of pedicle vertebral arch intersert into vertebral were recorded. On sagittal view, the head or tail angle(β)and length (sagittal length,SL)of anterior cervical pedicle axial line was also measured from C3 to C7- Vertebral were divided into four areas,and from measured side of pedicle of vertebral began to record, orderly 1 to 4, the area of pedicle verte-bralarch arch intersert into vertebral were recorded. The above data were statistically analyzed to find the best entry point and trajectory of anterior cervical screw in the cervical screw and insert pedicle screw. Results:The lateral angle of lower cervical spine was 38° to 45° on transverse plane,C3 to C5 increasing gradually,C5 to C7 decreasing. On sagittal view,C3,C4 pedicle were head tulting, C5 were basic level, C6, C7 were tail. C3 to C5 decreasing gradually, C5 to C7 increasing gradually. C3 to C7 in AL and SL increased gradually. On horizontal axis, the intersection of C3, C4 and C5 were in the second area, the number of C6 in the second and third area were the same,but C7 were in the third area. The intersection in the first and forth area were less. On sagittal view, the intersection of C3, C4 and C5 were in the first area, the number of C6 in third

  20. Clinical study of titanium cages subsidence following anterior cervical fusion%颈推前路融合术后12例钛笼下沉临床分析

    Institute of Scientific and Technical Information of China (English)

    蔡忠香; 马永刚

    2011-01-01

    Objective To explore primarily the cause of titanium cage subsidence following cervical fusion. Method 56 patients with underwent anterior cervical decompression and fusion (ACDF) from June 2005 to June 2009. Al1 patients were followed up at 1 years following surgery including cervical plain film and clinical symptom. The diagnosis of titanium cage subsidence was made according to plain film and the possible cause was analyzed. Results Titanium cage subsidence was found in 12 patients. Incidence of subsidence in the cervical trauma was higher significantly than that of the CSM(P<0.05). Neck collar helped to decrease the incidence of subsidence(P<0.05). Patients with an intervertebral distracting angle over 30°was liable to subside than the angle less than 20° . Conculsion Titanium cage subsidence was a result of multiple biomerchanizm factors. Moderate intervertebral distracting force during operation and early neck collar post operation were necessary to prevent subsidence.%目的 探讨颈椎前路融合术后钛笼下沉的因素.方法 2005年6月至2009年6月56例患者在我科行ACDF手术,包括颈椎外伤14例,脊髓型颈椎病42例,手术方式均为C5椎体次全切钛笼植骨融合术.回顾性分析56例患者的颈椎平片和手术资料,研究影响钛笼下沉的因素.结果 56例手术患者中,术后1年复查时植骨全部融合,12例(21.4%)钛笼下沉.14例颈椎外伤患者中4例发生下沉,发生率为28.6%,而42例脊髓型颈椎病患者发生率为19.0%差异有显著性(P<0.05).术后佩戴颈托6~8周的25例患者,4例发生下沉,而佩戴颈托少于4周的患者中有8例发生下沉,两者发生率有显著差异(P<0.05).测9椎间撑开角,其中角度在10°-20°者46例,成角大于30°者10例,两组发生下沉例数分别为8例和4例,发生率有a著差异(P<0.05).结论 颈椎钛笼下沉是多种生物力学因素共同作用的结果,术中应避免椎间过度撑开,术后早期严格佩戴颈托.

  1. Insertion of lower cervical spine anterior pedicle screw in 18 cadavers%下颈椎前路椎弓根螺钉置入的实验研究

    Institute of Scientific and Technical Information of China (English)

    王远政; 刘洋; 邓忠良

    2012-01-01

    目的 探讨下颈椎前路椎弓根螺钉置入技术的可行性.方法 取18具成人尸体正常颈椎标本,剔除其周围软组织至清楚显露椎体前壁.CT扫描后,用Mimics软件重建三维模型,并测量C3~C7个体化置钉参数,包括进钉点(即椎弓根中轴线在椎体前壁投影点)、置钉方向(螺钉在横断面和矢状面上的倾斜角度)以及螺钉长度.严格按照测量结果,直视下置入椎弓根螺钉.术后作CT扫描,评价置钉效果.结果 进针点:C3、C4位于置钉椎弓根对侧,正中矢状面旁2~3 mm,距上终板6~7 mm;C5~ C7与置钉椎弓根同侧,其中C5位于正中矢状面旁1~2 mm,距上终板7.0~7.5 mm,C6、C7则为4~5 mm和7.5 ~8.5 mm.置钉方向:理想角度在C3、C4为外倾角46°~47°,头倾角-11°~-7°;在C5外倾角约48°,头倾角接近0°;C6、C7为36°~40°和8~13°.螺钉长度:可选择28、30、32 mm,其直径为3.5 mm.本组共置钉144枚.术后CT示,全部螺钉均经椎体前方置入椎弓根内抵达侧块.其中,有16枚胀破椎弓根外侧皮质,3枚穿破外侧皮质(均发生在C3、C4节段).结论 下颈椎前路椎弓根螺钉置入技术是可行的.%Objective To study the feasibility of lower cervical spine anterior pedicle screw ( APS) insertion and provide basis for its clinical application according to the preoperative APS related technological parameters. Methods Normal cervical spine specimens of 18 cadavers were carefully dissected to resect the surrounding tissue and to clearly expose the centrum antetheca. Following the CT scans, three dimensional model was reconstructed by Mimics software. The imaging data to measured key parameters of anterior transpedicular screw fixation were also produced by Mimics software. The individual screw insertion parameters including intersection point (projective point of pedicle central axis on the centrum antetheca) , insertion angle (the inclined angle of screws in cross-sectional and sagittal

  2. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  3. 颈前钢板置入内固定并植骨融合修复成人颈椎结核:生物相容性良好%Anterior cervical plate fixation and graft fusion in the repair of adult cervical tuberculosis:good biocompatibility

    Institute of Scientific and Technical Information of China (English)

    梁亮; 甫拉提•买买提; 朱松青; 徐韬; 盛伟斌

    2015-01-01

    背景:脊柱结核累及颈椎的较少。抗结核药物的应用对于伴有神经功能障碍及椎体破坏较重出现椎间不稳的患者收效甚微。目的:评价一期前路病灶清除植骨融合内固定修复成人颈椎结核后技术植入物与宿主的生物相容性。方法:收集于2010年5月至2012年6月在新疆医科大学第一附属医院脊柱外科进行治疗的颈椎结核患者14例,均采用Zephir 颈椎前路钢板进行一期前路病灶清除植骨融合内固定治疗。结果与结论:与内固定前相比,末次随访患者血沉、C-反应蛋白、目测类比评分下降(P <0.05),日本骨科协会评分增加(P <0.05)。除1例Frankel 脊髓损伤分级C 级患者恢复到D 级外,其余患者Frankel 脊髓损伤分级没有明显变化。与内固定前相比,7例伴后凸畸形患者的Cobb 角明显缩小。且内固定后椎体与植骨区域可见骨小梁通过,融合节段无移位及骨吸收、骨不连、假关节形成等现象出现。内固定后颈部疼痛及功能受限均得到不同程度的缓解或消失。说明此方法能有效治疗颈椎结核,且钢板与宿主的生物相容性良好。%BACKGROUND:Spinal tuberculosis seldom involves cervical vertebra. The application of anti-tuberculosis drug has slight effects on patients combined with nerve dysfunction and severe vertebral destruction, which results in unstable cervical vertebra. OBJECTIVE: To evaluate biocompatibility of graft and host after one-stage anterior debridement graft fusion and internal fixation in the repair of adult cervical tuberculosis. METHODS: A total of 14 patients who suffered from cervical tuberculosis were admitted into Department of Spinal Surgery, First Affiliated Hospital, Xinjiang Medical University between May 2010 and June 2012. They underwent Zephir anterior cervical plate for one-stage anterior debridement graft fusion and internal fixation. RESULTS AND CONCLUSION:Compared with pre

  4. 早期颈前路手术治疗多节段急性颈椎间盘突出并脊髓损伤的研究%Early anterior approach operation with internal fixation in treatment of acute multilevel cervical disc herniation patients with cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    李晓彬; 刘涛; 程应全; 王伟

    2012-01-01

    Objective To evaluate the clinical effect of early anterior approach operation with internal fixation in treating traumatic cervical disc herniation patients with cervical spinal cord injury.Methods Twenty-three patients with spinal cord injury caused by acute cervical disc herniation,admitted to our hospital from January 2010 to January 2011,were chosen in our study; all patients underwent anterior cervical surgery with the application of titanium mesh plate and cage to perform decompression and reconstruction; 14 patients received surgery within 72 h of injury and other 9 adopted surgery after 72 h of injury.The clinical data and postoperative recovery degree of the spinal cord injury were retrospectively analyzed.Results All patients were followed up for 6 to 13 months (averaged 11 months).X-ray examination showed bony fusion in the fusion segments without loosening/breakage of internal fixation or interbody fusion sinking.Except for 1 patient having grade A according to American Spinal Injury Association (ASIA) criteria enjoyed no recovery after the operation,the remaining patients enjoyed good improvement.The postoperative average Japanese Orthopedic Association (JOA) scale scores were significantly higher than those before surgery; the postoperative average JOA scale scores and recovery ratio of JOA in patients received surgery within 72 h of injury were obviously higher than those in patients received surgery over 72 h of injury (P<0.05).Conclusion Early anterior titanium mesh combined with cage and locking plate operation can make acute cervical disc herniation patients with spinal cord injury get rapid improvement and restoration; the earlier the operation time,the better the recovery degree; surgery can make cervical operation section obtain immediate stability,fusion and clinical effects are satisfied.%目的 探讨早期颈前路手术治疗多节段急性颈椎间盘突出引起的颈脊髓损伤的临床疗效. 方法 河南省人民

  5. Microendoscopic lumbar discectomy: Technique and results of 188 cases

    Directory of Open Access Journals (Sweden)

    Arvind G Kulkarni

    2014-01-01

    Full Text Available Background: Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED utilizing tubular retractors in terms of safety and efficacy of the technique. Materials and Methods: 188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5 for back and leg pain and ODI (Oswestry Disability Index. Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years. Results: The mean age of patients was 46 years (range 16-78 years and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months. The mean VAS scale for leg pain improved from 4.14 to 0.76 ( P < 0.05 and the mean VAS scale for back pain improved from 4.1 to 0.9 ( P < 0.05. The mean ODI changed from 59.5 to 22.6 ( P < 0.05. The mean operative time per level was about 50 minutes (range 20-90 minutes. Dural punctures occurred in 11 (5% cases. Average blood loss was 30 ml (range 10-500 ml. A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement. Conclusion: MED for herniated discs

  6. Clinical efficacy and changes of radiology imaging of multilevel anterior cervical decompression and fusion for cervi-cal spondylosis in elderly%老年颈椎病前路多节段减压融合内固定术后的临床疗效和影像学变化

    Institute of Scientific and Technical Information of China (English)

    张良; 王林; 王强; 申剑; 孙常太

    2014-01-01

    目的:探讨老年颈椎病前路多节段减压融合内固定术后的临床疗效,观察其影像学变化。方法2003年1月~2012年12月收治167例多节段颈椎病患者,其中33例获得完整随访的患者资料纳入本次研究。33例患者术前和末次随访时均拍摄颈椎正侧位、过伸过屈位X线片,比较分析手术前后Cobb角和相邻节段活动度( range of motion, ROM)的变化以及术后颈椎手术节段Cobb角在动力位X线片上的变化。行颈椎日本骨科学会( Japanese Orthopaedic Association, JOA)评分,分析相邻节段退变骨赘形成情况及其与钛板长度的相关性,并用Epstein标准对手术结果行主观评价。结果33例患者术后Cobb角和相邻节段ROM较术前明显增大。术后颈椎手术节段Cobb角在过屈及过伸位X片上变化不明显。骨赘形成与钛板是否偏长之间无相关性。术后JOA评分较术前明显减少,改善率为66.35%。患者主观评价结果优良率为75.76%。结论应用颈椎前路多节段经椎间隙减压融合内固定术治疗老年颈椎病,能有效改善颈椎手术节段Cobb角,手术疗效良好;术后相邻节段可能退变;部分患者术后相邻节段有骨赘形成,但与钛板是否偏长无关。%Objective To investigate the clinical efficacy of the multilevel anterior cervical decompression and fusion for cervical disease in elderly , and to observe imaging changes of radiology .Methods From January 2003 to december 2012, 167 patients with multilevel cervical spondylosis were treated by anterior cervical decompression and fusion ( ACDF ) .Of all patients, 33 cases that got complete follow-up were involved in this study .The cervical X-ray films and the cervical Japanese Orthopaedic Association (JOA) scores of all 33 patients before surgery and at the final follow-up were analyzed.The Cobb’s angle of the surgical segment , the range of motion ( ROM) of adjacent segments , and

  7. 颈前路植骨融合内固定手术治疗不稳定的Hangman骨折%Anterior Fusion with the Internal Fixation System in the Treatment for Unstable Hangman Fracture

    Institute of Scientific and Technical Information of China (English)

    王海; 叶君健; 陈春永; 谢昀; 林章雄

    2015-01-01

    目的:探讨采用颈前路C2~C3椎间Cage植入融合+钛板内固定治疗不稳定型 Hangman骨折的临床疗效。方法收集行颈前路C2~C3椎间Cage植入融合+钛板内固定术的不稳定 Hangman骨折患者19例,并回顾性研究其临床治疗效果。结果术后随访37月(10~66月),围手术期无椎动脉损伤及脑脊液漏等并发症,无内植物断裂。椎弓骨折处骨性愈合15例,骨折线仍可见4例;无迟发性脊髓损伤症状,5例颈髓损伤评级提高1~2级。结论颈前路C2~C3融合内固定方法可用于Ⅱ型及ⅡA型 Hangman骨折患者。%Objective To observe the clinical efficacy of anterior fusion with the internal fixation system in the treatment for unstable Hangman fractures . Methods 19 cases with unstable Hangman fracture were involved in this study ,who all underwent anterior cervical discectomy and fusion . Results All patients were followed up for 10~66 months ,average 37 months . No spinal cord injury ,vertebral artery injury or cerebrospinal fluid leakage occurred ,complications such as plate‐screw internal fixation of fracture failure did not occur . 15 patients were cured with bony union and restoration of cervical curva‐ture ,fracture line in 4 cases could be seen but no delayed symptoms of spinal cord injury . 5 cases w hich have cervical spinal cord injury spinal cord function was improved from 1~2 grade in 4 cases . Conclusions Anterior cervical fusion with internal plate fixation could be used for treating unstable Hangman fracture patients with type Ⅱ or type ⅡA .

  8. 一期前路病灶清除植骨内固定术治疗颈椎化脓性感染%Anterior debridement, graft and instrument for the treatment of cervical pyogenic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    尚晖; 皮海菊; 王达义

    2016-01-01

    目的:探讨前路病灶清除并取自体骨植骨钛板固定术治疗颈椎化脓性感染的疗效。方法回顾性研究2008年1月至2013年1月收治的12例颈椎椎体化脓性感染患者,其中男8例,女4例;年龄为41~71岁,平均56.7岁。所有患者均有较为严重的颈肩部疼痛,4例伴神经功能损害;术前疼痛视觉模拟量表(visual analogue scale, VAS)评分为7~10分,平均(8.1±1.5)分;按照日本骨科协会(Japanese Or⁃thopaedic Association, JOA)颈椎评分标准评分为7~11分,平均(9.2±1.5)分。所有患者诊断明确,均行手术治疗,术后局部行闭式冲洗并结合敏感抗生素静脉治疗不少于6周。结果患者获得12~24个月的随访,平均18.5个月,所有患者术后症状明显改善,末次随访复查植骨融合,无内固定物失败。所有患者感染病灶无复发,神经功能均完全恢复正常。无严重并发症出现,仅有1例出现伤口皮下积液故延迟1周愈合。结论一期前路病灶清除植骨融合内固定治疗颈椎化脓性感染,结合后期规范的敏感抗生素治疗,能够取得良好的效果。%Objective To discuss the efficacy of one⁃stage debridement, autologous graft and instru⁃ment via the anterior approach for the treatment of cervical pyogenic osteomyelitis. Methods A retrospective analysis was carried out on 12 cases of cervical pyogenic osteomyelitis admitted to our hospital from January 2008 to January 2013, including 8 males and 4 females, aged 41⁃71 years old (mean 56.7 years old). All cases suffered from severe neck and shoulder pain. The preoperative scores of Visual Analogue Scale (VAS) for pain were 7⁃10 (everage, 8.1±1.5) points. Four cases had nerve function deficit, and the Japanese Orthopaedic Asso⁃ciation (JOA) scores for cervical vertebrae were 7⁃11 (everage, 9.2 ± 1.5) point. All cases were explicitly diag⁃nosed and received wide⁃spectrum anti

  9. Anterior pedicle screw insertion for low cervical spine:anatomical observation%下颈椎前路椎弓根螺钉置入相关的解剖学观察

    Institute of Scientific and Technical Information of China (English)

    王远政; 刘洋; 陈富; 陈亮; 晏铮剑; 柯珍勇; 邓忠良

    2012-01-01

    目的:观察成人下颈椎前路椎弓根螺钉(Anterior pedicle screw,APS)置入相关的径线和角度,为该术的临床应用提供相关解剖学参数.方法:成人干燥尸体下颈椎(C3~C7)标本22具,分别用手工和CT测量椎弓根最窄处的高度、宽度及内外侧皮质厚度,椎弓根中轴线全长,轴线夹角,并进行统计学分析.随机在CT室资料库中抽取100例成人活体颈椎CT图像,用Mimics 软件行三维重建,除以上参数外,还测量进钉点位置的相关数据,计算置钉参数的95%CI.结果:22具标本的相关径线及角度,其手工测量值与CT测量值间无统计学差异.成人活体下颈椎CT图像测量结果通过95%CI的计算,可以得出:C3、C4进钉点位于椎体正中矢状面受术椎弓根对侧2~3 mm,距椎体上终板平面6~7 mm,进钉角度为外倾角46°~48°,头倾角C3:-11°~-12°,C4-6°~7°.C5进钉点位于椎体正中矢状面受术椎弓根同侧旁1~2 mm,距椎体上终板平面7~8 mm,进钉角度为外倾角47°~49°,头倾角1°~2°.C6、C7进钉点位于受术椎弓根同侧,正中矢状面旁4~5 mm,距椎体上终板平面7.5~8.5 mm,进钉角度为外倾角C6:40°~42°,C7:36°~38°,头倾角C6:6°~7°,C7:11°~13°.置钉长度选择30、32、34 mm较为适宜,螺钉直径可选择3.5 mm或4.0mm.结论:本实验证实了CT测量下颈椎APS置入技术相关参数的准确性,同时在国内首次利用大样本研究对该技术置钉参数进行了探索.%Objective:To observe the pathlines and angles related to lower cervical spine anterior pedicle screw(APS)fixation in adults so as to provide anatomical parameters in clinics. Methods:A total of 22 cervical spine(C3-C7)specimens of human adult cadavers were individually measured by hand and CT scan to determine the height and width of the narrowest part in pedicle, thickness of inner and outer cortexes, pedicle axis length and included angle of axes followed by statistical methods. One

  10. Anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy:a meta-analysis%颈前路与后路内固定系统置入治疗多节段脊髓型颈椎病的Meta分析

    Institute of Scientific and Technical Information of China (English)

    谢冲; 金格勒; 李忠伟; 王鹏; 赵学飞; 汪坤; 耿冲; 陈波

    2014-01-01

    背景:目前以植入物置入稳定脊柱的方法治疗多节段脊髓型颈椎病的主要置入路径为前路入路和后路入路,如何选择存在争议。  目的:对于前路与后路入路治疗多节段脊髓型颈椎病的疗效及安全性进行比较。  方法:检索 MEDLINE、EMBASE、PubMed 数据库、万方以及中国知网等数据库中有关前路与后路入路方式治疗多节段脊髓型颈椎病的相关研究和文献,对颈椎前路组和颈椎后路组患者置入治疗时间、治疗中出血量、治疗前JOA评分、治疗后JOA评分、并发症发生率、邻近节段退变发生率、颈椎活动度以及再手术率等指标进行比较。  结果与结论:12篇研究符合纳入标准,累计病例790例,其中前路组359例,后路组431例。Meta分析表明前路组与后路组治疗前JOA评分、治疗时间、治疗中出血量比较差异无显著性意义(P >0.05)。与后路组相比,前路组治疗后JOA评分高(P OBJECTIVE:To compare the therapeutic effect and safety of anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. METHODS:Databases such as MEDLINE, EMBASE, PubMed, Wanfang data and China National Knowledge Infrastructure were searched about related research and literature on anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Operative time, amount of blood loss, preoperative Japanese Orthopedic Association score, postoperative Japanese Orthopedic Association score, complication rate, degeneration rate of adjacent segments, cervical range of motion and reoperation rate were compared between anterior and posterior groups. RESULTS AND CONCLUSION:12 studies were accorded with the inclusion criteria, total y containing 790 cases (359 cases in the anterior group, and 431 cases in the posterior group). Meta-analysis showed that no significant difference in preoperative Japanese Orthopedic

  11. Influência do suporte e fixação anterior na resistência mecânica do fixador interno vertebral Influencia del soporte y de la fijación anterior sobre la resistencia mecánica del fijador interno vertebralartrodesis cervical anterior por hernia del disco cervica The influence of anterior reconstruction and fixation on the mechanical performance of an internal fixator

    Directory of Open Access Journals (Sweden)

    Gisele Cristina Ale dos Santos

    2009-03-01

    Full Text Available OBJETIVO: avaliar a influência da reconstrução e fixação anterior no desempenho mecânico do fixador interno da coluna vertebral. MÉTODOS: foram formados três grupos experimentais de acordo com a reconstrução e fixação anterior: grupo I -sem suporte anterior; grupo II - com suporte anterior; grupo III - com suporte e fixação anterior. Os corpos de prova foram submetidos a ensaios mecânicos de flexo-compressão, flexão lateral e torção, realizados em máquina de universal de ensaios, tendo sido realizados dez ensaios para cada modalidade (flexo-compressão, flexão lateral e torção em cada grupo experimental, perfazendo um total de 90 ensaios mecânicos. As propriedades mecânicas estudadas foram: o momento-fletor, o torque e a rigidez obtidos a partir da curva carga x deflexão de cada ensaio mecânico. RESULTADOS: observou-se que a colocação do suporte e da fixação anterior aumentou a resistência mecânica nos ensaios de flexo-compressão. Nos ensaios de flexão lateral observou-se aumento da resistência mecânica somente com a fixação anterior. CONCLUSÃO: nos ensaios de torção o suporte anterior e a fixação anterior não aumentaram a resistência mecânica do sistema de fixação vertebral.OBJETIVO: evaluar la influencia de la reconstrucción y fijación anterior en el desempeño mecánico del fijador interno de la columna vertebral. MÉTODOS: fueron formados tres grupos experimentales de acuerdo com la reconstrucción y fijación anterior: grupo I- sin soporte anterior, grupo II- con soporte anterior y grupo III- con soporte y fijación anterior. Los cuerpos de prueba fueron sometidos a ensayos mecánicos de flexocompresión, flexión lateral y torción, realizados en la máquina universal de ensayos, habiéndose realizados 10 ensayos para cada modalidad (flexocompresión, flexión lateral y torción en cada grupo experimental,con untotal de 90 ensayos mecánicos. Las propiedades mecánicas estudiadas fueron el

  12. Observation of curative effect after treatment of cervical spondylopathy with the artifitial cervical disc prosthesis%人工颈椎间盘置换术治疗颈椎病疗效观察

    Institute of Scientific and Technical Information of China (English)

    文益民; 葛宝丰; 蓝旭; 张军华; 王世勇; 张巧娥; 李慎松

    2009-01-01

    and right bending position. No obvious loss of lordosis was found. No ossification was in the replaced levels. No neurological or vascular complication were found during or after surger-y. [ Conclusion ] It is a good early outcome for 6 cases of artifical disc replacement The curative effect of implantation of the cervical disc prosthesis is better than anterior cervical discectomy and fusion. Patients could recover quickly and maintain segmental motion.

  13. Clinical study of a cervical anterior hybrid technique for multilevel cervical spondylotic myelopathy%颈椎前路融合与人工椎间盘置换术联合治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    朱云荣; 蒋玉权; 胡洪涛; 刘继春; 许国华; 何海龙; 叶晓健

    2011-01-01

    Objective:To explore the early clinical effects of cervical anterior hybrid technique using anterior corpectomy and fusion (ACF) combined with cervical artificial disc replacement (C-ADR) for multilevel spondylotic myelopathy.Method: Hybrid technique was applied in 24 cases of multilevel cervical spondylotic myelopathy (group A), and 28 patients were treated by the traditional anterior noncontiguous decompression and fusion (group B) between Oct 2008 and Jun 2009. Clinical results were evaluated by JOA score preoper-atively and postoperatively at 3d,3 months, 12 months,and 24 months.The operative time and blood loss were recorded.The range of movement (ROM) in replaced segment and C2-7 of all cases were evaluated by radiograph (X-rays of bending,extending).CT or MRI scan was applied postoperatively to find out the pressure of the spine and heterotopic ossification in the replaced segment.Result: There was no serious complication.Improvement in all cases occurred obviously, and JOA score increased (P0.05).The mean C2-7 ROM of both groups did not recover to the preoperative value,but group A showed faster and better C2-7 ROM recovery. Replaced segment achieved stability and restored partial of ROM.There was no prosthesis subsidence or ex-cursion.No hetertopic ossification was found in the replaced level,and the movement had no significant difference (P>0.05) between preoperative and postoperative at two years post-operation.But the deteriorated adjacent level of 2 cases were found in group B.Conclusion:In term of surgical time,blood loss and restoring stabilityand partial motion of the C2-7 ROM,the anterior hybrid technique is superior compared with the traditional anterior noncontiguous decompression and fusion.At the same time,less compensatory motion occurs at the adjacent segments,and less ASD will result.%目的:探讨颈椎前路减压后行融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病的临床疗效.方法:2008年10月~2009年6

  14. 单纯前路或后路手术治疗多节段颈椎病的疗效观察%Observation of the Efficacy of Simple Anterior or Posterior Operation for the Treatment of Multi-level Cervical Spondylosis

    Institute of Scientific and Technical Information of China (English)

    盛斌; 黄象望; 肖晟; 向铁城; 刘向阳; 张毅

    2014-01-01

    [Objective] To evaluate the clinical efficacy of cervical anterior or posterior operation for the treat-ment of multilevel cervical spondylosis and its influence on cervical curvature .[Methods] A total of 32 patients (aged 36~67 years of average 55 years ,19 males and 13 females) with multilevel cervical spondylosis underwent the operation via anterior or posterior approach from Jan .2005 to Jan .2013 .In anterior group(n=16) ,8 patients underwent selective anterior cervical hybrid decompression and fusion (ACHDF) ,and 4 patients underwent anteri-or cervical corpectomy and fusion(ACCF) on two segments ,and 4 patients underwent artificial cervical disc arthro-plasty combined with adjacent segment fusion(Hybrid) .In posterior group( n=16) ,8 patients underwent lamin-oplasty and 8 patients underwent laminectomy with internal fixation and fusion (LIFF) .Surgical complications were recorded .Visual analogue scale(VAS) and Japanese orthopedic association(JOA) score during preoperative and postoperative follow-up were compared between anterior and posterior approach patients .Cervical curvature was observed by lateral X-ray .[Results]Compared with before operation ,neck and upper limb VAS and JOA score in anterior group and posterior group after operation were obviously improved (all P 0 .05 ) .During the follow-up ,the image examination showed that the location of implants were right and bone fusion was obtained within 3 ~ 6 months .Compared with before operation ,cervical curvature had different levels of recovery in two groups after operation ( P 0 .05) .[Conclusion]Individualized appropriate surgical methods should be planned .Both anterior and posterior operation can effectively relieve nerve compression and recover cervical curvature so as to get a good clinical efficacy .Compared with poste-rior operation ,the anterior operation has certain advantages in reducing the operative time and intraoperative bleed-ing .%[目的]评价采用单纯颈椎前路或后路治

  15. Clinical observation and analysis of adjacent segment degeneration after anterior cervical fusion%颈椎前路融合术后相邻节段退变的临床观察与分析

    Institute of Scientific and Technical Information of China (English)

    王义生; 邓俊森

    2012-01-01

    [Objective] To study whether the anterior cervical fusion inevitably lead to the adjacent segment degeneration (ASD) . [Methods] From 1986.1 to 1999. 12, a total of 346 patients with cervical degenerative disease underwent the surgery of enlarged decompression with circular saw and auto iliac bone grafting. Among them there were 1 segment in 55 patients, 2 segments in 223 patients and 3 segments in 68 patients. The two motion segments adjacent to the fused segment and interval from the fused segment were evaluated respectively for imaging changes and divided the results into groups for statistical test. [Results] The patients were followed up for 13. 5 (4.1 ~ 18) years on average. Total 156 cases (45. 1% ) had obvious adjacent segment degeneration, 23 cases (6. 6% ) had obvious interval segment degeneration. The interval segment degeneration was less than that of adjacent segment degeneration, and the comparative differences had statistically significance (P 0.05 ) . [ Conclusion] The anterior cervical fusion accelerated the occurrence of ASD. The incidence of cephalic adjacent segment ASD was higher than that of tail side adjacent segments. The incidences of postoperative ASD in single segment and several segment fusion have no significant differences.%[目的]研究颈椎前路融合术是否必然导致邻近节段退变(adjacent segment degeneration,ASD).[方法]1986~1999年,共346例采用“环锯法前路扩大脊髓减压+椎体间植骨内固定术”治疗颈椎退变性疾病,其中,1个间隙55例,2个间隙223例,3个间隙68例.分别评定融合节段头、尾侧相邻间隙及间隔间隙的影像学表现,对结果分组进行统计学检验.[结果]术后随访13.5 (4.1 ~18)年,发生邻近节段明显退变的156例(45.1%),间隔节段明显退变的23例(6.6%).间隔节段退变明显少于邻近节段退变,两者比较差异有统计学意义(P<0.05).单纯头侧邻近节段发生ASD 84例,单纯尾侧邻近节段发生ASD 27例,头

  16. 护理干预在下颈椎骨折脱位前路复位减压植骨手术中的应用%Application of Nursing Intervention in Anterior Reduction and Decompression and Bone Graft Surgery in Lower Cervical Spine Fracture and Dislocation

    Institute of Scientific and Technical Information of China (English)

    李永岩

    2015-01-01

    目的:研究分析护理干预应用于下颈椎骨折脱位前路复位减压植骨手术的使用情况。方法根据我院2007年1月~2010年12月的35例下颈椎骨折脱位前路复位减压植骨手术治疗患者来进行研究分析。结果不完全性脊髓损伤的患者术后神经功能恢复Ⅰ级以上;完全性脊髓损伤的患者术后神经功能恢复无明显改善,患者疼痛缓解,肌力改善,没有肺部感染和泌尿系统症状存在。结论下颈椎骨折脱位前路复位减压植骨治疗手术需要提前做好准备,让患者的颈椎稳定,做好患者的生命体征以及并发症观察和预防,提升手术治疗效果,让患者的生活质量得到改善。%Objective To study and analyze the application of anterior reduction and decompression of the lower cervical spine fracture and dislocation of the lower cervical spine fracture and dislocation.MethodsAccording to our hospital from January 2007 to December 2010, 35 cases of lower cervical spine fracture and dislocation anterior reduction and bone graft surgery for patients to study and analysis.ResultsPatients with incomplete spinal cord injury recovered more than one grade. After surgery, patients with complete spinal cord injury had no obvious improvement in neurological function recovery. ConclusionAnterior reduction and decompression and bone grafting in the treatment of lower cervical spine fracture and dislocation need to be prepared in advance, so that patients with cervical stability, good life signs and complications observation and prevention, improve the surgical treatment effect, so that the quality of life of patients has been improved.

  17. Application of bone repair materials containing recombinant human bone morphogenetic protein-2 in anterior cervical discectomy and fusion%含骨形态发生蛋白2骨修复材料在颈椎前路减压植骨融合中的应用

    Institute of Scientific and Technical Information of China (English)

    许运; 金耀; 史勇; 姜为民; 唐天驷

    2014-01-01

      结果与结论:经过治疗后,两组均获得了即刻的颈椎稳定,颈椎前凸、融合节段椎体前缘高度及椎间高度均较治疗前明显增加(P<0.05)。随访12个月时,试验组Cobb角明显大于对照组(P<0.05),两组融合节段椎间隙前缘高度与融合节段椎间高度、椎间融合率、颈部与上肢目测类比评分、JOA评分比较差异无显著性意义,均获得骨性愈合。表明含骨形态发生蛋白2的骨修复材料结合自体骨赘植骨应用于颈椎前路减压融合可有效恢复并维持颈椎前凸、融合节段的高度,在改善临床症状方面与自体髂骨疗效相当。

  18. Cervical Cancer

    Science.gov (United States)

    ... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. Later, ...

  19. Percutaneous Posterolateral Transforaminal Endoscopic Discectomy: Clinical Outcome, Complications, and Learning Curve Evaluation.

    Science.gov (United States)

    Tenenbaum, Shay; Arzi, Harel; Herman, Amir; Friedlander, Alon; Levinkopf, Moshe; Arnold, Paul M; Caspi, Isreal

    2011-12-01

    Ongoing technological development combined with better understanding of endoscopic anatomy has made posterolateral endoscopic discectomy an appealing surgical option for the management of herniated lumbar disc. We evaluated clinical outcomes, complication rates, and surgical learning curve with the percutaneous posterolateral transforaminal endoscopic discectomy technique (PPTED). PPTED was performed on 150 patients from 2004 to 2008. And 124 patients were available for follow-up. Data regarding pain, postoperative complications, neurological status, operation time, and subjective patient satisfaction were recorded. A satisfactory clinical outcome as reflected in the VAS (mean 3.6) and ODI improvement (mean 21%) scores was reported; 20.9% of the patients required additional surgery. Learning curve assessment showed a significant difference (p = 0.043) for fewer revision surgeries as surgeons became more experienced. Patients who had endoscopic discectomy as a primary surgery achieved significantly lower VAS (p = 0.04) and ODI improvement (p = 0.004) scores compared with patients having transforaminal endoscopic discectomy as revision surgery. The complication rate was 1.6%, including one case of post-surgery hypoesthesia and one deep wound infection. The percutaneous posterolateral transforaminal endoscopic discectomy technique has a satisfactory clinical outcome with a low complication rate. Results for endoscopic surgery for revision or recurrent disc herniation are comparable to those of open revision surgery; the steep learning curve can be overcome with training and suitable patient selection.

  20. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies.

    Directory of Open Access Journals (Sweden)

    Jisheng Ran

    Full Text Available Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy versus conservative removal of the offending disc fragment alone (sequestrectomy provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis.A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes.Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001, lower visual analogue scale (VAS for low back pain (p<0.05, less post-operative analgesic usage (p<0.05 and better patients' satisfaction (p<0.05. Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference.According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.

  1. The Research of Artificial Cervical Disc Replacement

    Institute of Scientific and Technical Information of China (English)

    Zhao Zhua; Qiang Shenb

    2008-01-01

    Cervical arthroplasty after anterior decompression with insertion of a prosthetic total disc replacement has been suggested as an alternate to anterior cervical fusion. It develops quickly during recent years. Currently there are several cervical arthroplasty devices. Each device varies in terms of materials, range of motion and constraint. Early studies suggest that in the short term, the complication rate and efficacy is no worse than fusion surgery. Long-term results have not yet been reported. This review examines the current prostheses as well as discussing issues regarding indications and technique. It is hoped that an improvement of cervical arthroplasty occurs in terms of materials and design as spinal surgeons enter a new dines of the management of cervical spine disease.

  2. 一期前路病灶清除钛笼植骨内固定术治疗下颈椎结核%One-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis

    Institute of Scientific and Technical Information of China (English)

    沈生军; 官众; 任磊; 赵宇; 杨杰山

    2012-01-01

    Objectives: To evaluate the clinical efficacy of one-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis (TB). Methods: From December 2006 to July 2010, 10 patients suffering from lower cervical TB(6 males and 4 females, aged 42-71 years, mean age 52.1 years) underwent one-stage anterior debridement, titanium cage fusion with autograft and instrumentation. The defect sites were C3-C4 in 1 case, C4-C5 in 1 case, C5-C6 in 3 cases, C6-C7 in 2 cases, CS-C7 vertebrae in 3 cases. All patients had neck pain, fever, night sweats, 6 cases han limb sensory-motor dysfunction, the preoperative Frankel grade: 1 Frankel B, 2 Frankel C, 3 Frankel D, 4 Frankel E. 5 of them with cold abscess had no perforation to the posterior longitudinal ligament. The mean preoperative kyphosis angle was 19.1°±5.1 °(ranged from 10° to 30°). Preoperative anti-TB treatment was given for at least 2 weeks, then the treatment lasted for 6-12 months postoperatively. Improvement of clinical symptoms and bone fusion were followed up. Results: The operations were successfully completed without injury of blood vessels, spinal cord, esophagus and trachea. The incision healed with no complications such as sinus formation and wound infection. The mean follow-up was 14.5 months ranged from 10 to 24 months. The patients' clinical symptoms and the neurological dysfunction had different degrees of improvement, 5 cases combined with neurological deficits improved to Frankel E, 1 case improved from Frankel B to Frankel D. The kyphosis was corrected well. The average kyphosis angle of cervical spine was 2.9° ±1.6° after 1 week of operation,which was significantly lower than preoperative one(P0.05). After 3-6 months postoperatively, all cases were showed signs of bone fusion. All cases were observed fully integrated titanium cage bone graft between the upper and lower vertebrae at the final follow-up, and no recurrence or instrument

  3. Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2007-03-06

    Did you know that cervical cancer rates differ by race/ethnicity and region? Or that cervical cancer can usually be prevented if precancerous cervical lesions are found by a Pap test and treated? Find out how getting regular Pap tests can save a woman's life.  Created: 3/6/2007 by National Breast and Cervical Cancer Early Detection Program.   Date Released: 4/25/2007.

  4. EFFECTIVENESS OF OPEN DISCECTOMY FOR IVDP – A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ranganath

    2014-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Low back pain (LBP results in loss in productivity than any other medical condition. Approximately 70 - 80% of all people will develop LBP in their life . There are various causes of LBP , out of which the lumber disc herniation is one of the most frequent reason for physical , functional restriction in patients. Patients who have u ndergone surgical treatment are found to possess increased short term outcome instead of conservative treated patients. Surgically treated patients experienced fast pain relief , improvement of function & satisfaction in comparison to conservative patients. The comparative results of patients treated with surgery and conservatively treated patients have revealed that surgical treatment is much better at short term follow up (upto 1 year however no variations have been shown among treatment at long term foll ow up. Some patients operated for spine diseases are still left with poor results. The present study aims to evaluate the efficiency of open discectomy for L 4 – L 5 IVDP prospectively. METHODS : 30 cases of lumbar disc prolapse , above 18 years of age admitte d at KIMS hospital , Bangalore with MRI showing conclusive disc prolapsed were taken for the study. They were pre operatively evaluated for their ODI score. Only those patients who have scored 40% and above in ODI were included in the study. They underwent dis c ectomy. Methods of surgery used were fenestration , extended fenestration , hemilaminectomy & total laminectomy as per operative requirement. Follow - ups were carried out at 6 , 12 and 24weeks on selected areas. Pre and post of ODI total and sub scale scor es were compared at the end of 24 weeks. RESULTS : There was a significant reduction of post operative ODI score indicating good success rate in open disectomy. The pre operative mean ODI score was 58.28 , SD was 5.06 and the post operative mean ODI score wa s 15.28 and SD was 2.40 with t value of 38.56 and p value of

  5. Serial MRI in the early postoperative period after lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Annertz, M. [Dept. of Radiology, University Hospital, Lund (Sweden); Joensson, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Stroemqvist, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Holtaas, S. [Dept. of Radiology, University Hospital, Lund (Sweden)

    1995-04-01

    The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation. (orig.)

  6. Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst

    Science.gov (United States)

    Jha, Subash C.; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Abe, Mitsunobu; Nagamachi, Akihiro; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports. PMID:26357581

  7. Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst

    Directory of Open Access Journals (Sweden)

    Subash C. Jha

    2015-01-01

    Full Text Available Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED. Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI. Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient’s low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

  8. Short-and medium-term efficacy of artificial cervical disc replacement versus fusion for cervical spondylosis%人工颈椎间盘置换与融合治疗颈椎病:中短期疗效的比较

    Institute of Scientific and Technical Information of China (English)

    高明勇; 陶海鹰; 卫爱林; 贺斌

    2014-01-01

    BACKGROUND:Recently, non-fusion technology representing as artificial cervical disc replacement continues to improve. On the basis of reconstruction of disc structure and function of involved segments, cervical spine structure of surgery area segment is significantly close to dynamic and static load stress distribution required by natural physiological systems. It effects are apparent in protecting intervertebral facet joints of degenerated segment and structure and function of the cervical spine of adjacent segments and in maintaining cervical dynamic stability, which presented obvious methodological strengths compared with segmental fusion technology. OBJECTIVE:To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Bryan artificial cervical disc replacement in the treatment of single-level cervical spondylotic myelopathy or radiculopathy. METHODS:A total of 43 middle and old age patients with single-level cervical spondylotic myelopathy or radiculopathy, who were treated from March 2010 to March 2012, were enrol ed in this study. They were randomly assigned to anterior cervical discectomy and fusion group (fusion group) and Bryan artificial cervical disc replacement group. Range-of-motion of cervical overal and adjacent intervertebral area near the intervertebral space was observed with radiography. During fol ow-up, postoperative recovery of neurological function was evaluated using Japanese Orthopaedic Association scale, visual analog scale and neck disability index. RESULTS AND CONCLUSION:None patients experienced complications of neurovascular injury during and after the surgery. Range-of-motion of postoperative overal cervical vertebra and adjacent joint was improved in the Bryan artificial cervical disc replacement group compared with the fusion group. Neurological function was apparently improved after surgery in each group. At 3 months after surgery, scores of Japanese Orthopaedic Association, visual analog scale and neck

  9. The analysis of therapeutic effect of Halo-vest reduction combined with anterior decompression and internal fixation on lower cervical spine fracture-dislocation%Halo-vest复位单纯前路减压内固定治疗下颈椎骨折脱位的疗效分析

    Institute of Scientific and Technical Information of China (English)

    姚关锋; 王新家; 罗滨; 王伟东; 曾机灿

    2013-01-01

    Objective:To investigate the efficacy of lower cervical spine fracture-dislocation treated by Halo-vest reduction combined with anterior decompression and internal fixation. Methods:A total of 17 patients with lower cervical spine fracture-dislocation were treated by operation from January 2009 to December 2011.The Halo-vest external fixation was performed under 1oca1 anesthesia in the first step, and then under reduction anterior decompression and internal fixation were carried out in the second step.Results: After surgery, al patients were fol owed up for more than 12 months.According to the X-ray films and CT scan,the fracture-dislocation was made in a complete reset,the natural arrangement of the cervical spine and physiological circular measure regained and the implanted bone was completely fused,without internal fixation breaking or loosening.According to the Frankel grading,the grade of 5 cases were remarkably reduced(2 levels),10 cases effectively reduced(1 leve1),and 2 cases were invalid.Conclusions: The treatment of lower cervical spine fracture-dislocation with Halo-vest reduction combined with anterior decompression and internal fixation is effective.%  目的探讨Halo-vest复位单纯前路减压内固定治疗下颈椎骨折脱位的疗效。方法对2009年l月至2011年12月17例下颈椎骨折脱位患者,首先在局麻下行Halo-vest固定术,然后逐步撑开,在复位情况下,行前路减压内固定术。结果术后随访12~24个月,平均15.4个月。常规X光正侧位片显示骨折脱位均复位,恢复颈椎的正常序列及生理弧度,CT显示植骨融合,未发现内固定断裂及松动。按Frankel分级,显效(降低2级)5例,有效(降低1级)10例,无效2例。结论在Halo-vest复位的基础上行前路减压植骨融合内固定是治疗下颈椎骨折脱位的安全有效方法。

  10. Effect of rigid cervical collar on tracheal intubation using Airtraq®

    OpenAIRE

    Padmaja Durga; Chiranjeevi Yendrapati; Geeta Kaniti; Narmada Padhy; Kiran Kumar Anne; Gopinath Ramachandran

    2014-01-01

    Background and Aims: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq ® was evaluated. Methods: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C...

  11. Bio-mechanical behavior of different types of fixed anterior inter-cervical fusion techniques on plateau%高原颈椎前路椎间融合后不同固定方式的生物力学特性的研究

    Institute of Scientific and Technical Information of China (English)

    王友良; 杨杰山

    2011-01-01

    [Objective]To compare differences in the biomechanical behavior of different types of fixed inter-cervical fusion techniques.[Method]Form normal people on the plateau, a three-dimensional finite element model of C5/6 can be established.C5/6 model was imported into ANSA13.0.2 software.The model was meshed manually and automatically according to principles of meshing.At last,main ligament and capsular were added to the model.The model was verified through the use of the FED to simulate anterior surgical procedures of replacement of the vertebral disc with bone to achieve inter-cervical body fusion, with anterior fixed plate insertion and with insertion of posterior trans-pedicle instrumentation.Simulations of the six directions and loads of physiological motions of the cervix,flexion/extension,left/right lateral bending,left/right rotation of physical loads were run on each technique.[Result]In the simulation, both systems of fixed biomechanics, the anterior and posterior, showed significant reduction of stress on the inter-cervical body fusion graft block.The posterior method of showed a greater reduction of stress on the graft block compared with the anterior method.The main concentration of stress was found at the junction of the vertebral body and screw, upward and downward movement.Other various movements of the screw demonstrated no significant difference in the stress.[Conclusion]Both systems of fixed biomechanics, the anterior and posterior, can be used to significantly reduce stress on the inter-cervical body fusion graft block.The posterior method results in a greater reduction of stress on the graft block compared with the anterior method.%[目的]分析比较颈椎前路椎间融合后不同固定方式的生物力学特性.[方法]建立正常高原人C5/6的三维有限元模型.利用有限元软件ANSA13.0.2对模型进行有限元网格划分,最后加入韧带和关节囊,通过模拟前路手术摘除椎间盘建立椎间植骨融合的有限元

  12. Biomechanics of the change of the anteroposterior stress due to the cervical cord-meningeal compression originated anterior and posterior%颈脊膜前后方联合致压致颈脊髓前后方压应力变化的生物力学研究

    Institute of Scientific and Technical Information of China (English)

    赵晓峰; 赵斌; 赵轶波; 陈祺; 王玲

    2014-01-01

    目的 通过模拟颈椎间盘突出合并黄韧带病变所致的急性颈脊髓损伤,观察颈脊髓受压时前后方压应力的变化趋势,探讨前后方压应力与致压深度的关系.方法 采用10具新鲜成人尸体颈脊柱标本(C1 ~T1),通过前后方C4 ~ C5间骨窗伸入两根半球形测压杆,模拟颈椎间盘退变突出合并黄韧带病变时对颈脊髓前后方所形成的压迫.实验对颈脊髓前后方同时致压,致压深度最大和为椎管矢状径的60%,逐渐增加致压深度,分别测量不同致压深度下,颈脊髓脊膜前后方所受压应力的变化.结果 (1)前方致压深度一定,后方致压深度逐渐增加时,颈脊膜前方压应力无明显变化;颈脊膜后方压应力明显增大,其中致压深度为椎管中矢径的10% ~ 20%时各相邻致压深度间颈脊髓后方压应力两两比较差异无统计学意义(P>0.05);致压深度为椎管中矢径的30%~60%时各相邻致压深度间颈脊髓脊膜后方压应力两两比较差异有统计学意义(P<0.05);(2)后方致压深度一定,前方致压深度依次递增时,颈脊膜前方压应力明显增大,其中致压深度为椎管中矢径的10%~20%时各相邻致压深度间颈脊髓后方压应力两两比较差异无统计学意义(P>0.05);致压深度为椎管中矢径的30% ~ 60%时各相邻致压深度间颈脊髓脊膜后方压应力两两比较差异有统计学意义(P<0.05);颈脊膜后方压应力无明显变化.结论 颈脊髓脊膜前、后方所受压应力与致压深度呈非线性关系,所受压应力随致压深度增加而增大,前方或后方致压深度超过椎管中矢径的30%临界值后差异有统计学意义.%Objective To observe the anterior and posterior pressure change of the cervical spinal cord and to evaluate the relationship between the stress on cervical cord-meningeal complex (CCMC) compressed anteroposterior and the degree of canal occlusion by simulating cervical disc

  13. 一期后前路联合手术治疗多节段脊髓型颈椎病%One-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    刘新宇; 原所茂; 田永昊; 郑燕平; 李建民

    2012-01-01

    Objective: To evaluate the clinical results of one-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy (CSM).Method:A total of 28 patients (16 males and 12 females) suffering severe CSM underwent one-stage combined anterior-posterior approach, the average age was 51.3 years (range: 32-63 years).The affected level was C2/3 in 5 cases,C3/4 in 21 cases,C4/5 in 26 cases,C5/6 in 28 cases and C6/7 in 16 cases.The clinical results including JOA scores,the number of hand action in ten seconds, hand-grip strength,visual analog scale(VAS) of axial pain,and Cobb angle of sagittal alignment(C2-C7) were assessed retrospectively .Result: The average surgical time was 6.5h,the average blood loss was 375ml.All cases, were followed up for one year.No neurological deterioration due to spinal cord injury,CSF leakage,or wound infection was noted.The JOA scores improved from preoperative 9.8±2.1 to 15.9±1.2 of 1 year later,with the average improve rate of (84.7±9.2)%.The number of hands action in ten seconds improved from preoperative 11.2±3.1 of left and 10.8±l of right to postoperative 18.2±2.6 of left and 17.8±3.9 of right,and hand-grip strength improved from preoperative 18.7±7.1kg of left and 19.2±3.6kg of right to postoperative 33.2±6.3 of left and 35.8±2.5 of right (PO.O5).A11 cases showed satisfactory decompression and good bony fusion on MRI or CT.No ASD and instrument failure were noted.Conclusion: Combined anterior-posterior approach is less invasive and can decrease postoperative axial pain;anterior approach can manage compression effectively.%目的:探讨一期后前路联合手术治疗多节段脊髓型颈椎病的临床疗效.方法:回顾性分析2009年9月~2010年7月我院收治的行一期后前路联合手术治疗的多节段脊髓型颈椎病患者28例,男16例,女12例,年龄32~63岁,平均51.3岁,病程平均5.6年.术前病变节段:3节段16例,4节段12例.其中累及C2/3节段5例次、C3/4 21例次、C4/5 26

  14. Cervical Angina

    Science.gov (United States)

    Sussman, Walter I.; Makovitch, Steven A.; Merchant, Shabbir Hussain I.

    2015-01-01

    Cervical angina has been widely reported as a cause of chest pain but remains underrecognized. This series demonstrates the varied clinical presentation of patients with cervical angina, the delay in diagnosis, and the extensive cardiac examinations patients with this condition typically undergo prior to a definitive diagnosis. Recognition of this condition in patients with acute chest pain requires a high index of suspicion and an awareness of the common presenting features and clinical findings of cervical angina. PMID:25553225

  15. 探讨 ProDisc-C 人工颈椎间盘置换术与颈前路椎间盘切除融合治疗颈椎病的临床疗效%To evaluate clinical outcomes of ProDisc-C cervical disc replacement versus fusion for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    郭卫春; 黄文俊; 汪光晔

    2015-01-01

    目的探讨ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合( ACDF)治疗单节段椎间盘退变引起的脊髓或神经根颈椎病的临床疗效。方法自2010年10月至2012年年8月武汉大学人民医院收治的46例颈椎病病例,随机进行分组,其中实验组:24例行ProDisc-C 置换术,对照组:22例行ACDF。评价指标主要如下:两组手术时间及术中出血量;两组术前、术后3、12月VAS评分,JOA评分,手术邻近节段活动度,颈椎活动度( ROM)以及术后并发症。结果46例患者全部获得平均12个月(8~18个月)随访。两组手术时间及术中出血量无统计学差异(P>0.05)。两组术后VAS评分,JOA评分均较术前明显提高( P <0.05),两组差异无统计学意义( P >0.05)。试验组整个下颈椎的活动度及邻近节段活动度各个随访时段与术前相比无变化(P>0.05);对照组在术后3个月整个下颈椎活动度较术前相比有统计学差异(P<0.05),术后12个月时逐渐恢复正常,术后12个月邻近节段活动度较术前有统计学差异(P<0.05)。其中对照组术后出现3例吞咽困难。结论  ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合( ACDF)治疗单节段椎间盘退变引起的脊髓或神经根颈椎病在中短期随访中临床效果满意,人工颈椎间盘置换术能有效保留颈椎活动度,减少临近节段的退变,并且术后吞咽困难发生率较低。%Objective To prospectively compare the clinical effects of ProDisc-C cervical disc replacement with those of anterior cervi-cal discectomy and fusion ( ACDF) in the treatment of single-level cervical spondylotic myelopathy or radiculopathy.Methods From the Department of Orthopaedics in Renmin Hospital of wuhan University within the period of October 2010 to August 2012,A total of 46 patients with single-level cervical spondylotic

  16. Spondilitis Tuberkulosa Cervical

    Directory of Open Access Journals (Sweden)

    Roni Eka Saputra

    2015-05-01

    Full Text Available Abstrak Spondilitis tuberkulosa servikalis adalah penyakit yang cukup jarang dijumpai, hanya berkisar 2-3% dariseluruh kasus spondilitis tuberkulosa. Gambaran klinis sangat bervariasi, mulai dari gejala ringan dan tidak spesifikhingga komplikasi neurologis yang berat. Seorang wanita berusia 29 tahun datang dengan keluhan lemah keempatanggota gerak yang semakin memberat dalam 10 hari terakhir yang didahului oleh nyeri leher yang menjalar ke bahudan lengan sejak 6 bulan sebelumnya. Nyeri awalnya dirasakan sebagai keterbatasan gerakan leher saat menolehkesamping kiri dan kanan serta menundukkan kepala. Nyeri dirasakan semakin berat dengan pergerakan danberkurang jika istirahat. Pasien mengalami penurunan berat badan sejak 2 bulan terakhir. Tidak dijumpai riwayat batukatau nyeri dada. Pemeriksaan neurologis menunjukkan kelemahan  pada keempat ekstremitas. Hasil laboratoriumditemukan peningkatan Laju Endap Darah (LED. Rontgen foto toraks dalam batas normal. Roentgen foto cervicalmenunjukkan destruksi setinggi C5. MRI cervical menunjukkan destruksi pada korpus C5-6 dengan penyempitan padadiscus intervertebrae C5-6 disertai dengan  massa/abses paravertebral dengan penekanan ke posterior. MRI Thorakaltampak destruksi corpus verebre T4,5 dengan diskus intervertebralis yang menyempit. Sugestif suatu spondilitistuberkulosa. Pasien dilakukan tindakan pembedahan anterior corpectomi melalui microscopic surgery dengan graftdari iliac sinistra, serta insersi anterior plate 1 level. Hasil pemeriksaan patologi anatomi menunjukkan spodilitis TBCkaseosa. Pada spondilitis vertebre T4,5 dilakukan laminectomi, debridement costotrasversektomi, dan stabilisasidengan pedicle screw T2, T3, dan T5. Pasien diterapi dengan obat antituberkulosis. Keadaan pasien saat ini, pasiensudah bisa beraktifitas normal dengan motorik dan sensorik baik. Spondilitis tuberkulosa merupakan bentuktuberkulosa tulang yang paling sering dijumpai. Spondilitis tuberkulosa cervical berkisar 2

  17. Motor tic disorder and traumatic cervical myelopathy: a case report Trastorno de tic motor y mielopatía cervical traumática: relato de caso Transtorno de tique motor e mielopatia cervical traumática: relato de caso

    Directory of Open Access Journals (Sweden)

    Ericson Sfredo

    2011-01-01

    Full Text Available The association between motor tics and cervical myelopathy is rare and not well understood. Only a few papers in the literature reported this disorder until the present date. This is a case report of a cervical myelopathy case secondary to a motor tic disorder. A 23-year-old male with a 10-year history of motor tic disorder, involving sudden forced extension of the head and cervical spine. Disturbed tactile sensation and kinetic posturing that progressed to the Lhermitte sign every time he made the movement were detected over the last six months. Magnetic resonance imaging (MRI showed hyperintense intramedullary lesion at C2-C3, degeneration at C3-C4, and no signs of spinal cord compression. On sagittal view, functional MRI with head extension showed anterior compression with protrusion of the intervertebral disc and posterior compression of the yellow ligaments causing spinal cord stenosis. Anterior discectomy and fixation of C3-C4 were performed. There were no complications. The patient showed improvement and the motor tics were controlled by haloperidol. The patient remains symptom-free after 2 years of follow-up. Uncontrolled motor tics can compromise spinal cord function. Functional MRI can reproduce the abnormal movements and clarify the physiopathology.La asociación entre tics motores y mielopatía cervical es rara y no es bien comprendida. Pocos estudios, que analizan este disturbio, han sido encontrados en la literatura hasta el momento. Este es el relato de un caso de mielopatía cervical secundaria a tics motores. Paciente masculino de 23 años con historial de trastorno de tic motor desde hace diez años, involucrando extensión forzada de la cabeza y columna cervical. En los últimos seis meses, se diagnosticaron deficiencias de sensaciones táctiles y postura cinética que progresaron hacia la señal de Lhermitte, cada vez que el paciente se movía. La Resonancia Magnética (RM reveló lesión intramedular hiperintensa al nivel de

  18. Biomechanical analysis of three types of treatment after loop-saw method anterior cervical decompression%颈椎前路环锯法减压术后三种 处理方法的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    石志才; 李家顺; 侯铁胜; 贾连顺; 丁祖泉; 李明

    2001-01-01

    :Objective To study the biomechanical stability of three types of operation,after anterior cervical loop-saw method decompression and to provide biomechanical basis for clinical surgery. Methods The fresh cervical spine speciman of young cadaver were used for biomechanical test.The anterior cervical loop-saw decompression were carried out at C5~6 and a autogenous bone graft taken from iliac bone were implanted into decmopressed intervertebral space.After test,the bone graft were removed and a threaded cervical intervertebral inner fixation device were implanted into C5~6.The stability of C5~6were tested respectively under anterior flexion,posterior extensive,lateral flexion and rotation when the speciman were loaded with 1.53 nm moment at normal,and three types of operative management diseribed as above.The spinal stability were expressed by space displacement and angular displacement between two neighbour vertebrae.Results The stability of C5~6were significantly decreased after loop-saw decompression that exhibited as the increasing of range of motion(ROM).Bone graft results in a increasing of height of intervertebral space and decreasing of the ROM of the fusion segment,but its stability is inferior to that of normal segment.After implant the threaded intervertebral cervical device,the ROM of C5~6 in anterior flexion rotation and lateral bending are significantly decreased with no change of the range in extension.Conclusion The stability of cervical spine were significantly decreased after anterior loop-saw decompression.Bone graft and fusion is essential for prevent the possible non-union or mal-union of decompressed segement.Though bone graft at intervertebral space can significantly improve the stability of the cervical spine,a postoperative assistant external fixation is still required.Threaded cervical intervertebral fusion device can provide a satisfactory stability of the fusion segment without require any external fixation.%目的 

  19. Generalized cervical root resorption associated with periodontal disease

    NARCIS (Netherlands)

    Beertsen, W; Piscaer, M; Van Winkelhoff, AJ; Everts, P. A. M.

    2001-01-01

    Background and description of case: The etiology and pathogenesis of generalized cervical root resorptions is not well understood. In the present report, a case of severe cervical root resorption involving 24 anterior and posterior teeth is presented. The lesions developed within a period of 2 years

  20. Cervical dysplasia - series (image)

    Science.gov (United States)

    ... to detect cervical cancer. Limited or early cervical cancer (carcinoma in situ, or cervical intraepithelial neoplasia, or dysplasia) requires treatment with ablation therapy, usually in the form of ...

  1. 经前路椎体次全切钛笼置入锁定钢板螺丝钉内固定治疗相邻两节段脊髓型颈椎病%Adjacent Two Segments Anterior Subtotal Titanium Cage into the ;Locking Plate Screw Fixation for the Treatment of Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    青祖宏; 刘明; 高巍; 何蔚; 刘杨; 李永焕

    2013-01-01

    Objective To summarize the clinical efficacy of the anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent cervical spondylotic myelopathy.Method August 2010~December 2012,Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of adjacent two segments cervical spondylotic myelopathy 25 cases,including 18 men and 7 women patients,aged 33~75 years,mean 56.5 years.In 25 patients with varying degrees of symptoms of spinal cord compression. There are 9 cases(C4/C5). There are 15 cases(C5/C6).There are 1 case(C6/C7).Observed lateral cervical spine,cervical hyperextension flexion X-rays and cervical MR, before and after surg ery and follow-up phase,so as to learn spinal cord compression,cervical stability and postoperative cervical height,curvature,titanium cage plate screw position and cervical fusion. Compared preoperative to postoperative and follow-up,pain visual analog scale (VAS) and the Japan Orthopaedics Association (JOA) pain score.Results Operative time (120±30) min,blood loss (150±50)ml.The surgery does not appear related complications.The followed up time are 2~24 months (mean 12.5 months). Nerve function significantly improved.JOA score increased from preoperative 6.2±1.1 to the last follow-up 14.3±1.5,with an average improvement rate was (82.3±11.4)%.VAS average score is 2.1 points.The follow-up period is not found that the titanium cage shift,loose screws and lesion spinal cord compression phenomenon.Conclusion Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent segments of cervical spondylotic myelopathy,effectively relieve nerve compression of the spinal cord,quickly restored cervical curvature and height,reconstruction of spinal stability,shorter operative time,less bleeding, and less damage.It has created favorable conditions for the rehabilitation of neurological function in patients,which is an

  2. Treatment of anterior decompression, bone grafting and internal fixation combined with coblation neucleoplasty for patients with cervical spondylosis involved multilevel%前路减压植骨内固定联合髓核成形术治疗多节段受累颈椎病

    Institute of Scientific and Technical Information of China (English)

    张非; 李青; 张爱明; 梁道臣

    2013-01-01

    目的:探讨前路减压植骨内固定联合等离子髓核成形术治疗多节段受累颈椎病的临床效果。方法回顾性分析2012年3月至12月中山市人民医院采用前路减压植骨内固定结合等离子髓核成形术治疗的30例多节段受累颈椎病患者的临床资料,采用日本骨科学会(JOA)评分对术后临床症状改善情况进行评价。结果30例患者均获得有效随访,随访时间4~9个月(平均6.8个月)。患者术前不适症状均有不同程度改善,无神经功能加重及内固定松动、骨笼脱出等严重并发症发生。术后3个月JOA评分为(14±1)分,较术前的(10±2)分明显改善(t =8.143,P=0.000),JOA改善率为45%。结论前路减压植骨内固定结合等离子髓核成形术治疗多节段受累颈椎病近期效果稳定,并发症少。%Objective To explore clinical effect of anterior decompression, bone grafting and internal fixation combined with coblation neucleoplasty in the treatment of multilevel cervical spondylosis. Methods Clinical data of 30 patients with multilevel cervical spondylosis from March 2012 to December 2012 were retrospectively analyzed and all of them were treated by mono-segmented cervical anterior decompression, bone grafting and internal fixation combined with coblation neucleoplasty in Zhongshan People's Hospital. Clinical effects were evaluated by Japanese Orthopaedic Association (JOA) score. Results All patients obtained follow-up with the average time of 6.8 months (4-9 months). Discomfort symptoms were improved after the operation. No nerve function aggravation occurred, also, no serious complications such as internal fixation loosening or cage pull-out had happened. Compared to preoperative JOA score, JOA score at 3 months postoperatively was improved from (10 ± 2) to (14 ± 1) (t = 8.143,P = 0.000), JOA improvement rate was 45%. Conclusions Mono-segmented cervical anterior decompression, bone graft fusion

  3. Therapeutic effect of methylprednisolone combined with anterior decompression and internal fixation in treating cervical spine hyperextension injury%甲泼尼龙联合颈前路减压内固定治疗颈椎过伸伤的疗效研究

    Institute of Scientific and Technical Information of China (English)

    秦力; 吴可沁; 刘师良

    2015-01-01

    目的:探讨甲泼尼龙联合颈前路减压内固定治疗颈椎过伸伤的临床疗效。方法收集2014年7月~2015年7月浙江省嘉兴市第一医院骨科收治的颈椎过伸伤患者42例,随机分为对照组和实验组,每组各21例,对照组患者单纯给予颈前路减压内固定术治疗,实验组给予甲泼尼龙联合颈前路减压内固定术治疗,治疗结束后,对所有患者的血清肿瘤坏死因子α( TNF-α)、超氧化物歧化酶( SOD)水平及美国脊髓损伤协会( American Spinal Injury Association ,ASIA)神经功能评分进行检测。结果治疗后,与对照组比较,实验组患者的血清TNF-α水平较低、SOD水平较高、ASIA评分较高,差异均有统计学意义( P<0.05)。结论甲泼尼龙联合颈前路减压内固定治疗能够显著降低颈椎过伸伤患者血清TNF-α水平,提高血清SOD水平及ASIA评分,减轻炎症损伤,提高抗氧化能力,具有良好的临床疗效。%Objective To analyse the therapeutic effect of methylprednisolone combined with anterior decompression and internal fixation in the treatment of cervical spine hyperextension injury. Methods 42 patients who were diagnosed with cervical hyperextension injury in orthopaedics department of the First Hospital of Jiaxing were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.Patients in control group received anterior cervical decompression and internal fixation only , patients in experimental group received methylprednisolone combined with anterior decompression and internal fixation, after treatment, the serum levels of TNF-α, SOD and American Spinal Injury Association (ASIA) score were detected in all patients.Results After treatment, compared with control group, the serum levels of TNF-αwas lower, SOD was higher and ASIA score was higher in experimental group, and the differences were statistically

  4. 一期后路单开门联合前路选择性减压融合术治疗多节段脊髓型颈椎病%One-stage Expansive Open-door Laminoplasty and Selective Anterior Decompression and Fusion for Multilevel Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    黄勇全; 刘先明; 黄华伟; 陈文明

    2012-01-01

    目的 评估一期后路单开门联合前路选择性减压治疗多节段脊髓型颈椎病的手术疗效.方法 对46例多节段(≥3节段)脊髓型颈椎病患者,均行后路单开门椎管成形+前路选择性椎体次全切除和(或)椎间盘切除椎间钛网、Cage或髂骨块植骨+前路钢板内固定术.术后测量颈椎曲度角评价颈椎排列,采用日本矫形外科学会(japanese orthopaedic association,JOA)评估系统评价其功能恢复情况,采用正侧位、动力位X线摄片和三维CT重建方法评估融合程度.同时,进行MRI检查,以观察脊髓减压程度和脊髓情况.结果 所有病例均获得平均24.1(12~28)个月的有效随访.JOA评分:术前为(9.0±1.2)分,术后6个月为(13.9±0.7)分,与术前比较,差异有统计学意义(P=0.007);末次随访为(14.1±0.6)分,与术前比较,差异有统计学意义(P=0.004).颈椎曲度角术前为(34.7±4.1)°,术后6个月为(37.1±5.1)°,术后6个月曲度角与术前比较,差异有统计学意义(P=0.024).术后12个月和末次随访,所有病例均已达到骨性融合,且椎管减压明显.结论 一期后路单开门联合前路选择性减压融合术是治疗多节段脊髓型颈椎病一种安全、有效的方法,在达到充分解除脊髓前后压迫的同时恢复颈椎排列,提高植骨融合率.%Objective To evaluate the curative efficacy of one-stage expansive open-door laminoplasty combined with selective anterior decompression and fusion in multilevel cervical spondylotic myelopathy. Methods Forty-six patients with multilevel cervical spondylotic myelopathy (≥3 consecutive segments) were treated with expansive open-door laminoplasty, selective anterior corpectomy,and (or) cervical reconstruction with titanium mesh cages,iliac bone graft,and anterior rigid plate fixation. The cervical curvature was determined to evaluate cervical spine arrangement. The functional recovery was assessed by Japanese orthopaedic association (JOA) scoring system

  5. Cervical Laminoplasty

    Science.gov (United States)

    ... spine showing extension of the spine following a cervical laminoplasty. B) Post-operative lateral x-rays of the same patient showing flexion. Note that the range of motion is maintained after the laminoplasty and that no ...

  6. Cervical spondylosis

    Science.gov (United States)

    Cervical osteoarthritis; Arthritis - neck; Neck arthritis; Chronic neck pain; Degenerative disk disease ... therapist). Sometimes, a few visits will help with neck pain. Cold packs and heat therapy may help your ...

  7. Cervical spine involvements in Reiter's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Moilanen, A.; Yli-Kerrtula, U.; Vippula, A.

    1984-07-01

    Cervical spine radiographs of 38 patients orginating from 145 consecutive cases with Reiter's syndrome (RS) were reviewed. Five of these 145 patients (3.4%) had cervical spine manifestations: anterior atlanto-axial dislocation 2, craniovertebral lesions typical for rhreumatoid arthritis (RA), spondylitis typical for ankylosing spondylitis (AS) and anterior ossification, one each. Four of these patients were males. Cervical lesions in RS turned out to be rare. These lesions are alone indistinguisable from those of other chronic rheumatic inflammatory diseases.

  8. Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2012-02-01

    The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. Data was analysed using Mann-Whitney test for statistical significance. 100 patients were recruited. A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.

  9. The clinical evaluation of anterior/posterior decompression in treating radiculopathy and axial symptoms caused by multilevel cervical spondylosis%多节段颈椎病前路与后路减压对神经根及轴性症状的疗效评估

    Institute of Scientific and Technical Information of China (English)

    王坤; 陈赞; 吴浩; 菅凤增

    2012-01-01

    Objective To evaluate the clinical outcomes about root and axial symptoms of multilevel cervical spondylosis operated via anterior or posterior approach.Methods We retrospectively,analyzed the JOA scores,JOA recovery rate,NDI,VAS and Nurick grades of 85 patients with multilevel cervical spondylosis who were divided into the anterior and posterior groups by method of different approach,then SPSS 17.0 was used to analyze the related status.Results The mean JOA scores of the anterior and posterior groups were,respectively,improved by 3.33 and 3.77 points,meanwhile,the corresponding JOA recovery rates were (62.79 ±41.12)% and (50.86 ±50.49)%,and no differences exist between the two groups.We used Median M (25%,75 % ) to describe Nurick grades,the pre - and post -operation M were ( 1,3,3 ),( 1,3,4) VS(0,0,2),(0,1,3)and there was no significant difference.However,in the aspects of NDI and VAS,via nonparametric test,the result showed the anterior group was superior.All surgery related complications occurred in the anterior group. Conclusions In the respect of releasing root/axial symptoms,the anterior approach was probably superior to the posterior group,but the complications related to surgery should be paid cautiously.%目的 评估多节段颈椎病前路与后路减压对神经根及轴性症状的疗效.方法 回顾性分析85例多节段颈椎病患者手术前后JOA评分及其改善率,NDI及VAS评分,Nurick分级.根据不同手术方式对85例患者分成前路及后路手术两组,并对手术疗效进行统计学分析.结果 前后路手术组JOA评分分别提升3.33分、3.77分,JOA改善率分别为(62.79±41.12)%、(50.86±50.49)%,两组间差异无统计学意义,P<0.05.Nurick分级采用中位数M(25%、75%)表示,前后路两组术前分别为(1、3、3)和(1、3、4),术后分别为(0、0、2)和(0、1、3),均比术前有改善,两组间差异无统计学意义.但在NDI、VAS评分方面,经非参数检验后,结果显示前

  10. Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

    LENUS (Irish Health Repository)

    Hickey, Oonagh T

    2010-08-01

    One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.

  11. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  12. Comparison of safety and efficiency of microendoscopic discectomy with automatic nerve retractor and with nerve hook

    OpenAIRE

    Yin, He-Ping; Wang, Yu-Peng; Qiu, Zhi-Ye; Du, Zhi-Cai; Wu, Yi-Min; Li, Shu-Wen

    2016-01-01

    This study compares the safety and efficiency of two techniques in microendoscopic discectomy (MED) for lumbar disc herniation. The two techniques are MED with automatic nerve retractor and MED with nerve hook which had been widely used for many years. The former involves a newly developed MED device which contains three parts to protect nerve roots during operation. Four hundred and twenty-eight patients underwent MED treatments between October 2010 and September 2015 were recruited and rand...

  13. Discectomia lombar transforaminal: estudo quantitativo em cadáveres Discectomía lumbar transforaminal: estudio cuantitativo en cadáveres Transforaminal lumbar discectomy: quantitative study in cadavers

    Directory of Open Access Journals (Sweden)

    Emiliano Neves Vialle

    2009-06-01

    Full Text Available OBJETIVO: avaliar a eficácia da discectomia lombar por via transforaminal, de modo quantitativo, em estudo experimental com cadáveres. MÉTODOS: este estudo utilizou cinco cadáveres humanos frescos, submetidos à discectomia pela via de acesso póstero-lateral nos níveis L3-L4 e L4-L5, visando remover a maior quantidade de material discal possível. Uma abordagem anterior complementar, expondo os mesmos discos intervertebrais, permitiu a remoção do material discal remanescente, para posterior comparação. RESULTADOS: em L3-L4, a remoção transforaminal do disco obteve, em média, 48% do volume total, e em L4-L5, cerca de 38%. CONCLUSÃO: apesar de segura e de fácil realização, a via transforaminal não é tão eficaz quanto à via anterior na remoção do disco intervertebral.OBJETIVO: evaluar la eficacia de la discectomía lumbar por vía transforaminal, de modo cuantitativo, en un estudio experimental con cadáveres. MÉTODOS: este estudio utilizó cinco cadáveres humanos frescos, sometidos à discectomía por vía de acceso posterolateral en los niveles L3-L4 y L4-L5, visando remover la mayor cantidad de material discal posible. Un abordaje anterior complementar, exponiendo los mismos discos intervertebrales, permitió la remoción del material discal remanente, para posterior comparación. RESULTADOS: en L3-L4, la remoción transforaminal del disco obtuvo en promedio 48% del volumen total y en L4-L5, cerca del 38%. CONCLUSIÓN: aunque segura y de fácil realización, la vía transforaminal no es tan eficaz como la vía anterior en la remoción del disco intervertebral.OBJECTIVE: to evaluate the quantitative efficacy of transforaminal lumbar discectomy, through a cadaver study. METHODS: this study used five fresh human cadavers, that underwent L3-L4 and L4-L5 posterolateral discectomy, aiming to remove as much disc material as possible. After that, the remaining disc material was removed through an anterior approach, for further

  14. Displaced fracture through the anterior atlantal synchondrosis

    Energy Technology Data Exchange (ETDEWEB)

    Thakar, Chrishan; Allibone, James [Royal National Orthopaedic Hospital NHS Trust, Department of Spinal Deformity, Stanmore, Middlesex (United Kingdom); Harish, Srinivasan [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College, The Institute of Orthopaedics and Musculoskeletal Sciences, London (United Kingdom)

    2005-09-01

    In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

  15. Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

    Science.gov (United States)

    Azimi, Parisa; Benzel, Edward C; Montazeri, Ali

    2016-01-01

    Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI) over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more) improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3) years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.

  16. [Therapy of cervical rheumatoid arthritis].

    Science.gov (United States)

    Kothe, R; Wiesner, L; Rüther, W

    2004-08-01

    The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression cannot be stopped by conservative treatment, which is of great importance at the beginning of the cervical manifestation. Patient education, physiotherapy and immobilization with a stiff collar can significantly reduce pain. Early and effective DMARD therapy can have a positive effect on the natural history of the disease. In case of progressive instability, cervical myelopathy or severe pain operative treatment is indicated. If there is an isolated AAS, fusion can be restricted to the C1/C2 segment. The Magerl transarticular screw fixation is the preferred technique for stabilization. If there is evidence for vertical instability or severe destruction of the C0/C1 joints, occipital cervical fusion has to be performed. Durin the preoperative planning it is necessary to look for signs of subaxial instability. If this is the case, fusion should include the entire cervical spine. Transoral decompression may be necessary when there is persistent anterior compression of the myelon, typically seen in fixed AAS. Non-ambulatory myelopathic patients are more likely to develop severe surgical complications. Therefore, it is important to avoid the development of severe cervical instability by early surgical intervention. The right timing for surgery is still a matter of controversy. Future prospective randomized trials should address this topic to improve the treatment concept for the rheumatoid patient.

  17. Usurering af osteosyntesemateriale gennem øsofagus efter anterior cervikalkirurgi

    DEFF Research Database (Denmark)

    Wiis, Julie Therese; Nittby, Henrietta Carolina; Lauritsen, Anne Oberg

    2014-01-01

    The rare, potentially life-threatening complication to anterior cervical surgery, oesophageal perforation, occurs after surgical trauma or due to erosion by migrating hardware. Symptoms are hoarseness, dysphagia, neck/throat pain, subcutaneous emphysema and fever. Imaging and endoscopic diagnosis...... can give false negative results. We present a case of a 74-year-old male, who was readmitted with sepsis and abscess in the operation area three weeks after anterior cervical surgery. Veillonella parvula was found in the abscess material and computed tomography confirmed the diagnosis of oesophageal...

  18. Percutaneous endoscopic lumbar discectomy: clinical and quality of life outcomes with a minimum 2 year follow-up

    Directory of Open Access Journals (Sweden)

    Tan Seang B

    2009-06-01

    Full Text Available Abstract Background Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to work. Method 55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS, Medical Outcomes Study Short Form-36 scores (SF-36 and Pain Visual Analogue Scale (VAS and return to work. Results The mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p Conclusion Percutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.

  19. Fracture of the Atlas through a Synchondrosis of Anterior Arch

    Directory of Open Access Journals (Sweden)

    Gamze Turk

    2013-01-01

    Full Text Available Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years.

  20. 锚定式颈椎椎间融合器临床应用中期随访报告%A retrospective mid-term study on the application of anchoring cervical intervertebral fusion cage

    Institute of Scientific and Technical Information of China (English)

    鲍达; 马远征; 陈兴; 李宏伟; 高天君; 罗小波

    2012-01-01

    目的:观察在颈椎前路椎间盘切除减压后应用锚定式颈椎椎间融合器(anchoring cervical intervertebral fusion cage,ACIFC)植骨融合的中期随访结果.方法:2006年10月~2008年2月收治颈椎疾病患者42例,男22例,女20例;年龄25~69岁,平均48.2岁.颈椎病31例,其中脊髓型14例,神经根型9例,混合型8例;下颈椎不稳症4例;急性颈椎间盘突出症5例;Klippel-Feil综合征2例.均经前路行椎间盘切除减压、ACIFC植骨术,融合节段:单节段27例,双节段14例,三节段1例;共置入ACIFC 58枚,C3/4 11枚,C4/5 13枚,C5/618枚,C6/7 14枚,C7/T1 2枚.初次行颈椎手术者40例,颈椎术后再手术2例.术后定期行X线片及MRI复查,判定植骨融合及邻近节段退变情况;采用中华医学会骨科分会(COA)40分法及颈椎残障指数(NDI)评分系统评价患者术前、术后颈脊髓神经功能及生活质量.结果:5例患者术后24h内出现咽部疼痛,经对症治疗于术后1周内症状消失.术后48h内发生轴性症状2例(3.4%),经对症处理术后1周症状明显改善.患者均获随访,随访时间3~4.5年,平均4年.58个椎间隙均获骨性融合,融合时间2.5~6个月,平均3.5个月.术前COA评分30.21±2.69分,术后末次随访时37.18±1.20分,差异有统计学意义(P<0.05),平均改善率71.2%;术前NDI为40.03±3.92,术后末次随访时为29.95±4.51,差异有统计学意义(P<0.05).术后3.5~4.5年(平均4年)发现融合节段邻近节段退变5例(11.9%),其中融合节段相邻上位椎间盘3例,下位椎间盘2例.结论:在颈椎前路椎间盘切除减压后应用ACIFC行植骨融合,融合率高,轴性症状及邻近节段退变的发生率低,中期随访结果较满意.%Objective:To study the mid-term outcome of clinical application of the anchoring cervical inter-vertebral fusion cage (ACIFC) following anterior cervical discectomy.Method:42 cases with cervical disorders from October 2006 to February 2008 were

  1. 颈椎前路融合致邻近节段椎间盘退变的原因探讨%Causes of adjacent segments disc degeneration caused by anterior cervical fusion

    Institute of Scientific and Technical Information of China (English)

    张克非; 刘伟; 于长水; 袁绍辉; 潘琦

    2011-01-01

    目的 探讨颈椎前路融合后邻近节段椎间盘退变的原因及其防治办法.方法 对实施颈椎前路融合术的126例颈椎间盘突出症患者进行回顾性分析,归纳可能导致颈椎前路融合术后临近椎间盘退变突出的原因.结果 随访时间最短10个月,最长10年,平均7.8年.37例颈椎间盘突出症患者发生临近节段椎间盘退变加重,其中7例患者再次手术.结论 颈椎前路融合后邻近节段椎间盘退变的原因可能为临近节段原有退变加重,椎间融合后生物力学改变,临近节段应力集中.%To investigate the causes of the adjacent intervertebral disc degeneration after anterior decompression and interbody fusion of C-spine and search for the way of prevention.Methods A retrospective study was given to 126 patients who underwent an anterior decompression and interbody fusion of C-spine, the causes of the adjacent intervertebral disc degeneration after anterior decompression and interbody fusion of C-spine were analyzed. Results The follow-up time was from 10 months to 10 years, average 7.8 years. Thirty-seven patients occurred the aggravation of adjacent intervertebral discs degeneration, in which 7 patients underwent reoperation. Conclusion The possible causes of the adjacent intervertebral disc degeneration after anterior decompression and interbody fusion of C-spine is that the aggravation of original degeneration of adjacent intervertebral disc, the alteration of biomechanics after anterior decompression and interbody fusion of C-spine induces the stress concentration of the adjacent intervertebral disc.

  2. PRELIMINARY CLINICAL STUDY ON ARTIFICIAL CERVICAL DISC REPLACEMENT BY Mobi-C PROSTHESIS%Mobi-C人工颈椎间盘临床应用初步报告

    Institute of Scientific and Technical Information of China (English)

    鲍达; 马远征; 陈兴; 李宏伟; 胡明; 高天君

    2011-01-01

    Objective To study the clinical application of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR). Methods Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, C5, 6 in 7 cases, C6,7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by "40 score" system (COA) preoperatively, immediately postoperatively, and at follow-up. The quality of life was evaluated by neck disability index (NDI) and visual analogue scale (VAS) score. Results All incisions healed by first intention. No perioperative complication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operatied segment between preoperation and follow-up duration (t=0.808, P=0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 ± 1.14) was significantly higher than preoperative one (32.10 ± 2.96), (t=9.278, P=0.000), and the improvement rate at last follow-up was 77.2% ± 5.4%. VAS score at last follow-up (3.20 ± 1.23) had significant difference when compared with preoperative one (5.10 ± 1.29), (t=10.585, P=0.000). NDI score at last follow-up (29.40 ± 4.55) had significant difference when compared with preoperative one (39.20 ± 3.80), (t=16.039, P=0.000). Conclusion A satisfactory short-term curative effect

  3. Epidural steroid following discectomy for herniated lumbar disc reduces neurological impairment and enhances recovery: a randomized study with two-year follow-up

    DEFF Research Database (Denmark)

    Rasmussen, S.; Krum-Moller, D.S.; Lauridsen, L.R.;

    2008-01-01

    STUDY DESIGN: We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up. OBJECTIVE: To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease. SUMMARY OF BACKGROUND DATA......: Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous studies in arthroscopic and abdominal surgery demonstrate steroids, which reduce the inflammatory response and enhance recovery. Here we report a 2-year follow-up of a randomized trial...... of epidural steroid following lumbar discectomy. METHODS: Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were randomly allocated to receive epidural methylprednisolone 40 mg or none. In the control group (62 males and 38 females, median age 41 years, 18-66) 48 L5, 50 L4...

  4. Cervical spondylosis: recognition, differential diagnosis, and management.

    Science.gov (United States)

    Voorhies, R M

    2001-04-01

    In contemporary clinical practice, the prevalence of neck pain in the general population is approximately 15%. The challenge for the primary care specialist is to be able to recognize the more serious disorders that require early referral. Additionally, it is important to have the confidence to institute specific treatment for nonurgent conditions in order to avoid unnecessary referral of patients with generally self-limiting conditions.CERVICAL SPONDYLOSIS IS A GENERAL AND NONSPECIFIC TERM THAT ENCOMPASSES A BROAD SPECTRUM OF AFFLICTIONS BUT, FOR PURPOSES OF CLARITY, CAN BE ORGANIZED INTO THREE CLINICAL SYNDROMES: Type I Syndrome (Cervical Radiculopathy); Type II Syndrome (Cervical Myelopathy); and Type III Syndrome (Axial Joint Pain). It is important to remember that shoulder problems can masquerade as cervical problems, and vice versa (e.g. adhesive capsulitis, recurrent anterior subluxation, impingement syndrome, rotator cuff tear, etc.). A number of management options, including pharmaceutical, physical therapy, and psychological therapies, are available once a diagnosis has been made.

  5. Treatment of multilevel cervical spondylotic myelopathy by conjugation of anterior vertebral subtotal resection and intervertebral space decompression and bone graft fusion%前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    刘斐文; 张彤; 孙川江; 谢涛江; 王永亮; 张雪锋

    2016-01-01

    Objectives To evaluate clinical effect of multilevel cervical spondylotic myelopathy( CSM) treated by an-terior vertebral subtotal resection conjugated with intervertebral space decompression and bone graft fusion. Methods Forty-six cases of CSM whose three segments were received anterior approach treatment. Among them, 24 cases re-ceived vertebral subtotal resection conjugated with single cell gap decompression and bone graft fusion as Group A, and the other 22 cases were given subtotal resection decompression of two vertebral bodies and decompression and bone graft fusion as Group B. Operation time and bleeding, bone graft fusion rate, nerve function amelioration and cervical vertebra physiological curvature restoration were observed and compared. Results All patients were followed up for 15~36 months. Operation time in Group A was (105 ± 20) min, while that in Group B was (180 ± 30) min, bleeding during operation were (120 ± 35) ml in group A and (210 ± 25) ml in group B, the difference of the data between two groups were statistically significant ( P0. 05). Postopera-tion cervical vertebra physiological curvature of both groups were obviously ameliorated, without statistical significance (P>0. 05). Conclusions Multilevel CSM treatment by anterior vertebral subtotal resection conjugated with interver-tebral space decompression and bone graft fusion can gain satisfactory effect, with advantages such as relatively simp-ler operations, less bleeding, shorter operation time, higher bone graft fusion rates, and so on. It is a safe, effective operation method which can also reduce complications.%目的:评价前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病( CSM )的临床疗效。方法采用前路手术治疗累及3个节段的CSM患者46例。其中24例行椎体次全切除+单间隙减压植骨融合术( A组);22例行2个椎体次全切除减压植骨融合术( B组)。观察比较两组手术时间、术中

  6. 早期清创闭合负压引流二期修复治疗颈椎前路术后并发食道瘘的疗效观察%Early debridement and vacuum sealing drainage followed by esophagus repairing for esophageal fistula due to anterior cervical surgery

    Institute of Scientific and Technical Information of China (English)

    张保亮; 唐朝阳; 肖东民; 姜德红; 唐海军; 高杨; 郭威

    2012-01-01

    Objectives: To investigate the clinical outcome of early debridement and vacuum sealing drainage (VSD) followed by esophagus repairing for esophageal fistula due to anterior cervical surgery. Methods: From February 2006 to February 2012, 728 cases underwent anterior cervical spine surgery, 3 of them were complicated with esophageal fistula while the other 2 came from other hospitals. All the 5 cases were retrospectively reviewed. 4 of them developed to esophageal fistula five to nine days after anterior cervical surgery, and 1 case was noted 46 days later. Oral intake was prohibited and nasogastric tube was used for nutrition support after diagnose of esophageal fistula via esophagoscope. Intravenous broad-spectrum antibiotic therapy was utilized. The original surgical incision was used for debridement after preoperative preparation as soon as possible, and all sutures were removed. As for 1 case developing bone graft inflammatory and dissolved, the original instrument was removed and fixed by Halo-Frame after operation, while the internal fixation was kept in the other 4 cases. After complete debridement, the sponge was cut into suitable wedge-shape and placed in the wound and fixed by skin suture. The sponge was removed after 10 to 12 days drainage, then the second suture was performed to repair the esophagus perforation. For the patient suffering from delayed perforation, a piece of medical biological proteogel was used to cover the sutured perforation, auto illiac crest bone graft was performed and Halo-Frame was added. Drainage was used for 2 or 3 days and sutures were re-moved at 9 to 12 days after operation. Results: 4 patients had wound healed after second debridement, and the delayed esophageal fistula still had a few light yellow transparent secretion even after sutures were removed, and one week later scar tissue developed after conventional dressing changed. The patient with delayed esophagus fistula died at home one month later, and the cause of death

  7. Cervical disc hernia operations through posterior laminoforaminotomy

    Directory of Open Access Journals (Sweden)

    Coskun Yolas

    2016-01-01

    Full Text Available Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years. Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%. On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.

  8. Efifcacy of bilateral anterior cervical­shoulder skin lfaps in the treatment of cicatricial contracture def­ ormity of neck%双侧颈肩皮瓣修复颈前瘢痕挛缩畸形疗效探讨

    Institute of Scientific and Technical Information of China (English)

    王运成; 翟刚; 吴永芳

    2014-01-01

    目的:探讨双侧颈肩皮瓣修复颈前瘢痕挛缩畸形的方法及疗效。方法选取2008年本院烧伤整形科收治的22例烧伤后颈前瘢痕挛缩畸形患者为研究对象,首先切除患者颈前瘢痕,松解挛缩带,然后从侧颈向肩峰方向设计、形成双侧颈肩皮瓣,最后向内旋转交叉修复颈前创面。结果22例患者采用的44个皮瓣全部成活,其中,优18例(81.82%),良4例(18.18%),优良率达100.00%。患者颈部活动功能恢复良好,皮肤质软,外观及功能良好,供皮区瘢痕增生不明显,无一例继发性颈部瘢痕挛缩畸形。无一例患者要求二期修整术。22例患者获随访1~5年,随访率达100.00%,与治疗前相比,患者颈部活动度各项指标均有不同程度的改善,差异均具有显著性(t=41.7592、21.2191、30.6134、16.7351、27.3986、54.2873,P均<0.01)。同时,经治疗后患者的颈颏角显著改善,差异具有显著性(t=62.2417,P<0.01)。患者对治疗的满意度较高,且疗效显著。结论双侧颈肩皮瓣血运可靠,能充分覆盖修复颈前部大创面,是修复颈前瘢痕的一种可行方法。%ObjectiveTo evaluate the efifcacy of bilateral anterior cervical-shoulder skin lfaps for repairing cicatricial contracture deformity of neck and to improve the method for the repair of soft tissue defect of neck. Method22 cases with cicatricial contracture deformity of neck in Baise City People’s Hospital were repaired by ifrst of all removed cervical scar removal, released contracture, then the second forming a bilateral anterior cervical-shoulder skin lfaps along the lateral neck to the acromion, the last ifnally repaired the front wound of neck by inward rotation cross.Result22 cases with cicatricial contracture deformity of neck by burn were operated with this method, with excellent in 18 cases (81.82%), good in 4 cases (18.18%), and optimal rate of 100.00%. All 44 skin

  9. Comparing clinical outcomes of repeat discectomy versus fusion for recurrent disc herniation utilizing the N(2)QOD.

    Science.gov (United States)

    Guan, Jian; Ravindra, Vijay M; Schmidt, Meic H; Dailey, Andrew T; Hood, Robert S; Bisson, Erica F

    2017-01-01

    OBJECTIVE Recurrent lumbar disc herniation (RLDH) is a significant cause of morbidity in patients undergoing lumbar discectomy and has been reported to occur in up to 18% of cases. While repeat discectomy is often successful in treating these patients, concern over repeat RLDH may lead surgeons to advocate instrumented fusion even in the absence of instability. The authors' goal was to compare clinical outcomes for patients undergoing repeat discectomy versus instrumented fusion for RLDH. METHODS The authors used the National Neurosurgery Quality and Outcomes Database (N(2)QOD) to assess outcomes of patients who underwent repeat discectomy versus instrumented fusion at a single institution from 2012 to 2015. Primary outcomes included Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, and quality-adjusted life year (QALY) measures. Secondary outcomes included hospital length of stay, discharge status, and hospital charges. RESULTS The authors identified 25 repeat discectomy and 12 instrumented fusion patients with 3- and 12-month follow-up records. The groups had similar ODI and VAS scores and QALY measurements at 3 and 12 months. Patients in the instrumented fusion group had significantly longer hospitalizations (3.7 days vs 1.0 days, p fusion group were also significantly higher ($54,458.29 vs $11,567.05, p fusion result in similar clinical outcomes at short-term follow-up. Patients undergoing repeat discectomy had significantly shorter operative times and length of stay, and they incurred dramatically lower hospital charges. They were also less likely to require acute rehabilitation postoperatively. Further research is needed to compare these two management strategies.

  10. Open-door laminoplasty for the treatment of failed anterior cervical spine surgery%单开门椎管扩大椎板成形术在颈椎病再手术中的应用及疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘勇; 陈亮; 顾勇; 杨惠林; 唐天驷

    2010-01-01

    Objective To evaluate the outcome of open-door laminoplasty for the treatment of failed anterior cervical spine surgery. Methods From February 2003 to June 2009, 15 patients underwent opendoor laminoplasty for the failed anterior cervical spine surgery. The causes of revision and the progression of disease were analyzed. Japanese Orthopedic Association (JOA)scores and Nurick grade were adopted to record the improvement of neurological status and walking ability. Results Two patients were excluded for analysis because of lost follow-up and follow-up less than 12 months. The mean follow-up period after revision surgery for the other 13 patients was 26 months (ranged 13-52 months). The mean interval between the initial and revision surgery was 24 months ( ranged 5 months to 6 years). The causes of revision were as following: degeneration of the adjacent segment in 2 cases, inadequate decompression in 5 cases, misdiagnosis of ossification of posterior longitudinal ligament(OPLL) as myelopathy in 4 cases, and progression of OPLL in 2 cases. Posterior laminoplasty was recommended for each patient. After the operation,13 patients improved neurologically with respect to JOA score, 12 patients improved their walking ability while 1 remained unchanged. The mean modified JOA scores improved from 10. 5 to 13.8 ( P < 0. 05 ), the average recovery rate was 53.0% after the revision operation. The mean overall Nurick grade was 3.1 preoperatively and 1.9 at the final follow-up ( P < 0.05 ), the mean improvement of the Nurick grade was 1. 2. Complications included cerebrospinal fluid leakage in 1 case, new axial neck pain in 1 case, and transient C5 nerve root palsy in 1 case. Conclusions Open-door laminoplasty is a straightforward and effective treatment for failed anterior cervical spine surgery due to inadequate decompression, progressive OPLL or degeneration of the adjacent segment. The merit of the open-door laminoplasty for failed anterior spine fusion is able to avoid

  11. Progressively Unstable C2 Spondylolysis Requiring Spinal Fusion: Case Report

    OpenAIRE

    Nishimura, Yusuke; ELLIS, Michael John; Anderson, Jennifer; Hara, Masahito; Natsume, Atsushi; GINSBERG, Howard Joeseph

    2014-01-01

    Cervical spondylolysis is a rare condition defined as a corticated cleft at the pars interarticularis in the cervical spine. This is the case of C2 spondylolysis demonstrating progressive significant instability, which was successfully treated by anterior cervical discectomy and fusion (ACDF) with cervical anterior plate. We describe a 20-year-old female with C2 spondylolysis presenting with progressive worsening of neck pain associated with progressive instability at the C2/3 segment. The pr...

  12. The clinical study on the application of calcium sulfate/Demineralized bone matrix (DBM) granule in the cervical interbody fusion%硫酸钙/脱钙骨基质颗粒在颈椎椎体间融合中的应用

    Institute of Scientific and Technical Information of China (English)

    谢幼专; 张蒲; 富灵杰; 李华; 赵杰

    2011-01-01

    Objective To investigate the clinical outcome of interbody fusion with calcium sulfate/demineralized bone matrix ( DBM ) granule in the cervical spine. Methods 35 patients had undergone anterior cervical discectomy and interbody fusion ( 59 segments )with the polyetheretherketone (PEEK )cages filled with calcium sulfate/DBM granule. There were 19 male and 16 female. The mean age was 53.2 years old (range, 32-65 1 The fusion was agumented with anterior cervical plate. There were 12 cases of cervical spondylotic radiculopathy, 15 cases of cervical spondylotic myelopathy and 8 cases of combined cervical spondylosis. The JOA score, cervical curvature and the fusion status were evaluated after the operation. Results All the patients were followed up consecutively for 24 months. The preoperative JOA score was 7.7± 2.1. At final follow-up, the score was 14.2±2.9 (P < 0.01 I The recovery rate was 69.9%. There was no breakage, looseness or migration of the implants. The fusion rate was 100%. Conclusion It is feasible to achieve the cervical interbody fusion with the PEEK cage filled with calcium sulfate/DBM granule.%目的 观察应用硫酸钙/脱钙骨基质颗粒作为植骨替代材料促进颈椎椎体间融合的效果.方法 对35例患者(59个节段)行颈椎前路间隙减压植骨融合钛板固定术,椎体间植骨采用填充硫酸钙/脱钙骨基质颗粒的聚醚醚酮(PEEK)融合器.其中男19例,女16例,年龄32~65岁,平均53.2±12.5岁.其中神经根型颈椎病12例,脊髓型颈椎病15例,混合型颈椎病8例.术后观察JOA评分、颈椎曲度、椎体间融合情况.结果 35例均获随访,随访时间24个月.JOA评分术前为7.7±2.1,随访终止时为14.2±2.9(P<0.01),恢复率为69.9%.术后无钛板、螺钉断裂或松动,无融合器移位现象发生.所有融合节段均融合.结论 颈椎前路减压融合术中使用填充硫酸钙/脱钙骨基质颗粒的PEEK椎体间融合器能够获得满意的椎体间融合.

  13. Efficacy of transforaminal endoscopic discectomy using TESSYS technique in treatment of lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    Liang Li|; Li-Ming Fang; Tao Niu; Xiao-Jun Yang

    2016-01-01

    Objective:To explore the clinical efficacy of transforaminal endoscopic discectomy using TESSYS technique in the treatment of lumbar disc herniation (LDH).Methods:A total of 60 patients with LDH who were admitted in our hospital from June, 2014 to February, 2016 were included in the study and randomized into the study group and the control group. The patients in the study group were performed with transforaminal endoscopic discectomy using TESSYS technique, while the patients in the control group were performed with the vertebral lamina fenestration. VAS was used to evaluate the pain relieving before operation, 1 d, 1 month, 3 months, and 6 months after operation. The fasting elbow venous blood before operation, 3, 6, 12, 24, and 48 h after operation was collected. The immune scatter turbidity was used to detect hs-CRP. ELISA was used to detect IL-6.Results:The difference of VAS scores before operation between the two groups was not statistically significant (P>0.05). With the time extending after operation, VAS score was significantly reduced (P0.05). The difference of hs-CRP and IL-6 before operation between the two groups was not statistically significant (P>0.05). The levels of hs-CRP and IL-6 after operation at each timing point in the study group were significantly superior to those in the control group (P<0.05). Conclusions:Transforaminal endoscopic discectomy using TESSYS technique in the treatment of LDH has advantages of small trauma, less stress reaction, and rapid postoperative recovery; therefore, it deserves to be widely recommended in the clinic.

  14. Cervical Cancer Stage IVA

    Science.gov (United States)

    ... historical Searches are case-insensitive Cervical Cancer Stage IVA Add to My Pictures View /Download : Small: 756x576 ... Large: 3150x2400 View Download Title: Cervical Cancer Stage IVA Description: Stage IVA cervical cancer; drawing and inset ...

  15. The use of rigid internal fixation in the surgical management of cervical spondylosis.

    Science.gov (United States)

    Kwon, Brian K; Vaccaro, Alexander R; Grauer, Jonathan N; Beiner, John M

    2007-01-01

    In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. Numerous options currently exist for anterior cervical plating systems; some lock the screws to the plate rigidly (constrained), whereas others allow for some rotational or translational motion between the screw and plate (semiconstrained). The role of anterior fixation in single and multilevel fusions is still the subject of some controversy. Long anterior cervical reconstructions may require additional posterior fixation to reliably promote fusion. Rigid fixation in the posterior cervical spine can be achieved with lateral mass screws or pedicle screws. Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.

  16. Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum

    Directory of Open Access Journals (Sweden)

    Samer Al-Khudari

    2013-01-01

    Full Text Available We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.

  17. 有限元分析方法在山羊第三~第四颈椎前路融合术后生物力学研究中的应用%Biomechanical application of finite element method in goat cervical C3-C4 spine treated with anterior decompression and body fusion

    Institute of Scientific and Technical Information of China (English)

    李晓辉; 宋跃明; 段宏; 刘军; 于建华; 任凯晶

    2015-01-01

    目的 建立山羊颈椎C3 ~ C4前路融合术后三维有限元模型,为颈椎前路融合术后生物力学评测提供新的评估方法.方法 选取1只雌性成年山羊,进行影像学检查排除脊柱疾病后,行螺旋CT扫描,得到的连续断层数据图片以DICOM格式输出,导入Materialise公司的交互式医学影像控制系统(MIMICS)软件,生成表面三维图像,再通过有限元分析(ABAQUS)软件建立颈椎植入性融合器PDLLA Cage和三面皮质髂骨实体.将其组合,进行网格划分,赋予材料力学参数,构建出PDLLA Cage和三面皮质髂骨2种颈椎C3 ~ C4融合术后三维有限元模型.进行前屈、后伸、侧屈和旋转的生物力学测定,比较两组平均刚度及活动范围(ROM).结果 平均ROM在前屈、后伸、旋转和侧弯各向量上,PDLLA Cage组分别为2.67°、3.31°、2.53°和2.85°,自体髂骨组分别为4.14°、6.50°、4.16°和3.45°,组间差异均有统计学意义(P<0.05).平均刚度在前屈、后伸和旋转3个向量上,PDLLA Cage组分别为0.38、0.30、0.40 Nm/°,自体髂骨组分别为0.24、0.15、0.24 Nm/°,组间差异均有统计学意义(P<0.05).结论 建立的山羊颈椎C3 ~ C4融合术后三维有限元模型可用于评价融合后的生物力学行为.%Objective To establish the goat cervical three-dimensional finite element model and to provide a new method for evaluation of the immediate stability of the goat C3-C4 spine treated with anterior decompression and body fusion.Methods One healthy adult female goat with no any spinal disease by radioactive examination was selected.The data of CT imaging were taken and saved with DICOM format.After the CT imaging was processed with Materialise Interactive Medical Image Control System (MIMICS) software,the superficial 3D imaging and its boundary coordination were achieved.Using the ABAQUS software,two types of cervical three-dimensional finite element model (the PDLLA Cage model and the tricortical iliac

  18. Halo-vest reduction combined with anterior decompression and internal fixation for lower cervical spine fracture and dislocation%Halo-vest支架复位联合前路减压内固定治疗下颈椎骨折脱位

    Institute of Scientific and Technical Information of China (English)

    姚关锋; 王新家; 王伟东; 郑瑞武; 陈灵梓

    2015-01-01

    Objective To investigate the efficacy of lower cervical spine fracture and dislocation treated by Halo-vest reduction combined with anterior decompression and internal fixation.Methods From January 2009 to December 2012,26 cases of lower cervical spine fracture and dislocation underwent Halovest reduction combined with anterior decompression and internal fixation.There were 18 males and 8 females,aged 19-64 years (mean,42.1 years).Injury resulted from traffic crashes in 11 cases,high falls in 9,and hit by heavy objects in 6.Segment of injury was C5/6in 10 cases,C6/7in 9,C3/4in 4,and C4/5in 3.Prior to anterior decompression/internal fixation and fusion,the Halo-vest external fixation was performed.Neurological performance was evaluated after operation.Results All the patients were followed up for 24-36 months (mean,27.4 months).According to the X-ray films and CT scan at the final follow-up,the alignment of the cervical spine was maintained and the implanted bone was completely fused without internal fixation breaking or loosening.Preoperative neurological status according to the Frankel grading was grade A in 6 cases,grade B in 8,grade C in 7,and grade E in 2.After operation,there were 5 cases in grade A,3 in grade B,4 in grade C,5 in grade D,and 9 in grade E.All together,6 cases presented two-grade improvement in neurological status,13 one-grade improvement,and 5 no changes (P < 0.05).Conclusion Halo-vest reduction combined with anterior decompression and internal fixation is safe and effective in treatment of lower cervical spine fracture and dislocation.%目的 探讨Halo-vest支架复位联合前路减压内固定治疗下颈椎骨折脱位的临床疗效. 方法 2009年1月-2012年12月采用Halo-vest支架复位联合前路减压融合内固定治疗下颈椎骨折脱位患者26例,其中男18例,女8例;年龄19~64岁,平均42.1岁.致伤原因:交通伤11例,高处坠落伤9例,重物压砸伤6例.骨折脱位部位:C5/610例,C6/79例,C3/44例,C4/53

  19. Comparison of curative effects of traditional reconstruction plate and sacroiliac anterior cervical butterfly plate in treatment of sacroiliac joint injury%传统重建钢板与骶髂前路蝶形钢板治疗骶髂关节损伤的疗效比较

    Institute of Scientific and Technical Information of China (English)

    赵亮; 邢宏; 王劲松; 李雪松

    2015-01-01

    目的::对比传统重建钢板与骶髂前路蝶形钢板治疗骶髂关节损伤的疗效。方法:将64例患者分为观察组和对照组,每组各32例。观察组患者行骶髂前路蝶形钢板治疗,对照组患者行传统重建钢板治疗。结果:两组患者的损伤恢复优良率对比,观察组患者优于对照组(P>0.05);功能恢复、手术时间、盆骨稳定时间对比,观察组患者也好于对照组(P0. 05), and the time of function recovery, operation time, pelvic stability time were also better than those of control group (P<0. 05) with no severe complications. Conclusions:The sacroiliac anterior cervical butterfly plate in the treatment of sacroiliac joint injury has signifi-cant curative effects.

  20. The 100 Most Influential Articles in Cervical Spine Surgery.

    Science.gov (United States)

    Skovrlj, Branko; Steinberger, Jeremy; Guzman, Javier Z; Overley, Samuel C; Qureshi, Sheeraz A; Caridi, John M; Cho, Samuel K

    2016-02-01

    Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith's 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand's 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.

  1. 下颈椎前路椎弓根螺钉固定系统的有限元法生物力学研究%Three-dimensional finite-element study on anterior transpedicular screw fixation system of the subaxial cervical spine

    Institute of Scientific and Technical Information of China (English)

    李杰; 赵刘军; 祁峰; 马维虎; 徐荣明; 蒋伟宇; 刘王宓; 张明; 洪锦炯

    2015-01-01

    目的 比较下颈椎前路椎弓根螺钉内固定系统(ACTPS)和颈椎前路椎体螺钉钛板系统(ACLP)重建两节椎体次全切后的生物力学特性.方法 选择一名28岁成年健康男性志愿者,采集颈椎(C1 ~T1)的CT数据,应用Mimics 10.0、Rapidform XOR3、Hypermesh10.0、CATIA5 V19、ANSYS14.0软件建立下颈椎三维非线性的(C3~C7)完整模型.在C3上分别施加75 N的轴向压力和1N·m的纯力偶矩,使模型在屈伸、侧弯、旋转方向上运动.将模型的椎间活动度与文献报道的体外生物力学实验数据相比进行验证.建立ACTPS模型和ACLP模型,利用ANSYS计算两种模型在前屈、后伸、侧弯、旋转等工况下的椎间活动度.记录下ACTPS模型组和ACLP模型组的Von Mises应力云图及最大应力值,将ACTPS固定模型、ACLP固定模型的椎间活动度与完整模型进行比较.结果 本次实验建立了健康人的下颈椎(C3~C7)三维非线性有限元模型,模型包括85 832个单元,23 612个节点,其外形逼真,椎间活动度与文献报道的体外生物力学实验结果吻合.ACTPS模型组应力分布的相对比较均匀,ACLP模型组在螺钉与钛板接触部位出现应力集中.两组模型的最大应力值相比差异较明显.ACTPS组固定节段与ACLP组相比,椎间活动度更小,邻近节段椎间活动度相比差异不明显;与完整组比较,ACTPS组和ACLP组整体椎间活动度在屈伸、侧屈、旋转方向上分别减小约25°、20°和8°,相应的邻近C3~4节段的椎间活动度代偿性的变化约0.3°、3°和0.1°.结论 ACTPS的生物力学稳定性优于ACLP,适用于2节段及以上颈椎前路减压后稳定性重建.与ACLP相比,ACTPS的断裂风险更低.%Objeetive To evaluate the biomechanical effects of the anterior cervical transpedicularscrew system (ACTPS), compared to the anterior cervical screw plate system (ACLP), in the subaxial cervical spine after 2-level corpectomy.Methods A verified intact finite

  2. Cervical Musculoskeletal Impairments and Temporomandibular Disorders

    Directory of Open Access Journals (Sweden)

    Susan Armijo-Olivo

    2012-09-01

    Full Text Available Objectives: The study of cervical muscles and their significance in the development and perpetuation of Temporomandibular Disorders has not been elucidated. Thus this project was designed to investigate the association between cervical musculoskeletal impairments and Temporomandibular Disorders. Material and Methods: A sample of 154 subjects participated in this study. All subjects underwent a series of physical tests and electromyographic assessment (i.e. head and neck posture, maximal cervical muscle strength, cervical flexor and extensor muscles endurance, and cervical flexor muscle performance to determine cervical musculoskeletal impairments. Results: A strong relationship between neck disability and jaw disability was found (r = 0.82. Craniocervical posture was statistically different between patients with myogenous Temporomandibular Disorders (TMD and healthy subjects. However, the difference was too small (3.3º to be considered clinically relevant. Maximal cervical flexor muscle strength was not statistically or clinically different between patients with TMD and healthy subjects. No statistically significant differences were found in electromyographic activity of the sternocleidomastoid or the anterior scalene muscles in patients with TMD when compared to healthy subjects while executing the craniocervical flexion test (P = 0.07. However, clinically important effect sizes (0.42 - 0.82 were found. Subjects with TMD presented with reduced cervical flexor as well as extensor muscle endurance while performing the flexor and extensor muscle endurance tests when compared to healthy individuals. Conclusions: Subjects with Temporomandibular Disorders presented with impairments of the cervical flexors and extensors muscles. These results could help guide clinicians in the assessment and prescription of more effective interventions for individuals with Temporomandibular Disorders.

  3. One-stage posterior-anterior approach surgery for cervical fracture and dislocation combined with locked facet%Ⅰ期后、前路手术治疗伴关节突交锁的颈椎骨折脱位

    Institute of Scientific and Technical Information of China (English)

    郭超峰; 张宏其; 刘金洋; 吴建煌; 唐明星

    2014-01-01

    Objective To evaluate the clinical effect of one-stage posterior-anterior approach surgery for patients with cervical fracture and dislocation combined with locked facet.Methods A retrospective review was conducted on 21 cases of cervical dislocation and fracture combined with locked facet treated by one-stage posterior-anterior approach surgery between April 2011 and December 2012.There were 16 males and 5 females at age ranging from 23 to 61 years (mean,38.3 years).Posterior unlocking reduction by partial facetectomy and lateral mass screw fixation was performed,followed by anterior decompression,internal fixation and interbody fusion by titanium meshes.Outpatient or telephone follow-up was performed to evaluate bone fusion and recovery of neurologic function.Results Mean operation time was 140 minutes (130-210 minutes) and mean blood loss was 340 ml (range,150-600 ml).All incisions got primary healing with no operation-correlated complications.Five patients complicated with severe lung infection after surgery and one died of respiratory failure two week later.Titanium meshes achieved bone fusion within 3-9 months (mean,6 months) after surgery.At a mean follow-up of 17 months (range,12-30 months),there was no implant breakage and mesh displacement or collapse.According to the American Spinal Injury Association (ASIA) score,preoperative neurologic deficit restored by mean one grade at final follow-up.Conclusion One-stage posterior-anterior approach surgery is an ideal choice for cervical fracture and dislocation combined with locked facet,for it provides unlocking reduction,canal decompression,and rigid reconstruction of the anterior-posterior column.%目的 探讨Ⅰ期后、前路联合手术治疗伴关节交锁的颈椎骨折脱位的临床疗效.方法 回顾性分析2011年4月-2012年12月采用Ⅰ期后、前路手术治疗的21例颈椎骨折脱位伴关节突交锁患者,其中男16例,女5例;年龄23 ~61岁,平均38.3岁.先行后路手术切除部

  4. Insertion of PCB to treat traumatic cervical intervertebral disc herniation

    Institute of Scientific and Technical Information of China (English)

    马远征; 隰建成; 陈兴; 关长勇; 全长彬

    2002-01-01

    Objective: To evaluate the clinical effect of PCB (a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate) in treating traumatic cervical intervertebral disc herniation. Methods: Anterior decompression and PCB internal fixation were used in 22 patients with traumatic cervical intervertebral disc herniation. They were followed up from 3 to 16 months and analyzed by symptom and image data. Among them, 16 patients underwent fixation at one level and 6 patients at two levels. Results: This technique did not cause intraoperative complications. After surgery no screw backout or device failure was found. Based on the JOA grade, 20 patients improved clinically and 2 gently because of serious cervical stenosis. The general excellent rate was 90.9%. Conclusions: PCB internal fixation is stable. Morbidity of donor and acceptor sites is less. No collars are needed after surgery.

  5. Insertion of PCBto treat traumatic cervical intervertebral disc herniation

    Institute of Scientific and Technical Information of China (English)

    马远征; 陈兴; 等

    2002-01-01

    Objective:To evaluate the clinical effect of PCB(a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate)in treating taunatic cervical intervertebral disc herniation.Methods:Anterior decompression and PCB internal fixation were used in 22patients with traumatic cervical intervertebral disc herniation.They were followed up from3to16months and analyzed by symptom and imape data.Among them,16 patients underwent fixation at one level and 6patients at two levels.Results:This technique did not cause intraoperative complications.After surgery on screw backout or device failure was found.Based on the JOAgrade,20 patients improved clinically and 2gently because of serious cervical stenosis.The general excellent rate was90.9%.Conclusions:PCB internal fixation is stable.Morbidity of donor and acceptor sites is less.No collars are needed after surgery.

  6. 内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳%Endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability

    Institute of Scientific and Technical Information of China (English)

    姚女兆; 王文军; 王麓山; 晏怡果; 李学林; 欧阳智华

    2012-01-01

    目的:探讨内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳的临床可行性及其疗效.方法:2006年1月至2009年12月采用内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳患者13例,男8例,女5例;年龄17~65岁,平均46.8岁.JeffersonⅡ型骨折6例,JeffersonⅢ型骨折1例,寰枢椎脱位3例,陈旧性齿状突骨折3例.患者均有枕颈部不适和活动受限,术前VAS评分为3.2~4.1分,平均3.8分;2例伴有不同程度脊髓功能损害者,按Frankel分级C级1例,D级1例.随访患者临床症状改善和植骨融合情况.结果:均在内镜辅助下顺利完成手术,13例患者共置入26枚螺钉;手术时间60~130min,平均80min;术中出血110~290ml,平均190ml.术中无脊髓、椎动脉损伤等并发症.术后复查CT显示1枚螺钉位置欠佳,螺钉外斜角偏小且上斜角偏大,螺钉部分进入椎管,但未损伤脊髓,未做处理;25枚位置良好.寰枢关节基本复位,固定可靠.术后随访12~60个月,平均18个月,末次随访时VAS评分降至1.0~2.0分,平均1.3分,与术前比较有统计学差异(P<0.05).2例伴颈髓损伤患者的症状均有改善,Frankel分级C级者恢复到D级,D级者恢复到E级.12例患者术后3个月开始出现植骨融合,末次随访时寰枢关节间隙植骨均达到融合;1例患者未见明显植骨融合,但寰枢关节稳定性良好,未出现断钉等并发症.结论:内窥镜辅助下前路经寰枢关节螺钉固定植骨融合术治疗上颈椎不稳是可行的,能取得较好的治疗效果,且在一定程度上克服了传统手术显露困难的缺点,从而减少手术并发症.%Objectives: To evaluate the operation method and clinical outcome of atlantoaxial joint fusion using endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability. Methods: 13 cases with upper cervical instability who underwent anterior release

  7. Our Experience with 67 Cases of Percutaneous Transforaminal Endoscopic Lumbar Discectomy

    Directory of Open Access Journals (Sweden)

    Mehmat Ozer

    2016-07-01

    Full Text Available Aim: Minimally invasive interventions have become increasingly popular with the developments in technology and surgical tools. In this article, we present our experience with 67 cases of percutaneous transforaminal endoscopic lumbar discectomy. Material and Method: A total of 67 cases that underwent endoscopic surgery for foraminal and extraforaminal disc hernia between 2004 and 2010 were retrospectively examined. Results: The mean pre-operative VAS score was 8.13. The mean post-operative VAS score was 2.4 in the 1st month and 2.01 in the 12th month. Satisfaction according to MacNab criteria in the 12th month was excellent in 35 (52.2% patients, good in 18 (26.9% patients, fair in 11 (16.4% patients, and poor in 3 (4.5% patients. Microdiscectomy was required due to continuing symptoms in 3 patients (4.5%. Temporary dysesthesia was found in 3 patients. Discussion: Percutaneous endoscopic discectomy has become a good alternative to microsurgery for foraminal and extraforaminal disc herniations because of the developments in technology and surgical tools as well as the increased experience of surgeons. The technique is not limited to these localizations; it can also be used for free fragments within the channel, recurrent disc herniations, and narrow channels.

  8. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure.

    Science.gov (United States)

    Caspar, W; Campbell, B; Barbier, D D; Kretschmmer, R; Gotfried, Y

    1991-01-01

    The outcome in 119 patients who were operated on with a conventional standard lumbar discectomy procedure was retrospectively compared with that in 299 patients who were operated on with a microsurgical discectomy technique developed in Homburg/Saar, Federal Republic of Germany by the senior author (W.C.). All patients in this consecutive series had "virgin" lumbar radiculopathy evaluated and operated upon by two experienced surgeons at one institution. Determination of the final outcome was made objectively by an impartial third party using identical criteria for both groups, and with a patient self-evaluation form. The study looked at various pertinent aspects of the treatment course and at final outcome. The results in the microsurgical group were significantly favorable: fewer levels were explored: there was less operative blood loss and a decreased incidence of deep venous thrombosis, urinary tract infections, pulmonary emboli, and bladder catheterization; the time to full ambulation, discharge, and return to work was faster: and there was a decrease in change of occupation and a greater percentage of satisfactory final outcomes, as measured both objectively and subjectively. A description of the microsurgical technique used in this study, which differs significantly from existing microdisectomy techniques, is presented. The authors conclude that the microsurgical disectomy technique presented in this study is a safe and effective approach to the treatment of lumbar radiculopathy.

  9. Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

    LENUS (Irish Health Repository)

    Hickey, Oonagh T

    2012-02-03

    BACKGROUND AND OBJECTIVE: One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus. METHODS: A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed. RESULTS: Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome. CONCLUSION: Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.

  10. [The post-discectomy syndrome: clinical and electroneuromyographic characteristics and methods of treatment].

    Science.gov (United States)

    Musaev, A V; Guseĭnova, S G; Musaeva, I R

    2008-01-01

    The data of the Azerbaijan Neurosurgical Center, including 2618 case-reports of patients operated on for low back discal hernia between 1997 and 2002, have been analyzed. The retrospective analysis of the data reveals that 26,4% of patients need further restorative treatment due to the presence of various neurological disturbances: pain syndromes of different intensity, motor deficits (pareses), sensory disorders and functional disorders of pelvic organs. The retrospective analysis of the data reveals that 26,4% of patients need further restorative treatment due to the presence of various neurological disturbances: pain syndromes of different intensity, motor deficits (pareses), sensory disorders and functional disorders of pelvic organs. Along with these data, the results of our own clinical and neurophysiological study of 110 patients have been summarized as well. Along with these data, the results of our own clinical and neurophysiological study of 110 patients have been summarized as well. A high effectiveness of electrostimulation and naphthalan therapy alone and in combination with massage and medical gymnastics has been revealed. A high effectiveness of electrostimulation and naphthalan therapy alone and in combination with massage and medical gymnastics has been revealed. Electroneuromyographic data revealing the positive dynamics as a result of the treatment of patients with the post-discectomy syndrome are presented. Electroneuromyographic data revealing the positive dynamics as a result of the treatment of patients with the post-discectomy syndrome are presented.

  11. Analysis of functional CT scan in cervical vertebral disease

    Energy Technology Data Exchange (ETDEWEB)

    Hirofuji, Eiichi; Tanaka, Seisuke; Tomihara, Mitsuo; Kita, Hiroshi; Yamasaki, Hiroyuki

    1982-12-01

    The atlantoaxial joint showed displacement in various directions in rheumatoid arthritis and cervical spondylosis. The displacements were promoted by anterior flexion and rotatory movements, exerting great influences on the spnial cord. The intervertebral space between the 5th and 6th vertebra showed narrowing of the vertebral canal in cervical spondylosis and was promoted by posterior flexion to affect the spinal cord to a great extent. Functional CT scan was useful for observation of pathologic conditions of vertebral diseases.

  12. Zero-P interbody fusion clinical efficacy in treatment of cervical myelopathy%Zero-P椎间融合术治疗脊髓型颈椎病的临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘敏强; 谢敏; 毛吉刚; 何大川; 徐晓杰

    2015-01-01

    目的:探讨颈椎前路椎间融合固定系统(Zero -P)治疗脊髓型颈椎病的临床疗效。方法:回顾性分析2010年6月~2013年6月在我院手术治疗的脊髓型颈椎病患者88例,根据手术方法不同分为Zero-P组行前路椎间盘切除Zero-P内固定、cage组行前路椎间盘切除椎间融合与钢板内固定,每组各44例。比较2组手术情况及临床疗效。结果:Zero-P组手术时间、术中出血量及住院时间显著优于cage组,2组比较具有统计学意义(P<0.01);2组术前、术后3个月及终访JOA评分、融合率比较差异均无统计学意义;术后Zero-P组出现1例髂骨供区轻度酸痛;cage组出现2例钛板松动未融合,1例明显吞咽异物感。结论:Zero-P椎间融合术手术时间短、术中出血少、融合率高,且术后并发症少,值得临床推广。%Objective:To investigate the road before cervical interbody fusion fixation system ( Zero-P) treatment of cervical myelop-athy clinical efficacy.Methods:A retrospective analysis of June 2010 June 2013 in our hospital surgical treatment of patients with cervical myelopathy 88 cases, according to the surgical methods were divided into groups of rows before the Zero-P discectomy Zero-P fixation, cage group anterior discectomy and interbody fusion with plate fixation, 44 cases in each group.Were compared surgical and clinical effi-cacy.Results:Zero-P operative time, blood loss and length of hospital stay was significantly better than the cage group between the two groups was statistically significant ( P <0.01);the two groups before surgery, three months and a final visit JOA score, integration There was no significant difference in the rate;after Zero-P group had one case of mild iliac crest donor site pain;cage group had two cases ti-tanium loose unfused, one case of obvious foreign body sensation swallowing.Conclusion:Zero-P interbody fusion could shorten opera-tive time, less blood

  13. [Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine].

    Science.gov (United States)

    Grgić, Vjekoslav

    2013-01-01

    Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis. Because of the close anatomical relationship of cervical spine with the pharynx and cervical part of esophagus, the consequences of the degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints such as the changes in the physiological curvature of the cervical spine, changes in elasticity and contractility in the neck muscles and decreased mobility of the cervical spine, adversely affect the dimensions of the pharynx and cervical part of esophagus, that is, swallowing capacity which can result in dysphagia. Degenerative changes in the cervical discs and facet joints are common additional cause of dysphagia in elderly people with disorders of the central control of swallowing (stroke, Parkinson's disease, senile dementia etc). The most important therapeutic options in patients with CD are: medicamentous therapy, physical therapy, manual therapy, kinesiotherapy and surgical treatment. The aim of the conservative therapy in patients with CD is to improve the swallowing capacity (for example, soft tissue techniques, stretching of the

  14. 颈椎严重后纵韧带骨化症前路手术脑脊液漏的预防和处理%Prevention and treatment of cerebrospinal fluid leakage in anterior cervical surgery for severe ossification of posterior longitudinal ligament

    Institute of Scientific and Technical Information of China (English)

    雷涛; 王林峰; 申勇; 曹俊明; 丁文元; 马清华

    2012-01-01

    目的 探讨前路手术治疗颈根严重后纵韧带骨化症过程中,预防和处理脑脊液漏(cerebrospinal fluid leakage,CSFL)的经验.方法 回顾性分析2008年1月至2011年5月行前路手术治疗的47例颈椎严重后纵韧带骨化症(骨化厚度>5 mm,椎管狭窄率>50%)患者资料,其中15例患者术中出现硬膜缺损,男11例,女4例;年龄40~68岁,平均55.6岁.术前认真分析CT影像,行针对性的减压准备;术中应用直接切除、间接漂浮等技巧减少硬膜损伤,采用缝线修补、肌肉覆盖等方法处理硬膜缺损;术后给予卧床、引流等措施治疗CSFL.结果 术后15例患者均获得随访,随访时间为12~18个月,平均14.8个月. 10例患者伤口愈合,术后未发生CSFL;5例患者确诊出现CSFL,其中4例经加压包扎、引流等治疗4~6 d后脑脊液漏出停止;1例形成脑脊液囊肿,经反复穿刺3周内囊肿消失.所有患者伤口均完全愈合,无一例发生椎管内及颅内感染、气道阻塞等并发症,且无一例行二次修补或转流手术,术后神经功能恢复良好.结论 颈前路手术治疗严重后纵韧带骨化过程中,术前分析CT片并行充分减压准备,术中避免硬膜损伤及有效修补缺损,术后给予卧床、引流等措施能有效预防和处理CSFL.%Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass > 5 mm,spinal stenosis >50%),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the

  15. Microdiscectomy or tubular discectomy: Is any of them a better option for management of lumbar disc prolapse

    Science.gov (United States)

    Bhatia, Pallav S; Chhabra, Harvinder S; Mohapatra, Bibhudendu; Nanda, Ankur; Sangodimath, Gururaj; Kaul, Rahul

    2016-01-01

    Objectives: Various types of minimally invasive techniques have been developed for the treatment of lumbar disc herniation. The original laminectomy was refined into microdiscectomy (MD). MD is the gold standard in management of lumbar disc herniation and is used as a yardstick for comparison with newer procedures such as tubular discectomy. So far, no studies have been reported in Indian population comparing tubular discectomy and microdiscectomy. The aim of this study was to compare immediate postoperative and 1-year outcome of patients undergoing tubular discectomy with those undergoing MD and to evaluate the learning curve as well as complication rates of tubular discectomy. Materials and Methods: Forty-six patients of MD and 102 (48 early and 54 late) patients of tubular discectomy (TD) were operated at Indian Spinal Injuries Centre, which is a tertiary level center between July 2009 and January 2012. They were studied for the following data: Baseline characteristics, visual analog scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI) scores, length of hospital stay, time taken to return to work, duration of surgery, intra- and post-operative complications, and reoperation rates. Results: The VAS score for leg pain, back pain, and ODI scores showed improvement in both groups during the 1st year after surgery. Time taken to return to work and mean hospital stay was shorter in case of TD as compared to MD group. The mean duration of surgery was 34 min shorter for conventional MD. The incidence of dural tear was 6.5% in MD group and 10.4% in early TD and decreased to 7.4% in late TD group. Conclusion: This study revealed that rate of recovery is significantly faster for TD as compared to conventional MD. In contrast, we encountered fewer complications in MD approach as compared to TD which although were not statistically significant and which also decreased as we gained experience. PMID:27630476

  16. Long term preservation of motion with artificial cervical disc implants: A comparison between cervical disc replacement and rigid fusion with cage

    Science.gov (United States)

    Cincu, Rafael; Lorente, Francisco de Asis; Gomez, Joaquin; Eiras, Jose; Agrawal, Amit

    2014-01-01

    Background: With the advancement of technologies there is more interest in the maintenance of the spine's biomechanical properties focusing on the preservation of the functional motion segment. In present article we describe our experience with 25 cases managed with artificial cervical discs with 28 Solis cage following cervical discectomy with a mean follow-up period of 7.5 year. Materials and Methods: All surgeries were performed by single surgeon from March 2004 to June 2005 with a follow-up till date. Patients with symptomatic single or multiple level diseases that had no prior cervical surgery were candidates for the study. Cohort demographics were comparable. Standardized clinical outcome measures and radiographic examinations were used at prescribed post-operative intervals to compare the treatment groups. Relief in radicular pain, cervical spine motion, and degenerative changes at follow-up were noted. Results: In a total 53 cases, the mean age in prosthesis group was 47 years (age range: 30-63 years) and mean age in cage group was 44 years (32-62 years). Mean hospital stay was 2.7 days in both the groups. At 4 weeks complete cervical movements could be achieved in 19 cases in artificial disc group. Maintenance of movement after 7.5 years was in 76% of these patients. Lordosis was maintained in all cases till date. There was no mortality or wound infection in our series. Conclusions: We conclude that artificial cervical disc could be an alternative to fixed spinal fusion as it represents the most physiological substitute of disc. However, there is need for further studies to support the use of artificial cervical disc prosthesis. PMID:25685218

  17. 急性颈椎脊髓损伤并发呼吸功能障碍的早期救治%Early treatment of respiratory dysfunction after acute cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    徐广辉; 满毅; 张咏; 史建刚; 贾连顺

    2013-01-01

    目的 探讨急性颈椎脊髓损伤并发呼吸功能障碍的临床特点及早期有效的治疗措施.方法 回顾性分析105例急性颈椎脊髓损伤患者的临床资料,分析患者入院时的呼吸模式、血气分析指标,判断患者脊髓损伤平面,以ASIA评分评价瘫痪程度,根据患者颈椎损伤情况及呼吸功能状况行颈部牵引制动、气管切开及呼吸机辅助呼吸、加强翻身拍背及支气管镜吸痰、抗感染、颈椎前后路减压植骨内固定手术等治疗措施.结果 出现呼吸功能障碍97例,其中严重呼吸衰竭行气管切开、呼吸机辅助呼吸34例,单纯气管切开48例,15例未气管切开、仅行吸氧及支气管镜吸痰治疗.2例死亡,其中l例肺部严重感染,1例颅脑外伤合并纵隔血肿等多发伤.气管切开、呼吸机辅助呼吸患者全部脱机封管成功.结论 急性颈椎脊髓损伤患者应早期进行呼吸功能评估,采用气管切开等进行有效的呼吸道管理,调整患者营养状态并加强抗感染,必要时行颈椎手术等综合治疗.%Objective To explore the clinical characteristics and early effective treatment for respiratory dysfunction after acute cervical spinal cord injury.Methods Retrospectively 105 patients with acute cervical spinal cord injury were analyzed.When the patients were in hospital,respiratory mode and blood gas analysis were recorded and the ASIA score was used to evaluate the degree of paralysis and spinal cord injury level.According to the respiratory condition and cervical injury,cervical traction and other immobilization were finished.Some patients were operated for incision of trachea and the breath was supported by ventilator.All the patients were turned over and slapped the back in order to excrete phlegm on time.Sometimes bronchial lavage was used to excrete phlegm.Anti-infection was emphasized.Anterior cervical discectomy and fusion or posterior decompression and fusion operation were finished once the

  18. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; Design of a prospective randomized controlled trial

    NARCIS (Netherlands)

    P.A. Brouwer (Patrick); W.C. Peul (Wilco); R. Brand (René); M.P. Arts (Mark); B.W. Koes (Bart); A.A. van den Berg (Annette); M.A. van