WorldWideScience

Sample records for anterior cervical fusion

  1. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available Anterior Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I'm Dr. Matthew Moore, head of the Spine Care Center here at North Broward Medical Center. And ...

  2. 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.

  3. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I' ... the Spine Care Center here at North Broward Medical Center. And today we're operating on an ...

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Bone graft substitutes in anterior cervical discectomy and fusion

    OpenAIRE

    Chau, Anthony M.T.; Mobbs, Ralph J.

    2009-01-01

    Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in hum...

  6. Anterior cervical decompression and fusion with caspar plate fixation

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of anterior cervical decompression and fixation with Caspar plating in cervical spine injury on neurological outcome. Study Design: A case series. Place and Duration of Study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, from July 2008 to March 2011. Methodology: Thirty patients admitted with cervical spine injuries were inducted in the study. All cases were evaluated for their clinical features, level of injury and degree of neurological injury was assessed using Frankel grading. Pre and postoperative record with X-rays and MRI were maintained. Cervical traction was applied to patients with sub-luxation. All patients underwent anterior cervical decompression, fusion and Caspar plate fixation. The follow-up period was 6 months with clinical and radiological assessment. Results: Among 30 patients, 24 (80%) were males and 6 (20%) were females. Age ranged from 15 to 55 years. Causes of injury were road traffic accident (n = 20), fall (n = 8) and assault (n = 2). Commonest mode of injury was road traffic accident (66.6%). Postoperative follow-up showed that pain and neurological deficit were improved in 21 patients. There was no improvement in 7 patients, one patient deteriorated and one expired. All patients developed pain at donor site. Conclusion: Anterior decompression, fusion and fixation with Caspar plate is an effective method with good neurological and radiological outcome. However, it is associated with pain at donor site. (author)

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

    OpenAIRE

    Friedman Jonathan A; Briner Rudy P; Liu Jeffrey T

    2009-01-01

    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 structur...

  8. Anterior Cervical Corpectomy and Fusion Accelerates Degenerative Disease at Adjacent Vertebral Segments

    OpenAIRE

    Pickett, Gwynedd E.; Duggal, Neil; Theodore, Nicholas; Sonntag, Volker K.H.

    2008-01-01

    Background Anterior cervical corpectomy provides the most direct and thorough surgical approach for anterior decompression when spinal cord compression is found directly behind the vertebral body. However, anterior cervical fusion has been shown to be associated with the development of new degenerative changes at levels immediately adjacent to the fused segments. Th e incidence of adjacent segment disease (ASD) following anterior cervical corpectomy has not been widely reported. We set out to...

  9. 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.

  10. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease (Review)

    NARCIS (Netherlands)

    Jacobs, W.; Willems, P.C.P.H.; Limbeek, J. van; Bartels, R.H.M.A.; Pavlov, P.; Anderson, P.G.; Oner, C.

    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

  11. Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To investigate a novel surgical method for multilevel cervical spondylotic myelopathy (CSM). Methods: Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association (JOA) scores were used to evaluate the restoration of lordosis (Cobb's angle), intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results: Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72.2%, including excellent in 9 cases (42.9%), good in 7 cases (33.3%), fair in 3 cases (14.3%) and poor in 2 cases (9.5%). Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine (P<0.01). There is no evidence of instrument failure during the mean follow-up period of 14.2 months (9-24 months, P>0.01). Conclusion:Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

  12. Effect of Anterior Cervical Discectomy and Fusion on Patients with Atypical Symptoms Related to Cervical Spondylosis.

    Science.gov (United States)

    Muheremu, Aikeremujiang; Sun, Yuqing; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove ineffective. PMID:27168319

  13. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Fei Q

    2015-11-01

    Full Text Available Qi Fei,* Jinjun Li,* Nan Su, Bingqiang Wang, Dong Li, Hai Meng, Qi Wang, Jisheng Lin, Zhao Ma, Yong Yang, Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China *These authors contributed equally to this work Background: Whether anterior cervical discectomy with fusion (ACDF or anterior cervical corpectomy with fusion (ACCF is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy.Methods: PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China, and CNKI (China National Knowledge Infrastructure, People’s Republic of China were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies.Results: Eighteen studies (17 observational studies and one randomized controlled trial were included in this meta-analysis. Our results suggest that hospital stay (WMD =-1.33, 95% confidence interval [CI]: -2.29, -0.27; P=0.014, operation time (WMD =-26.9, 95% CI: -46.13, -7.67; P=0.006, blood loss (WMD =-119.36, 95% CI: -166.94, -71.77; P=0.000, and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003 in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =-0.27, 95

  14. 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.

  15. 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

  16. Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis.

    Science.gov (United States)

    King, V; Swart, A; Winder, M J

    2016-10-01

    Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2-C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0months and 6.0° (± 5.7°) at 24months post-operatively. Graft subsidence was observed to occur at 6months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12months post-operatively than in the following 12months (p<0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2years of follow-up and 100% fusion rates after 2years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period. PMID:27515543

  17. Total Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Cervical Spine: Competitive or Complimentary? Review of the Literature

    OpenAIRE

    Jawahar, Ajay; Nunley, Pierce

    2012-01-01

    Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degenerati...

  18. Biomechanics of Hybrid Anterior Cervical Fusion and Artificial Disc Replacement in 3-Level Constructs: An In Vitro Investigation

    OpenAIRE

    Liao, Zhenhua; Fogel, Guy R.; Pu, Ting; Gu, Hongsheng; Liu, Weiqiang

    2015-01-01

    Background The ideal surgical approach for cervical disk disease remains controversial, especially for multilevel cervical disease. The purpose of this study was to investigate the biomechanics of the cervical spine after 3-level hybrid surgery compared with 3-level anterior cervical discectomy and fusion (ACDF). Material/Methods Eighteen human cadaveric spines (C2-T1) were evaluated under displacement-input protocol. After intact testing, a simulated hybrid construct or fusion construct was ...

  19. Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum.

    Science.gov (United States)

    Park, Jong Myung; Kim, Chang Wan; Kim, Do Hyung

    2016-08-01

    A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a case of a pharyngeal diverticulum after an ACDF, which was misdiagnosed as a typical Zenker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum. PMID:27525244

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

    Science.gov (United States)

    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.

  1. Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages

    OpenAIRE

    Cabraja Mario; Oezdemir Soner; Koeppen Daniel; Kroppenstedt Stefan

    2012-01-01

    Abstract Background Titanium (TTN) cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK) cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF) and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings. Methods From 2002 to 2007 15...

  2. A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse

    Science.gov (United States)

    Kamani, Mayur M; Shetty, Vikram; Rai, H. Ravindranath; Hegde, Deepak

    2016-01-01

    Introduction Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine. Aim To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse. Materials and Methods A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0). Results Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the ‘mild category’ as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative. Conclusion Single level

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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.

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

    Science.gov (United States)

    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 benefit and reliability of HS for the treatment of cervical disk diseases. PMID:27227922

  6. 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

    NARCIS (Netherlands)

    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

  7. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, W.; Willems, P.C.P.H.; Kruyt, M.; Limbeek, J. van; Anderson, P.G.; Pavlov, P.; Bartels, R.H.M.A.; Oner, C.

    2011-01-01

    STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine which technique of anterior cervical interbody fusion (ACIF) gives the best outcome in patients with cervical degenerative disc disease. SUMMARY OF BACKGROUND DATA: The number of surgical techniques for decomp

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

    Directory of Open Access Journals (Sweden)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Donk, R.; Wilt, G.J. van der; Grotenhuis, J.A.; Venderink, D.

    2006-01-01

    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 d

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. Recurrence of cervical myelopathy secondary to a strut graft fracture 20 years after anterior decompression and fusion: a case report.

    Science.gov (United States)

    Kida, Kazunobu; Takaya, Shogo; Tadokoro, Nobuaki; Kumon, Masashi; Kiyasu, Katsuhito; Kato, Tomonari; Takemasa, Ryuichi; Ikeuchi, Masahiko; Tani, Toshikazu

    2015-08-01

    This study reports on a 70-year-old man with recurrent cervical myelopathy 20 years after anterior decompression and fusion of C4-7 using a free vascularised strut graft. The recurrent myelopathy was secondary to a kyphotic deformity of a fractured graft and residual ossification of the posterior longitudinal ligament with stenosis at C3/4. Intraoperative spinal cord-evoked potentials indicated that spinal cord traction secondary to progressive kyphosis of the cervical spine after the graft fracture was the cause. The patient underwent laminoplasty at C3 and laminectomy at C4 to decompress the stenosis at C3/4 as well as posterior cervical spinal fusion at C3-7 with pedicle screws and a lateral mass screw and a bone graft to prevent further progression of the kyphosis. At postoperative 18 months, the patient's Japanese Orthopaedic Association score had improved to 14 from 8, and he could walk without support. PMID:26321562

  15. 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.

  16. 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. PMID:27234612

  17. 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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  20. Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages

    Directory of Open Access Journals (Sweden)

    Cabraja Mario

    2012-09-01

    Full Text Available Abstract Background Titanium (TTN cages have a higher modulus of elasticity when compared with polyetheretherketone (PEEK cages. This suggests that TTN-cages could show more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF and therefore might lead to a higher loss of correction. We compared the long term results of stand-alone PEEK- and TTN-cages in a comparable patient collective that was operated under identical operative settings. Methods From 2002 to 2007 154 patients underwent single-level ACDF for degenerative disc disease (DDD. Clinical and radiological outcome were assessed in 86 eligible patients after a mean of 28.4 months. 44 patients received a TTN- and 42 patients a PEEK-cage. Results Solid arthrodesis was found in 93.2% of the TTN-group and 88.1% of the PEEK-group. Cage subsidence was observed in 20.5% of the TTN- and 14.3% of the PEEK-group. A significant segmental lordotic correction was achieved by both cage-types. Even though a loss of correction was found at the last follow-up in both groups, it did not reach the level of statistical significance. Statistical analysis of these results revealed no differences between the TTN- and PEEK-group. When assessed with the neck disability index (NDI, the visual analogue scale (VAS of neck and arm pain and Odom’s criteria the clinical data showed no significant differences between the groups. Conclusions Clinical and radiological outcomes of ACDF with TTN- or PEEK-cages do not appear to be influenced by the chosen synthetic graft. The modulus of elasticity represents only one of many physical properties of a cage. Design, shape, size, surface architecture of a cage as well as bone density, endplate preparation and applied distraction during surgery need to be considered as further important factors.

  1. Recurrent laryngeal nerve injury following reoperative anterior cervical discectomy and fusion: a meta-analysis.

    Science.gov (United States)

    Erwood, Matthew S; Hadley, Mark N; Gordon, Amber S; Carroll, William R; Agee, Bonita S; Walters, Beverly C

    2016-08-01

    OBJECTIVE Recurrent laryngeal nerve (RLN) injury is one of the most frequent complications of anterior cervical discectomy and fusion (ACDF) procedures. The frequency of RLN is reported as 1%-11% in the literature. (4 , 15) The rate of palsy after reoperative ACDF surgery is not well defined. This meta-analysis was performed to review the current medical evidence on RLN injury after ACDF surgery and to determine a relative rate of RLN injury after reoperative ACDF. METHODS MEDLINE, PubMed, and Google Scholar searches were performed using several key words and phrases related to ACDF surgery. Included studies were written in English, addressed revisionary ACDF surgery, and studied outcomes of RLN injury. Statistical analysis was then performed using a random-effects model to calculate a pooled rate of RLN injury. The heterogeneity of the studies was assessed using Cochran's Q statistic and I(2) statistic, and a funnel plot was constructed to evaluate publication bias. RESULTS The search initially identified 345 articles on this topic. Eight clinical articles that met all inclusion criteria were included in the meta-analysis. A total of 238 patients were found to have undergone reoperative ACDF. Thirty-three of those patients experienced an RLN injury. This analysis identified a rate of RLN injury in the literature after reoperative ACDF of 14.1% (95% confidence interval [CI] 9.8%-19.1%). CONCLUSIONS The rate of RLN palsy of 14.1% was greater than any published rate of RLN injury after primary ACDF operations, suggesting that there is a greater risk of hoarseness and dysphagia with reoperative ACDF surgeries than with primary procedures as reported in these studies. PMID:27015129

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Zero-P zero incisura anterior cervical interbody fusion fixation system (ACIF) in anterior cervical decompression and fusion applications%ACIF 在颈前路减压融合术的应用

    Institute of Scientific and Technical Information of China (English)

    汪冉; 王炤; 赵志芳

    2012-01-01

    目的 探讨Zero-P 零切迹颈椎前路椎间融合固定系统(ACIF)在颈前路融合术中的临床疗效.方法 回顾分析自2009-01-2010-12 对36 例颈椎患者采用的颈前路椎间盘切除减压Zero-P椎间融合术治疗.采用日本骨科学会(JOA)及视觉模拟评分(VAS)评分,观察术前、术后3 天、3 个月、12 个月疗效.结果 所有患者采用JOA 评分,术前(8.57±1.03)分,随访终末评分:(14.3±1.22)分.VAS 评分:(6.73±1.12)分,随访终末评分(2.03±1.06)分.术后12 个月植骨融合率为100%,手术前Cobb 角为11.2°(-5.5°~17.1°),随访终末Cobb 角为15.7°(0°~19.1°).术前与术后差异均有统计学意义(P<0.05).术后均无感染、喉返神经、喉上神经及椎动脉损伤,切口均一期愈合,无翻修手术者.结论 Zero-P零切迹颈椎前路椎间融合固定系统(ACIF)能使融合节段获得即刻稳定,融合率高,疗效满意,具有创伤小、神经损伤风险小、可预防临近节段的骨化、操作简便的优点.%Objective To explore the Zero-P zero ineisura anterior cervical interbocly fusion fixation system (ACIF.J in cervical anterior fusion in clinical efficacy. Methods Retrospective analysis from January 2009 to December 2010 in 36 eases of cervical spondylosls with anterior cervical discectomy ir.tervertebral fusion for the treatment of decompression of Zero —P. Using the Japanese Orthopaedic Association (Japanese orthopaedics association ,JOA.) and visual analogue scale (visualanalogous scale,VASJ score, observation of prcoperatlve,postoperative 3days,3 months, 3.2 months, curative effect. Results All the patients with JO A score, preoperative (8.57 + 1.03), follow—up final score: (14.3 + 1.22,) points. The score of VAS: (6.73 + 1.12), follow—up final score (2.03+1.06) points. 12 months after bone grafting fusion rate of 300%, before the operation of Cobb angle is 11.2 degrees (-5.5° to 17.3.°), follow-up of terminal Cobb( s angle 3.5.7° (0° to 19.1

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

    DEFF Research Database (Denmark)

    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...... of the nervous elements have been performed. To date, no randomized studies have compared simple discectomy with discectomy followed by an interbody fusion with a titanium cage. METHODS: Eighty-six patients with symptoms of nerve root compression at 1 level were randomly allocated to either discectomy followed...... 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...

  5. Efficacy of PEEK Cages and Plate Augmentation in Three-Level Anterior Cervical Fusion of Elderly Patients

    OpenAIRE

    Song, Kyung Jin; Kim, Gyu Hyung; Choi, Byeong Yeol

    2011-01-01

    Background To evaluate the clinical efficacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cages and plate fixation for aged and osteoporotic patients with degenerative cervical spinal disorders. Methods Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct for degenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolled in this study....

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    Science.gov (United States)

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome. PMID:27695567

  9. Fusion around cervical disc prosthesis: case report.

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Donk, R.

    2005-01-01

    OBJECTIVE AND IMPORTANCE: Cervical arthroplasty is a relatively new method to maintain motion after cervical anterior discectomy. Two cases are presented in which bony fusion occurred around a cervical disc prosthesis. CLINICAL PRESENTATION: A 30-year-old man and a 49-year-old woman underwent a righ

  10. 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.

  11. Anterior Cervical Fusion with Cervical Hollow Threaded Fixator for Cervical Spondylotic Myelopathy%脊髓型颈椎病前路减压椎间融合器临床应用

    Institute of Scientific and Technical Information of China (English)

    刘利乐; 曹盛俊; 王文军; 陈志伟

    2001-01-01

    Objectives: To evaluate the effect of anterior cervica l fusion with cervical hol low threaded fixator (CHTF,Synthys) for cervical spondylotc myelopathy as substi tute for the conventional anterior fusion. Methods: 18 patients with cervi cal spondylofie myelopathy were treated with the new method and followed up afte r surgery.Results:6 months to 1 year postoperatively, the clinical symptom s were obviously improved, the stability of cervical segmental unit was satisfact ory and the normal lordosis was obtained. There were no stenosis of the cervical canal and no displacement of the cervical body. The average time for the cervic al fusion was 4.5 months.%目的 探讨脊髓型颈椎病(CSM)前路减压,颈椎空心螺纹内固定器(CHTF)椎间融合,代替 传统的前路减压,植骨融合的方法。方法 对18例CMS采用环锯减压再潜行扩大减压,植入C HTF无磁性医用钛合金空心螺纹内固定器椎间融合,随访疗效,进行分析。结果 植入CHTF 术后随访6个月至1年,症状改善明显,稳定性好,生理曲度恢复达正常,无椎间隙高度丢 失,无CHTF滑脱、移位。术后平均4.5个月椎间隙融合。

  12. 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

    Directory of Open Access Journals (Sweden)

    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

  13. 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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  16. Preliminary results in anterior cervical discectomy and fusion with an experimental bioabsorbable cage – clinical and radiological findings in an ovine animal model

    OpenAIRE

    Daentzer, Dorothea; Floerkemeier, Thilo; Bartsch, Ivonne; Masalha, Waseem; Welke, Bastian; Hurschler, Christof; Kauth, Theresa; Kaltbeitzel, Daniel; HOPMANN, Christian; Kujat, Bernd; Kalla, Katharina

    2013-01-01

    Background Bioabsorbable implants are not widely used in spine surgery. This study investigated the clinical and radiological findings after anterior cervical discectomy and fusion (ACDF) in an ovine animal model with an experimental bioabsorbable cage consisting of magnesium and polymer (poly-ϵ-caprolactone, PCL) in comparison to a tricortical bone graft as the gold standard procedure. Materials and Methods 24 full-grown sheep had ACDF of C3/4 and C5/6 with an experimental bioabsorbable impl...

  17. Surgical treatment of dysphagia after anterior cervical interbody fusion%前路颈椎融合术后吞咽困难的外科治疗

    Institute of Scientific and Technical Information of China (English)

    Fogel GR; McDonnell MF

    2005-01-01

    BACKGROUND CONTEXT: Dysphagia is a frequent complication after anterior cervical interbody fusion (ACIF). Although dysphagia usually improves over 6 months, it remains a significant and persistent problem for some patients. The etiology is poorly understood but has been reported to be associated with vocal cord paralysis, dislodgement of instrumentation and unidentified causes, such as hematoma, adhesion formation and denervation of the pharyngeal plexus. A surgical treatment of dysphagia after ACIF has not been reported.

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

    Science.gov (United States)

    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. PMID:27635392

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Haghnegahdar, Ali

    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. PMID:27635392

  1. 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.

    Directory of Open Access Journals (Sweden)

    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

  2. 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

  3. 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.

  4. Diagnosing Cervical Fusion: A Comprehensive Literature Review

    OpenAIRE

    Sethi, Nanin; Devney, James; Steiner, Holly L.; Riew, K. Daniel

    2008-01-01

    Study Design Comprehensive literature review. Purpose To document the criteria for fusion utilized in these studies to determine if a consensus on the definition of a solid fusion exists. Overview of Literature Numerous studies have reported on fusion rates following anterior cervical arthrodesis. There is a wide discrepancy in the fusion rates in these studies. While factors such as graft type, Instrumentation, and technique play a factor in fusion rate, another reason for the difference may...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy%颈前路分节段减压融合治疗多节段颈椎病

    Institute of Scientific and Technical Information of China (English)

    林昊; 何仿; 李健; 崔庆元; 陈小强; 田纪伟

    2011-01-01

    Objective To evaluate the clinical value of the segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy.Methods 24 patients of multilevel cervical myelopathy with 3 or 4 consecutive segments were treated with segmental anterior cervical decompression with fusion.All patientst' cervical plain films,magnetic resonance imaging( MRI ) on preoperation and cervical plain films on postoperation were ohserved.The JOA scores of preoperation and 3 months postoperatively were collected.Results 24 cases were followed up from 3 months to 48 months, average 28 months.All patients improved their functional status in different degree.No complications such as graft nonunion and graft suhsidence occurred.The mean preoperative JOA score of all patients was ( 8.20 ±2.26 ),the postoperative of 3 months was ( 13.50 ± 1.28 ) , the average JOA recovery rate was 60.2%.Fusion rate was 100%.Conclusions The segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy appears to be effective in decompressing spinal cord, improving nerve functional status and restoring lordosis to the cervical spine with high fusion rate and fewer complications.%目的 评价颈前路分节段减压植骨融合术治疗多节段颈椎病的临床疗效.方法 对24例连续3或4个节段病变的颈椎病患者采用分节段减压融合术治疗.均行术前X线、MRI和术后X线片检查.均于术前及术后3个月进行JOA评分.结果 24例均获随访,时间3~48(28±20)个月.患者功能均有不同程度的改善.无植骨块不愈合、内置物下沉等并发症发生.JOA评分术前平均为(8.20±2.26)分,术后3个月平均为(13.50±1.28),改善率为60.2%,植骨融合率100%.结论 颈椎前路分节段减压融合术具有减压彻底、术后神经功能恢复好、恢复颈椎曲度、融合率高、并发症少等优点.

  7. 保留椎体后壁的椎体次全切除术治疗脊髓型颈椎病%Anterior Cervical Corpectomy and Fusion with Preserved Posterior Vertebral Wall for Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    郑军; 申才良; 董福龙; 巩陈; 汪卫兵

    2011-01-01

    Objective:To investigate the effect of anterior cervical corpectomy and fusion with preserved posterior vertebral wall for cervical spondylotic myelopathy (CSM), and to compare the results with preserved posterior vertebral wall with the classical anterior cervical corpectomy with ft,sion. Methods :Forty patients with CSM were randomized into two groups, anterior cervical eorpeetomy with fusion (n = 20) and anterior cervical eorpeetomy and fusion with preserved posterior vertebral wall (n=20). The values of operation time, surgical bleeding, the numbers and types of complications, disc height, segmental lordosis, and fusion tale were compared hetween two groups. Results: The average operation time and surgical hleeding decreased significantly in the anterior cervical corpectomy and fusion with preserved posterior vertebral wall group. Improvements in segmental lordosis and disc height were similar in both groups (P>0.05). Both fusion rates after 2 processes reached 100% at 3 months postoperatively. Conclusion: Anterior cervical corpectomy and fusion with preserved posterior vertebral wall is a feasible procedure for anterior decompression and fusion, with a shorter operation time, less surgical bleeding and smaller structural damage to the cervical vertebrae.%目的:探讨保留椎体后壁椎体次全切除术治疗脊髓型颈椎病的疗效,并与传统的椎体次全切除术比较.方法:脊髓型颈椎病患者40例随机均分为2组,分别行传统的椎体次全切除术和保留椎体后壁的椎体次全切除术.比较2组的手术时间、出血量、并发症、节段高度、节段曲度及植骨融合评分等指标变化.结果:保留椎体后壁组较椎体次全切除术组的手术时间短、出血少.2组节段高度和曲度的改善差异均无统计学意义(P>0.05).2种术式术后3个月植骨融合率均为100%.结论:保留椎体后壁的椎体次全切除术具有手术时间短、出血少、对颈椎椎体结构破坏小等优

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

    OpenAIRE

    Hui Xu; Yan Wang; Xiaojing Su; Xuelian Zhang; Xuesong (Sonya) Zhang

    2014-01-01

    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 compa...

  9. 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.

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

    Science.gov (United States)

    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.

  11. Commentary on the effect of steroid use in anterior cervical discectomy and fusion surgery; a randomized controlled trial by Shiveindra B. et al. Journal of Neurosurgery Spine 2015;23:137-43

    OpenAIRE

    Nancy E Epstein

    2015-01-01

    Background: Steroids are often used in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery to limit postoperative dysphagia. However, a major concern remains steroids′ impact is on fusion. Methods: In this prospective, randomized, double-blinded controlled study, the authors assessed the impact of steroids on swallowing/airway and fusion rates in 112 patients undergoing multilevel ACDF. The patients were randomly assigned to saline or dexamethasone groups prior to s...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.    

  14. Anterior Cervical Spinal Surgery for Multilevel Cervical Myelopathy.

    OpenAIRE

    Jung-Ju Huang; Lih-Huei Chen; Chi-Chien Niu; Tsai-Sheng Fu; Po-Liang Lai; Wen-Jer Chen

    2004-01-01

    Background: In multilevel spinal cord compression caused by cervical spondylosis, surgeonsface the choice of performing a posterior route as a laminectomy orlaminoplasty, or an anterior route as multiple adjacent interbody decompressionsor corpectomies. The anterior cervical operation is not considered bysome clinicians because of concerns about complications and the complexityof multilevel anterior cervical surgery.Methods: In this retrospective study, 14 patients with multilevel cervical sp...

  15. 生物活性玻璃联合颈椎椎间融合器在颈椎前路椎间融合中的应用%Anterior cervical discectomy and fusion by cervical cage with bioactive glass

    Institute of Scientific and Technical Information of China (English)

    李宏; 李淳德; 邑晓东; 刘洪

    2014-01-01

    BACKGROUND:Bioactive glass has been largely reported to have perfect clinical results in the bone nonunion and fracture healing, but its effect during spinal fusion progress is rarely reported. OBJECTIVE:To explore the safety and effectiveness of anterior cervical discectomy and fusion by cervical cage with bioactive glass METHODS:A total of 68 cases of cervical spondylosis myelopathy were treated with single level anterior cervical discectomy and fusion. Their clinical data were retrospectively analyzed. Al the cases underwent polyetheretherketone cervical cage with autogenous bone (n=32, control group) or bioactive glass (n=32, experimental group). The bone fusion, neurological functional recovery, intervertebral height, change of cervical curve and wound complications in the two groups was recorded and analyzed. RESULTS AND CONCLUSION:Neurological improvement had no difference between the two groups and there was no complication about wound, such as infection and delayed healing. The average rate of bone fusion was 97%in the control group while 94%in the experiment group 3 months after operation which had no significant differences. Six months after operation, al cases gained bone fusion. The intervertebral height and change of cervical curve both maintained wel in the two groups within 3, 6, 12 months after operation which had no significant differences between the two groups. So, anterior cervical discectomy and fusion by cervical cage with bioactive glass is safe and effective.%背景:已有文献报道生物活性玻璃在骨不连、骨折愈合过程中有较佳的临床疗效,但其在脊柱骨融合过程中的效果鲜有报道。  目的:观察生物活性玻璃联合颈椎椎间融合器在颈椎前路椎间融合中应用的安全性和有效性。  方法:回顾性分析68例颈椎前路单节段椎间融合患者资料,全部病例均采用聚醚醚酮材料椎间融合器,其中内填充自体松质骨植骨32

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Anterior cervical reconstruction using interbody fusion cage with cervical compressive mini frame%椎间融合器配合颈椎压力固定器在颈椎前路重建中的应用

    Institute of Scientific and Technical Information of China (English)

    尹华; 李继春; 汤立; 程国林; 朱爱平

    2011-01-01

    目的 探讨颈椎间前路减压椎间融合器配合颈椎压力固定器治疗单间隙颈椎病及单间隙颈椎间盘突出症的短期临床疗效.方法 2008年1月至2009年4月对12例单间隙颈椎病及单间隙颈椎间盘突出症患者行颈前路减压同时采用椎间融合器配合颈椎压力固定器内固定.结果 所有患者获得随访,术后平均随访12 个月( 6~15个月),植骨均在6个月达到临床融合,无颈椎压力固定器松动等不良现象.术后疗效按JOA 评分,术前5~12 分,术后提高4~6分,脊髓功能平均改善率为85.2%.结论 颈椎前路减压术同时采用椎间融合器配合颈椎压力固定器可使颈椎得到即刻稳定,具有便捷省时、加压固定、弹性固定有利于骨性融合等优点.%Objective To retrospect and explore the nearly clinical effect of using interbody fusion cage with cervical compressivemini frame in cervical reconstruction.Methods From January 2008 to April 2009,12 patients with single gap cervical spondylosisor cervical disc herniation were treated through anterior cervical decompression by interbody fusion cage with cervical compressivemini frame.Results All cases were follow-up from 6 to 15 months (average 12 months ).After operation, there was radiographicevidence of fusion in all cases,there was no loosen or shift cervical compressive mini frame.The cases with incomplete paraplegiaimproved 4~6 scores according to JOA neurological criterial postperation.Conclusion Using interbody fusion cage with cervicalcompressive mini frame has many advantages, such as convenience,time efficient, compressive fixation and elastic fixation.

  18. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years.

    Science.gov (United States)

    Ogihara, Satoshi; Kunogi, Junichi

    2015-01-01

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  19. Freeze-dried fibular allograft in anterior spinal surgery: cervical and lumbar applications.

    OpenAIRE

    Wetzel, F.T.; Hoffman, M. A.; Arcieri, R. R.

    1993-01-01

    Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assi...

  20. Hospital charges associated with "never events": comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty.

    Science.gov (United States)

    Daniels, Alan H; Kawaguchi, Satoshi; Contag, Alec G; Rastegar, Farbod; Waagmeester, Garrett; Anderson, Paul A; Arthur, Melanie; Hart, Robert A

    2016-08-01

    OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that "never events" are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than

  1. 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.

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

    Science.gov (United States)

    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.

  3. Anterior cervical decompression and fusion by microscope for the treatment of cervical spondylotic myelopathy%显微镜下减压融合术治疗脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    宋红浦; 郭峭峰; 张晓文; 张春

    2012-01-01

    目的:探讨显微镜下颈前路减压融合术治疗脊髓型颈椎病的疗效.方法:2005年2月至2010年3月,在显微镜辅助下经颈前路减压融合术治疗脊髓型颈椎病21例,男13例,女8例;年龄32~71岁,平均51.5岁;病程6个月~3年,平均12.5个月.手术操作:在显微镜下应用高速磨钻等工具进行减压操作,脊髓充分减压后取自体髂骨植骨融合加内固定.对手术前后JOA颈椎病评分进行比较并评价其疗效.结果:21例患者均获随访,时间18~24个月,平均20个月.患者脊髓神经功能均有不同程度提高,JOA评分由术前9.26±1.72增加至术后的13.64±1.38 (t=2.452,P=0.000).根据JOA评分评定疗效:优12例,良7例,一般2例.结论:显微镜下颈前路减压融合术具有操作精细、减压充分等优点,治疗脊髓型颈椎病安全、有效.%Objective: To explore clinical effects of anterior cervical decompression and fusion by microscope in treating cervical spondylotic myelopathy. Methods:From February 2005 to March 2010,21 patients with cervical spondylotic myelopathy, 13 males and 8 females with an average age of 51.5 years (ranged, 32 to 71) ,were treated with anterior cervical decompression using high-speed bur,then bone grafting and fusion with auto iliac bone and internal fixation by microscope. According to JOA score of cervical spondylosis to evaluate clinical effects before and after operation. Results: All patients were followed up from 18 to 24 months with an average of 20 months. JOA score improved significantly from preoperative 9.26±1.72 to postoperative 13.64±1.38 (t=2.452,P=0.000). According to JOA score, 12 cases were excellent,7 good and 2 fair. Conclusion : Anterior cervical decompression and fusion by microscope is a refined, safe and effective surgical procedure for cervical spondylotic myelopathy.

  4. 锚定式颈椎椎间融合器在颈椎前路再手术中的应用%Clinical application research on anterior cervical reoperation by using of anchoring cervical intervertebral fusion cage

    Institute of Scientific and Technical Information of China (English)

    鲍达; 马远征

    2014-01-01

    目的:观察既往曾行颈椎前路手术的病例,再次行其他病变椎间盘切除减压并应用锚定式颈椎椎间融合器( anchoring cervical intervertebral fusion cage,ACIFC)行植骨融合的临床疗效。方法2009年1月~2012年6月收治颈椎前路手术后,其他颈椎节段再次发病患者12例,其中男7例,女5例;年龄35~64岁,平均49.6岁。再次手术原因:融合邻近节段退变性疾病8例,非邻近节段再发颈椎病3例,急性颈椎椎间盘突出症1例。均经前路行病变颈椎椎间盘切除减压、ACIFC植骨术,共置入ACIFC 12枚。术后定期行X线片及MRI复查;采用中华医学会骨科学分会( Chinese Orthopaedic Association, COA)40分法及颈椎残障指数( neck disability index, 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。结果随访时间2~4.5年,平均3.5年。12个再手术节段均获骨性融合,融合时间2.5~5个月,平均3.3个月。术前COA评分32.00±2.00分,术后末次随访时37.92±1.08分,差异有统计学意义(P<0.05)。术前NDI评分39.08±3.32,术后末次随访时29.08±2.15,差异有统计学意义(P<0.05)。结论在颈椎前路再手术中应用ACIFC行植骨融合,施术方便、固定确切、融合率高,近期随访结果满意。%Objective To study the clinical application of the anchoring cervical intervertebral fusion cage ( ACIFC ) , which was used in the anterior cervical reoperation.Methods All 12 cases of the cervical spinal diseases in another segments from January 2009 to June 2012 were reviewed, who were operated with anterior cervical decompression and fusion ( ACDF) before.There were total 7 male and 5 female, 35-64 years old (mean 49.6 years old).Adjacent segment disease(ASD), 8 cases, cervical spondylosis, 3 cases and 1 case was acute cervical disc herniation.All patients were treated with anterior dis

  5. Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage

    Directory of Open Access Journals (Sweden)

    Roenning Paal

    2010-03-01

    Full Text Available Abstract Background Anterior cervical discectomy with fusion (ACDF is challenging with respect to both patient selection and choice of surgical procedure. The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: fusion with an autologous iliac crest graft (AICG versus fusion with an artificial cage made of polyetheretherketone (PEEK. Methods This was a non-randomized prospective single-center outcome study of 258 patients who underwent ACDF for cervical disc degeneration (CDD. Fusion was attained with either tricortical AICG or PEEK cages without additional anterior plating, with treatment selected at surgeon's discretion. Radicular pain, neck-pain, headache and patient satisfaction with the treatment were scored using the visual analogue scale (VAS. Results The median age was 47.5 (28.3-82.8 years, and 44% of patients were female. 59% had single-level ACDF, 40% had two level ACDF and 1% had three-level ACDF. Of the patients, 181 were fused with AICG and 77 with a PEEK-cage. After surgery, the patients showed a significant reduction in radicular pain (ΔVAS = 3.05, neck pain (ΔVAS = 2.30 and headache (ΔVAS = 0.55. Six months after surgery, 48% of patients had returned to work: however 24% were still receiving workers' compensation. Using univariate and multivariate analyses we found that high preoperative pain intensity was significantly associated with a decrease in pain intensity after surgery, for all three pain categories. There were no significant correlations between pain relief and the following patient characteristics: fusion method (AICG or PEEK-cage, sex, age, number of levels fused, disc level fused, previous neck surgery (except for neck pain, previous neck trauma, or preoperative symptom duration. Two hundred out of the 256 (78% patients evaluated the surgical result as successful. Only 27/256 (11% classified the surgical result as a failure

  6. Anterior Cervical Discectomy with Arthroplasty versus Arthrodesis for Single-Level Cervical Spondylosis: A Systematic Review and Meta-Analysis

    OpenAIRE

    Aria Fallah; Elie A Akl; Shanil Ebrahim; Ibrahim, George M.; Alireza Mansouri; Foote, Clary J.; Yuqing Zhang; Fehlings, Michael G.

    2012-01-01

    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...

  7. ANTERIOR OSTEOPHYTE IDENTIFICATION IN CERVICAL VERTEBRAE

    Directory of Open Access Journals (Sweden)

    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.

  8. 颈前路非融合与融合技术联合应用治疗颈椎病%Anterior combination of non-fusion and fusion approach for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    毛宁方; 赵颖川; 倪海健; 李明; 王传锋; 吴云刚; 白玉树; 朱晓东; 石志才

    2012-01-01

    目的:评价颈前路融合与非融合技术联合应用治疗颈椎病的临床疗效.方法:2008年3月~2010年6月期间,采用前路减压融合(anterior cervical discectomy and fusion,ACDF)术联合颈人工椎间盘置换术(cervical artificial disc replacement,C-ADR)治疗28例颈椎病患者,手术涉及二个椎间隙19例,涉及三个椎间隙9例,置换和融合为相邻间隙24例,非相邻间隙4例.术前、术后进行JOA评分和颈椎残障功能量表(neck disability index,NDI)评定,按Odom标准评定治疗效果.根据术前、术后、随访时的颈椎标准侧位X线片,观察植骨融合、内固定及人工椎间盘的情况.结果:手术均顺利完成,手术时间70~150min,平均85min;出血量50~300ml,平均180ml.1例患者术后出现轻度呼吸困难,对症处理后症状逐步好转.术后切口均Ⅰ期愈合,无椎动脉损伤及喉返神经损伤发生.经过14~39个月(平均22个月)随访,所有患者内置人物无松动、移位,植骨融合时间在3~8个月,平均4.5个月;所有人工椎间盘置换节段运动功能良好.术前JOA评分为10.3分,末次随访时为13.8分,平均改善率为52.2%;术前NDI评分为38.5分,末次随访时为22.3分,较术前显明改善(P<0.01).末次随访时接Odom标准评定手术疗效:优14例,良8例,尚可5例,差1例.结论:颈前路融合与非融合技术联合应用可综合两种技术的优点,在彻底减压的同时,减可少固定融合节段.%Objectives: To observe ihe clinical outcome of anterior combination of non-fusion and fusion approach for cervical spondylosis. Methods: Twenty-eight cases with cervical spondylosis (CS) undergoing combination of anterior cervical discectomy and fusion(ACDF) and cervical artificial disc replacement(C-ADR) between March 2008 and June 2010 were reviewed. Two levels of intervertebral discs were involved in 19 cases, while three levels were involved in 9 cases. The levels of fusion and non-fusion were adjacent in 24

  9. Discover颈人工椎间盘置换术联合颈椎前路减压融合术治疗颈椎病的临床疗效%The clinic effect of discover cervical artificial disc replacement combined with anterior cervical decompression and fusion in treatment of cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    吴兴林

    2014-01-01

    Objective To explore the clinic effect of discover cervical artificial disc replacement combined with anterior cervical decompression and fusion in treatment of cervical spondylosis. Methods 96 patients were selected from our hospital,and the they were evenly divied into two group by random,experimental group patients were treated with discover cervical artificial disc replacement combined with anterior cervical decompression,the control group patients were treated with anterior cervical decompression and fusion.Compared and analyzed the two groups'cervical spine,the average hospital stay,postoperative cervical fixation time,normal activity recovery time and clinical effect after treatment. Results The experimental group's cervical average activity was (44.6±4.7) degree which was higher than control group,and the difference was significantly(P < 0.05);The experimental group was shorter than control group in average hospital stay,postoperative cervical fixation time,normal activity recovery time,and the difference was significantly(P < 0.05);Experimental group's total effective rate was 97.9% which was higher than the control group(87.5%),and the difference was significantly(P<0.05). Conclusion Discover cervical artificial disc replacement combined with anterior cervical decompression and fusion can reduce the average hospital stay,postoperative cervical fixation time,normal activity recovery time,can ensure the patients's cervical average activity to recover normal,and can improve the clinical effect.%目的:探讨分析Discover颈人工椎间盘置换术联合颈椎前路减压融合术的临床疗效。方法选择我院96例患者,将其随机均分为两组,实验组行Discover颈人工椎间盘置换术联和颈椎前路减压融合术治疗;对照组行颈椎前路减压融合术治疗,比较患者术后颈椎活动度、平均住院时间、术后颈椎固定时间、恢复正常活动时间以及患者临床疗效,并进行统计学分析。

  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. Pharyngocutaneous fistula after anterior cervical spine surgery

    OpenAIRE

    Sansur, Charles A.; Early, Stephen; Reibel, James; Arlet, Vincent

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closu...

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

    Science.gov (United States)

    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.

  13. 零切迹颈前路椎间融合固定系统在颈前路融合术中的初步应用%The primary clinical application of Zero-p anterior cervical intervertebral fusion system for cervical intervertebral fusion

    Institute of Scientific and Technical Information of China (English)

    贺瑞; 尚希福; 张文志; 胡业丰; 许翔; 姚刚; 李旭; 段丽群; 葛畅

    2012-01-01

    Objective To revaluate the clinical effect of zero-p anterior cervical intervertebral fusion system (zero-p ACIDfor cervical anterior intervertebral fusion. Method From 2009.12 to 2010.10,24cases of patients were treated surgically by zero-p ACIF. 22 cases of single-level, 2cas- es of two-level,incloud 7 cases cervical injury and 17 cases cervical spondylotic myelopathy. Result All cases obtained follow up with average of 14months (range 12 to 20 months),all cases have no postoperative dysphagia and tardive esophageal fistula. The disc height were achieved in final follow-up respectively. Place of intervertebral fusion system has no change or loose. Conclusion Zero-p ACIF has more excellent material and mechanical properties,can effectively maintain the fusion cage height and no effect on the prevertebral tissue. It is a new means of anterior cervical fusion.%目的 探讨零切迹颈前路椎问融合固定系统(Zero-p ACIF)在颈椎前路融合术中的应用效果.方法 2009-12-2010-10,对24例(26节段)颈椎疾病患者行前路椎问零切迹椎问融合固定系统内固定,其中颈椎外伤性椎间盘突出、不稳7例,颈椎问盘疾患17例,其中双节段2例.结果 24例患者随访12~20个月,平均随访14个月,JOA评分由术前平均8.6分上升到末次随访时15.2分,术后X线片与末次X线片提示椎间高度无丢失,内固定无松动.结论 Zero-p ACIF有较优异的材料和力学性能,能有效维持融合椎间高度,对椎前组织无影响,是一种新的颈前路融合手段.

  14. 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

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

    Science.gov (United States)

    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

  16. 颈椎椎体间融合器的临床应用(附135例报告)%Anterior Decompression and Fusion with Cages in the Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    陈德玉; 赵定麟; 贾连顺; 倪斌; 肖建如; 沈强; 叶晓健; 朱海波

    2001-01-01

    To observe and compare the stability and fusion rate of three kinds of the interbody fusion cages after anterior decompression in the cervical spine.Methods:135 patients with cervical spondylosis and disc herniation were stabilized by using interbody fusion cages after anterior decompression,among them,65 cases with BAK,42 cases with CHTF and 28 cases with InterFix technique.X-ray films and CT were taken after operation to observe the stability and fusion of the segments.Results:The patients were followed up from 8 months to 31 months.The operated segments were stable.There was no difference in the fusion rate among three interbody fusion techniques.Conclusion:The immediate stability of the operated segments can be obtained by using interbody fusion cages.These techniques eliminate the complications of autograft and may be an alternative for replacing the traditional cervical interbody fusion with bone graft.%目的:观察比较3种颈椎椎体间融合器前路减压后椎体间融合的固定及融合效果。方法:采用BAK、CHTF和InterFix?3种颈椎椎体间融合器行颈椎病及颈椎间盘突出症前路减压后椎体间融合135例,其中BAK 65例,CHTF 42例,InterFix 技术28例。术后颈椎X线片及CT检查,观察手术椎节的稳定性和融合情况。结果:随访8~31月,施术节段稳定,3种颈椎椎体间融合器固定融合率无显著差异。结论:颈椎椎体间固定融合技术使施术椎节立即稳定,避免了自体植骨引起的并发症,可作为替代传统颈前路椎体间植骨融合术的方法之一。

  17. Anterior cervical allograft arthrodesis and instrumentation: Multilevel interbody grafting or strut graft reconstruction

    OpenAIRE

    Swank, M. L.; Lowery, G. L.; Bhat, A. L.; McDonough, R. F.

    1997-01-01

    This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidenc...

  18. Artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation:a 3-year follow-up%颈椎人工间盘置换与前路减压融合修复单节段颈椎间盘突出症:3年随访

    Institute of Scientific and Technical Information of China (English)

    程俊杰; 眭江涛; 马原; 田慧中

    2015-01-01

    stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration. These two methods which applied in cervical degenerative intervertebral disc herniation stil remain controversial. OBJECTIVE:To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS:Total y 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month fol ow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or al ogeneic fibularing. They were fol owed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the fol ow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION:During the final fol ow-up, the fusion rate in fusion group was 93%(25/27). Comparisons between groups:at the 1 week and final fol ow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were al lower than those before treatment;the Japanese Orthopaedic Association scores were higher than those before treatment (P0.05). The

  19. Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial.

    Science.gov (United States)

    Radcliff, Kris; Coric, Domagoj; Albert, Todd

    2016-08-01

    OBJECTIVE The purpose of this study was to report the outcome of a study of 2-level cervical total disc replacement (Mobi-C) versus anterior cervical discectomy and fusion (ACDF). Although the long-term outcome of single-level disc replacement has been extensively described, there have not been previous reports of the 5-year outcome of 2-level cervical disc replacement. METHODS This study reports the 5-year results of a prospective, randomized US FDA investigational device exemption (IDE) study conducted at 24 centers in patients with 2-level, contiguous, cervical spondylosis. Clinical outcomes at up to 60 months were evaluated, including validated outcome measures, incidence of reoperation, and adverse events. The complete study data and methodology were critically reviewed by 3 independent surgeon authors without affiliation with the IDE study or financial or institutional bias toward the study sponsor. RESULTS A total of 225 patients received the Mobi-C cervical total disc replacement device and 105 patients received ACDF. The Mobi-C and ACDF follow-up rates were 90.7% and 86.7%, respectively (p = 0.39), at 60 months. There was significant improvement in all outcome scores relative to baseline at all time points. The Mobi-C patients had significantly more improvement than ACDF patients in terms of Neck Disability Index score, SF-12 Physical Component Summary, and overall satisfaction with treatment at 60 months. The reoperation rate was significantly lower with Mobi-C (4%) versus ACDF (16%). There were no significant differences in the adverse event rate between groups. CONCLUSIONS Both cervical total disc replacement and ACDF significantly improved general and disease-specific measures compared with baseline. However, there was significantly greater improvement in general and disease-specific outcome measures and a lower rate of reoperation in the 2-level disc replacement patients versus ACDF control patients. Clinical trial registration no. NCT00389597

  20. Application of Zero-P interbody fusion in degenerative disease at the adjacent segments after anterior cervical fusion%Zero-P椎间融合术在治疗颈前路融合术后相邻节段退变性疾病中的应用

    Institute of Scientific and Technical Information of China (English)

    程彩霞; 卢旭华; 谢宁; 郭翔; 郭群峰; 倪斌

    2012-01-01

    Objective To investigate the clinical outcomes of Zero-P interbody fusion in the treatment of degenerative disease at the adjacent segments after anterior cervical decompression and fusion with internal fixation. Methods Sixteen patients with degenerative diseases at adjacent segments after anterior cervical decompression and fusion with internal fixation received Zero-P anterior cervical interbody fusion. Japanese Orthopaedic Association ( JOA) scores were compared before and after the operation. Postoperative dysphagia and intervertebral fusion were observed. Results Postoperative JOA score was significantly increased as compared with preoperative score (P<0.05). No dysphagia occurred and all the patients obtained solid fusion. Conclusion The mid- and short-term curative effect is satisfactory for the Zero-P intervertebral fusion in the treatment of cervical degenerative disease in the adjacent segments after anterior cervical fusion.%目的 探讨采用Zero-P椎间融合术治疗颈前路减压融合内固定术后相邻节段退变性疾病的疗效.方法 对16例颈前路减压融合内固定术后发生相邻节段退变性疾病的患者采用Zero-P行颈前路椎间融合术,比较患者手术前后日本骨科学会(Japanese Orthopaedic Association,JOA)评分,观察患者术后吞咽困难发生情况及椎间融合情况.结果 患者术后JOA评分较术前提高,差异有统计学意义(P<0.05),未发生吞咽困难,所有患者均获得牢固融合.结论 采用Zero-P椎间融合术治疗颈前路融合术后相邻节段退变性疾病中短期疗效较好.

  1. Anterior retropharyngeal approach to the cervical spine.

    Directory of Open Access Journals (Sweden)

    Behari S

    2001-10-01

    Full Text Available The anterior retropharyngeal approach (ARPA accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing for a simultaneous arthrodesis and instrumentation during the primary surgical procedure. Experience of five patients with high cervical extradural compression, who underwent surgery using this approach between 1994 and 1999, is presented. The surgical procedures included excision of ossified posterior longitudinal ligament (n=2; excision of prolapsed disc and osteophytes (n=2; and excision of a vertebral body neoplasm (n=1. Following the procedure, vertebral arthrodesis was achieved using an iliac graft in all the patients. Only one patient with vertebral body neoplasm required an additional anterior cervical plating procedure for stabilisation the construct. The complications included transient respiratory insufficiency and neurological deterioration in two patients; and, pharyngeal fistula and donor site infection in one patient.

  2. 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 disc spaces significantly reduced range of motion, more so in the rhBMP-2/ACS group. At 24 months, HO negatively affected Neck Disability Index scores (excluding neck/arm pain scores), neurological status, and overall success in patients in the rhBMP-2/ACS group, but not in patients in the allograft group. CONCLUSIONS Implantation of rhBMP-2/ACS at 1.5 mg/ml with polyetheretherketone spacer and titanium plate is effective in inducing fusion and improving pain and function in patients undergoing ACDF for symptomatic single-level cervical degenerative disc disease. At 24 months, the rate and dimensions (length and

  3. 23例颈椎病颈椎前路髂骨植骨融合手术治疗分析%Analysis of 23 Cases of Cervical Spondylosis Treated by Anterior Iliac Bone Graft Fusion

    Institute of Scientific and Technical Information of China (English)

    冯恺

    2016-01-01

    目的:探究颈椎病颈椎前路髂骨植骨融合手术临床效果。方法选取我院2014年1月~2015年9月接收的23例颈椎病患者行颈椎前路髂骨植骨融合手术,分析临床情况。结果23例均成功手术,21例复查结果显示恢复良好。4例出现轻微饮水呛咳,发生率为17.39%。患者均未出现严重并发症。结论颈椎病颈椎前路髂骨植骨融合手术,整体的治疗效果满意,故在临床中可以采用该方法进行治疗,但需注意操作的严密性和谨慎性,以保证临床治疗的效果。%Objective To explore the clinical effect of anterior iliac bone graft fusion in the treatment of cervical spondylosis.Methods23 patients with cervical spondylosis received from January 2014 to September 2015 in our hospital were selected and underwent anterior iliac bone graft fusion. Results 23 cases were successfuly operated,and 21 cases showed good recovery. 4 cases of mild drinking cough occurred,the incidence rate was 17.39%. There were no serious complications in the patients.Conclusion In the patients with cervical spondylosis anterior iliac graft bone fusion surgery,the overal treatment effect was significantly,so in clinical can use this method of treatment,but should pay attention to the operation of the strict and cautious,in order to guarantee the effect of clinical treatment.

  4. Effects of anterior fusion cage fixation on cervical curvature, stability and axial symptoms%增加前路cage融合对颈椎曲度、稳定性及轴性症状的影响

    Institute of Scientific and Technical Information of China (English)

    李宽宽; 夏磊; 桑亮

    2014-01-01

    背景:对于严重的颈椎间盘突出、后纵韧带钙化、黄韧带增生,实施前后联合入路不仅可以达到彻底减压的目的,同时植入cage及前路钢板矫形固定可部分恢复椎体间隙及颈椎生理曲度。  目的:比较颈椎病颈后路单开门椎管扩大成形及增加前路cage融合内固定对治疗后患者颈椎曲度、稳定性及轴性症状发生的影响。  方法:回顾性分析颈椎病外科治疗50例患者的临床资料。其中行一期前后联合入路脊髓减压(前路 cage+钢板融合固定)22例(前后路联合治疗组);单纯行颈后路单开门椎管扩大成形(后路开窗铆钉固定)28例(单纯后路治疗组)。治疗后随访6-24个月,分别对两组治疗后神经功能恢复情况、轴性症状的发生率及颈椎曲度指数、病变节段椎间滑移度进行统计分析。  结果与结论:两组患者的神经功能恢复均获得较好的日本骨科学会(JOA)改善率,前后路联合治疗组患者轴性症状的发生率相对低,颈椎曲度指数较单纯后路治疗组患者有较为明显的改善,而单纯后路治疗组椎间滑移度相对较大。结果表明一期前后联合入路使用 cage、前路钢板、后路铆钉行脊髓减压可以有效维持颈椎的生理曲度从而维持矢状面的平衡,减少患者轴性症状的发生率,对维持治疗后颈椎长期的稳定性起到重要作用。%BACKGROUND:The combination of anterior and posterior approaches for severe cervical intervertebral disk herniation, posterior longitudinal ligament calcification and ligament flava hyperplasia can completely reduce compression. Simultaneously, cage implantation and anterior plate fixation partial y recover vertebral interspace and physiological curvature of cervical vertebra. OBJECTIVE:To compare the effects of cervical posterior single-door laminoplasty for cervical spondylosis and anterior cage-assisted fusion on curvature

  5. 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

  6. Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

    OpenAIRE

    Yusuf Kurtuluş Duransoy; Mesut Mete; Baha Zengel; Mehmet Selçukı

    2013-01-01

    Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw ...

  7. Complications of the anterior approach to the cervical spine

    OpenAIRE

    Marcelo Lemos Vieira da Cunha; Francisco Alves de Araújo Júnior; Cássio Czottis Grapiglia; Denildo César Amaral Veríssimo; Roberta Rehder; Samir Ale Bark; Luis Alencar Biurrum Borba

    2014-01-01

    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,...

  8. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Liu W

    2016-04-01

    Full Text Available Weijun Liu,1,* Ling Hu,2,* Po-Hsin Chou,3 Ming Liu,1 Wusheng Kan,1 Junwen Wang1 1Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Anesthesiology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, People’s Republic of China; 3Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC *These authors contributed equally to this work Purpose: A meta-analysis was conducted to evaluate the clinical outcomes, complications, reoperation rates, and late neurological deterioration between anterior decompression and fusion (ADF and laminoplasty (LAMP in the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL. Methods: All related studies published up to August 2015 were acquired by searching PubMed and EMBASE. Exclusion criteria were case reports, revision surgeries, combined anterior and posterior surgeries, the other posterior approaches including laminectomy or laminectomy and instrumented fusion, non-English studies, and studies with quality assessment scores of <7. The main end points including Japanese Orthopedic Association (JOA score, recovery rate of JOA, cervical lordosis, complication rate, reoperation rate, and late neurological deterioration were analyzed. All available data was analyzed using RevMan 5.2.0 and Stata 12.0. Results: A total of seven studies were included in the meta-analysis. The mean surgical level of ADF was 3.1, and the mean preoperative occupation ratios of ADF and LAMP group were 55.9% and 51.9%, respectively. No statistical difference was observed with regard to preoperative occupation ratio and preoperative JOA score. Although LAMP group had a higher preoperative cervical lordosis than ADF group (P<0.05, weighted mean difference [WMD

  9. 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

  10. 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.

  11. 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

  12. 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

  13. 前路减压植骨融合内固定术治疗颈椎间盘突出症的疗效分析%Analysis of anterior cervical decompression and autograft fusion combined with internal fixation in the treatment of cervical disc protrusion

    Institute of Scientific and Technical Information of China (English)

    杨朝晖; 吴险峰; 邹磊

    2013-01-01

    Objective To explore the clinical outcome of treatment of the anterior cervical discertomy and fusion with rigid plate fixation for cervical disc herniation. Methods Twenty five patients with cervical disc herniation had been treated by multilevel anterior cervical discectomy and fusion with rigid plate fixation from Oct 2008 to Oct 2011. Results All patients had been followed - up for 8 to 24 months ( I I months in average ). Bone union was achieved in all patients. All cases were scored after operation to assess the curative effect. There were 15 cases that belonged to the excellent, 8 to the good, 2 to the fair and 0 to the poor based on the Jndet criteria. The good and excellence rate was 92% in patients. Conclusion The treatment of traumatic cervical disc protrusion with anterior cervical decompression and bone autograft fusion combined with internal fixation has satisfactory clinical effect with fewer complications.%目的 探讨前路减压植骨融合钢板内固定治疗颈椎间盘突出症的疗效.方法 对收治的25例颈椎椎间盘突出症患者行颈椎前路减压,取自体髂骨植骨融合内固定治疗.结果 本组患者均获得随访,随访时间8~24个月,平均11个月.植骨均达到骨性愈合,无骨不连发生.25例患者神经功能获得改善,根据JOA神经功能评定标准,优15例,良8例,可2例,差0例,优良率92%.结论 颈椎前路减压、椎间盘切除、植骨融合钢板内固定是治疗颈椎间盘突出症的一种有效方法.

  14. Anterior cervical fusion and fixed system (Zero-P) for treating cervical spondylosis%新型颈椎前路椎间融合固定系统(Zero-P)治疗颈椎病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    包肇华; 邹俊; 朱若夫; 吴春屾; 曹成

    2013-01-01

      背景:颈椎前路减压融合内固定术是治疗颈椎病的有效手段。但接骨板内固定在增加融合率的同时常导致一些并发症。  目的:探讨一种新型零切迹颈椎前路椎间融合固定系统(Zero-P)治疗颈椎病的疗效,以降低术后并发症的发生率。  方法:2010年6月至2011年6月对51例颈椎病患者行颈椎前路减压融合术。A组33例使用椎间融合器联合钛板固定;B组18例使用Zero-P。比较两组手术时间,术中出血量,JOA评分及改善率,NDI评分,术后融合率,术后并发症发生率。  结果:A组随访9~18个月,平均12个月;B组随访6~19个月,平均10个月。两组手术时间,术中出血量,JOA评分及改善率,NDI评分,融合率均无显著差异(P>0.05)。但B组术后并发症发生率明显低于A组(P  结论:Zero-P能降低术后并发症的发生率,尤其是吞咽不适的发生,是一种值得进一步临床应用的颈椎前路椎间融合固定系统。%Background: Anterior cervical discectomy and fusion (ACDF) is an effective treatment for cervical spondylosis. But inter-nal fixation with plate often results in some postoperative complications. Objective: To evaluate the clinical outcomes of a new anterior cervical fusion and fixed system (Zero-Profile) in the treat-ment of cervical spondylosis so as to decrease the postoperative complications. Methods: A total of 51 patients with cervical spondylosis were treated with ACDF between June 2010 and June 2011. Cage and titanium plate implantation were used in 33 patients of group A. Zero-Profile anterior cervical fusion and fixed system was applied in 18 patients of group B. Operation time, intraoperative blood loss, JOA and NDI scores, fusion rate and com-plications were compared between groups. Results: The mean follow-up period of group A was 12 months (range, 9 to 18 months). And the mean follow-up period of group B was10 months

  15. Dysphagia due to anterior cervical osteophytosis: case report

    OpenAIRE

    Frederico Miguel Santos Silva Marquez Correia; João Paulo de Sousa Goucha Jorge; Ana Sofia Teixeira Neves; Gabriel Filipe Gonçalves Xavier; Marco Miguel Barroso de Oliveira; José Eduardo Paiva Ferreira

    2014-01-01

    The objective of this study is to highlight the possibility of dysphagia induced by anterior cervical osteophytes. When not diagnosed early this condition may be responsible for complications such as severe dysphagia and potential lung aspiration, especially in elderly patients. Analysis of a case report of a 72-year old woman who presented cervical pain and progressive dysphagia. Imaging studies have shown anterior ce...

  16. Multisegmental cervical ossification of the posterior longitudinal ligament: Anterior vs posterior approach

    OpenAIRE

    Jain Subodh; Salunke Pravin; Vyas K; Behari Sanjay; Banerji Deepu; Jain Vijendra

    2005-01-01

    Aims : To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. Methods and Materials : Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion=14 patients) or posterior approach (laminectomy=12, laminoplasty=1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors su...

  17. 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

  18. 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

  19. Thyroid storm following anterior cervical spine surgery for tuberculosis of cervical spine

    Directory of Open Access Journals (Sweden)

    Sanjiv Huzurbazar

    2014-01-01

    Full Text Available Objective: The primary objective was to report this rare case and discuss the probable mechanism of thyroid storm following anterior cervical spine surgery for Kochs cervical spine.

  20. Is posterior fusion necessary with laminectomy in the cervical spine?

    OpenAIRE

    McAllister, Beck D.; Rebholz, Brandon J.; Wang, Jeffery C.

    2012-01-01

    Background: Cervical decompressive laminectomy is a common procedure for addressing multilevel cervical spine pathology. The most common reasons for performing simultaneous posterior cervical fusion include the prevention of progressive postlaminectomy kyphotic deformity or other types of instability which can contribute to late neurological deterioration. Methods: The medical literature (Pub Med with MeSH) concerning cervical laminectomy, posterior cervical fusion, and complications of lamin...

  1. 下颈椎脱位早期复位前路内固定疗效分析%Analysis of Dislocation of the Lower Cervical with Early Reset Combined Internal Fixtion of Anterior Fusion

    Institute of Scientific and Technical Information of China (English)

    付涟桥; 刘晓岚; 张金明; 唐金平; 谭震; 童杰; 刘社庭

    2011-01-01

    objective To observe the clinical effect with early reset combined internal fixation of anterior fusion in treatment of patients with dislocation of the lower cervical. Methods Dislocation of the lower cervical early closed traction reset (Skull traction reset and general anesthesia closed traction reset) and open surgery Skiing dial vertebral reset.and the vertebral between bone graft fusion fixation 64 cases. Results Closed reduction 54 cases of success,a-mong skullt traction reset 33 cases ,general anesthesia closed traction reset 21 cases, 10 cases in the way traction and rotating prying reset success. There are 48 cases have 8~30 months follow-up,All patients were with cervical reset completely,fusion bone graft, no internal fixation loose, fracture. Nerve damage in different degree recovery. Spinal cord Frankel grading by an average of grade 1. Conclusion Early traction reset combine fixation surgery therapies, make spinal cord compression time shorten, favors the neural function recovery .complication less, recover faster, effective relieve nursing difficulty. It is a safe and effective treatment.%目的 观察下颈椎脱位患者早期复位结合前路内固定手术治疗的临床效果.方法 选择下颈椎骨折脱位早期行闭合复位(颅骨牵引复位和在全麻下行闭合牵引复位)以及前路开放撬拨椎体复位,并予以椎间植骨融合内固定64例.结果 闭合复位成功54例,其中颅骨牵引复位33例,全麻下闭合手法牵引复位21例;在前路手术中牵引下行旋转撬拨复位成功10例.48例患者获8~30个月随访,颈椎复位完全,植骨均融合,无内固定松动、断裂及脱出,神经损伤均有恢复,脊髓Frankel分级平均提高1级.结论 早期复位结合前路内固定手术治疗下颈椎骨折脱位是一种安全、有效的治疗方法.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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

  3. 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...

  4. Clinical outcomes of selective anterior cervical corpectomy combined with segmental disectomy and fusion for treating three-level cervical myelopathy%前路选择性椎体切除结合单间隙减压植骨融合术治疗三节段脊髓型颈椎病的临床疗效

    Institute of Scientific and Technical Information of China (English)

    曹涌; 张烽; 陈向东; 姜星杰

    2011-01-01

    Objective To evaluate the clinical outcomes of selective anterior cervical corpectomy combined with segmental disectomy and fusion for treating three-level cervical myelopathy. Methods Thirtee patients of multilevel cervical myelopathy with 3 consecutive segments were treated with anterior cervical corpectomy combined with segmental disectomy and fusion. Study parameters included JOA score and grading the Odom criteria. The sagittal segmental alignment of fusion levels was measured using the Cobb method before and after surgery. Graft fusion rate was observed during final follow up. Results The patients were followed up for 12 to 39 months. The JOA score of 13 patients was higher three months after surgery than that before[(14. 6± 1.0) points vs. (11.1 ± 1.0) points] (P<0. 01). Surgical results of Odom criteria were excellent in 8 cases, good in 3 cases, fair in 2 cases. Graft fusion rate was 100%. Radiograph analysis indicated that the Cobb angle of mean segmental lordosis was 3.7 degrees before, 10.7 degrees one week later and 10.4 degrees during the final follow up. Conclusion Selective anterior cervical corpectomy combined with segmental disectomy and fusion results in high fusion rates with sufficient decompression in the treatment of three-level cervical myelopathy.%目的 分析颈前路选择性椎体次全切除十单间隙减压植骨融合术治疗三节段脊髓型颈椎病的临床疗效.方法 13例脊髓型颈椎病患者行颈前路选择性椎体次全切除十单间隙减压、自体髂骨植骨、钢板内固定术.分析术前及随访时的日本骨科协会(JOA)评分,记录术后Odom分级.测量术前、术后1周及末次随访时颈椎侧位X线片,观察术后颈椎植骨融合率、颈椎曲度(Cobb角)维持、症状及功能改善率.结果 13例患者随访12~39个月,术后3个月JOA评分为(14.6±1.0)分,明显高于术前的(11.1±1.0)分(P<0.01).术后Odom分级:优8例,良3例,一般2例,植骨融合率100%.

  5. Dysphagia due to anterior cervical osteophytosis: case report

    Directory of Open Access Journals (Sweden)

    Frederico Miguel Santos Silva Marquez Correia

    2014-12-01

    Full Text Available The objective of this study is to highlight the possibility of dysphagia induced by anterior cervical osteophytes. When not diagnosed early this condition may be responsible for complications such as severe dysphagia and potential lung aspiration, especially in elderly patients. Analysis of a case report of a 72-year old woman who presented cervical pain and progressive dysphagia. Imaging studies have shown anterior cervical osteophytosis and multilevel degenerative changes in the cervical spine. The patient underwent surgical excision of the cervical anterior osteophytes (C4, C5 and C6 and C5/C6 arthrodesis through anterior approach. The postoperative period was uneventful and symptoms resolved within 2 weeks. Early diagnosis and treatment led to complete resolution, avoiding late and serious complications associated with this pathology in the geriatric population, especially severe and progressive dysphagia and risk of pulmonary aspiration, and the consequent morbidity and mortality associated. A multidisciplinary approach is essential for the correct assessment of this condition

  6. 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

    OpenAIRE

    Lyonel Beaulieu Lalanne; Gonzalo Arriagada Ocampo

    2012-01-01

    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 quir...

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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.

  9. Clinical Observation on Anterior Cervical Decompression and Bone Graft Fusion with Locking Plate Internal Fixation in Treatment of Cervical Spinal Cord Injury without Fracture and Dislocation%颈前路减压植骨融合带锁钛板内固定治疗无骨折脱位型颈脊髓损伤的临床探讨

    Institute of Scientific and Technical Information of China (English)

    孙海中

    2016-01-01

    Objective To discuss the effect of anterior cervical decompression and bone graft fusion with locking plate inter-nal fixation in treatment of cervical spinal cord injury without fracture and dislocation (SCIWORA). Methods 60 cases of patients with SCIWORA treated in our hospital from March 2011 to March 2014 were selected as the research object and randomly divided into two groups, the control group were given anterior cervical decompression and bone graft treatment, and the observation group were given anterior cervical decompression and bone graft fusion with locking plate internal fixa-tion treatment, both groups were scored by Japan department of orthopedics association (JOA)before and after operation, and the improvement rates of clinical symptoms after operation and the intervertebral fusion rates after half a year of the two groups were evaluated. Results Six months later after operation, the intervertebral fusion rate in the observation group was obviously higher than that in the control group (96.67%vs 80.0%), the difference was statistically significant (P<0.05), the JOA scores after three months of operation and six months of operation in the observation group were respectively (12.38± 1.69)points and (15.96±2.33)points, which were obviously higher than those in the control group, and the differences were statistically significant (P<0.05). Conclusion The curative effect of anterior cervical decompression and bone graft fusion with locking plate internal fixation in treatment of SCIWORA is definite.%目的 探讨颈前路减压植骨融合带锁钛板内固定治疗无骨折脱位型颈脊髓损伤(SCIWORA)的效果. 方法 整群选取该院2011年3月—2014年3月收治的无骨折脱位型颈脊髓损伤(SCIWORA)患者60例作为研究对象,采用数字随机对照表将患者分为对照组和观察组,对照组行颈前路减压植骨融合术治疗,观察组在对照组基础上加锁钛板内固定治疗,手术前后均行日本骨科协

  10. Clinical Observation on Anterior Cervical Decompression and Bone Graft Fusion with Locking Plate Internal Fixation in Treatment of Cervical Spinal Cord Injury without Fracture and Dislocation%颈前路减压植骨融合带锁钛板内固定治疗无骨折脱位型颈脊髓损伤的临床探讨

    Institute of Scientific and Technical Information of China (English)

    孙海中

    2016-01-01

    目的 探讨颈前路减压植骨融合带锁钛板内固定治疗无骨折脱位型颈脊髓损伤(SCIWORA)的效果. 方法 整群选取该院2011年3月—2014年3月收治的无骨折脱位型颈脊髓损伤(SCIWORA)患者60例作为研究对象,采用数字随机对照表将患者分为对照组和观察组,对照组行颈前路减压植骨融合术治疗,观察组在对照组基础上加锁钛板内固定治疗,手术前后均行日本骨科协会(JOA)评分,评估两组术后临床症状好转率及半年后植骨融合率.结果 观察组术后半年后植骨融合率为96.67%显著高于对照组80.0%,差异具有统计学意义(P<0.05);观察组术后3、6个月JOA评分分别为(12.38±1.69)分、(15.96±2.33)分均显著高于对照组,差异具有统计学意义(P<0.05). 结论 颈前路减压植骨融合带锁钛板内固定治疗SCIWORA疗效确切.%Objective To discuss the effect of anterior cervical decompression and bone graft fusion with locking plate inter-nal fixation in treatment of cervical spinal cord injury without fracture and dislocation (SCIWORA). Methods 60 cases of patients with SCIWORA treated in our hospital from March 2011 to March 2014 were selected as the research object and randomly divided into two groups, the control group were given anterior cervical decompression and bone graft treatment, and the observation group were given anterior cervical decompression and bone graft fusion with locking plate internal fixa-tion treatment, both groups were scored by Japan department of orthopedics association (JOA)before and after operation, and the improvement rates of clinical symptoms after operation and the intervertebral fusion rates after half a year of the two groups were evaluated. Results Six months later after operation, the intervertebral fusion rate in the observation group was obviously higher than that in the control group (96.67%vs 80.0%), the difference was statistically significant (P<0.05), the JOA scores after three

  11. Is dysphonia permanent or temporary after anterior cervical approach?

    OpenAIRE

    Kahraman, Serdar; Sirin, Sait; Erdogan, Ersin; Atabey, Cem; Daneyemez, Mehmet; Gonul, Engin

    2007-01-01

    The rate, causes and prognosis of dysphonia after anterior cervical approach (ACA) were investigated in our clinical series. During a 10-year interval, 235 consecutive patients with cervical disc disease underwent surgical treatment using anterior approach. Retrospective chart reviews showed recurrent laryngeal nerve (RLN) injury in 3 (1.27%) patients. All three patients were men and only one patient had multilevel surgery. These patients had RLN injury after virgin surgery. Laryngoscopic exa...

  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. 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. Application of n-HA/PA66 in anterior cervical subtotal corpectomy and fusion for treatment of cervical spondylotic myelopathy%纳米羟基磷灰石/聚酰胺在脊髓型颈椎病椎体次全切减压融合术中的应用

    Institute of Scientific and Technical Information of China (English)

    杨朝垒; 王利民; 谭洪宇; 王卫东; 廖文胜; 鲍恒; 刘屹林

    2011-01-01

    Objective To discuss the application effect of nano-hydroxyapatite and polyamide composite (n-HA/PA66) in anterior cervical subtotal corpectomy and fusion with plate for the treatment of cervical spondylotic myelopathy. Methods Thirty patients with cervical spondylotic myelopathy were treated with anterior cervical subtotal corpectomy, in which n-HA/PA66 was grafted and platted for the decompression and fusion. The clinical results and graft fusion were evaluated after the operation. Results All patients were operated successfully and followed up for 9 to 17 months with an average of 12.6 months. The neurological symptoms and signs of patients were greatly improved. There was no allergic and toxic reactions induced by n-HA/PA66 implantation. Imaging studies showed that cervical alignments and intervertebral height were well maintained, and graft fusions were achieved in all cases 6 to 8 months after operation. However, there were heterotopic ossifications of different degrees in the posterior edge of n-HA/PA66 artificial vertebral body. Conclusions n-HA/PA66 artificial vertebral body has good fusion rate, and could effectively maintain the biological alignment and cervical intervertebrai height. The long-term effects depend on further follow-up.%目的 探讨纳米羟基磷灰石/聚酰胺(n-HA/PA66)在脊髓型颈椎病椎体次全切减压融合术中的应用效果.方法 对30例脊髓型颈椎病患者均行颈椎前路椎体次全切n-HA/PA66植入钛板内固定术,对其疗效及融合情况进行评价.结果 30例患者均成功完成手术并获得随访,随访时间9~17个月,平均12.6个月.所有患者神经症状均明显改善,植入物未引起过敏及毒性反应,颈椎生理曲度、椎间高度有良好的恢复和维持,术后6~8个月时获得植骨融合,n-HA/PA66人工椎体后缘存在不同程度的异位骨化.结论 n-HA/PA66人工椎体作为颈椎前路手术植骨材料融合率高,可以有效保持颈椎生理曲度及椎

  15. 桥形椎间锁定融合器(ROI-C)在颈椎病前路减压融合术中应用的临床研究%Bridge Intervertebral Fusion Lock Device (ROI - C) in Cervical Spondylosis Anterior Decompression Fusion Application in Clinical Research

    Institute of Scientific and Technical Information of China (English)

    何彦国

    2015-01-01

    objective to study and analyze the bridge between vertebra locking fusion in cervical spondylosis application of the clinical effect of anterior decompression fusion.Methods to collect a total of 100 patients with cervical spondylosis, randomly divided into observation group and control group, the 50 cases, control group patients with cage combined anterior internal fixation with titanium plate, observation group carries on the bridge a locked intervertebral fusion, both before and after operation for X-ray inspection, two group of patients with cervical physiological curvature and lesion intervertebral height, the incidence of dysphagia observation and comparison.Results the observation group of patients with cervical physiological curvature of the improvement of the degree of improvement and pathology of the intervertebral height was significantly higher than that of control group, the incidence of dysphagia in patients with significantly lower than the control group,P<0.05).Conclusion in the cervical spine anterior decompression fusion, application of bridge intervertebral target fusion can make cervical physiological curvature and pathological changes of intervertebral height effectively restore, and lower the incidence of postoperative patients with dysphagia, shorter operation time, simple operation, is worthy of popularization and application.%目的:研究和分析桥形椎间锁定融合器在颈椎病前路减压融合术中应用的临床效果。方法收集颈椎病患者共100例,随机分为观察组与对照组,各50例,对照组患者进行cage联合前路钛板内固定,观察组进行桥形椎间锁定融合器固定,手术前后均进行了X线片的检查,将两组患者的颈椎生理曲度、病变椎间高度、吞咽困难发生率等进行观察和对比。结果观察组患者的颈椎生理曲度的改善程度、病变椎间高度的改善程度明显高于对照组,患者的吞咽困难发生

  16. Comparison of adjacent segment degeneration five years after single level cervical fusion and cervical arthroplasty:a retrospective controlled study

    Institute of Scientific and Technical Information of China (English)

    SUN Yu; ZHAO Yan-bin; PAN Sheng-fa; ZHOU Fei-fei; CHEN Zhong-qiang; LIU Zhong-jun

    2012-01-01

    Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration.Whether accelerated adjacent segment degeneration is prevented in the long term is unclear.This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery.Methods We studied patients with single level degenerative cervical disc disease.The extent of adjacent segment degeneration was estimated from lateral X-rays.Results Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion.All patients were followed up for an average of sixty months.In the Bryan arthroplasty group,nine(17.6%)segments developed adjacent segment degeneration,which was significantly lower than that(60.4%)in the anterior cervical decompression and fusion group.Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee's classification and two segments had range of motion less than 2°.In the heterotopic ossification group,four(19.5%)segments developed adjacent segment degeneration,similar to the number in the non-heterotopic ossification group(16.7%).Adjacent segment degeneration rate was 50% in gradeⅣ?group but 11.8% in gradeⅡ?to Ⅲ.Conclusions Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion.However,Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion.Patients with gradeⅣ?heterotopic ossification lost motion,and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.

  17. 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.

  18. 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

    OpenAIRE

    Rui Peixoto Pinto; José Oliveira; Rui Matos; Nuno Neves; Manuel Ribeiro da Silva; Pedro Cacho Rodrigues; Rui M Barros; Abel Trigo Cabral

    2010-01-01

    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-ope...

  19. Clinical application of anterior cervical subtotal corpectomy and fusion with n-HA/PA66 composite artificial vertebral body for cervical spondylosis%纳米羟基磷灰石/聚酰胺66复合人工椎体在颈椎病前路椎体次全切除术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    张文志; 王潇; 段丽群; 尚希福; 许翔; 胡业丰; 姚刚

    2012-01-01

    目的 探讨纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合人工椎体在颈椎前路次全切除术中应用的短中期临床疗效.方法 自2008年5月~2009年6月对44例脊髓型颈椎病行前路椎体次全切除、椎管减压、n-HA/PA66复合人工椎体植骨融合+钢板内固定术治疗,以JOA评分改善率评价神经功能恢复情况,并依据X线片判断椎间稳定性和融合情况.结果 本组无术中并发症,伤口均一期愈合.患者获随访12~26个月,平均18个月,症状均明显改善,JOA评分由术前(6.4±1.8)分提高到术后(15.2±1.5)分,JOA改善率83.0%,优良率86.4%,问卷调查满意度97.6%.X线检查证实无人工椎体移位、下沉,融合率100%.结论 n-HA/PA66复合人工椎体具有良好的生物相容性及安全性,是一种较理想的骨移植材料,适用于颈椎病前路次全切除术中.%Objective To evaluate the short and mid-term clinical effect of anterior cervical subtotal corpectomy and fusion with n-HA/PA66 composite artificial vertebral body for cervical spondylosis. Methods From may 2008 to June 2009, 44 patients with cervical spondylosis received anterior cervical subtotal corpectomy,spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. Neurological function was assessed by improvement rate of JOA score, and roentgenograms was analyzed to identify the stability of the fused level. Results In all patients, no complications occurred during operation. Wounds were normally healed without acute or chronic infection. All patients were followed up for 12 to 26 months, with an average of 18 months. Preoperative symptoms were all improved in patients, the mean JOA scores was (6.4±1.8) preoperatively and improved to (15.2±1.5) at final follow-up, JOA improvement rate was 83.0%, the excellent and good rate was 85.7%, patients of 97.6% were satisfied with this procedure. The X-ray films demonstrated that no

  20. 人工椎间盘置换加颈前路椎体次全切减压植骨融合术治疗多节段颈椎病%Artificial Disc Replacement Combined with Anterior Cervical Decompression and Autograft Bone Fusion for the Treatment of Multi-segment Cervical Spondylosis

    Institute of Scientific and Technical Information of China (English)

    廖维峰; 肖晟; 黄象望; 刘向阳; 张毅; 向铁城

    2014-01-01

    [目的]探讨人工椎间盘置换加颈前路椎体次全切减压植骨融合术治疗多节段颈椎病的临床疗效。[方法]湖南省人民医院2008年2月至2012年6月收治的12例多节段颈椎病手术病例,均行人工椎间盘置换加颈前路椎体次全切减压植骨融合术,随访时间为12~18个月,平均随访15.5个月,均摄术前、术后及末次随访时的颈椎正侧位及颈椎过伸过屈位X线片及磁共振检查,观察植骨融合、内固定及人工椎间盘的情况,以JO A评分评价神经功能改善情况。[结果]所有病例内置物无松动、移位,植骨融合时间在3~6个月,平均4.9个月。置换间隙活动度术后1年时为12.5°±5.0°,与术前(12.3°±4.9°)比较无统计学差异(P>0.05)。术前JOA 评分平均为9.3分,术后6个月时平均为16.1分,平均改善率为91.2%。[结论]人工椎间盘置换加颈前路椎体次全切减压植骨融合术治疗多节段颈椎病近期疗效满意,是治疗多节段颈椎病的一种可行方法。%[Objective]To explore the clinical efficacy of cervical artificial disc replacement combined with anterior cervical decompression and autograft bone fusion for the treatment of multi -segment cervical spon-dylosis .[Methods]Twelve patients with multi- segment cervical spondylosis operated in Hunan provincial people's hospital from Feb .2008 to June 2012 underwent cervical artificial disc replacement combined with an-terior cervical decompression and autograft bone fusion .The follow up time was 12~18 months(average 15 .5 months) .Cervical MRI and X-ray films of cervical normal lateral position ,hyperextension and hyperflexion position were performed before and after operation and at the last time of follow up .Bone fusion ,internal fixa-tion and artificial disc were observed .JOA score was used to evaluate the improvement of neurological func-tion .[Results]No loosening and displacement of

  1. 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.

  2. 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

  3. 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

    院时间均明显少于/短于长节段减压组(P<0.05),平均住院费用明显高于长节段减压组(P<0.05).分节段减压组、三间隙减压组和长节段减压组术后JOA评分提高分数和植骨融合率相近(P>0.05).结论:综合植骨融合率、神经功能恢复情况、手术时间、术中出血量、住院时间多种因素,3种术式中以颈前路分节段减压植骨融合术为治疗多节段颈椎病的手术方式较佳方案.%BACKGROUND:As a traditional treatment for multilevel cervical myelopathy,nterior long-segmental decompression has the shortcomings of great operative trauma,high difficulty,low fusion rate,etc.,which can affect the postoperative efficacy.OBJ ECTIVE:To evaluate the clinical effects of three different anterior surgeries on multilevel cervical myelopathy.DESIGN:A comparative observation.SETTING:Department of Orthopaedics,Changzheog Hospital,the Second Military Medical University of Chinese PLA.PARTICIPANTS:Thirty-six patients with multilevel cervical myelopathy of 3 consecutive segments,who were surgically treated,were selected from the Department of Orthopaedics,Changzheng Hospital,the Second Military Medical University of Chinese PLA from June 1999 to June 2003,including 25 males and 11 females,35-62 years of age,the disease course ranged from 3 to 26 months. According to the clinical manifestations and imaging esults,they were diagnosed as multilevel cervical myelopathy,and they were not suffering from consecutive ossification of posterior longitudinal ligament and ossification of ligamenta flava. Informed contents were obtained from all the patients and their relatives.METHODS:All the patients were grafted with utologous bone. Autologous ilium or cancellous bone excluding vertebral body was filled into titan net or Cage,which were made of titan and characterized by high intensity,tolerance to decay,good biocompatibility,etc. According to the operative manner,the patients were divided into 3 groups:① two

  4. Fibular Allograft After Anterior Cervical Corpectomy: Long Term Follow-Up

    OpenAIRE

    McKoy, Brodie E; Wingate, Jeffrey K; Poletti, Steven C; Johnson, Donald R.; Stanley, Mark D; Glaser, John A.

    2002-01-01

    The purpose of this study was to provide clinical and radiographic evaluation after a minimum of two years in patients who had an anterior cervical corpectomy and a fibular allograft strut. Nineteen patients returned for a follow-up visit which included independent radiographic evaluation as well as completing a Visual Analogue Scale and Oswestry and Short-Form 36 questionnaires. The categories of fusion were as follows: 1) definitely fused (84%) 2) questionably fused (11%) 3) definitely not ...

  5. Observation of the effect of multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy%前路经椎间隙减压植骨融合术治疗老年人多节段脊髓型颈椎病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王军; 刘玉芹; 朱洪新; 师大雷; 仇立萍; 李翠萍; 杨磊

    2011-01-01

    目的 探讨颈前路经椎间隙减压植骨融合术治疗老年人多节段脊髓型颈椎病的疗效.方法 对25例老年脊髓型颈椎病患者行颈前路椎间隙减压、椎间植骨融合器(cage)植骨、钛板螺钉内固定术治疗,术后随访3~10个月,观察JOA评分改善率、Odoms临床疗效、植骨融合情况以及并发症发生情况.结果 末次随访时Odoms临床疗效评定,优8例,良14例,中3例,优良率为88%.JOA评分由术前的7.8分提高到末次随访时的12.8分,JOA评分平均改善率为54%.末次随访时cage及内固定位置良好,植骨融合率为100%.结论 颈前路经椎间隙减压植骨融合内固定术治疗老年人多节段脊髓型颈椎病临床疗效良好,值得推广.%Objective To explore the efficacy of multilevel anterior cervical discectomy and fusion for aged patients with cervical spondylotic myelopathy. Methods 25 aged patients with cervical spondylotic myelopathy were treated by multilevel anterior cervical discectomy and fusion. Japanese Orthopedic Association (JOA) scores were evaluated,clinical results were graded from excellent to poor using Odoms criteria,and the sagittal alignment of fusion segements were measured using Cobb method. Bone fusion and complications was evaluated. Results The final follow up score according to Odoms criteria was excellent in 8 patients ,good in 14 patients,and fair in 3 patients ,with excellent and good rate of 88%. The JOA score at final follow up(7.8) was significantly higher than preoperative(12. 8),with average improvement rate of 54%. At final follow up,bone fusion rate was 100%. Conclusion Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy was effective.

  6. [Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases].

    Science.gov (United States)

    Achouri, M; Hilmani, S; Lakhdar, H; Ait Ben Ali, S; Naja, A; Ouboukhlik, A; el Kamar, A; el Azhari, A; Boucetta, M

    1997-01-01

    This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction. PMID:9452797

  7. Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

    Directory of Open Access Journals (Sweden)

    Yusuf Kurtuluş Duransoy

    2013-01-01

    Full Text Available Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.

  8. Complications of Anterior and Posterior Cervical Spine Surgery

    OpenAIRE

    Cheung, Jason Pui Yin; Luk, Keith Dip-Kei

    2016-01-01

    Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achi...

  9. Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

    OpenAIRE

    Korovessis, Panagiotis; Katonis, Pavlos; Aligizakis, Agisilaos; Christoforakis, Josef; Baikousis, Andreas; Papazisis, Zisis; Petsinis, Giorgos

    2001-01-01

    The authors report on 32 consecutive patients with instability at the craniocervical, cervical and cervicothoracic regions suffering from various pathologies, who were treated with posterior instrumentation and fusion using the posterior hooks-rods-plate cervical compact Cotrel-Dubousset (CCD) instrumentation alone or, in three patients, in combination with anterior operation. The patients were observed postoperatively for an average of 31 months (range 25–44 months) and evaluated both clinic...

  10. In Vivo and In Vitro Study of a Polylactide-Fiber-Reinforced β-Tricalcium Phosphate Composite Cage in an Ovine Anterior Cervical Intercorporal Fusion Model

    Directory of Open Access Journals (Sweden)

    Janek Frantzén

    2011-01-01

    Full Text Available A poly-70L/30DL-lactide (PLA70–β-tricalcium phosphate (β-TCP composite implant reinforced by continuous PLA-96L/4D-lactide (PLA96 fibers was designed for in vivo spinal fusion. The pilot study was performed with four sheep, using titanium cage implants as controls. The composite implants failed to direct bone growth as desired, whereas the bone contact and the proper integration were evident with controls 6 months after implantation. Therefore, the PLA70/β-TCP composite matrix material was further analyzed in the in vitro experiment by human and ovine adipose stem cells (hASCs and oASCs. The composites proved to be biocompatible as confirmed by live/dead assay. The proliferation rate of oASCs was higher than that of hASCs at all times during the 28 d culture period. Furthermore, the composites had only a minor osteogenic effect on oASCs, whereas the hASC osteogenesis on PLA70/β-TCP composites was evident. In conclusion, the composite implant material can be applied with hASCs for tissue engineering but not be evaluated in vivo with sheep.

  11. 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

  12. Comparative study on the effect of anterior and posterior decompression in the treatment of multi-segmental cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Liang Li; Mei-Lin Jiang; Xiao-Jun Yang

    2016-01-01

    Objective: To analyze and compare the clinical efficacy of anterior and posterior decompression in the treatment of multi-segmental cervical spondylotic myelopathy (MCSM), providing certain guidance for the clinical treatment. Methods:A total of 72 patients with MCSM who were admitted in our hospital from September, 2012 to October, 2014 were included in the study and divided into the anterior group (n=37) and the posterior group (n=35) according to different surgical methods. The patients in the anterior group were given anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF), while the patients in the posterior group were given laminoplasty (LP). The general materials, surgical materials, and postoperative functional recovery in the two groups were compared. Results:The comparison of gender, age, course, preoperative JOA score, follow-up time, and affected segment between the two groups was not statistically significant. The operation time in the anterior group was significantly longer than that in the posterior group, but the intraoperative amount of bleeding was significantly less than that in the posterior group. The postoperative spinal cord function in the two groups was significantly improved when compared with before operation;moreover, the improved degree in the anterior group was more obvious. The postoperative cervical physiological curvature in the anterior group was significantly increased, but in the posterior group was significantly reduced. The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant. Conclusions:The anterior and posterior surgeries in the treatment of MCSM can significantly improve the postoperative spinal cord function, among which the anterior surgery can effectively recover the cervical physiological curvature. It is recommended that an appropriate surgical method should be reasonably selected by comprehensively considering the

  13. 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

  14. 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.

  15. Anterior retropharyngeal approach to the cervical spine.

    OpenAIRE

    Behari S; Banerji D; Trivedi P; Jain V; Chhabra D

    2001-01-01

    The anterior retropharyngeal approach (ARPA) accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing ...

  16. 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...

  17. Anterior spinal artery syndrome of the cervical hemicord.

    Science.gov (United States)

    Baumgartner, R W; Waespe, W

    1992-01-01

    Three patients developed signs of a unilateral cervical cord lesion 6 to 36 h after the acute onset of severe cervico-brachial pain. The neurological deficit progressed over 6 to 18 h. On the painful side a central Horner's syndrome, a hemiparesis with plegia of the hand, and a slight pallhypaesthesia were found. On the opposite side thermhypaesthesia and hypalgesia were noted with a level at the dermatome C5 or C6. T2-weighted MR images revealed in one patient a small area of increased signal intensity restricted to one half of the cervical cord, and electromyography in another patient showed after 6 months evidence of segmental chronic denervation. Both abnormalities were found at the clinically expected level. The findings are consistent with a small infarction of the cervical cord in the perfusion territory of a central (sulco-commissural) artery, a duplicated anterior spinal artery or an anterior spinal branch of the vertebral artery. PMID:1315578

  18. 用自体骨赘填充椎体护架行颈前路椎间融合手术的临床观察%Clinical observation of treatment with Cage filled with osteophyte in anterior cervical disectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    王兴武; 陆建猛; 俞武良; 韦勇力; 方明

    2014-01-01

    目的 观察单纯采用椎体骨赘填充椎体护架(Cage)行颈前路椎体间融合的融合率.方法 2010年1月至2012年7月,对81例行颈前路椎间盘切除减压、融合、钛板内固定手术的患者单纯采集手术间隙椎体前后缘的骨赘填充Cage.男52例,女29例;年龄55~78岁,平均64.1岁,单节段手术46例,双节段35例.术后3个月、6个月和1年复查颈椎X线片和CT观察重建融合效果.结果 术后3个月总融合率为76.5%(62/81),单节段融合率为78.3%(36/46),双节段融合率为74.3%%(26/35).术后6个月总融合率为93.8%(76/81),单节段融合率为95.7%(44/46),双节段融合率为91.4%(32/35).术后1年总融合率为100%(81/81).不同节段手术的融合率差异无统计学意义. 结论 对颈前路单节段或双节段手术,以骨赘填充Cage进行椎体间融合可获得满意的融合率.%Objective To observe the fusion rate by using cage filled with osteophyte in anterior cervical disectomy and fusion.Methods From January 2010 to July 2012,81 patients receiving anterior cervical disectomy and spine fusion underwent treatment with cages containing exclusively autologous osteophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space.There were 52 males and 29 females,aged from 55 to 78 years,average 64.1 years in this study.46 patients received one-level fusion,and 35 patients received two-level fusion respectively.Patients were followed up at 3 months,6 months and 1 year after operation.The fusion was evaluated by X-ray film and reconstructive CT.Results The total fusion rate after 3 months of operation was 76.5% (62/81),the one-level and two-level fusion rate were 78.3% (36/46) and 74.3% (26/35),respectively.The total fusion rate after 6 months of operation was 93.8% (76/81),the one-level and two-level fusion rate were 95.7% (44/46) and 91.4% (32/35),respectively.The total fusion rate was 100% (81/81) after 1 year of

  19. Anterior and Posterior Approaches in One Stage Operation for Treatment of Cervical Spondylotic Myelopathy with Cervical Spine Threaded Fusion Cage%应用颈椎螺旋融合器前后路一次性手术 治疗脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    袁峰; 龚维成; 郭开今; 周冰; 葛保健

    2001-01-01

    Objective: To discuss the procedure and the clinical significance of one stage operation accomplished through posterior and anterior routes with threaded fusion cage (TFC) for the treatment of cervical spondylotic myelopathy (CSM) of severe multi-segmental cervical disc herniation, intervertebral instability and spinal canal stenosis. Methods: The posterior approach was carried out with laminoplasty or laminectomy firstly on 7 patients, then the anterior intervertebral decompression was executed and the TFC was planted. Assessment after surgery was based on the recovery rate using the scoring system of the Japanese Orthopaedic Association. Results: The average follow-up were 12 months. After operation 7 patients′ skin sensation showed improvement and limb muscle strength elevated. The overall mean improvement was 76.2%. Conclusion: The procedure is decompressed completely and carried safely. The instability of the cervical spine is resolved.%目的:对合并发育性颈椎管狭窄的严重的多节段颈椎间盘突出及不稳的脊髓型颈椎病患者应用颈椎螺旋融合器前后路一次性手术治疗,并进行分析。方法:对7例合并发育性颈椎管狭窄的多节段颈椎间盘突出及不稳的脊髓型颈椎病患者先行后路颈椎单开门椎板成形术或颈椎板切除减压术,然后前路行颈椎间盘、骨赘切除减压颈椎螺旋融合器植入术,术后采用日本整形外科学会标准17分法进行测评。结果:平均随访时间12个月,7例患者术后均有不同程度皮肤感觉改善和四肢肌力提高,其中2例大小便障碍者括约肌功能恢复,脊髓功能的平均改善率为76.2%。结论:本手术方法减压彻底,具有安全性,颈椎螺旋融合器的应用解决了颈椎间稳定性问题。

  20. Anterior Cervical Surgery Cervical Disc Experience%颈椎前路手术治疗颈椎间盘突出症体会

    Institute of Scientific and Technical Information of China (English)

    吴向东; 刘绍武; 唐佩福

    2012-01-01

    Objective:Observation of the anterior cervical surgical treatment of cervical disc herniation .Methods:52cases of cervical disc herniation, anterior cervical decompression, bone graft and application of cervical locking anterior plate internal fixation. Results:46 cases after 2~ 18months, anaverage of 8.2 months of follow-up of all cases of graft to achieve bone fusion, the integration time of 12 ~ 16 weeks, with an average of 12.6 weeks, 100% of the fusion rate; MRI examination of spinal cord deformation. The compression performance of spinal cord function tests, with the exception of three cases of unsatisfactory outside. The results were satisfactory in all cases bone graft. Conclusion:Indications to choose the right anterior cervical decompression surgery bone graft and plate system is simple and can provide a fixed segmental stability, conducive to the recovery of neurological function, applicable to the treatment of cervical disc herniation, cervical trauma. Anterior cervical surgery for two cervical disc, three vertebrae. Power and restricted anterior cervical fixation materials was no significant differencein clinical therapy.%目的:观察颈椎前路手术治疗颈椎间盘突出症的疗效.方法:对52例颈椎间盘突出症,行颈椎前路减压、植骨并应用锁定型颈椎前路钢板内固定.结果:46例经过2~18个月、平均8.2月的随访,所有病例植骨均达到骨性融合,融合时间12~16周,平均12.6周,融合率100%;MRI检查无脊髓变形、受压表现,脊髓功能检查,除3例不理想外.所有病例植骨疗效满意.结论:适应症选择正确,颈椎前路手术减压植骨、钢板系统操作简单,可提供有效的固定节段稳定性,利于神经功能恢复,适用于颈椎间盘突出症、颈椎外伤的治疗.颈椎前路手术适用于2个颈椎间盘,3个椎体.动力性和限制性颈椎前路内固定材料在临床治疗疗效上无明显差别.

  1. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... see better here. This is number three vertebrae, number four can incise the disc. We're still well in front of the spinal cord, which is deep and behind the vertebrae here. So this is the first part of the procedure, the discectomy, which means ...

  2. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... this point, we've cleaned out the disc space and we're going to put in distracting ... visualize better towards the back of the disc space. And this will open the space as you ...

  3. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... also on this side, which is her left side. The upper level is now decompressed, so we'll move down to the lower level and do the same thing again, spreading the disc space open, thinning the ...

  4. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... going to make this small incision on the right side of her neck. So the skin is ... coagulate little blood vessels. We're on the right side of her neck, and going between muscles ...

  5. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... is going to be a hormone bone morphogenic protein that will -- it's actually good to have some ... of the cage. This is the bone morphogenic protein, which has been mixed up on a sponge ...

  6. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... family that we're finishing up. I'll be out in about ten minutes to talk to them. This is a skin stitch and it's a dissolvable stitch because it's a particular --. Everything seemed to go very well. Her spinal cord is now decompressed. The nerves ...

  7. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available ... We control bleeding with these small forceps that send a current through them that coagulate little blood ... here called the platysma. I'm going to send word out to the family that we're ...

  8. 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.

  9. 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

  10. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Laryngeal dislocation after ventral fusion of the cervical spine

    Directory of Open Access Journals (Sweden)

    Jenny Krauel

    2013-01-01

    Full Text Available We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5 for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery - laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences. Leftward dislocation of the larynx became apparent post-operatively, but prior to extubation. Extubation was therefore postponed and a subsequent computed tomography (CT scan revealed entrapment of laryngeal structures within the osteosynthesis. A trial of repositioning using microlaryngoscopy performed by otolaryngology (ears, nose and throat specialists failed, making open surgical revision necessary. At surgery, the entrapped laryngeal tissue was successfully mobilised. Laryngeal oedema developed despite prompt repositioning; thus, necessitating tracheotomy and long-term ventilation. Laryngeal dislocation may be an unusual cause of post-operative neck swelling after anterior cervical spine surgery and should be considered in the differential diagnosis if surgical site haematoma and other causes have been ruled out. Imaging studies including CT of the neck may be needed before extubation to confirm the suspicion and should be promptly obtained to facilitate specific treatment.

  13. Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

    OpenAIRE

    Yalamanchili, Praveen K.; Vives, Michael J.; Chaudhary, Saad B.

    2012-01-01

    Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Rec...

  14. Multisegmental cervical ossification of the posterior longitudinal ligament: Anterior vs posterior approach

    Directory of Open Access Journals (Sweden)

    Jain Subodh

    2005-01-01

    Full Text Available Aims : To determine the surgical approach in patients with multisegmental (four or more segments OPLL of the cervical spine. Methods and Materials : Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion=14 patients or posterior approach (laminectomy=12, laminoplasty=1 patient for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. Results : There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. Conclusions : In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.

  15. 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

  16. Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    L(U) Guo-hua; WANG Bing; KANG Yi-jun; LU Chang; MA Ze-min; DENG You-wen

    2009-01-01

    To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondyli-tis-(AS) and the effect of combined anterior and posterior operation. Methods: Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D accord-ing to Frankel's score. There were 15 cases of Grade Ⅲ dislocation and 3 cases of Grade Ⅱ. All patients underwent surgical procedures by combined anterior and posterior approach.Results: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-an-terior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neorological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up. Conclusions: The study suggests that anterior com-bined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.

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

    Directory of Open Access Journals (Sweden)

    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

  18. Results of the biocompatible osteoconductive polymer (BOP) as an intersomatic graft in anterior cervical surgery.

    Science.gov (United States)

    Ibáñez, J; Carreño, A; García-Amorena, C; Caral, J; Gastón, F; Ferrer, E

    1998-01-01

    Eighty-two patients operated on in our Department between 1989 and 1995 with an anterior cervical approach for soft and hard cervical disc herniations and cervical stenosis were included in this study. In 41 cases a heterologous intersomatic bovine graft (Surgibone) was used. Another 41 patients underwent surgery with a biocompatible osteoconductive polymer (BOP) as intervertebral graft. Both groups were retrospectively reviewed and compared with the objectives of evaluating the biodynamic behaviour of the grafts in the intersomatic space, the complications which appeared (specially those related to the grafts), the bone fusion rate achieved and the clinical outcome of the patients. The results of our study show that the BOP group presented a higher tendency to intersomatic space collapse 6 months after discectomy. There were no differences in the general surgical complications between both groups, but those related directly to the graft were significantly higher in the BOP group. The vast majority of the graft complications recorded had no clinical correlation. Without a strict radiological follow-up such complications would never have been discovered. Bone fusion in the BOP group was significantly slower and worse. Finally, the clinical outcome in both groups did not show any significant difference. PMID:10398991

  19. The advantages of submandibular gland resection in anterior retropharyngeal approach to the upper cervical spine

    OpenAIRE

    Skaf, Ghassan S.; Sabbagh, Amira S.; Hadi, Usamah

    2006-01-01

    Anterior surgery to the upper cervical spine, although rare, several successful approaches were described in the literature. To avoid the risks and limitations of transoral approach, the anterior retropharyngeal approach was developed. In this study, we describe our experience with anterior retropharyngeal approach to the upper cervical spine and discuss the significance of resecting the submandibular gland. From July 2001 to July 2004, we performed six anterior prevascular retropharyngeal ap...

  20. Vergleich klinischer und radiologischer Parameter nach anteriorer Diskektomie und Fusion der Halswirbelsäule mit Polyetheretherketon- und Titan-Cages

    OpenAIRE

    Özdemir, Soner

    2015-01-01

    Background: Compared with polyetheretherketone (PEEK) titanium (TTN) cages have a higher modulus of elasticity and are reported to show a higher loss of correction and more frequent cage subsidence after anterior cervical discectomy and fusion (ACDF). Direct comparison of both cage types appears to favour PEEK cages to maintain cervical interspace height and achieve better fusion in patients with a degenerative disc disease (DDD), but clinical studies on this subject are very rare. Metho...

  1. A comparative study on the treatment of cervical spondylosis with the surgery of dynamic cervical implant implantation and anterior decompression fusion with cage%颈椎动态稳定器植入与颈前路减压融合内固定治疗脊髓型颈椎病的比较

    Institute of Scientific and Technical Information of China (English)

    贾杰; 刘宏建; 尚国伟; 吴志彬; 王俊魁; 周权发; 皮国富

    2015-01-01

    目的 比较颈椎动态稳定器(DCI)植入术与颈前路减压融合内固定术(ACDF)治疗单节段脊髓型颈椎病的中期疗效.方法 对行DCI植入术(DCI组)的23例患者,与行颈前路减压融合内固定术(ACDF组)的47例患者进行随访,分别于术后24、36、48个月末行日本矫形外科协会(JOA)评分,并拍摄X线片观察手术节段椎间隙的高度和活动度以及上下邻近节段的活动度.结果 两组术后各期的JOA评分和椎间隙高度与术前比较差异均有统计学意义(P<0.05),随访各期组间比较差异无统计学意义(P>0.05).DCI组手术节段的活动度在各随访期末与术前比较差异无统计学意义(P>0.05);其上下邻近节段的活动度在随访期末[(6.99±0.56)°、(6.83±0.35)°]与术前[(6.78±0.51)°、(6.63 ±0.48)°]比较差异无统计学意义(P>0.05),而ACDF组随访期末上下邻近节段活动度[(8.56 ±0.51)°、(8.34±0.43)°]均较术前[(6.81±0.53)°、(6.67±0.49)°]增加(P<0.05).结论 两种手术均能明显缓解患者症状,恢复并维持椎间隙高度.与ACDF比较,DCI为手术节段提供持续的动态稳定,可减缓邻近节段的退变,但手术节段的椎体可能出现退变增生.%Objective To compare post-operative mid-term clinical outcomes between dynamic cervical implant (DCI) non-fusion group and anterior cervical discectomy and fusion (ACDF) group.Methods From March 2011 to January 2013, 23 patients were subjected to DCI non-fusion and 47 to ACDF respectively.The clinical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores and all treated patients re-examined by lateral (full extention) views during follow-up at 24th month, 36 month, and 48 month respectively aiming to observe the intervertebral height of the treated level and the segmental range of motion (ROM) of adjacent levels of treated 1 evel in both two groups.Results Both the two groups showed good clinical outcomes by JOA scores.We found no

  2. Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases

    Institute of Scientific and Technical Information of China (English)

    LI Lei; ZHOU Feng-hua; WANG Huan; CUI Shao-qian

    2008-01-01

    Objective: To evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases. Methods: Twenty-three consecutive patients with up-per cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation (4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson Ⅱ C, 3 ruptures of the C1 transverse ligament, and 2 fractures ofC1), 2 cases ofC2 tumor (instability after the resection of the tumors), and 2 giant neurilemomas of C2-C3(instability after resection of the tumors), were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of Cr The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT. Results: In the 23 patients, 46 C1 pedicle screws, 42 C2 pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months (average 15 months). Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure. Conclusions: Posterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.

  3. Risk factors and treatment strategy for adjacent segment diseases after anterior cervical decompression and fusion%颈椎前路融合术后邻近节段退变性疾病的原因分析及治疗策略

    Institute of Scientific and Technical Information of China (English)

    王洪立; 姜建元; 吕飞舟; 马晓生; 夏新雷; 王立勋

    2014-01-01

    目的 探讨颈椎前路融合术后邻近节段退变性疾病的发生原因及治疗策略.方法 对2005年12月至2012年8月颈椎前路减压融合术后并发邻近节段退变性疾病的14例进行回顾性分析.男10例,女4例,初次手术年龄36~68岁,平均(52.0±11.0)岁.测量初次手术后颈椎整体曲度、手术节段局部曲度、钢板与上、下间隙的距离.二次手术时对节段数量≤2个且不伴严重后纵韧带或黄韧带骨化的9例采用颈椎前路减压融合内固定术,对节段数量≥3个且不伴明显后凸畸形、排列不稳及严重黄韧带骨化的3例采用颈椎后路减压椎管扩大成形术,对伴有明显后凸畸形、排列不稳且因技术原因无法行前路减压及合并严重黄韧带骨化的2例采用颈椎后路全椎板切除减压融合术.结果 初次术后邻近节段退变性疾病的发生时间为(9.3±4.4)年,二次手术时患者年龄(61.3±12.4)岁.初次术后颈椎整体曲度与手术节段局部曲度分别为12.4°±10.8°、1.5°±6.8°;钢板与上、下间隙的距离分别为(0.9±1.8)mm、(3.8±3.2) mm.二次术后平均随访(30.4±17.8)个月,末次随访时日本骨科学会颈椎病疗效评分改善率为73.9%±9.7%.结论 钢板与邻近间隙距离过小、手术节段局部曲度恢复不良可能是前路融合术后邻近节段退变性疾病的发生原因;二次手术方案的选择应根据病变累及节段、致压因素、颈椎曲度等因素进行综合分析.%Objective To investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males

  4. 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

  5. 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

  6. Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy

    OpenAIRE

    Warren, Daniel T.; Ricart-Hoffiz, Pedro A.; Andres, Tate M.; Hoelscher, Christian M.; Protopsaltis, Themistocles S.; Goldstein, Jeffrey A; Bendo, John A.

    2013-01-01

    Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM....

  7. Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: Analysis of outcomes in 204 patients

    OpenAIRE

    Xu, Risheng; Bydon, Mohamad; Sciubba, Daniel M.; Witham, Timothy F.; Wolinsky, Jean-Paul; Gokaslan, Ziya L; Bydon, Ali

    2011-01-01

    Background: Many studies offer excellent demonstration of the ability of bone morphogenic protein (BMP) to enhance fusion rates in anterior as well as posterior lumbar surgery. Recently, BMP has also been shown to increase arthrodesis rates in anterior cervical surgery, albeit with concomitant increases in complication rates. To date, however, few studies have investigated the safety and efficacy of BMP in cervical surgeries approached posteriorly. Methods: We retrospectively reviewed 204 con...

  8. Distracted cervical spinal fusion for management of caudal cervical spondylomyelopathy in large-breed dogs

    International Nuclear Information System (INIS)

    Using an autogenous bone graft (obtained from the iliac crest), 4-mm cancellous bone screws, and polymethylmethacrylate, a distracted cervical spinal fusion technique was performed on 10 dogs with myelographic evidence of caudal cervical spondylomyelopathy. All dogs had evidence of dynamic soft tissue spinal cord compression, as indicated by flexion, extension, and traction myelographic views. Of the 10 dogs, 4 previously had undergone surgery by use of ventral slot or cervical disk fenestration techniques, and their neurologic status had deteriorated after the original surgery. Preoperative neurologic status of the 10 dogs included nonambulatory tetraparesis (n = 5), severe ataxia with conscious proprioceptive deficits (n = 2), and mild ambulatory ataxia with conscious proprioceptive deficits (n = 3). Five dogs had signs of various degrees of cervical pain. Clinical improvement was observed in 8 of 10 dogs--either improved neurologic status or elimination of cervical pain. Implant loosening developed in 3 dogs; 2 of them were euthanatized because of lack of neurologic improvement. Radiographic evidence of bony cervical fusion was observed during a 9- to 24-week period in 6 of the 8 surviving dogs. The distracted cervical fusion technique appears to be a valid surgical procedure to manage cervical spondylomyelopathy in those dogs in which the lesions are limited to one cervical intervertebral disk space

  9. One stage anterior-posterior approach for traumatic at- lantoaxial instability combined with subaxial cervical spinal cord injury

    Directory of Open Access Journals (Sweden)

    WANG Chang-sheng

    2011-06-01

    Full Text Available 【Abstract】 Objectives: To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury (CSCI, and to analyze the feasibility, indication and therapeutic effects of ante- rior-posterior approach in such cases. Methods: From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixa- tion and bone graft fusion were conducted to manage trau- matic 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 pa- tients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association (JOA scores ranged from 10 to 16 one year postoperatively, 13.95±2.06 on average (improvement rate=70.10%. X-rays, spiral CT and MRI con- firmed normal cervical alignments, complete decompression and fine implants’ position. There was no breakage or loos- ening 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 immedi- ately restore the normal alignments and stability of the cer- vical spine and effectively

  10. Surgical Treatments on Patients with Anterior Cervical Hyperostosis-Derived Dysphagia

    OpenAIRE

    Song, Ah Rom; Yang, Hee Seung; Byun, Eunjin; Kim, Youngbae; Park, Kwan Ho; Kim, Kyung Lyul

    2012-01-01

    Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight lo...

  11. Anterior versus posterior approach for four-level cervical spondylotic myelopathy.

    Science.gov (United States)

    Lin, Dasheng; Zhai, Wenliang; Lian, Kejian; Kang, Liangqi; Ding, Zhenqi

    2013-11-01

    The purpose of this study was to compare the results of 2 surgical strategies for 4-level cervical spondylotic myelopathy: a hybrid procedure using anterior cervical diskectomy and fusion (ACDF) combined with segmental corpectomy versus posterior laminectomy and fixation. Between 2002 and 2010, fifty-one patients with consecutive 4-level cervical spondylotic myelopathy were treated surgically, with 27 patients undergoing the hybrid procedure and 24 undergoing posterior laminectomy and fixation. Radiologic data were compared between the 2 groups, including cervical curvature and cervical range of motion (ROM) in the sagittal plane. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system and the Nurick grading system. Mean ROM at last follow-up was not significantly different between the 2 groups (P>.05). In the hybrid group, mean JOA score and Nurick grade improved from 9.6±1.4 and 2.74±0.45 respectively, preoperatively, to 13.9±1.3 and 0.86±0.38 respectively, postoperatively. In the fixation group, mean JOA score and Nurick grade improved from 9.4±1.2 and 2.81±0.42 respectively, preoperatively, to 13.1±1.5 and 1.32±0.36 respectively, postoperatively. The JOA scores and Nurick grades at last follow-up were significantly different between the 2 groups (Pcervical kyphosis, preoperative JOA score and Nurick grade were not significantly different between the 2 groups (P>.05); however, JOA scores and Nurick grades at last follow-up showed better improvement in the hybrid group than in the fixation group (Pcervical lordosis, the preoperative and last follow-up JOA score and Nurick grade were not significantly different between the 2 groups (P>.05). PMID:24200449

  12. Artificial Cervical Disc Replacement Improves Mobility

    Medline Plus

    Full Text Available ... been utilized to perform anterior cervical discectomies and fusions. The fusion procedure has been the most common way to ... significant benefits over the previous procedure of the fusion, and that is, able to maintain motion of ...

  13. Effects of platelet-rich plasma on subsidence of fiber porous titanium Cage for old dogs with anterior cervical interbody fusion%富血小板血浆对老龄犬纤维多孔钛颈椎椎间融合器沉降的影响

    Institute of Scientific and Technical Information of China (English)

    曹师锋; 谢宁; 宋鑫; 赵振国; 倪明; 焦鲲; 尹伟忠

    2015-01-01

    Objective To observe the effects of platelet-rich plasma (PRP) on subsidence of fiber porous titanium (FPT) Cage for old beagle dogs with anterior cervical interbody fusion.Methods Six old healthy beagle dogs (3 male and 3 female,weighing 12.5-15.0 kg,aged 7-9 years) were selected in this study.Peripheral venous blood from dog's forelimb was collected,PRP was prepared by double centrifugal methods,and blood platelet counts of peripheral venous blood and PRP were recorded.Then the dogs underwent anterior C4/5 and C5/6 discectomy and FPT Cage interbody fusion.FPT Cage was used alone at C4/5 segment,and at C5/6 segment,FPT Cage was augmented with PRP.The animals were sacrificed in 4 months after the surgery,and the subsidence of FPT Cage was evaluated by X-ray and Micro-CT examinations.Results Subsidence of FPT Cage was found at four C4/5 segments,other two FPT Cages at C4/5 segment showed anterior migration; No subsidence of FPT Cage was observed at six C5/6 segments,only one FPT Cage with anterior dislocation was found.Conclusion Compound PRP could reduce the subsidence of FPT Cage in old aged Beagle dogs with anterior cervical interbody fusion.%目的 观察富血小板血浆(PRP)对老龄比格犬颈椎前路椎间融合术纤维多孔钛椎间融合器(FPT Cage)沉降的影响.方法 选取6只7~9岁、12.5~15.0 kg的健康比格犬(雌雄各3只)作为实验动物.取比格犬前肢外周静脉血,采用二次离心法制备PRP,同时对外周静脉血及PRP进行血小板计数.行颈椎前路C4/5、C5/6椎间盘切除、FPT Cage椎间融合术,单纯使用未浸泡PRP的FPT Cage行C4/5椎间融合,采用浸泡激活后的PRP复合FPT Cage融合C5/6,术后4个月处死实验犬后行X线片及Micro-CT检查,观察C4/5、C5/6椎间融合器的沉降情况.结果 C4/5节段有4例出现不同程度的椎间融合器沉降,另2例出现Cage向前移位;C5/6节段未有椎间融合器发生沉降,仅1例出现Cage向前移位.结论 复合PRP可减少老龄比

  14. Anterior cervical corpectomy: review and comparison of results using titanium mesh cages and carbon fibre reinforced polymer cages.

    Science.gov (United States)

    Kabir, Syed M R; Alabi, J; Rezajooi, Kia; Casey, Adrian T H

    2010-10-01

    Different types of cages have recently become available for reconstruction following anterior cervical corpectomy. We review the results using titanium mesh cages (TMC) and stackable CFRP (carbon fibre reinforced polymer) cages. Forty-two patients who underwent anterior cervical corpectomy between November 2001 and September 2008 were retrospectively reviewed. Pathologies included cervical spondylotic myelopathy (CSM), cervical radiculopathy, OPLL (ossified posterior longitudinal ligament), metastasis/primary bone tumour, rheumatoid arthritis and deformity correction. All patients were evaluated clinically and radiologically. Outcome was assessed on the basis of the Odom's criteria, neck disability index (NDI) and myelopathy disability index (MDI). Mean age was 60 years and mean follow-up was 1½ years. Majority of the patients had single-level corpectomy. Twenty-three patients had TMC cages while 19 patients had CFRP cages. The mean subsidence noted with TMC cage was 1.91 mm, while with the stackable CFRP cage it was 0.5 mm. This difference was statistically significant (p 0.05) or between subsidence and post-operative sagittal alignment (p > 0.05) in either of the groups. Three patients had significant subsidence (> 3 mm), one of whom was symptomatic. There were no hardware-related complications. On the basis of the Odom's criterion, 9 patients (21.4%) had an excellent outcome, 14 patients (33.3%) had a good outcome, 9 patients (21.4%) had a fair outcome and 5 patients (11.9%) had a poor outcome, i.e. symptoms and signs unchanged or exacerbated. Mean post-operative NDI was 26.27% and mean post-operative MDI was 19.31%. Fusion was noted in all 42 cases. Both TMC and stackable CFRP cages provide solid anterior column reconstruction with good outcome following anterior cervical corpectomy. However, more subsidence is noted with TMC cages though this might not significantly alter the clinical outcome unless the subsidence is significant (>3 mm).

  15. Ankle Joint Fusion With an Anatomically Preshaped Anterior Locking Plate.

    Science.gov (United States)

    Wiewiorski, Martin; Barg, Alexej; Schlemmer, Thomas; Valderrabano, Victor

    2016-01-01

    We present a novel fixation plate for primary ankle joint fusion. A single anatomically preshaped angular stable plate was used with an anterior approach. An excellent result with good bone consolidation was present at the 1-year follow-up examination. PMID:25998475

  16. Feasibility of low anterior cervical approach decompression and bone graft fusion for internal fixation in the treatment of patients with spine and spinal cord trauma in cervicothoracic junction%低位颈前入路减压植骨融合内固定治疗颈胸段脊柱脊髓损伤的可行性

    Institute of Scientific and Technical Information of China (English)

    刘明明; 程建; 华臻

    2015-01-01

    Objective:To explore the feasibility of low anterior cervical approach decompression and bone graft fusion for internal fixation in the treatment of patients with spine and spinal cord trauma in cervicothoracic junction.Methods:20 patients with spine and spinal cord trauma in cervicothoracic junction were selected.All patients were treated with low anterior cervical approach decompression and bone graft fusion for internal fixation.We discussed the efficacy and postoperative recovery of the patients. Results:All patients recovered well,and there was no case with loosening of the screws,loss of the titanium plate,the fracture of the titanium plate and other circumstances.Only 1 case with the position of titanium mesh not well fixed when detected by X tablets after operation.It has been adjusted after six months of surgery,after 1 year of operation,it recovered well,no titanium mesh moved. Conclusion:Patients with spine and spinal cord trauma in cervicothoracic junction with low anterior cervical approach decompression and bone graft fusion and internal fixation for the treatment can effectively promote the patients with cervicothoracic spine sequence returned to normal,and improve the patients' postoperative recovery.%目的:探讨低位颈前入路减压植骨融合内固定治疗颈胸段脊柱脊髓损伤的可行性。方法:收治颈胸段脊柱脊髓损伤患者20例,实施低位颈前入路减压植骨融合内固定治疗,对术后疗效及恢复情况进行探讨。结果:所有患者恢复良好,无一例患者出现螺钉松动、脱落、钛板断裂等情况,只有1例在术后经过X片检测后发现其钛网位置固定不佳,术后0.5年对其进行了调整,术后1年检测见其恢复良好,没有出现钛网移动情况。结论:颈胸段脊柱脊髓损伤患者采用低位颈前入路减压植骨融合内固定治疗,可以有效促进患者颈胸段脊柱序列恢复正常,改善患者的术后恢复情况。

  17. 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

  18. 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。

  19. Cervical vertebral body fusions in patients with skeletal deep bite.

    Science.gov (United States)

    Sonnesen, Liselotte; Kjaer, Inger

    2007-10-01

    Cervical column morphology was examined in 41 adult patients with a skeletal deep bite, 23 females aged 22-42 years (mean 27.9) and 18 males aged 21-44 years (mean 30.8) and compared with the cervical column morphology in an adult control group consisting of 21 subjects, 15 females, aged 23-40 years (mean 29.2 years) and six males aged 25-44 years (mean 32.8 years) with neutral occlusion and normal craniofacial morphology. None of the patients or control subjects had received orthodontic treatment. For each individual, a visual assessment of the cervical column and measurements of the cranial base angle, vertical craniofacial dimensions, and morphology of the mandible were performed on a profile radiograph. In the deep bite group, 41.5 per cent had fusion of the cervical vertebrae and 9.8 per cent posterior arch deficiency. The fusion always occurred between C2 and C3. No statistically significant gender differences were found in the occurrence of morphological characteristics of the cervical column (females 43.5 per cent, males 38.9 per cent). Morphological deviations of the cervical column occurred significantly more often in the deep bite group compared with the control group (P analysis showed that the vertical jaw relationship (P vertebrae (R(2) = 0.40).

  20. Application of a stand-alone anchored spacer in noncontiguous anterior cervical arthrodesis with radiologic analysis of the intermediate segment.

    Science.gov (United States)

    Shi, Sheng; Liu, Zu-De; You, Wen-Jie; Ouyang, Yue-Ping; Li, Xin-Feng; Qian, Lie; Zhong, Gui-Bin

    2016-03-01

    The purpose of this study was to describe the clinical features of noncontiguous cervical degenerative disc disease (cDDD), investigate the efficacy and complications of a stand-alone anchored spacer (SAAS) for patients with noncontiguous cDDD, and present radiologic analysis of the intermediate segment (IS) after skip-level fusion. Nineteen consecutive patients with noncontiguous cDDD who underwent skip-level anterior cervical discectomy and fusion (ACDF) with SAAS from January 2010 to December 2012 were enrolled in this study. Clinical outcomes were assessed preoperatively and at 24 months postoperatively using the Japanese Orthopaedic Association score, Neck Disability Index, and Visual Analog Scale. Overall cervical alignment (OCA) of the cervical spine, and the range of motion (ROM), intervertebral disc height (IDH), disc signal intensity and disc protrusion of IS were measured and compared before and after surgery. Clinical outcomes significantly improved compared to preoperative scores. The OCA was corrected and maintained at 24 months postoperatively compared with preoperative values (p0.05). However, decreased signal intensity on T2-weighted MRI was evidenced in three mobile IS at final follow-up (20.0%). Skip-level ACDF with SAAS may be an efficacious option for the treatment of noncontiguous cDDD. PMID:26597607

  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. 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.

  3. 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%.

  4. Commentary on the effect of steroid use in anterior cervical discectomy and fusion surgery; a randomized controlled trial by Shiveindra B. et al. Journal of Neurosurgery Spine 2015;23:137-43

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Conclusions: The authors concluded that dexamethasone administered at the time of ACDF surgery improved swallowing within the 1 st postoperative month, reduced perioperative airway complications, reduced the length of stay, and reduced 6 month but not 12 month fusion rates. Although the findings regarding postoperative dysphagia are helpful, the performance of multiple 3D-CT scans postoperatively to document fusion would appear to subject these patients to excessive radiation exposure without sufficient clinical indications.

  5. 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.

  6. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Muralidharan, Aditya; Loke, Yoon K; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey

    2016-03-01

    The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries. PMID:26677786

  7. 颈前路减压并桥形椎间锁定融合器内固定术治疗Ⅱ型及Ⅱa型Hangman骨折%Anterior cervical decompression with double-way connection intervertebral fusion device implantation for type Ⅱ or type H a Hangman fracture

    Institute of Scientific and Technical Information of China (English)

    曹贵君; 孟纯阳; 张卫红; 孔祥清; 张聪

    2016-01-01

    目的 探讨颈前路减压并桥形椎间锁定融合器(ROI-C)内固定术治疗Ⅱ型及Ⅱa型Hangman骨折的临床疗效. 方法 回顾性分析自2011年2月至2014年3月14例行颈前路ROI-C置入治疗的Ⅱ型及Ⅱa型Hangman骨折患者.其中男11例,女3例;年龄22 ~46岁,平均26.4岁.致伤原因:交通伤9例,坠落伤4例,砸伤1例.按照Levine-Edwards分型:Ⅱ型9例,Ⅱa型5例.所有患者入院均行颈椎正侧位X线片、CT平扫及三维重建、MRI检查.术前神经功能按美国脊髓损伤协会(ASIA)分级均为E级.记录术前及末次随访时的创伤后颈椎临床评分、视觉模拟评分(VAS)、枢椎移位及成角数据;观察椎问节段融合情况,有无椎间隙塌陷、融合器移位及畸形愈合. 结果 14例患者均手术顺利,手术时间平均为61 min(45 ~ 116 min).术中无喉上神经、舌下神经、咽喉壁及血管损伤;术后无喉头水肿、吞咽困难、舌肌瘫痪、血肿形成及伤口感染等并发症.平均随访24.2个月(4~32个月),手术融合节段及骨折部位平均于术后3个月时骨性融合,末次随访时融合器无下沉、移位,椎间无塌陷,未见畸形愈合.创伤后颈椎临床评分:术前(53.1±7.2)分,末次随访时(91.1±5.0)分(P<0.05);颈部疼痛VAS:术前3.38 (2.43,4.33)分,末次随访时0.58(0,1.29)分(P<0.05);枢椎移位:术前(4.0±1.5)mm,末次随访时(1.3±1.2)mm(P<0.05);枢椎成角:术前(9.2±4.7)°,末次随访时(2.1±1.9)°(P<0.01). 结论 应用ROI-C行颈前路融合手术治疗Ⅱ型及Ⅱa型Hangman骨折,可以获得良好的融合率,临床疗效满意.%Objective To analyze the clinical effect of anterior cervical decompression with double-way connection intervertebral fusion device (ROI-C) implantation for type Ⅱ or type Ⅱ a Hangman fracture.Methods A retrospective study was made on 14 patients with type Ⅱ or type Ⅱ a Hangman fracture treated with anterior cervical ROI-C implantation between February 2011

  8. Simultaneously Combined Anterior-Posterior Approaches for Subaxial Cervical Circumferential Reconstruction in a Sitting Position.

    Science.gov (United States)

    Han, Yue; Xia, Qun; Hu, Yong-cheng; Zhang, Ji-dong; Lan, Jie; Ma, Xin-long

    2015-11-01

    The purpose of this article is to introduce and analyze the feasibility of simultaneously combined anterior-posterior approaches for subaxial cervical circumferential reconstruction in sitting position. A retrospective case review was performed for above surgery procedure. A 79-year-old man was confirmed subaxial cervical fracture and dislocation with facet locked by radiological examination, and the involved levels were C5-6. According to American Spinal Injury Association (ASIA) classification, the impairment scale was grade B. And the Subaxial Cervical Spine Injury and Severity Score (SLIC) were 9. The patient was restricted in sitting position with traction on a halo in extension to immobilize the head during the operation. A posterior laminectomy and pedicle screws insertion to the involved cervical spine was performed firstly. And then the anterior discectomy and strut graft were accomplished through an anterior cervical approach. The final fixation was finished by clamping the strut graft with pedicle screw system. Total blood loss was 600 ml and the total operating time was 150 min. The patient was followed up for 6 months. The symptom of neck pain improved distinctly and no evidence about implant failure was noted. Neurological status improvement was confirmed and the ASIA scale was improved to grade C. We believed that the simultaneously combined anterior-posterior approach in sitting position was safe and more advantageous for appropriate cases. PMID:26790982

  9. In vitro comparison of bioresorbable and titanium anterior cervical plates in the immediate postoperative condition.

    Science.gov (United States)

    Freeman, Andrew L; Derincek, Alihan; Beaubien, Brian P; Buttermann, Glenn R; Lew, William D; Wood, Kirkham B

    2006-12-01

    Bioresorbable plates have recently been used with anterior cervical discectomy and fusion (ACDF). Compared with metallic plates, bioresorbable plates provide segmental stabilization with minimal imaging artifact, eventual resorption, and increased load sharing. The objectives of the present study were to determine whether a bioresorbable plate can withstand simulated physiologic static and cyclic loading, to compare the reduction in flexibility provided by bioresorbable and titanium plates, and to quantify load sharing between the plate and spine with graft. Sixteen human cervical motion segments were tested to +/-2.5 Nm in flexion-extension, lateral bending, and axial rotation. Range of motion (ROM) was measured (1) in the intact state, (2) with ACDF without plating, (3) after addition of either a bioresorbable or titanium plate, and (4) after 500 cycles of combined flexion-extension and axial torsion. Load sharing was evaluated by applying the same fixed rotation both without and with the plate, and was calculated as the moment resisted by the uninstrumented ACDF expressed as a percentage of the plated ACDF state. No plate failures or graft migration occurred during testing. Compared with the uninstrumented ACDF, bioresorbable plates reduced mean ROM by 49% in flexion-extension and 25% in lateral bending, with very little change in torsion. Titanium plates reduced uninstrumented ACDF ROM by 69% in flexion-extension, 45% in lateral bending, and 27% in torsion. Differences between bioresorbable and titanium plates were significant in flexion-extension and lateral bending. Cyclic loading did not significantly change ROM for either plate. More moment was shared in lateral bending by the spine/graft with bioresorbable plates (78%) compared with titanium plating (63%). Bioresorbable plates contained an intervertebral graft, provided some stabilization, remained intact throughout the simulated immediate postoperative loading, and shared more load with the graft and

  10. 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

  11. Cervical nerve root decompression by lateral approach as salvage operation after failed anterior transdiscal surgery: technical case report

    OpenAIRE

    Cornelius, Jan Frédérick; George, Bernard

    2009-01-01

    Cervical nerve root compression caused by disco-osteophytic changes is classically operated by anterior transdiscal approach with disc replacement. If compression persists or recurs, reoperation via the same surgical route may be difficult, because of scar tissue and/or implants. An alternative approach may be necessary. We recommend the lateral cervical approach (retrojugular) as salvage operation in such cases. We report a patient with cervical nerve root compression operated by anterior tr...

  12. Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients

    Directory of Open Access Journals (Sweden)

    Victor Chang

    2014-01-01

    Conclusion: Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon′s armamentarium.

  13. 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.

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

    OpenAIRE

    Víctor Rodrigo Paradells; Juan Bosco Calatayud Pérez; Francisco Javier Díaz Vicente; Luciano Bances Florez; Marta Claramonte de la Viuda; Francisco Javier Villagrasa

    2014-01-01

    Background: The number of esophageal and pharyngeal perforations occurring in anterior cervical surgeries ranges from 0.25% to 1% and 0.2% to 1.2%, respectively. Symptoms usually appear postoperatively and are attributed to: Local infection, fistula, sepsis, or mediastinitis. Acute postoperative hematoma, although very rare (

  15. Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

    Directory of Open Access Journals (Sweden)

    Praveen K. Yalamanchili

    2012-01-01

    Full Text Available Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment.

  16. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy

    Directory of Open Access Journals (Sweden)

    Salih Gulsen

    2015-03-01

    CONCLUSION: We achieved better cervical lordotic angles at the postoperative period by implanting one-level, two-level, three-level or four-level PEEK cage filled with demineralized bone matrix. Also, the causes of cervical root and or medulla spinalis impingement were different in group1 and 2. While extruded cervical disc impingement was the first pathology in group 1, osteophyte formation was the first pathology in group 2.

  17. 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

    OpenAIRE

    Marcel Luiz Benato; Ed Marcelo Zaninell; Xavier Soler i Graells; Marcos Andre Sonagli

    2009-01-01

    OBJETIVO: avaliar a taxa de consolidação em pacientes submetidos à artrodese cervical anterior de três e quatro níveis utilizando dispositivo intersomático não associado à placa cervical no sexto mês de pós-operatório. MÉTODOS: no período de Novembro de 2005 a Julho de 2008, 20 pacientes foram submetidos ao tratamento cirúrgico proposto. Os critérios de inclusão foram: diagnóstico clínico e por imagem de doença discal degenerativa cervical em três ou quatro níveis; dor axial e/ou irradiada co...

  18. 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.

  19. One stage solution and posterior fusion surgery through the high anterior cervical retropharyngeal approach for irreducible atlantoaxial dislocation%一期前方咽后入路松解后路融合治疗难复性寰枢椎脱位

    Institute of Scientific and Technical Information of China (English)

    徐峰; 蔡贤华; 陈庄洪; 康辉; 黄勇

    2011-01-01

    Objective To explore the feasibility of one stage solution and posterior fusion surgery through the high anterior cervical retropharyngeal approach for irreducible atlantoaxial dislocation and its curative effect. Method The solution and posterior fusion surgery was performed in 12 patients (age range, 26~58 years; mean age, 46 years) with irreducible atlantoaxial dislocation, of whom, 8 were males and 4 females. All the patients received skull traction and the translocation and rotation of the atlas were assessed by X-ray, MRI and CT three-dimensional reconstruction before the surgery in all the patients. The articular capsules of articulatio atlantoepistrophicas were exposed and the scar tissue and steophyma were resected by the surgery. With continuous skull traction, the atlas was reduced and fixed with pedicle screws and the atlantoaxial fusion was performed by iliac bone graft during one stage surgery. Japanese orthopaedic Association (JOA) score system was used to evaluate the clinical outcomes before the surgery and 12 months after the surgery. Results All the patients were followed up from 12 to 28 months (mean, 18 months). Hypoglossal palsy occurred in one patient, who recovered from hypoglosed palsy 2 months after the surgery. The nerves, vertebral arteries and esophagus injuries, and leakage of cerebrospinal fluid were not observed in all the patients. JOA score [(15.6±l.l)points] was significantly higher 12 months after the surgery than that [(9.3±l.l)points] before the surgery (P<0.05). The grafted bones was well fused into the receptor bones and there was good internal fixation in all the patients. Conclusion The one stage solution and posterior fusion surgery through the high anterior cervical retropharyngeal approach is an effective method to treat the irreducible atlantoaxial dislocation.%目的 探讨一期颈椎前方高位咽后入路松解后路寰枢椎融合治疗难复性寰枢椎脱位的可行性及效果.方法 本组共收治

  20. Pulmonary function after less invasive anterior instrumentation and fusion for idiopathic thoracic scoliosis

    OpenAIRE

    Huitema, Geertje C; Jansen, Rob C; Dompeling, Edward; Willems, Paul; Punt, Ilona; Lodewijk W van Rhijn

    2013-01-01

    Purpose Standard thoracotomy for anterior instrumentation and fusion of the thoracic spine in idiopathic scoliosis may have detrimental effects on pulmonary function. In this study we describe a less invasive anterior surgical technique and show the pre- and postoperative pulmonary function with a minimum follow-up of 2 years. Methods Twenty patients with Lenke type 1 adolescent thoracic idiopathic scoliosis were treated with anterior spinal fusion and instrumentation. The mean preoperative C...

  1. Complication avoidance and management in anterior lumbar interbody fusion.

    Science.gov (United States)

    Than, Khoi D; Wang, Anthony C; Rahman, Shayan U; Wilson, Thomas J; Valdivia, Juan M; Park, Paul; La Marca, Frank

    2011-10-01

    The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Cervical radiculopathy.

    Science.gov (United States)

    Iyer, Sravisht; Kim, Han Jo

    2016-09-01

    Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed. PMID:27250042

  4. ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

    Institute of Scientific and Technical Information of China (English)

    沈建雄; 邱贵兴; 翁习生; 赵宏; 金今; 王以朋; 叶启彬; 林进

    2003-01-01

    Objective.To introduce a new spinal internal fixation system,Texas Scottish Rite Hospital(TSRH),and to investigate its early clinical outcomes. Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diag-nosed as idiopathic scoliosis and 1 as neuromuscular scoliosis. Results. Preoperatively,the Cobb's angle on the coronal plane was 55.8°(range 35°~78°),and 14°postoperatively,with an average correction of 74.8 %. The average unfused thoracical curve was 35.9 ° preoperatively(range 26°~51°)and 21.8°(10°~42° )postoperatively,with 40% correction. The sagittal curve of lumbar was kept physiologically,preoperative 27.9°and postoperative 25.7°respectively. The trunk shift was 13.4 mm(5~28mm)preoperatively and 3.5 mm(0~7 mm)postoperatively. The averaged apic vertebra derivation was 47.8 mm(21~69 mm)before operation and 10.8 mm(3~20 mm)after operation. The distance of C7 to center sacrum vertical line(CSVL)was 19.5 mm(16~42)preoperatively and 11.3 mm(0~32 mm)postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively,and were improved to normal in 10 patients,1 degree in 4 patients,and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side,and the symptom vanished at 3-month followed up.Conclusion. If used appropriately,TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.

  5. Clinical Application Of Locking Cervical lntervertebral Fusion Cage In Unisegmental Intervertebral Disk Hernia Of Cervical Vertebrae%锁定式颈椎融合器治疗单节段颈椎问盘突出症

    Institute of Scientific and Technical Information of China (English)

    范磊; 何斌; 邵增务; 王云华

    2011-01-01

    目的 探讨应用颈椎前路减压结合锁定式颈椎融合器治疗单节段颈椎间盘突出症的临床疗效.方法 21例单节段颈椎间盘突出症应用颈椎前路减压加锁定式颈椎融合器植骨融合术治疗,并对其疗效进行评价.结果 所有病例随访12~24个月,平均17.6个月.6个月后椎体间均达到骨性融合,无并发症出现,脊髓功能状态评分术后1个月及术后6个月优良率分别达66.67%、85.71%.结论 应用颈椎前路减压结合锁定式颈椎融合器治疗单节段颈椎间盘突出症疗效肯定.%Objective To evaluate the clinic curative effect of anterior cervical decompression and implantation of cervical intervertebral fusion cage in the treatment of unisegmental intervertebral disk hernia of cervical vertebrae. Methods 21 cases of unisegmental intervertebral disk hernia of cervical vertebrae were treated with anterior cervical decompression and implantation of locking cervical Intervertebral fusion cage and the curative effect was evaluated. Results All cases were followed up for 12~24 months (17. 6 months in average). All patients gained osseous fusion 6 monthes after the operation and there was no complication. According to the functional status score of spinal cord. The fineness rate was 66. 67% 1 month after the operation and 85. 71% 6 monthes after the operation. Conclusion The curative effect of the treatment of unisegmental intervertebral disk hernia of cervical vertebrae anterior cervical decompression and implantation of locking cervical Intervertebral fusion cage was affirmative.

  6. 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.

  7. Kinematic Changes in Swallowing After Surgical Removal of Anterior Cervical Osteophyte Causing Dysphagia: A Case Series

    OpenAIRE

    Jeong, Hyeonghui; Seo, Han Gil; Han, Tai Ryoon; Chung, Chun Kee; Oh, Byung-Mo

    2014-01-01

    This retrospective case series included five patients who underwent surgical resection of the cervical anterior osteophyte due to dysphagia. Videofluoroscopic swallowing studies (VFSSs) were performed before and after surgery on each patient, and kinematic analysis of the video clips from the VFSS of a 5-mL liquid barium swallow was carried out. Functional oral intake improved after surgery in 3/4 patients who had required a modified diet before surgery. Kinematic analysis showed increases in...

  8. Anterior Cervical Osteophytes Causing Dysphagia and Paradoxical Vocal Cord Motion Leading to Dyspnea and Dysphonia

    OpenAIRE

    Seo, Joon Won; Park, Ji Woong; Jang, Jae Chil; Kim, Jae Wook; Lee, Yang Gyun; Kim, Yun Tae; Lee, Seok Min

    2013-01-01

    Anterior cervical osteophytes are common and usually asymptomatic in elderly people. Due to mechanical compressions, inflammations, and tissues swelling of osteophytes, patients may be presented with multiple complications, such as dysphagia, dysphonia, dyspnea, and pulmonary aspiration. Paradoxical vocal cord motion is an uncommon disease characterized by vocal cord adductions during inspiration and/or expiration. This condition can create shortness of breath, wheezing, respiratory stridor o...

  9. 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.

  10. The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain.

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Beems, T.; Schutte, P.J.; Verbeek, A.L.M.

    2010-01-01

    OBJECT: Cervical anterior discectomy with stand-alone cage (CADC) placement is a known treatment for cervical radiculopathy due to a herniated intervertebral disc or an osteophyte. Routine radiographs are obtained at regular postoperative intervals, but the consequences of routinely obtained radiogr

  11. Cervical ossification of the posterior longitudinal ligament: Anterior versus posterior approach

    Directory of Open Access Journals (Sweden)

    Dasheng Lin

    2012-01-01

    Full Text Available Background: The optimal approach to provide satisfactory decompression and minimize complications for ossification of the posterior longitudinal ligament (OPLL involving multiple levels (3 levels or more remains controversial. The purpose of this study was to compare the results of two surgical approaches for cervical OPLL involving multiple levels; anterior direct decompression and fixation, and posterior indirect decompression and fixation. We present a retrospective review of 56 cases followed at a single Institution. Materials and Methods: We compared patients of multiple levels cervical OPLL that were treated at a single institution either with anterior direct decompression and fixation or with posterior indirect decompression and fixation. The clinical records of the patients with a minimum duration of follow-up of 2 years were reviewed. The associated complications were recorded. Results: Fifty-six patients constitute the clinical material. 26 cases were treated by anterior corpectomy and fixation and 30 cases received posterior laminectomy and fixation. The two populations were similar. It was found that both anterior and posterior decompression and fixation can achieve satisfactory outcomes, and posterior surgery was accomplished in a shorter period of time with lesser blood loss. Although patients had comparable preoperative Japanese Orthopaedics Association (JOA scores, those with a canal occupancy by OPLL more than 50% and managed anteriorly had better outcomes. However, for those with more severe stenosis, anterior approach was more difficult and associated with higher risks and complications. Despite its limitations in patients with high occupancy OPLLs, through the multiple level laminectomy, posterior fixation can achieve effective decompression, maintaining or restoring stability of the cervical spine, and thereby improving neural outcome and preventing the progression of OPLL. Conclusions: The posterior indirect decompression

  12. 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

    2016-01-01

    Abstract 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 disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation. PMID:27336892

  13. 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.

  14. 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. PMID:27336892

  15. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    Science.gov (United States)

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included

  16. Spheno-Occipital Synchondrosis Fusion Correlates with Cervical Vertebrae Maturation

    Science.gov (United States)

    Fernández-Pérez, María José; McNamara, James A.; Velasco-Torres, Miguel; Benavides, Erika; Galindo-Moreno, Pablo; Catena, Andrés

    2016-01-01

    The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation. PMID:27513752

  17. Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage

    Science.gov (United States)

    Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Rotta, Marcus Alexandre Cavalcanti; Dias, Guilherme Marcos Soares; Rezende, André Luiz; Rotta, José Marcus

    2014-01-01

    Background: Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. Case Description: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. Conclusion: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive. PMID:25317354

  18. Clinical and Radiological Comparison of Femur and Fibular Allografts for the Treatment of Cervical Degenerative Disc Diseases

    OpenAIRE

    Oh, Hyeong-Seok; Shim, Chan Shik; Kim, Jin-Sung; Lee, Sang-Ho

    2013-01-01

    Objective This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. Methods A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with ...

  19. 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

    Science.gov (United States)

    Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-01-01

    Objectives 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. Methods 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. Results 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. Conclusions 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. PMID:27441736

  20. The Comparison between Cervical Artificial Disc Arthroplasty and Anterior Cervical Decompression and Fusion on the Influence of the Adjacent Segments Degeneration%颈椎间盘置换术与颈椎前路减压融合术对邻近节段退变情况影响的比较

    Institute of Scientific and Technical Information of China (English)

    王鲲鹏; 邱玉金; 王玉凤; 刘守勇; 吴磊磊

    2013-01-01

    Objective To compare CADR with ACDF on the influence of the adjacent segments degenera-tion.Methods From February 2008 to October 2010,a total of 62 cases of cervical spondylosis was retrospectively re-viewed.All the patients were divided into CADR group and ACDF group ,depending on different surgical methods .The symptoms and neurological function were evaluated by the cervical Japanese Orthopaedic Association ( JOA) Scores and neck disability index ( NDI ) .The Cobb angle of C 2~7 and the mobility of adjacent segments were valuated the cervical range of mobility and degeneration .Results Compared with the preoperation , the last follow-up neurological function significantly improved ,the difference was statistically significant ( P0 .05 ) .At last follow-up Cobb angle of C 2~7 and the mobility of adjacent upper and lower segments in CADR group were similar to the preoperative ,there was no significant difference statistically (P>0.05).And there was significant difference statistically in ACDF group and between the groups ( P<0.05) .Conclusion CADR is less influ-ential on the adjacent segments degeneration postoperative .%目的:比较分析颈椎间盘置换术( CADR )与颈椎前路减压融合术( ACDF )对邻近节段退变情况的影响。方法回顾性分析2008年2月~2011年10月手术治疗的62名患者,根据术式不同,分为CADR组与ACDF组。采用颈椎JOA、NDI评分评价症状及神经功能,C2~7 Cobb角和手术相邻节段活动度评价颈椎活动范围及退变情况。结果与术前比较,末次随访时两组患者神经功能明显改善,组内差异有显著性(P<0.05),但组间比较差异无显著性(P>0.05)。与术前相比,末次随访时CADR组C2~7 Cobb角和手术相邻上、下节段活动度相近,差异无显著性(P>0.05);ACDF组内比较与两组间末次随访时比较C2~7 Cobb角和手术相邻上、下节段活动度,差异有显著性( P<0.05

  1. Delayed Esophageal Perforation after Cervical Spine Plating

    OpenAIRE

    Kim, Seong Jung; Ju, Chang Il; Kim, Dong Min; Kim, Seok Won

    2013-01-01

    Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to pai...

  2. Outcomes observed during a 1-year clinical and radiographic follow-up of patients treated for 1- or 2-level cervical degenerative disease using a biodegradable anterior cervical plate.

    Science.gov (United States)

    Chen, Mengcun; Yang, Shuhua; Yang, Cao; Xu, Weihua; Ye, Shunan; Wang, Jing; Feng, Yong; Yang, Wen; Liu, Xianzhe

    2016-08-01

    OBJECTIVE The purpose of this study was to present an initial surgical experience in the management of 1- or 2-level degenerative disc disease of the cervical spine using biodegradable anterior cervical plates (bACPs) in anterior cervical discectomy and fusion (ACDF). The authors also aimed to provide insight into this critical and controversial clinical issue by clarifying outcomes for patients receiving bACPs and by comparing their outcomes with those achieved using a traditional metallic anterior cervical plate (mACP) implant. METHODS A retrospective review was conducted for 2 series of patients who had undergone ACDF using either bACP (31 patients, 38 segments) or mACP (47 patients, 57 segments) instrumentation. The patients were followed up for a mean 13.5 ± 0.9 months (range 12-18 months) in the bACP group and 14.8 ± 1.5 months (range 14-22 months) in the mACP group. Clinical outcomes were determined according to scores on the visual analog scale (VAS), the modified Japanese Orthopaedic Association (mJOA) scoring system, and Odom's criteria. Radiological images were used to assess fusion rates, intervertebral height, Cobb's angle, and the width of prevertebral soft tissue. RESULTS Both VAS and mJOA scores were significantly improved at each follow-up in both groups. Excellent or good results according to Odom's criteria were achieved in 93.5% (29/31) of patients in the bACP group and 93.6% (44/47) of patients in the mACP group. At 6 months postoperatively, the fusion rate was 94.7% (36/38) in the bACP group and 96.5% (55/57) in the mACP group, but subsidence of the intervertebral space at the surgical level was more evident in the bACP group. Angulation, as measured by Cobb's angle, demonstrated obvious healing in both groups, while better maintenance was observed in the mACP group. The local inflammatory reaction was uneventful during follow-up. Dysphonia and dysphagia were observed in both groups during the follow-up. CONCLUSIONS The relatively comparable

  3. 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

  4. 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

    OpenAIRE

    André Rafael Hübner; Marcelo Ribeiro Mendes; Jean Carlo Frigotto Queruz; Jean Marcel Dambrós; Álvaro Diego Heredia Suárez; Leandro de Freitas Spinelli

    2011-01-01

    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...

  5. FGFR3–TACC3: A novel gene fusion in cervical cancer

    Directory of Open Access Journals (Sweden)

    Benedito A. Carneiro

    2015-08-01

    Full Text Available Cervical cancer epitomizes the success of cancer prevention through the human papillomavirus (HPV vaccine, but significant challenges remain in the treatment of advanced disease. We report the first three cases of cervical carcinoma harboring an FGFR3–TACC3 fusion, which serves as a novel therapeutic target. The fusion, identified by comprehensive genomic profiling, activates the FGFR pathway that has been implicated in HPV-driven carcinogenesis. One of the patients whose tumor contained the FGFR3–TACC3 fusion was treated with an investigational FGFR tyrosine kinase inhibitor. Concomitant molecular alterations involving the PI3K/AKT/mTOR and RAF/MEK pathways were also identified and suggest other treatment strategies that deserve investigation. This case series highlights the role of comprehensive genomic profiling in the identification of new therapeutic targets and in targeted therapy selection for patients with cervical cancer.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature

    OpenAIRE

    Molinari, Robert W.; Molinari, Christine

    2015-01-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Meth...

  11. Comparison of the extraction force of different interbody graft fixation at cervical vertebra after anterior cervical decompression%颈椎间不同植入物拔出载荷的比较

    Institute of Scientific and Technical Information of China (English)

    刘锦波; 唐天驷; 杨惠林

    2001-01-01

    目的:比较颈前路减压后分别植入钛合金螺纹融合支架、异体骨螺纹融合支架和自体髂骨的拔出载荷。方法:以人尸体颈椎为标本,颈前路环锯减压后,分别植入钛合金螺纹融合支架、异体骨螺纹融合支架和自体髂骨,测试以上植入物的最大拔出载荷。结果:减压后植入钛合金螺纹融合支架、异体骨螺纹融合支架、自体骼骨的最大拔出载荷分别为(114.7±23.3)、 (101.5±15.7)、 (58.7±8.3)N。结论:Cloward术减压后,钛合金螺纹融合支架、异体骨螺纹融合支架拔出载荷均大于植入自体髂骨。%Objective:To compare the extraction force of different interbody graft fixation at C4 and C5 after cervical decompression with the method of Cloward.Methods:Cervical vertebra was operated at C4 and C5 using orifice through anterior approach.The extraction force was measured after the allograft threaded fusion cage,titanium threaded fusion cage and autograft iliac bone graft were inserted separately into the interbody space.Results:The extraction force of titanium threaded fusion cage,allograft threaded fusion cage and autograft iliac bone graft were 114.0±23.3N and 101.5±15.7N and 58.7±8.3N respectively.Conclusion:Measured with the method of Cloward,the extraction forces of the allograft threaded fusion cage and titanium threaded fusion cage at C4 and C5 are bigger than that of autograft iliac bone graft after cervical decompression.

  12. Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel

    OpenAIRE

    Zhang, Ting; He, Xijing; Li, Haopeng; Xu, Siyue

    2016-01-01

    Background There has been no consensus regarding what is the optimal means of treating lumbosacral segment tuberculosis. The aim of this study was to evaluate the clinical outcomes of our newly developed one-stage anterior debridement and fusion combined with dual screw-rod construct anterior instrument underneath the iliac vessels for lumbosacral spinal tuberculosis. Methods We retrospectively reviewed 22 patients with lumbosacral spinal tuberculosis who underwent one-stage anterior debridem...

  13. 颈前路手术治疗脊髓型颈椎病并颈椎外伤所致急性颈髓损伤19例临床分析%Clinical analysis on 19 cases of anterior cervical surgical treatment of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma

    Institute of Scientific and Technical Information of China (English)

    张明友; 陈德元

    2014-01-01

    目的 探讨颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的疗效.方法 回顾性分析采用颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗的脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的19例患者病历资料,对患者外伤前(T1)、外伤后(T2)、术后1周内(T3)、术后10个月后(T4)四个时期的颈椎曲度及神经功能评分(JOA)变化进行分析,判断手术疗效.结果 所有患者均获得10~24个月随访,平均(15.2±6.7)个月.T1、T2、T3、T4四个时期的颈椎曲度分别为(28.621±1.850)°、(29.326±2.416)°、(38.384±2.611)°、(37.316±2.521)°.T1、T2、T3、T4四个时期的JOA脊髓型颈椎病评分分别为(12.79±1.316)、(4.00±2.082)、(9.68±3.001)、(11.68±3.334).结论 颈前路椎体次全切并后纵韧带切除减压植骨融合术可达到有效减压效果、可重建颈椎曲度,能提供脊髓型颈椎病并颈椎外伤所导致的颈髓损伤有效康复条件;术后积极康复治疗也是改善神经功能的重要方法.%Objective To explore the effect of anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic in acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma.Methods Retrospective analysis was carried out to 19 cases of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma who used anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic,and analysis of patients before trauma (T)1,post-traumatic (T2),within 1 week after operation (T3),10 months after operation (T4) these four periods about the changes of cervical curvature and neural function (JOA score) were analyzed,then evaluated the operation curative effect.Results All patients were followed

  14. Management of cervical polyradiculopathy through multisegmental laminoforaminotomies

    Directory of Open Access Journals (Sweden)

    Hosam Eldin Abdel Azim Mostafa Habib

    2014-12-01

    Conclusion: Cervical laminoforaminotomy is an effective technique in addressing multisegmental cervical radicular compression. Moreover, this technique eliminates the need of fusion and possible internal fixation, which are essential if the alternative anterior procedure was performed; thus, reducing the overall cost and morbidity.

  15. 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.

  16. 360° fusion for realignment of high grade cervical kyphosis by one step surgery: Case report.

    Science.gov (United States)

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Dugoni, Demo Eugenio; Tarantino, Roberto; Delfini, Roberto

    2014-07-16

    Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity (flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.

  17. 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

  18. Posterior and Anterior Spinal Fusion for the Management of Deformities in Patients with Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Masashi Sato

    2013-01-01

    Full Text Available Introduction. Spinal scoliosis and kyphosis in elderly people sometimes cause severe low back pain. Surgical methods such as osteotomy are useful for correcting the deformity. However, complications during and after surgery are associated with the osteotomy procedure. In particular, it is difficult to manage deformity correction surgery for patients with Parkinson's disease. Here, we present two cases of combined anterior and posterior surgery for deformity in patients with adult scoliosis and kyphosis due to Parkinson's disease. Case Presentation. Two 70-year-old women had spinal scoliosis and kyphosis due to Parkinson's disease. They had severe low back pain, and conservative treatment was not effective for the pain. Surgery was planned to correct the deformity in both patients. We performed combined posterior and anterior correction surgery. At first, posterior fusions were performed from T4 to the ilium using pedicle screws. Next, cages and autograft from the iliac crest were used in anterior lumbar surgery. The patients became symptom free after surgery. Bony fusion was observed 12 months after surgery. Conclusions. Combined posterior and anterior fusion surgery is effective for patients who show scoliosis and kyphosis deformity, and symptomatic low back pain due to Parkinson's disease.

  19. Minimally invasive L5-S1 oblique lumbar interbody fusion with anterior plate.

    Science.gov (United States)

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5-S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction. The video can be found here: https://youtu.be/VMUYWKLAl0g . PMID:27364428

  20. A computed tomography morphometric study of occipital bone and C2 pedicle anatomy for occipital-cervical fusion

    OpenAIRE

    Nicolas K.K. King; Tiruchelvarayan Rajendra; Ivan Ng; Wai Hoe Ng

    2014-01-01

    Background: Occipital-cervical fusion (OCF) has been used to treat instability of the occipito-cervical junction and to provide biomechanical stability after decompressive surgery. The specific areas that require detailed morphologic knowledge to prevent technical failures are the thickness of the occipital bone and diameter of the C2 pedicle, as the occipital midline bone and the C2 pedicle have structurally the strongest bone to provide the biomechanical purchase for cranio-cervical instrum...

  1. Design of Lamifuse : a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Verbeek, A.L.M.; Grotenhuis, J.A.

    2007-01-01

    BACKGROUND: laminectomy is a valuable surgical treatment for some patients with a cervical radiculomyelopathy due to cervical spinal stenosis. More recently attention has been given to motion of the spinal cord over spondylotic spurs as a cause of myelopathic changes. Immobilisation by fusion could

  2. Laminoplasty instead of laminectomy as a decompression method in posterior instrumented fusion for degenerative cervical kyphosis with stenosis

    OpenAIRE

    Yeh, Kuang-Ting; Lee, Ru-Ping; Chen, Ing-Ho; Yu, Tzai-Chiu; Liu, Kuan-Lin; Peng, Cheng-Huan; Wang, Jen-Hung; Wu, Wen-Tien

    2015-01-01

    Background Posterior laminectomy with instrumented fusion is a standard procedure for treating degenerative cervical kyphosis with stenosis (DCKS). Two major disadvantages of the surgery are adhesion of the dural membrane with significant disfiguring of cervical spine and a small fusion bed around the lateral mass. One of the advantages of laminoplasty over laminectomy is the protection of the dural membrane from adhesion through preservation of posterior bony elements. This study presents th...

  3. The design of a cervical vertebra titanium plate-interbody fusion cage

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To study the biomechanical feature of a newly designed cervical vertebra internal fixation device and its clinical applications Methods: Some functional spinal units were fixed respectively with titanium plate, fusion cage and new device designed by ourselves, then a controlled biomechanical study including flexion, extension, torsion and lateral bending was performed and the results were analyzed. Results: As to the mechanical performance, fusion cage showed poor performance in extension test and so did the titanium plate in the distortion test. However, the new device showed good performance in every test. Conclusion: Both simple titanium plate fixation and simple fusion cage fixation have biomechanical defaults, but they are complementary. The titanium plate-interbody fusion cage avoids the defaults and has specific advantages.

  4. 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

  5. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature.

    Science.gov (United States)

    Molinari, Robert W; Molinari, Christine

    2016-02-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Methods A retrospective review of the medical records was performed, and the patients were followed for 5 years. Two patients under 10 years of age with upper cervical instability were treated with occipitocervical instrumented fusion using rigid occipitocervical fixation techniques along with conventionally available low-dose BMP-2. A Medline and PubMed literature search was conducted using the terms "bone morphogenetic protein," "BMP," "rh-BMP2," "bone graft substitutes," and "pediatric cervical spine." Results Solid occipitocervical fusion was achieved in both pediatric patients. There were no reported perioperative or follow-up complications. At 5-year follow-up, radiographs in both patients showed successful occipital cervical fusion without evidence of instrumentation failure or changes in the occipitocervical alignment. To date, there are few published reports on this topic. Complications and the appropriate dosage application in the pediatric posterior cervical spine remain unknown. Conclusions We describe two pediatric patients with upper cervical instability who achieved successful occipital cervical fusion without complication using off-label BMP-2. This report underscores the potential for BMP-2 to achieve successful arthrodesis of the posterior occipitocervical junction in pediatric patients. Use should be judicious as complications and long-term outcomes of pediatric BMP-2 use remain undefined in the existing literature. PMID:26835215

  6. Degenerative cervical myelopathy.

    Science.gov (United States)

    Kato, So; Fehlings, Michael

    2016-09-01

    Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome. PMID:27250040

  7. Clinical efficacy of three different techniques of fusion in the treatment of cervical spondylotic myelopathy%三种前路手术治疗脊髓型颈椎病临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈占磊; 官众

    2013-01-01

    Objective To observe the clinical effects of cervical spondylotic myelopathy and bone graft fusion by different methods for cervical spondylotic myelopathy.Methods Seventy-one cases of cervical spondylotic myelopathy were treated by cervical anterior decompression and bone graft fusion with three surgical procedures from January 2009 to November 2011.Twenty-four cases were treated by anterior cervical discectomy and bone grafting and fusion (group A),27 cases were treated by cervical anterior decompression bone grafting and internal fixation with steel plate (group B),20 cases were treated by anterior cervical decompression,titanium plate internal fixation(group C),cervical disc prosthesis implantation.X-ray films and regular follow-up were taken after operation to observe the curative effects,the interbody height,the cervical vertebra antecttrvature and the fusion of operative segments.Results According to the results of the follow-up,the fusion rates of A,B,C group were 95.3%,95.4%,97.8%.When the follow-up was over,while there was no such difference in A,B or C group (F =2.32,P > 0.05),while there was no statistical significance in the differences among A,B or C group (F =2.23,P > 0.05).Condusions The key point of the treatment of cervical spondylotic myclopathy lies in thorough decompression and effective bone graft fusion,furthermore,different techniques of fusion affect the curative effects significantly.%目的 观察分析三种颈椎前路手术治疗脊髓型颈椎病(CSM)的临床疗效.方法 将2009年1月至2011年11月青海大学附属医院手术治疗的71例CSM患者分为A、B、C三组.A组24例采用颈椎前路减压植骨钢板内固定术;B组27例采用颈前路减压cage植入植骨术;C组20例采用颈椎间盘切除减压、人工颈椎间盘植入术.术后定期随访及拍摄X线片,观察疗效、椎间高度、颈椎前弯曲度和植骨融合情况.结果 经过随访,A组融合率为95.3%,B组为95.4%,C组为97.8

  8. 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 prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P 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 intervention appears underutilized in this population. PMID:23943072

  9. 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.

  10. 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

  11. Occipital Neuralgia after Occipital Cervical Fusion to Treat an Unstable Jefferson Fracture

    OpenAIRE

    Kong, Seong Ju; Park, Jin Hoon; Roh, Sung Woo

    2012-01-01

    In this report we describe a patient with an unstable Jefferson fracture who was treated by occipitocervical fusion and later reported sustained postoperative occipital neuralgia. A 70-year-old male was admitted to our center with a Jefferson fracture induced by a car accident. Preoperative lateral X-ray revealed an atlanto-dens interval of 4.8mm and a C1 canal anterior-posterior diameter of 19.94mm. We performed fusion surgery from the occiput to C5 without decompression of C1. The patient r...

  12. Tratamento das luxações traumáticas da coluna cervical por meio da abordagem anterior Treatment of traumatic dislocations of the cervical spine through anterior approach

    OpenAIRE

    Defino, Helton L. A.; Fábio Gomes Figueira; Lauro Schledorn de Camargo; Fabiano Ricardo de Tavares Canto

    2007-01-01

    Foram estudados 20 pacientes portadores de luxação traumática uni ou bifacetária da coluna cervical tratados pela artrodese e fixação anterior. Os pacientes foram avaliados por meio de parâmetros clínicos, radiológicos e funcionais. Os pacientes foram seguidos por um período que variou de 1 a 14 anos. A consolidação radiológica da artrodese foi observada em todos os pacientes e 1 paciente apresentou soltura tardia de um dos parafusos. A angulação no plano sagital do segmento vertebral lesado ...

  13. Design of Lamifuse: a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Grotenhuis J André

    2007-11-01

    Full Text Available Abstract Background laminectomy is a valuable surgical treatment for some patients with a cervical radiculomyelopathy due to cervical spinal stenosis. More recently attention has been given to motion of the spinal cord over spondylotic spurs as a cause of myelopathic changes. Immobilisation by fusion could have a positive effect on the recovery of myelopathic signs or changes. This has never been investigated in a prospective, randomised trial. Lamifuse is an acronyme for laminectomy and fusion. Methods/Design Lamifuse is a multicentre, randomised controlled trial comparing laminectomy with and without fusion in patients with a symptomatic cervical canal stenosis. The study population will be enrolled from patients that are 60 years or older with myelopathic signs and/or symptoms due to a cervical canal stenosis. A kyphotis shape of the cervical spine is an exclusion criterium. Each treatment arm needs 30 patients. Discussion This study will contribute to the discussion whether additional fusion after a cervical laminectomy results in a better clinical outcome. ISRCT number ISRCTN72800446

  14. 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.

  15. Observation on the Curative Effect of Anterior Approach Surgery for the Treatment of Cervical Fracture-Dislocation%前路手术治疗下颈椎骨折脱位的疗效观察

    Institute of Scientific and Technical Information of China (English)

    谢旭垣; 孔志强; 龙朝仪; 成本强

    2016-01-01

    目的:探讨颈椎前路减压复位植骨融合内固定手术治疗下颈椎骨折脱位的疗效。方法对本院自2010年6月至2014年6月收治的24例下颈椎骨折脱位患者采用前路减压复位、自体骨植骨、锁定钛板或加钛网内固定手术,评估术后颈椎生理曲度、植骨融合程度、神经功能恢复情况。结果术后随访4~24个月,定期X线检查,发现术后颈椎Cobb角测量结果比术前明显改善。按照Lenke标准分级,椎间植骨在术后6个月内均得到有效融合。根据Franke1分级显示,绝大部分患者术后神经功能得到不同程度的改善。所有患者的JOA得分均有明显提高。结论下颈椎骨折脱位应用前路减压复位植骨融合内固定手术操作简单,可早期稳定脊柱,恢复颈椎正常弯度及高度,能有效解除脊髓压迫,促进脊髓神经功能的恢复。%Objective To explore the curative effect of anterior cervical decompression and reduction, bone graft fusion and internal fixation for the treatment of subaxial cervical fracture-dislocation. Methods A total of 24 patients with cervical fracture-dislocation admitted to our hospital from June 2010 to June 2014 were selected. All patients received anterior decompression and reduction, autograft, and internal fixation. The postoperative cervical curvature, bone graft fusion degree and recovery of nerve function were evaluated. Results All patients were followed-up for 4~24 months. The X-ray examination showed that the cervical Cobb angle after operation was significantly better than that before operation. According to Lenke classification standard, all the lumbar intervertebrae fusion achieved to effective integration within 6 months. According to the Frankel classification, most patients had varying degrees of improvement in the postoperative nerve function, and the JOA score of all patients had significant improvement. Conclusions Anterior cervical decompression and reduction

  16. Artrodese na coluna cervical utilizando SICAP como substituto de enxerto ósseo Artrodesis en la columna cervical utilizando SICAP como sustituto de injerto óseo Cervical spine fusion utilizing silicated calcium phosphate bone graft substitute (SICAP

    Directory of Open Access Journals (Sweden)

    Juliano Fratezi

    2011-01-01

    Full Text Available OBJETIVO: Substitutos de enxerto ósseo autólogo foram desenvolvidos para evitar as complicações da retirada de enxerto ósseo autólogo. SiCaP (Actifuse, ApaTech EUA, Reino Unido é um enxerto ósseo composto de cálcio-fosfato com um substituição de silicato na estrutura química, com uma estrutura tridimensional que parece osso natural. MÉTODOS: 19 pacientes foram submetidos à fusão óssea cervical e analisados retrospectivamente. A avaliação radiográfica e avaliação clínica foram realizadas utilizando o questionário Neck Disability Index e a escala análoga da dor (VAS pré- e pós-operação. RESULTADOS: O período médio de acompanhamento pós-operatório foi de 14 meses ± 5 meses (7-30 meses. 11 pacientes foram submetidos à fusão via anterior; 5 pacientes via posterior e 3 pacientes via anterior e posterior. A revisão radiográfica mostrou 19/19 (100% de fusão óssea, nenhum caso apresentou subsidência, quebra ou soltura de material de implante ou movimento nos níveis fusionados. Nenhum exemplo de ossificação heterotópica ou de crescimento ósseo intracanal foi observado. Clinicamente, os escores médios do Neck Disability decresceram 13,3 pontos (media pré-op. de 34,5, pós-op. de 21,2, melhora de 39%, a média da VAS para dor cervical decresceu 2 pontos (2,7 pré-op para 0,7 pós-op.; melhora de 74,1%. Não foram observadas complicações como infecção, osteólise ou edema excessivo das partes moles. CONCLUSÃO: Os resultados preliminares obtidos nesta série foram encorajadores com o uso do SICaP como enxerto ósseo, com sólida fusão óssea obtida em todos os casos e sem formação de ossificação heterotópica ou crescimento de osso intracanal. SIcaP demonstra ser um substituto confiável para o enxerto ósseo autólogo na coluna cervical.OBJETIVO: Sustitutos de injerto óseo autólogo fueron desarrollados para evitar las complicaciones de la recogida de injerto óseo autólogo. SiCaP (Actifuse, Apa

  17. The early-to-mid treatment efficacy of applying ROI interbody fusion cage in cervical spondylotic myelopathy%双嵌式颈椎融合器治疗脊髓型颈椎病早中期效果

    Institute of Scientific and Technical Information of China (English)

    李战友; 潘兵; 阮立奇; 张志敬

    2015-01-01

    Objective:To observe the clinical effect and radiological outcomes of ROI interbody fusion cage in cervical spondylotic myelopathy. Methods:21 patients were treated with lumbar disc excision and cervical vertebra fusion with ROI cage trans anterior approach. Clinical effect was evaluated by Japanese Orthopaedic Association (JOA) score for cervical function.Each patient underwent cervical anteroposterior and lateral radiographs,CT scanning before operation,at 3 days,3 months,and 6 months after operation to assess fusion effect. Intervertebral height was measured. The time of operation,in-traoperative blood loss and complication relative to opration were recorded. Results:As time goes on,the score of JOA was increased gradually after operation,and patients were all cured after 6 months. The fusion rate was 100%. No complication was found. Conclusion:Favorable early and midterm outcomes may be yielded in patients with cervical spondylotic myelopathy treated by anterior cervical discectomy and fusion with ROI interbody fusion cage.%目的:评估双嵌式颈椎融合器(ROI-C)治疗脊髓型颈椎病的临床疗效及影像学效果. 方法:2012年5月-2013年6月我科应用颈椎压力固定器对21名患者行颈椎前路减压椎间盘切除椎体融合术.应用JOA功能评分评价临床疗效,并于术前,术后3d、术后3个月、术后6个月行常规X线正侧位片检查,评估椎体间融合情况及椎间高度,并记录每例病例手术时间、出血量及手术相关并发症情况. 结果:JOA评分随时间顺序逐渐升高,6个月内所有病例椎间全部融合,椎间高度在术后3 d即显著恢复,3个月内下降,术后6个月趋于稳定.在随访期间,未发生手术相关并发症.结论:应用双嵌式颈椎融合器治疗脊髓型颈椎病可在早中期达到较好的临床疗效.

  18. Tratamento das luxações traumáticas da coluna cervical por meio da abordagem anterior Treatment of traumatic dislocations of the cervical spine through anterior approach

    Directory of Open Access Journals (Sweden)

    Helton L. A. Defino

    2007-01-01

    Full Text Available Foram estudados 20 pacientes portadores de luxação traumática uni ou bifacetária da coluna cervical tratados pela artrodese e fixação anterior. Os pacientes foram avaliados por meio de parâmetros clínicos, radiológicos e funcionais. Os pacientes foram seguidos por um período que variou de 1 a 14 anos. A consolidação radiológica da artrodese foi observada em todos os pacientes e 1 paciente apresentou soltura tardia de um dos parafusos. A angulação no plano sagital do segmento vertebral lesado apresentou alteração no período pré-operatório, sendo obtido redução no pós-operatório imediato e manutenção da mesma após um ano do tratamento cirúrgico. A avaliação clínica e funcional de acordo com o SF-36 e escala de dor e trabalho de Denis demonstrou bons resultados clínicos sendo as principais queixas pós-operatórias decorrentes do grau da lesão neurológica. O hematoma da ferida operatória, que necessitou de drenagem cirúrgica foi a única complicação observada em um paciente. A realização da artrodese e fixação anterior para o tratamento das luxações traumáticas uni ou bifacetárias da coluna cervical apresentou bons resultados clínicos, radiológicos, funcionais e baixo índice de complicações, justificando nossa preferência por esse método de tratamento para esse tipo de lesão da coluna cervical.Twenty patients presenting with single-or bi-faceted traumatic dislocation of the cervical spine treated by means of arthrodesis and anterior fixation have been studied. Patients were assessed by clinical, X-ray, and functional parameters. The patients were followed up during a period ranging from 1 to 14 years. Union of the arthrodesis, as evidenced by X-ray, was noticed in all patients, with one patient presenting with late loosening of one of the screws. Angulations at sagittal plane of the injured vertebral segment showed a change preoperatively, with reduction being achieved at the early postoperative

  19. Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al

    OpenAIRE

    Nancy E Epstein

    2015-01-01

    Background: This is a commentary on the article laminoplasty versus laminectomy and fusion (LF) for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL) versus laminectomy and fusion (LF) to address three or more level multilevel cervical spondylotic myelopathy (CSM). Both procedures led to similar degrees of neurological recovery a...

  20. Chronic hypertrophic nonunion of the Type II odontoid fracture causing cervical myelopathy: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Mohammed F Shamji

    2016-01-01

    Conclusion: Rarely, nonunion of Type II odontoid fractures may be hypertrophic where both instability and compression cause neurological morbidity. Such cases require anterior transoral decompression, posterior cervical decompression, and instrumented fusions.

  1. 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.

  2. 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

    OpenAIRE

    Jorge Alfredo Léo; Antonio Carlos Shimano; Gilberto de Araújo Pereira; Helton Luiz Aparecido Defino

    2008-01-01

    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 enxer...

  3. Anterior approach on protrusion of intervertebral disc and early rehabilitation training after operation%颈椎间盘突出症的前路手术与术后早期康复训练

    Institute of Scientific and Technical Information of China (English)

    方军; 高克海; 李华壮; 褚俊良

    2002-01-01

    Backgroud: The main causes of protrusion of cervical intervertebral disc are degenerations such as osteophymas on degenerated protruded intervertebral disc and vertebral body anterior to vertebral canal. Decompression via cervical anterior approach and fusion of implanted bone are effective methods. And it is very important for surgical effect and functional restoration to make sufficient preoperative preparation and consummate postoperative rehabilitation.

  4. Pelvic Floor Support Defect in Apical Anterior Vaginal Prolapse with Cervical Hypertrophy. Review with Case Report in a 20-year-old Cadaver.

    Science.gov (United States)

    Chhetri, Kalpana

    2015-10-01

    Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery. PMID:26557506

  5. Anterior Lumbar Intervertebrai Fusion with Artificial Bone in Place of Autologous Bone

    Institute of Scientific and Technical Information of China (English)

    徐卫国; 陈安民; 冯旭; 印卫锋

    2003-01-01

    The feasibility of anterior lumbar intervertebral fusion with artificial bone in place of au-togenous bone was investigated. Porous hydroxyapatite(HA)/ZrO2 ceramics loading bone morpho-genetic protein (BMP) were implanted after removal of lumbar vertebral disc in rabbits. The adja-cent intervertebral discs were also removed by the same way and autogenous illic bone was implan-ted. SEM observation and biomechanical test were carried out. Compound bone had a bit lower os-teoinductive activity than autogenous bone by SEM(Osteoindutive activity of artificial bone in 12weeks was the same as that of autogenous bone in 9 weeks). Biomechanical test revealed that com-pound bone had lower anti-pull strength than autogenous bone (P<0. 001), but there was no sig-nificant difference in anti-pull strength between compound bone at 12th week and autogenous boneat 9th week (P>0.05). It was concluded that compound bone could be applied for anterior spinalfusion, especially for those patients who can't use autogenous bone.

  6. 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.

  7. MR and CT image fusion of the cervical spine: a noninvasive alternative to CT-myelography

    Science.gov (United States)

    Hu, Yangqiu; Mirza, Sohail K.; Jarvik, Jeffrey G.; Heagerty, Patrick J.; Haynor, David R.

    2005-04-01

    CT-Myelography (CTM) is routinely used for planning surgery for degenerative disease of the spine, but its invasive nature, significant potential morbidity, and high costs make a noninvasive substitute desirable. We report our work on evaluating CT and MR image fusion as an alternative to CTM. Because the spine is only piecewise rigid, a multi-rigid approach to the registration of spinal CT and MR images was developed (SPIE 2004), in which the spine on CT images is first segmented into separate vertebrae, each of which is then rigidly registered with the corresponding vertebra on MR images. The results are then blended to obtain fusion images. Since they contain information from both modalities, we hypothesized that fusion images would be equivalent to CTM. To test this we selected 34 patients who had undergone MRI and CTM for degenerative disease of the cervical spine, and used the multi-rigid approach to produce fused images. A clinical vignette for each patient was created and presented along with either CT/MR fusion images or CTM images. A group of spine surgeons are asked to formulate detailed surgical plans based on each set of images, and the surgical plans are compared. A similar study assessing diagnostic agreement is being performed with neuroradiologists, who also assess the accuracy of registration. Our work to date has demonstrated the feasibility of segmentation and multi-rigid fusion in clinical cases and the acceptability of the questionnaire to physicians. Preliminary analysis of one surgeon's and one neuroradiologist"s evaluation has been performed.

  8. 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

  9. Locally aggressive aneurysmal bone cyst of C4 vertebra treated by total en bloc excision and anterior plus posterior cervical instrumentation

    Directory of Open Access Journals (Sweden)

    Himanshu N Parmar

    2015-01-01

    Full Text Available We are presenting a case of cervical (C4 aneurysmal bone cyst in a 13-year-old girl, came to the outpatient department with neck pain and stiffness since 6 months and normal neurology. We did an en bloc excision of locally aggressive tumor through anterior plus posterior approach and stabilization by lateral mass screw fixation and anterior cervical instrumentation. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumor and instrumentation in a single stage to avoid instability.

  10. 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.

  11. [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.

  12. 上颈椎融合对颈椎活动度的影响%The impact of the upper cervical spine fusion on cervical range of motion

    Institute of Scientific and Technical Information of China (English)

    袁伟; 朱悦; 崔璀

    2012-01-01

    目的 探讨上颈椎融合对颈椎活动功能的影响,并评估颈椎活动度测量仪(cervical range of motion device,CROM)的可靠性.方法 我科于2010年7月至2011年10月对收治的14例上颈椎疾病患者使用CROM仪测量,其中5例为颈枕融合,2例寰枢椎融合,7例采用Halo架非融合治疗后2个月及6个月左右颈椎前屈、后伸、左右侧弯、左右旋转主动活动度,并与15例健康志愿者颈椎活动度进行比较,分析术后颈椎活动度丢失情况;使用CROM仪重复测量健康志愿者颈椎活动度并采用组间相关系数(intraclass correlation coefficients,ICC)来评价CROM仪的测量者内可靠性.结果 术后6个月随访时颈椎活动度六个方向中的三个方向:颈椎前屈、左旋转及右旋转,融合组与非融合组相比有显著降低(P<0.05),与正常组相比则在六个方向均有显著性差异(P<0.05).融合组中颈枕融合较寰枢椎融合在颈椎前屈、左右旋转活动上有显著性降低(P<0.05),术后第6个月随访各组颈椎活动度较3个月随访时均有一定程度的增加.CROM仪测量颈椎六个方向的活动度测量者内ICC均在0.91以上,有较高的可靠性.结论 上颈椎融合使颈椎活动范围显著性减小,对颈椎前屈、旋转功能影响最大.此外,CROM仪是一种可靠的颈椎活动度测量工具.%Objective To investigate the impact of the upper cervical spine fusion on cervical range of motion (CROM) and to evaluate the reliability of the CROM device. Methods From July 2010 to October 2011, 14 patients with upper cervical disease were adopted by our department and treated with cervical spine fusion or non-fusion, among whom there were 5 cases of cervicooccipital fusion, 2 cases of atlantoaxial fusion and 7 cases of Halo-vest treatment. The cervical flexion, backward extension, left and right lateral bending and rotation of all patients were measured by the CROM device about 2 months and 6 months after surgery

  13. The anterior operation for cervical ossification of posterior longitudinal ligament combined with adjacent disc herniation%前路手术治疗合并邻近椎间盘突出的颈椎后纵韧带骨化症

    Institute of Scientific and Technical Information of China (English)

    任斌; 蔡林; 陈志龙; 王建平; 胡超; 张桃根

    2012-01-01

    Objective To investigate the efficacy and the selection of surgery time of anterior operation for cervical ossification of posterior longitudinal ligament combined with cervical disc herniation. Methods Totally 24 cases of cervical ossification of posterior longitudinal ligament combined with cervical disc herniation underwent anterior operation in our department from January 2005 to January 2011. There were 21 males and 3 females. The mean age was 52 years old (range; 40-68 years). Preoperatively, 2-3 ossified segments of the posterior longitudinal ligament combined with contiguous cervical herniated disc compressing the spinal cord were revealed through cervical X-ray film, CT and MRI examinations. All patients were treated with the anterior cervical subtotal corpectomy combined with the discectomy of contiguous cervical herniated disc by the cage fusion surgery of internal fixation for reconstruction. The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were analyzed and compared, and the improvement rate was also calculated. Results All patients were followed up for an average period of 22 months (range; 8-36 months). The mean JOA score of neurological function was preoperatively 7.5 points (range; 4-13 points). The mean JOA score was postoperatively 13.6 points (range; 10-16 points). The mean improvement rate of neurological function was 65.6% (range; 32%-81%). The efficacy of 7 cases was excellent, 12 cases good, 5 cases fair and none bad. The excellence rate was 79.1%. Conclusions Cervical ossification of posterior longitudinal ligament often combines with contiguous cervical herniated disc resulting in spinal cord injury. To avoid the sharp deterioration of spinal cord function, early surgical intervention should be taken. The anterior cervical subtotal corpectomy combined with the discectomy of contiguous cervical herniated disc by the cage fusion surgery of internal fixation for reconstruction in the treatment of cervical

  14. 两种前路减压融合方式治疗双节段脊髓型颈椎病的疗效分析%Curative effect analysis of two kinds of anterior decompression and fusion methods for double cervical spondy-lotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    陈常华

    2014-01-01

    目的:比较前路椎间盘切除植骨融合并钛板置入内固定术( ACDF)及前路椎体次全切除植骨融合并钛板置入内固定术( ACCF)对相邻双节段脊髓型颈椎病的疗效。方法选择我院收治的76例双节段脊髓型颈椎病患者作为研究对象,将其随机分为ACCF组和ACDF组,观察2组患者围手术期相关指标、脊髓功能、颈椎正侧位和屈伸动力位X线片检查,记录Cobb’ s角及融合节段高度并评价植骨融合情况。结果2组患者手术相关指标结果显示,ACDF组患者的手术时间、出血量、住院时间等指标明显优于ACCF组(P0.05;ACDF组在术后Cobb’s角改善程度明显优于ACCF组(P 0. 05). The postoperative Cobb’s angle degree of ACDF group is better than that of AC-CF group (P<0. 05). Conclusion The effect of ACCF and ACCF on the treatment of two-level CSM were satisfactory,of which ACDF has the advantages of short operation time,less bleeding,fusion segments of Cobb’ s angle and fewer complications.

  15. Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate%颈椎带锁钢板内固定术对颈椎退变性疾病神经功能改善的分析

    Institute of Scientific and Technical Information of China (English)

    赖志军; 谢惠缄; 谢唏衷; 肖建如

    2002-01-01

    Objective To discuss the clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion.Neurological signs and symptoms were evaluated before and after surgery, and mean follow up time was 11.3 months.Result In all cases,radiography demonstrated a solid bony fusion.Additional general complications include a large wound hematoma in one and hoarseness in one.All patients' neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.

  16. Anterior surgery for the treatment of acute single segment 30 cases of cervical disc%前路手术治疗急性单节段颈椎间盘突出30例

    Institute of Scientific and Technical Information of China (English)

    吴成如; 张诗虎

    2013-01-01

    目的 研究探讨前路颈椎间盘切除+椎间融合器+钛板内固定治疗急性颈椎间盘突出症的效果.方法 采用前路手术对我科2008-03-2011-03收治的30例急性颈椎间盘突出症患者进行治疗,所有患者均获得平均15个月的随访,根据术后摄片及JOA评分判断疗效.结果 在随访过程中,所有患者均未出现临床并发症,术后摄片显示均获得骨性融合,依据JOA评分标准:优(改善率大于75%)20例,良(改善率50~75%)8例,好转(改善率25~50%)2例.结论 该方法治疗急性颈椎间盘突出症可达到充分减压、重建颈椎生理曲度、恢复椎间隙高度、椎体间高融合率、颈椎牢固固定的作用.而且该术式操作简单,手术时间短、出血少、并发症少,是治疗急性颈椎间盘突出一种可靠方法.%Objective research and discuss the effect of the treatment of acute cervical disc herniation by using anterior cervical discectomy, Intervertebral fusion and Internal fixation with titanium plate. Methods 30 cases of patients with acute cervical disc herniation in our department in March 2008-March 2011 were treated by using anterior surgery,all patients received an average of 15 months of follow-up visit,then judge the curative effect according to postoperative radiography and JOA scores. Results In the process of follow-up, all patients did not show clinical complications, postoperative radiography showed bony fusion,according to JOA scoring criteria, optimal (improvement rate more than 75%) 20 cases, fine (improvement rate 50%~75%) 8 cases,improved (improvement rate 25%-50%) 2 cases. Conclusion the treatment of acute cervical disc herniation can achieve full decompression, reconstruction of cervical physiological curvature, restore interverte-bral disc height,high fusion rate between the vertebral bodies, cervical vertebra firmly fixed. And the operation is simple,short operation time,less bleeding,fewer complications,so the treatment of acute

  17. 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

  18. Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病的临床分析%Clinic analysis of Hybrid Surgery to treat multi segmental anterior cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    福嘉欣; 江汉; 江毅; 肖联平; 田永刚

    2015-01-01

    Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion of adjacent segmental artificial disc replacement through anterior intervertenral spance (Hybrid Surgery) in the anteriorcervical spondylotic myelopathy treatment . Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi⁃cal spondylotic myelopathy . Follow up of 1-50 months. Patient’s conditions were assessed according to the Japanese Associ⁃ation for Department of orthopedics assessment score (JOA score) before and after operation. Effects of Hybrid operation were assessed by the improvement of JOA score, Odom’s follow-up grade and cervical mobility . Results The JOA scores of all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the difference is statistically significant (t=1.314, P 0.05). Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nerve function and preserve cervical mobility.%目的:探讨颈椎前路经椎间隙或椎体次全切除减压植骨融合联合邻近节段人工间盘置换(Hybrid Surgery)在颈前路多节段脊髓型颈椎病治疗中的效果。方法应用Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病患者18例。随访1~50个月,手术前后根据日本骨科协会评估分数(JOA)进行评分。通过JOA评分的改善情况, Odom’s分级随访结果及颈椎活动度的变化评价Hybrid Surgery的效果。结果18例术后JOA评分(13.5±2.4)分高于术前(10.6±1.7)分,差异有统计学意义(t=1.314,P0.05)。结论 Hybrid Surgery术式颈前路充分减压融合,既可改善患者神经功能,又可保留一定程度上的颈椎活动度。

  19. Cervical facet dislocation adjacent to the fused motion segment

    OpenAIRE

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

    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...

  20. Preliminary documentation of the comparable efficacy of vitoss versus NanOss bioactive as bone graft expanders for posterior cervical fusion

    OpenAIRE

    Nancy E Epstein

    2015-01-01

    Background: Laminectomies with posterior cervical instrumented fusions often utilize bone graft expanders to supplement cervical lamina/iliac crest autograft/bone marrow aspirate (BMA). Here we compared posterior fusion rates utilizing two graft expanders; Vitoss (Orthovita, Malvern, PA, USA) vs. NanOss Bioactive (Regeneration Technologies Corporation [RTI: Alachua, FL, USA]). Methods: Two successive prospective cohorts of patients underwent 1-3 level laminectomies with 5-9 level posterio...

  1. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    Directory of Open Access Journals (Sweden)

    Lance K. Mitsunaga

    2012-01-01

    Full Text Available Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy.

  2. 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

    OpenAIRE

    Rafael Barreto Silva; Paulo Tadeu Maia Cavali; Ivan Guidolin Veiga; Marcelo Italo Risso-Neto; Wagner Pasqualini; Marcus Alexandre Mello Santos; Alexander Junqueira Rossato; Maurício Antonelli Lehoczki; Elcio Landim

    2010-01-01

    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 Ho...

  3. Treatment of the upper cervical instability 18 cases with occipital-cervical fusion surgery%枕颈融合术治疗上颈椎不稳18例

    Institute of Scientific and Technical Information of China (English)

    宋楹卓; 杜俊杰; 罗卓荆; 梁伟; 张建

    2012-01-01

    Objective To study the effect of occipital-cervical fusion in the treatment of upper cervical instability. Methods 18 cases of patients with upper cervical instability in our department were used occipital-cervical fusion surgery, and spinal cord function was assessed by the JOA score. Results 18 cases were followed up 3 months to 2 years after surgery, all the patients showed complete fusion, the upper cervical were stability, JOA score improved rate was 67.0%. Conclusion The occipital-cervical fusion surgery is effective to treat the upper cervical instability and spinal cord compression.%目的 研究枕颈融合手术治疗上颈椎不稳的疗效.方法 对我科上颈椎不稳患者18例行枕颈融合内固定手术,按JOA评分进行脊髓功能评定.结果 术后3个月~2年随访,全部病例上颈椎稳定性良好,植骨全部愈合,JOA评分平均改善率为67.0%.结论 枕颈融合术治疗上颈椎不稳、脊髓受压有确切治疗效果.

  4. 融合与非融合固定治疗脊髓型颈椎病:谁更易于椎体的活动度及稳定性?%Fusion and non-fusion fixation for cervical spondylotic myelopathy:which is more appropriate for maintaining range-of-motion and stability of vertebrae?

    Institute of Scientific and Technical Information of China (English)

    申超; 王文军; 晏怡果

    2014-01-01

    BACKGROUND:In recent years, many scholars adopted a joint non-fusion and fusion spinal fixation for multisegmental cervical spondylotic myelopathy, and achieved good clinical results. However, long-term clinical efficacy and possible related complications also require long-term fol ow-up of more in-depth study. OBJECTIVE:To review the research and application progress of anterior fusion and non-fusion fixation surgical operation for cervical myelopathy. METHODS:Computer-based search was conducted in China Journal Ful-text Database and PubMed database by the first author for articles related to anterior fusion and non-fusion fixation surgical operation for cervical myelopathy published between January 2004 and January 2014. The key words were“implant material;cervical spondylotic myelopathy;anterior;surgery;fusion;non-fusion;progress;hybrid;summary”in Chinese and“implant material;cervical spondylotic myelopathy;anterior;surgery/operation;fusion;non-fusion;research progress;hybrid;summary”in English. Final y, 35 articles were included for review. RESULTS AND CONCLUSION:Fusion and non-fusion fixation methods for cervical spondylotic myelopathy had their own advantages. From the view point of indications, the non-fusion fixation was relatively limited. Currently, the fusion fixation was stil the main method in treatment of cervical myelopathy. Non-fusion method as an emerging fixation method also achieved good short-period results, but it needs a long fol ow-up study. Hybrid fixation integrates the advantages of both methods, and can reduce the pressure. Simultaneously, Hybrid fixation also can reduce fusion segments, and retain the range-of-motion of the cervical spine as much as possible. Hybrid fixation becomes a hot topic in recent studies. However, most current researches on Hybrid fixation are retrospective study, lack of control. The overal fol ow-up time is short. Thus, Hybrid fixation needs to be researched more deeply.%背景:近年来,许多国

  5. 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.

  6. 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.

  7. 颈前路经椎间隙减压盒状cage植骨融合术治疗单间隙颈椎病-附86例随访结果%Study on clinical results of single - level cervical discectomy and box - shape bone graft fusion in treatment of single - level cervical disease. A report of results in follow - up study of 86 cases.

    Institute of Scientific and Technical Information of China (English)

    唐拥军; 曾凡伟; 池雷霆

    2011-01-01

    目的 观察经颈前路椎间隙减压盒状椎体护架(cage)植融合术治疗单间隙颈椎病的结果.方法 选择86例患者应用盒状Cage行颈前路减压,植骨融合术治疗单间隙颈椎病,随访3个月至4年.结果 神经功能恢复率为86.0%(GDA评分),所有患者术后CT证实融合,术后并发症发生率7.0%.结论 经颈前路椎间隙减压盒状Cage植骨融合术治疗单间隙颈椎病,目前已成为公认的最佳术式之一.%Objective To observe the effectiveness and prognosis of anterior approach for decompression and bone - graft fusion in treatment of patients with cervical spondylosis. Methods Altogether 86 cases of cervical spondylosis were treated with anterior approach decompression and bone - graft fusion. All these cases were followed up for 3 to 4 months. Results The rate of symptomatic relief is 86% ( by JOA scores ),and all these cases are proved to be getting fusion by CT scanning. The rate of occurrence of complications is 7% ( 6 cases ). Conlusion The anterior approach for decompression and titanium cage bone - graft fusion are considered to be the best method for treatment of patients with cervical spondylosis.

  8. [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.

  9. Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

    OpenAIRE

    Woo, Jae Hee; Park, Hahck Soo

    2014-01-01

    Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion b...

  10. Preliminary documentation of the comparable efficacy of vitoss versus NanOss bioactive as bone graft expanders for posterior cervical fusion

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Conclusion: In this preliminary study combining cervical laminectomy/fusions, the time to fusion (5.65 vs. 5.35 months, pseudarthrosis (2.7% vs. 0%, and infection rates (2.7% vs. 0% were nearly comparable sequentially utilizing Vitoss (72 patients vs. NanOss (20 patients as bone graft expanders.

  11. 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

  12. 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.

  13. 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

  14. Progressive non-infectious anterior vertebral fusion in a baby with Saethre-Chotzen-acrocephalosyndactyly type III syndrome

    Directory of Open Access Journals (Sweden)

    Али Аль-Каисси

    2015-09-01

    Full Text Available We report on a 3-months old baby of Austrian origin and product of non-consanguineous parents. Abnormal craniofacial contour was the main deformity. The overall clinico-radiographic features were consistent with Saether-Chotzen-acrocephalosyndactyly type III syndrome. Bi-directional sequencing of the exon 8 and of the FGFR3-genes, exons 7 of FGFR3 (Fibroblast growth factor receptor3 genes, the exon 5 of the FGFR1 gene, revealed no mutations. Sagittal MRI imaging of the spine showed anterior vertebral fusion along the thoraco-lumbar vertebrae compatible with the non-infectious type.

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

    Directory of Open Access Journals (Sweden)

    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

  16. Design and clinical application of cervical hollow threaded fixator

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective Cervical hollow threaded fixator (CHTY) was designed and applied to stabilize tha cervical spine following anterior decompression due to cervical spondylosis or acute cervical disc herniation. Methods Medical use titanium alloy with no magnetism was made into a hollow threaded structure with holes on the wall of the fixator. Forly-two patients with cervical spondylosis and acute cervical disc herniation were stabilized using the CHTF technique after anterior decompression. X-ray films and CT scans were taken after the oberation to observe the stability ann fusion rate of the segments. Results Patients were allowed to walk one day after the operation and were followed up for 6 to 36 months. The operated segments were stable and solid fusion was observed 3-6 months after surgery. Conclusions Immediate stability of the operated segments can be obtained using the CHTF technique. Patients ware easy to manage after5 the operation and returned to their jobs in a short time.The CHTF technique is safe and simpa to perfoirme and eliminates the complications of an autograft.It may be an alternative to traditional cervical interbody fusion with bone graft.

  17. 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.

    Directory of Open Access Journals (Sweden)

    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.

  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

    scores of preoperation, 3 days, 6 months and 12 months after operation were (9.82±3.32), (13.72±3.23), (13.63±3.17), (13.56±3.24) scores respectively. Compared with the pre-operation, the cervical curvature of 3 days, 6 months and 12 months postoperation was significantly restored and the JOA scores were significantly improved (P<0.01). All the patients got intervertebral bone graft fusion at the final fol-low-up. There was no complications of infection, plate breakage, screw loosening subsidence or shift of cage except one case had difficulty in breathing caused hematoma 10 days postoperation, and recovered by removing the hematoma im-mediately. Conclusion Elaborative decompression under microscope through anterior cervical approach for treatment of multilevel cervical spondylotic myelopathy has the advantages of clear vision, good teamwork, complete decompression, immediate recovery of postoperative function, and significantly increases the fine rate of anterior cervical approach.

  19. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes.

    Science.gov (United States)

    Lee, Chang-Hyun; Lee, Jaebong; Kang, James D; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI -0.37 to 0.54, p = 0.07) and neck pain VAS score (MD -0.33, 95% CI -1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results. PMID:25815808

  20. A computed tomography morphometric study of occipital bone and C2 pedicle anatomy for occipital-cervical fusion

    Directory of Open Access Journals (Sweden)

    Nicolas K.K. King

    2014-01-01

    Full Text Available Background: Occipital-cervical fusion (OCF has been used to treat instability of the occipito-cervical junction and to provide biomechanical stability after decompressive surgery. The specific areas that require detailed morphologic knowledge to prevent technical failures are the thickness of the occipital bone and diameter of the C2 pedicle, as the occipital midline bone and the C2 pedicle have structurally the strongest bone to provide the biomechanical purchase for cranio-cervical instrumentation. The aim of this study was to perform a quantitative morphometric analysis using computed tomography (CT to determine the variability of the occipital bone thickness and C2 pedicle thickness to optimize screw placement for OCF in a South East Asian population. Methods: Thirty patients undergoing cranio-cervical junction instrumentation during the period 2008-2010 were included. The thickness of  the occipital bone and the length and diameter of the C2 pedicle were measured based on CT. Results: The thickest point on the occipital bone was in the midline with a maximum thickness below the external occipital protuberance of 16.2 mm (±3.0 mm, which was thicker than in the Western population. The average C2 pedicle diameter was 5.3 mm (±2.0 mm. This was smaller than Western population pedicle diameters. The average length of the both pedicles to the midpoint of the C2 vertebral body was 23.5 mm (±3.3 mm on the left and ±2.3 mm on the right. Conclusions: The results of this first study in the South East Asian population should help guide and improve the safety in occipito-cervical region instrumentation. Thus reducing the risk of technical failures and neuro-vascular injury.

  1. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes.

    Science.gov (United States)

    Lee, Chang-Hyun; Lee, Jaebong; Kang, James D; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI -0.37 to 0.54, p = 0.07) and neck pain VAS score (MD -0.33, 95% CI -1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.

  2. 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

  3. 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.

  4. Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients

    OpenAIRE

    Silvestre, Clément; Mac-Thiong, Jean-Marc; Hilmi, Radwan; Roussouly, Pierre

    2012-01-01

    Study Design A retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution. Purpose To report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine. Overview of Literature Different approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation. Methods A total of 179 patients with previous ...

  5. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    OpenAIRE

    Mitsunaga, Lance K.; Klineberg, Eric O.; Gupta, Munish C.

    2012-01-01

    Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation ...

  6. Fusion and Gemination in a Primary Mandibular Anterior teeth - A Case Report.

    Directory of Open Access Journals (Sweden)

    Prasanna Kumar Rao

    2014-04-01

    Full Text Available Tooth fusion is one of the rare anomalies of the shape of the tooth. It is due to the union of two separate tooth germs. Tooth fusion and gemination in mandibular primary teeth has very little documentation in Indian population. These conditions requires a minimal intervention approach, preventive procedures, and a long-term follow-up. Here we report a rare case of fusion between left mandibular primary central and lateral incisors and gemination in right primary mandibular lateral incisor in a four year old boy. [Cukurova Med J 2014; 39(2.000: 336-338

  7. [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.

  8. Artrodesis del raquis cervical por vía anterior con placa atornillada: criterios para la selección del implante

    OpenAIRE

    Barberá, José; Barberá, D.

    2005-01-01

    El propósito de esta revisión es analizar el mecanismo de acción de las placas utilizadas en la artrodesis instrumentada del raquis cervical por vía anterior, con el fin de llegar a un criterio que sirva para seleccionar aquella que sea más adecuada para cada tipo de patología. Se identifican cinco tipos de placas cuyo factor diferencial es la relación mecánica entre el tornillo y el orificio de la placa. Con este criterio se consideran cinco tipos de placa: 1º la de interfaz tornillo-placa l...

  9. 前后路联合手术治疗颈椎后纵韧带骨化症%The Safety of Combined Posterior-Anterior Approaches for Cervical Ossification of the Posterior Longitudinal Ligament

    Institute of Scientific and Technical Information of China (English)

    李永军; 唐小穗; 申勇; 于俊叶

    2011-01-01

    目的 回顾性分析研究采用后路单开门椎管成形术联合前路减压植骨融合内固定术治疗68例颈椎后纵韧带骨化症患者的临床及影像学资料,通过分析手术疗效、并发症、适应证评价手术安全性.方法 回顾性分析研究本院1999年3月至2010年4月采用前后路联合手术治疗的68例颈椎后纵韧带骨化症患者的临床及影像学资料,所有患者术后随访至少1年,平均18个月;对患者进行术前、术后JOA评分及Nurick分级,采用配对t检验及秩和检验分别对JOA评分及Nurick分级进行统计学分析,评价临床疗效及手术安全性.结果 患者JOA评分由术前(6.7±1.1)分提高到术后(15.1±0.6)分,差异有统计学意义(P<0.001,α=0.05),神经功能改善率为(81.5±5.6)%.Nurick分级从术前的(2.8±1.2)级提高到术后的(0.7±0.5)级,差异有统计学意义(P<0.001,α=0.05).术后神经根麻痹者4例,内固定物松动者1例,临近节段退变加重者3例,无脊髓或神经根永久性损伤、内固定物失败、颈椎后凸畸形等严重并发症发生.结论 前后路联合手术治疗颈椎后纵韧带骨化症,可以使脊髓彻底减压,纠正颈椎后凸畸形,维持颈椎稳定性,降低术中损伤脊髓的风险,减少内固定失败及假关节形成等并发症的发生,可获得理想手术疗效,提高了手术安全性.%Objective To evaluate the applicability and safety of posterior single open-door vertebral canaloplasty combined with anterior decompression , fusion and internal fixation for the management of cervical ossification of the posterior longitudinal ligament,the authors retrospectively reviewed 68 consecutive procedures of this type performed at their respective institutions and studied the surgical effects and surgical complications,surgical indications. Methods Retrospectively analyzed 68 patients with the disease of cervical ossification of the posterior longitudinal ligament operated by combining

  10. 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

    Directory of Open Access Journals (Sweden)

    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

  11. Biomechanics of Artificial Disc Replacements Adjacent to a 2-Level Fusion in 4-Level Hybrid Constructs: An In Vitro Investigation

    OpenAIRE

    Liao, Zhenhua; Fogel, Guy R.; Wei, Na; Gu, Hongsheng; Liu, Weiqiang

    2015-01-01

    Background The ideal procedure for multilevel cervical degenerative disc diseases remains controversial. Recent studies on hybrid surgery combining anterior cervical discectomy and fusion (ACDF) and artificial cervical disc replacement (ACDR) for 2-level and 3-level constructs have been reported in the literature. The purpose of this study was to estimate the biomechanics of 3 kinds of 4-level hybrid constructs, which are more likely to be used clinically compared to 4-level arthrodesis. Mate...

  12. 单节段双节段颈椎融合术后颈椎活动度的观察%Motion changes of cervical range after one or two-level cervical spine fusion

    Institute of Scientific and Technical Information of China (English)

    赵信; 徐宏光; 郑权; 方振; 赵泉来; 王弘; 刘平

    2015-01-01

    目的:探讨单节段及双节段颈椎融合手术对颈椎活动度的影响。方法:选取2010年6月~2012年6月在皖南医学院附属弋矶山医院脊柱外科行颈椎前路减压融合术的43例颈椎病患者,其中单节段融合29例,双节段融合14例。根据症状及X线片评价手术的有效率及融合节段的融合率。使用颈椎活动度测量仪( cervical range of motion device ,CROM)测量患者术前及术后随访24个月时颈椎前屈、后伸、左右侧弯、左右旋转6个方向的活动度。结果:从患者主诉分析,所有患者临床症状均得到缓解,通过X线评价融合节段融合率为100%。与术前相比单节段融合术后患者颈椎左右侧弯方向活动度无明显差异(P>0.05),而在前屈、后伸及左右旋转方向的活动度均较术前明显减低(P<0.05)。行双节段融合手术后患者颈椎在6个方向的活动度较术前均明显减低( P<0.05)。对两种不同融合术后患者颈椎活动度的差异进行统计学分析后发现双节段融合患者术后颈椎活动度在6个方向均较单节段融合患者降低( P<0.05)。结论:颈椎融合手术能够降低患者颈椎的活动度,与单节段融合相比双节段融合术后颈椎活动度的降低更为明显。%Objective:To observe the impact of one or two-level and double-level cervical spine fusion on the rang of cervical motion .Methods:Forty-three patients undergone cervical spine fusion in our department between June of 2010 and 2012 were included,among whom 29 received single-level fusion,and 14,two-level fusion.The curative effects and fusion rate of spine were evaluated by presented symptoms and X-ray findings.The cervical flexion,backward extension,left and right lateral bending,left and right rotation of the cervical vertebrae were measured by the cervical range of motion device(CROM) in all patients before operation and post-operative 24-month follow

  13. 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

  14. 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 cavity preparation resulted in lesser loss of dentin in the peri-cervical region. PMID:27656065

  15. 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

  16. Cell Fusion along the Anterior-Posterior Neuroaxis in Mice with Experimental Autoimmune Encephalomyelitis.

    Directory of Open Access Journals (Sweden)

    Sreenivasa R Sankavaram

    Full Text Available It is well documented that bone marrow-derived cells can fuse with a diverse range of cells, including brain cells, under normal or pathological conditions. Inflammation leads to robust fusion of bone marrow-derived cells with Purkinje cells and the formation of binucleate heterokaryons in the cerebellum. Heterokaryons form through the fusion of two developmentally differential cells and as a result contain two distinct nuclei without subsequent nuclear or chromosome loss.In the brain, fusion of bone marrow-derived cells appears to be restricted to the complex and large Purkinje cells, raising the question whether the size of the recipient cell is important for cell fusion in the central nervous system. Purkinje cells are among the largest neurons in the central nervous system and accordingly can harbor two nuclei.Using a well-characterized model for heterokaryon formation in the cerebellum (experimental autoimmune encephalomyelitis - a mouse model of multiple sclerosis, we report for the first time that green fluorescent protein-labeled bone marrow-derived cells can fuse and form heterokaryons with spinal cord motor neurons. These spinal cord heterokaryons are predominantly located in or adjacent to an active or previously active inflammation site, demonstrating that inflammation and infiltration of immune cells are key for cell fusion in the central nervous system. While some motor neurons were found to contain two nuclei, co-expressing green fluorescent protein and the neuronal marker, neuron-specific nuclear protein, a number of small interneurons also co-expressed green fluorescent protein and the neuronal marker, neuron-specific nuclear protein. These small heterokaryons were scattered in the gray matter of the spinal cord.This novel finding expands the repertoire of neurons that can form heterokaryons with bone marrow-derived cells in the central nervous system, albeit in low numbers, possibly leading to a novel therapy for spinal cord

  17. 椎体入路经皮内镜髓核摘除术治疗颈椎间盘突出症%Percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical disc herniation

    Institute of Scientific and Technical Information of China (English)

    楚磊; 刘超; 陈亮; 柯珍勇; 陈富; 邓忠良

    2016-01-01

    Objective To evaluate the feasiblility and efifcacy of percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical disc herniation.Methods From September 2013 to July 2014, 9 patients suffering cervical disc herniation received anterior transcorporeal approach for cervical disc herniation in the second Afifliated Hospital of Chongqing Medical University including 4 males, 5 females, with the average age of ( 44.5 ± 12.4 ) years ( range 24 - 68 years ). Levels of herniation: C3-4: 1, C4-5: 3, C5-6: 4, C6-7: 1. Percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical disc herniation: Guide wire was inserted between carotid sheath and tracheal esophageal sheath to the vertebra, then working trocar was applied. Burrs was used to make osseous channel in order to achieve access to the target. Herniated fragments and osteophyte were removed, and spinal cord and nerve roots were decompressed through the osseous channel. Operation time, amount of removed disc fragments and operation-related complications were observed and recorded. Clinical results were evaluated with VAS of shoulders and arms at one day before surgery, and postoperatively 1 day, 1 week, 1 month, 3 months 6 months. The follow-up included AP, lateral and dynamic X-ray of cervical spine, cervical CT and MRI.Results The surgeries were successfully performed for all the 9 patients, with an average operation time of ( 81.5 ± 23.4 ) min and an average amount of herniated disc fragments of ( 0.5 ± 0.2 ) g. One patient developed postoperative headache. One patient reported transient postoperative quadriplegia. Vertebral collapse were observed in 2 patients. The VAS was ( 75 ± 10 ) points before surgery, and respectively ( 32 ± 4 ) points, ( 22 ± 3 ) points, ( 19 ± 2 ) points, ( 16 ± 2 ) points and ( 8 ± 2 ) points at postoperatively 1 day, 1 week, 1 month, 3 months and 6 months. The VAS scores in follow-up were different from the one at

  18. 颈椎骨折经前路减压融合内固定术患者的围手术期的护理%Nursing Experience in Perioperative Period of Patients with Cervical Spine Fracture by Anterior Decompression and Internal Fixation

    Institute of Scientific and Technical Information of China (English)

    包秀梅

    2015-01-01

    Objective To investigate the cervical spine fracture by anterior decompression and fusion with internal fixation in patients with perioperative nursing.Methods A retrospective analysis of patients with general information from patients with anterior cervical surgery,preoperative and postoperative analysis of 2 nursing intervention patients,and observation of patients with complications. Results For 10 patients with anterior cervical spine surgery, the patients were given comprehensive, comprehensive and careful nursing, and no complications were found.Conclusion Careful nursing measures can promote the rehabilitation of patients, improve the quality of life of patients.%目的探讨颈椎骨折经前路减压融合内固定术患者的围手术期的护理。方法回顾性分析10例颈椎前路手术患者的一般资料,从术前、术后2方面分析给予患者的护理措施,并观察患者并发症的情况。结果对于10例颈椎前路手术患者的术前术后均给予全面、综合、精心的护理,未发现任何的并发症。结论精心的护理措施能促进患者的康复,提高患者的生活质量。

  19. 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

  20. Anterior transarticular screw fixation as a conventional operation for rigid stabilization

    OpenAIRE

    Manabu Sasaki; Katsumi Matsumoto; Koichiro Tsuruzono; Kazuhiro Yoshimura; Katsuhiko Shibano; Kazuo Yonenobu

    2014-01-01

    Background: Anterior transarticular screw (ATS) fixation is a useful surgical option for atlantoaxial (AA) stabilization. This report presents a revised ATS method for AA fusion. Methods: A 79-year-old male presented with AA instability attributed both to an old odontoid fracture and severe degeneration of the lateral atlantoaxial joints (LAAJs). ATS fixation was performed through the conventional anterior cervical approach. The longest screw trajectories were planned preoperatively using...

  1. Anterior discectomy and fusion with internal fixation for hangman fracture%前路颈2-3融合内固定术治疗Hangman骨折疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘浩; 童卫华; 扈佐鸿; 洪建明; 李祖国; 郭彩群; 吴吉光

    2013-01-01

    Objective To observe the injury mechanism, clinical effect of Anterior cervical surgery and bone graft fusion time for hangman fracture. Methods From January 2006 to June 2011,24 patients with hangman fracture underwent anterior discectomy and fusion with internal fixation at our department. According to the Levine-Edwards classification, all cases were divided into type Ⅰ (5 cases),type Ⅱ (12 cases),type Ⅱ A(3 cases),type Ⅲ(4 cases). Spinal cord compression was found in 7 cases. The average JOA score was 7.8(4-11). Traction was adopted for type Ⅱ and type Ⅱ A patients until complete reduction. The average skull tration time was 5 days. Anterior discec-tomy and fusion with internal fixation were adopted for all the patients. Results The follow-up periods for all the 24 patients ranged from 12 to 30 months with an average of 24 months.The average operative time was 85 minutes. No patients experienced worsening neurological postoperatively. No other intra-or postoperative complication was observed. All patients, axial pain was relieved after surgery. For 7 patients with neurological defict,JOA score enhanced to 14. Each patient showed evidence of a solid anterior C2-3 interbody fusion within 9 months (average 5 months). No bone graft or plate screws complication was observed in any of the follow-up period. Conclusion Anterior discectomy and fusion with internal fixation may be a feasible and safe way to treat Hangman fracture.%目的 探讨hangman骨折损伤机制、颈椎前路手术疗效、植骨融合时间.方法 2006-01-2011-06,我科收治24例Hangman骨折(其中Ⅰ型5例,Ⅱ型12例,ⅡA型3例,Ⅲ型4例),7例患者伴有不同程度颈髓和神经功能障碍,术前JOA评分4~11分,平均7.8分,其中稳定型骨折(Ⅰ型)术前行颈托固定,不稳定型骨折(Ⅱ型、ⅡA、Ⅲ型)术前行颅骨牵引,直至完全复位,术前平均牵引时间为5 d,患者行颈前路颈2-3椎间盘切除减压取髂骨植骨融合、颈

  2. Multilevel decompressive laminectomy and transpedicular instrumented fusion for cervical spondylotic radiculopathy and myelopathy: A minimum follow-up of 3 years

    Directory of Open Access Journals (Sweden)

    Kadir Kotil

    2011-01-01

    Full Text Available Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicular screws of the 70 pedicles of the 10 patients we operated due to degenerative stenosis in the cervical region, were investigated. Fixation was performed between C3 and C7, and we used resected lamina bone chips for fusion. Clinical indicators included age, gender, neurologic status, surgical indication, and number of levels stabilized. Dominant vertebral artery of all the patients was evaluated with Doppler ultrasonography. Preoperative and postoperative Nurick grade of each patient was documented. Results: No patients experienced neurovascular injury as a result of pedicle screw placement. Two patients had screw malposition, which did not require reoperation due to minor breaking. Most patients had 32-mm screws placed. Postoperative computed tomography scanning showed no compromise of the foramen transversarium. A total of 70 pedicle screws were placed. Good bony fusion was observed in all patients. At follow-up, 9/10 (90% patients had improved in their Nurick grades. The cases were followed-up for an average of 35.7 months (30-37 months. Conclusions: Use of the cervical pedicular fixation (CPF provides a very strong three-column stabilization but also carries vascular injury without nerve damage. Laminectomies technique may reduce the risk of malposition due to visualization of the spinal canal. CPF can be performed in a one-stage posterior procedure. This technique yielded good fusion rate without complications and can be considered as a good

  3. Post-traumatic cervical spondyloptosis: A rare entity with multiple management options.

    Science.gov (United States)

    Padwal, A; Shukla, D; Bhat, D I; Somanna, S; Devi, B I

    2016-06-01

    Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient. PMID:26922508

  4. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    OpenAIRE

    Barbagallo, Giuseppe M. V.; Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V.; Russo, Vittorio; Albanese, Vincenzo

    2009-01-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-fou...

  5. Associations between craniofacial morphology, head posture, and cervical vertebral body fusions in men with sleep apnea

    DEFF Research Database (Denmark)

    Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon;

    2009-01-01

    INTRODUCTION: The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. METHODS: Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies...... dimensions between the groups were assessed by unpaired t tests. RESULTS: No significant differences were seen between groups I and III. Between groups I and II, significant differences were seen in jaw relationship (P

  6. Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    Smith, M D; Bolesta, M J; Leventhal, M; Bohlman, H H

    1992-02-01

    Of twenty-two patients who had had anterior decompression of the spinal canal for ossification of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a cerebrospinal-fluid fistula developed postoperatively in five, and three had a second operation to repair the defect in the dura. On the basis of this experience, we recommend use of autogenous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safely possible and use of anti-emetic and antitussive medications to protect the remaining coverings of the spinal cord when the dura is found to be absent adjacent to an ossified portion of the posterior longitudinal ligament in the cervical spine. PMID:1541620

  7. Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel-Feil syndrome

    Directory of Open Access Journals (Sweden)

    Ioannis D Papanastassiou

    2011-01-01

    Full Text Available Cervical arthroplasty may be justified in patients with Klippel-Feil syndrome (KFS in order to preserve cervical motion. The aim of this paper is to report an arthroplasty failure in a patient with KFS. A 36-year-old woman with KFS underwent two-level arthroplasty for adjacent segment disc degeneration. Anterior migration of the cranial prosthesis was encountered 5 months postoperatively and was successfully revised with anterior cervical fusion. Cervical arthroplasty in an extensively stiff and fused neck is challenging and may lead to catastrophic failure. Although motion preservation is desirable in KFS, the special biomechanical features may hinder arthroplasty. Fusion or hybrid constructs may represent more reasonable options, especially when multiple fused segments are present.

  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. 颈椎前路内固定术后中远期食管并发症%Delayed esophageal complications after anterior cervical spine surgery

    Institute of Scientific and Technical Information of China (English)

    高瑞; 杨立利; 陈华江; 王新伟; 袁文

    2012-01-01

    Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17%.Esophageal perforation occurred in 2 patients; the incidence was 0.09%.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management

  10. Anterior or posterior approach for the treatment of severe ossification of posterior longitudinal ligament in the cervical spine%严重颈椎后纵韧带骨化症前路和后路手术比较

    Institute of Scientific and Technical Information of China (English)

    陈宇; 陈德玉; 王新伟; 杨立利; 宋滇文; 严望军; 叶晓健; 袁文

    2008-01-01

    目的 探讨前路和后路手术治疗严重颈椎后纵韧带骨化症的适应证选择、疗效及并发症.方法 2004年1月至2006年12月,手术治疗椎管狭窄率大于50%的严重颈椎后纵韧带骨化症患者34例(男29例,女5例,平均57.2岁),前路采用椎体次全切除减压钛网植骨内固定术14例(男12例,女2例),后路采用椎板切除减压侧块螺钉固定术20例(男17例,女3例).比较两种手术方式患者的颈椎管矢状径、颈椎曲度、椎管狭窄率、骨化物分型、骨化物范围、脊髓压迫率等的差异.采用JOA评分评价患者术前、术后神经功能,并计算改善率.结果 影像学结果显示前路手术主要为范围在3个节段以内的局限型和分节型骨化患者,而后路手术主要为范围超过3节段的连续型和混合型骨化患者,骨化物的分型及范围是选择的主要依据.所有患者随访6个月~3年,平均1.5年.前路手术组JOA评分从术前平均(9.3+1.8)分提高至术后平均(14.2±1.3)分,平均改善率62.3%±15.2%;后路手术组JOA评分从术前平均(8.7+1.6)分提高至术后平均(11.4±1.2)分,平均改善率33.5%±12.7%.两组患者疗效差异有统计学意义(P<0.01).结论 对于骨化范围在3个节段以内的患者,前路手术是安全、有效的治疗方式,而后路手术则适用于范围超过3个节段的严重颈椎后纵韧带骨化症患者.%Objective To discuss the surgical indications,results and complications of anterior or posterior approach for the treatment of severe ossification of posterior longitudinal ligament(OPLL)in the cervical spine.Methods Between 2002 and 2006,34 patients(29 males and 5 females,mean age 57.2 years)with severe cervical ossification of posterior longitudinal ligament(the canal stenosis rate exceeding 50%)were surgically treated in our hospital.Among them,14 patients(12 males and 2 females)underwent anterior corpectomy and fusion,and the other 20 patients (17 males and 3 females

  11. Clinical Outcomes After Cervical Transcorporeal Microdecompression and Vertebral Body Access Channel Repair

    OpenAIRE

    David W Lowry; Tuinstra, Scott M.; Liang, Kevin; Sclafani, Joseph A.

    2015-01-01

    Background Although anterior cervical decompression and fusion (ACDF) can be performed using minimally invasive techniques, the extensive removal of anatomical keystones during decompression requires a segmental fusion to restore biomechanical stability. Treatment with arthrodesis techniques may result in a prolonged recovery time, loss of motion, and the need for further treatment if a pseudarthosis or adjacent segment disease occur. Transcorporeal micro decompression (TCMD) is a newly devel...

  12. Two Cases of Klippel-Feil Syndrome with Cervical Myelopathy Successfully Treated by Simple Decompression without Fixation

    OpenAIRE

    Kim, Jin Bum; Park, Seung Won; Lee, Young Seok; Nam, Taek Kyun; Park, Yong Sook; Kim, Young Baeg

    2015-01-01

    Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic defor...

  13. Anterior surgical treatment of 4-level cervical spondylotic myelopathy%前路手术治疗4节段脊髓型颈椎病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    侯铁胜; 严宁; 虞舜志; 蔡晓冰; 张海龙; 顾广飞; 赵杉; 贺石生

    2015-01-01

    Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy (4-level CSM) who underwent anterior decompression and fusion surgery.Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected.Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated.Neurological function was measured at different times using Japanese Orthopedic Association (JOA) scores.The visual analogue score (VAS) was recorded for neck-shoulder pain evaluation.X-rays were conducted before and after surgery for cervical lordosis and fusion rate.Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well.Results All the operations were performed uneventfully.The mean operative time was 136± 18min and mean blood loss was 67±16ml.The overall follow-up period of the patients ranged from 1-8 years (average 3.6± 1.7years).The VAS score significantly decreased from 7.3± 1.2 preoperatively to 3.6±0.8 at 12 months postoperatively.The JOA score was 9.2± 1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively.Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100% at 6 months postoperatively.Titanium meshes were used in 28 patients, whose fusion rate was 85.7% at 6 months postoperatively and 100% at 12 months postoperatively.No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up.Complications included iliac pain (3 cases), dysphonia (1 case), C5 palsy (1 case), cerebral fluid leakage (2 cases), axial neck pain (5 cases) and temporary dysphagia (1 case).Conclusion Anterior

  14. Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1.

    Science.gov (United States)

    Kawabata, Soya; Watanabe, Kota; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2013-03-01

    Severe cervical kyphosis requiring surgical treatment is rare in patients with neurofibromatosis Type 1 (NF1). When it occurs, however, dystrophic changes in the vertebrae make surgical correction and fusion of the deformity extremely difficult. The authors report on 3 cases of severe cervical kyphosis associated with NF1 that were successfully treated with combined anterior and posterior correction and fusion. All patients underwent halo-gravity traction for approximately 1 month prior to surgery to correct the deformity gradually. Posterior correction and fusion were performed with segmental spinal instrumentation consisting of lateral mass screws, lamina screws, pedicle screws, and polyethylene tape for sublaminar wiring. Anterior spinal fusion was performed using a fibula strut to induce solid bone fusion. All patients used a halo vest for postoperative external fixation. Preoperative CT scans showed dystrophic cervical spine changes, and MR images demonstrated extensive neurofibromas outside the cervical spine in all 3 patients. The preoperative kyphotic angles were as follows: Case 1, 140°; Case 2, 81°; and Case 3, 72°; after halo-gravity traction, the kyphosis angles improved to 50°, 55°, and 51°, respectively; and after surgery, they were 50°, 15°, and 27°, respectively. Solid bone union was observed in all patients at the latest follow-up. All three patients experienced postoperative complications consisting of superficial infection, severe pneumonia, and partial dislocation of the distal fibula graft after removing the halo vest, in one patient each. Although dystrophic cervical vertebral changes in these patients with NF1 complicated the correction of severe cervical kyphosis, the use of preoperative halo-gravity traction, a combination of spinal instrumentations, an anterior strut bone graft, and postoperative halo-vest fixation made it possible to correct the kyphosis, maintain the correction, and achieve solid bone fusion. PMID:23289507

  15. Infection after anterior spinal fusion for idiopathic scoliosis using the Cotrel-Dubousset-Hopf system: A clinical case series of three patients

    Science.gov (United States)

    Willems, Paul C.; Punt, Ilona M.; van Rhijn, Lodewijk W.; van Ooij, André

    2016-01-01

    Background Three patients with late-onset infection after multilevel instrumented anterior spinal fusion for idiopathic scoliosis, using the Cotrel-Dubousset-Hopf (CDH) system, are presented. The CDH-system is an anterior instrumentation with high biomechanical stability and rigidity, ensuring a stable primary fixation. Unlike after posterior spinal fusion, infection after anterior spinal fusion (ASF) for idiopathic scoliosis has rarely been reported. Methods The files of three patients who developed an infection after ASF for scoliosis using the CDH-system, were reviewed. The clinical presentation and diagnostic and therapeutic options are discussed. Results All three patients had a late-onset infection of the CDH-system, which was difficult to diagnose because of nonspecific symptoms. Radiographs and technetium bone scan appeared to be of low value. When an abscess was present, this could accurately be diagnosed with MRI or CT imaging. Operative treatment with implant removal and antibiotic therapy was successful in all cases. Conclusion Late onset infections after ASF using the CDH-system presented with few and nonspecific symptoms. The clinical presentation was mainly characterized by vague abdominal- or back-pain after an interval of normal postoperative recovery, moderately raised infection parameters and inconclusive findings with imaging modalities. As treatment, implant removal, debridement and parenteral antibiotics are recommended. It should be noted though that implant removal poses serious risks for vascular and visceral structures. PMID:26913222

  16. Diaphragm paralysis from cervical disc lesions.

    Science.gov (United States)

    Cloward, R B

    1988-01-01

    An opera singer, who "made her living with her diaphragm", developed a post-traumatic unilateral radiculopathy due to cervical disc lesions, C3 to C6. During one year of severe neck and left arm pain she gradually lost the ability to sing difficult operatic passages which brought an end to her music career. Following a three level anterior cervical decompression and fusion, the neck and arm pain was immediately relieved. One week later her voice and singing ability returned to its full strength and power permitting her to resume her activities as a vocalist. The diagnosis of paresis of the left hemi-diaphragm as part of the cervical disc syndrome was implied by postoperative retrospective inference.

  17. Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: This is a commentary on the article laminoplasty versus laminectomy and fusion (LF for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL versus laminectomy and fusion (LF to address three or more level multilevel cervical spondylotic myelopathy (CSM. Both procedures led to similar degrees of neurological recovery and short-term loss of lordosis, but found that LF led to more favorable long-term results. Methods: For patients with three or more level CSM, laminectomy followed by an instrumented fusion (LF has major advantages; open bilateral decompression of the nerve roots, while minimizing the risk of inadvertent injury to the cord, and the fusion′s maintenance of lordosis. Results: Some would argue that inadvertent cord/root injury is greater utilizing any of the EL techniques; e.g., unilateral, bilateral, or spinous process splitting techniques. In short, why risk cord/root injury by manipulating the compressive posterior/posterolateral elements, which are already threatening neural function. Conclusion: Although the results of EL versus LF appeared comparable in the short-term in these seven articles, LF resulted in better long-term outcomes. Some would also argue that LF, utilizing an open approach offers safer bilateral neural exposure and decompression.

  18. 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

  19. [Langerhans cell histiocytosis causing cervical myelopathy].

    Science.gov (United States)

    Doléagbénou, A K; Mukengeshay Ntalaja, J; Derraz, S; El Ouahabi, A; El Khamlichi, A

    2012-08-01

    Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered. PMID:22552159

  20. 显微手术切除及椎管固定融合治疗高颈段椎管哑铃型肿瘤%Microsurgery Treatment and Cervical Vertebral Fusion for Upper Cervical Dumbbell Tumor

    Institute of Scientific and Technical Information of China (English)

    段波; 秦军; 赵洪洋

    2013-01-01

    目的 探讨显微手术切除高颈段椎管哑铃型肿瘤及椎管固定融合的方法及效果.方法 回顾性分析11例高颈段椎管哑铃型肿瘤患者的临床资料,其中ToyamaⅡ型6例,Ⅲ型4例,V型1例.均行显微手术切除,其中远外侧入路3例,颈后正中入路8例.同时行椎管固定融合6例.结果 本组全切10例,次全切除1例.术后病理学诊断为神经纤维瘤9例,脊膜瘤2例.术后症状明显改善9例,改善2例,无感染及死亡病例.随访10例,平均时间27个月(3个月~3年),患者的症状和神经功能均有不同程度的改善,无颈椎不稳及后凸畸形. 结论 高颈段椎管哑铃型肿瘤显微手术切除并椎管固定融合能明显改善症状,安全性好,并发症少.%Objective To study the method and effect on microsurgical treatment and spinal fusion of upper cervical vertebral canal dumbbell tumors. Methods The clinical data of 11 cases suffered upper cervical dumbbell tumor was analyzed retrospectively, including 6 cases of type Ⅱ , 4 cases of type Ⅲ and 1 case of type Ⅴ according to Toyama typing. All 11 cases were performed microsurgery via far lateral approach in 3 cases and cervical posterior midline approach in 8 cases. Among them, 6 cases received spinal fusion. Results 10 cases were performed total resection and 1 case were performed subtotal resection. The post operative pathology exam revealed neurofibroma in 9 cases and spinal meningioma in 2 cases. The symptoms were improved in all cases without infection and death after operation. 10 cases were followed up for 3 months to 3 years( average 27 months). All symptoms and nerve function were improved without cervical vertebral instability and cervical kyphosis. Conclusion Microsurgical resection and spinal fusion can improve the symptoms obviously for dumbbell tumor in upper cervical spinal cord with better security and fewer complications.

  1. Surgical staged treatment for moderate to severe adolescent cervical kyphosis

    Institute of Scientific and Technical Information of China (English)

    LIANG Lei; ZHOU Xu-hui; LIU Yang; GAO Rui; CHEN Hua-jiang; YANG Li-li; SHI Sheng; YUAN Wen

    2011-01-01

    Background Adolescent cervical kyphosis refers to manifestation characterized by loss of physiological cervical lordosis with involvement of multiple cervical vertebrae.There is no standard treatment strategy for this disease,especially in those patients who need surgical intervention.The aim of this study was to evaluate the surgical staged treatment for moderate to severe adolescents cervical kyphosis.Methods A total of 26 adolescent with cervical kyphosis were retrospectively assigned into following two groups according to the magnitude of kyphosis:moderate group (n=17),the Cobb angle was 46.6°±4.8°.The surgical procedure was that skull traction was first carried out for 5-7 days and then the anterior fusion and instrumentation were performed.Severe group (n=9),the Cobb angle was 61.6°±4.8°.The treatment strategy was that the anterior release were first performed,followed by skull traction for 7-10 days,and then anterior fusion were performed.Radiographic evaluation was performed postoperatively.Results Three days after surgery,the X-ray examination showed that the Cobb angle was -8.9°±6.8° in the moderate group and -6.0°±6.3° in the severe group.The deformed appearance was obviously corrected,with neck pain and neurologic function improved significantly.Further magnetic resonance imaging (MRI) indicated the physiology curvature of the cervical spine had been reconstructed.Conclusion Surgical staged treatment may be an ideal therapeutic intervention for cervical kyphosis patients with a Cobb angle exceeding 35° in adolescents.

  2. Cervical neurofibromatosis with quadriparesis: Management by fibular strut graft

    Directory of Open Access Journals (Sweden)

    Laohacharoensombat Wichien

    2010-01-01

    Full Text Available This is a case report of an eight-year old boy with neurofibromatosis and a 120º dystrophic kyphosis of the cervical spine. He presented with progressive quadriparesis caused by spondyloptosis of the C2/C3, and was successfully treated by skull traction and one-stage anterior fibular strut graft lying between the tubercle of the atlas through the C2 body slot and lower vertebrae. At seven years follow-up there was, loosening of lower vertebral screws which allowed growth and residual mobility of lower vertebral joints while the fusion of upper cervical spines was still solid.

  3. 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

  4. Artificial cervical disc replacement: Principles, types and techniques

    Directory of Open Access Journals (Sweden)

    Sekhon L

    2005-01-01

    Full Text Available Cervical arthroplasty after anterior decompression with insertion of a prosthetic total disc replacement has been suggested as an alternate to anterior cervical fusion. Currently there are four cervical arthroplasty devices available on the market whose results in clinical use have been reported. Each device varies in terms of materials, range of motion, insertion technique and constraint. It is not known which device is ideal. 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 available on the market as well as discussing issues regarding indications and technique. Pitfalls are discussed and early experiences reviewed. In time, it is hoped that a refinement of cervical arthroplasty occurs in terms of both materials and design as well as in terms of indications and clinical outcomes as spinal surgeons enter a new era of the management of cervical spine disease.

  5. 下颈椎骨折脱位修复方法的选择:植骨融合及颈椎稳定性分析%Restoration of fracture and dislocation of lower cervical spine:bone graft fusion and cervical stability

    Institute of Scientific and Technical Information of China (English)

    王建元; 邓强; 盛伟斌; 陆永江

    2015-01-01

    BACKGROUND:The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE:To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgicaly from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were 10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at folow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION:Al the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. Al patients were immobilized in a hard colar for 3 months postoperatively and were folowed up for 6-18 moths. At postoperative 6 months, 5 cases

  6. 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. PMID:26835204

  7. 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

  8. Incidence of secondary surgical procedures after cervical disc arthroplasty compared to fusion: a meta-analysis%颈椎人工椎间盘置换术与前路减压融合固定术再手术率的Meta分析

    Institute of Scientific and Technical Information of China (English)

    姜东杰; 顾庆国; 王占超; 王新伟; 袁文

    2015-01-01

    目的 比较颈椎人工椎间盘置换术与前路减压融合固定术治疗单节段颈椎病术后相邻节段和手术节段再手术的发生率.方法 计算机检索Pubmed、Medline、Ovid、Embase、Cochrane Library和中国生物医学文献数据库、万方、维普等数据库,英文检索词为"cervical"、"replacement OR arthroplasty OR prosthesis’,、"fusion OR arthrodesis","reoperation ORsecondary surgical procedure",中文检索词为"颈椎"、"间盘置换"、"融合"、"再手术".由2名评价者严格按照纳入及排除标准进行文献筛选,收集关于颈椎人工椎间盘置换术与前路减压融合固定术再手术发生率的前瞻性随机对照研究.根据Cochrane Reviews Handbook 5.1.0的RCT偏倚风险评价标准对纳入文献的偏倚风险进行独立评价,并采用Review Manager5.2软件进行统计分析相邻节段和手术节段的再手术发生率.结果12篇文献纳入研究,短期(2年)随机对照研究6篇,中远期(4~8.8年)随机对照研究6篇.4篇为低偏倚风险,7篇为中偏倚风险,1篇为高偏倚风险.Meta分析显示,短期随访结果 中两种术式在相邻节段的再手术发生率无明显差异,而中远期随访结果显示非融合组术后相邻节段再手术率低于融合组;非融合组手术节段再手术率均低于融合组.短期随访中两组患者采用Removal翻修方法的例数无差别;中远期随访中融合组患者采用该翻修方法进行翻修的人数多于非融合组.结论 非融合术式能在一定程度上降低相邻节段再手术的发生率,但是在短期(2年)内对降低邻近节段再手术的发生率效果并不明显.减少融合术后假关节形成是降低融合术式手术节段再手术率的有效方法.%Objective To compare the incidence of secondary surgical procedures after cervical disc arthroplasty vs anterior cervical discectomy with fusion in patients treated for symptomatic single level cervical spondylosis.Methods An online

  9. Epidemiologic trends in the utilization, demographics, and cost of bone morphogenetic protein in spinal fusions

    OpenAIRE

    Louie, Philip K.; Hassanzadeh, Hamid; Singh, Kern

    2014-01-01

    Bone morphogenetic protein (BMP) utilization as an adjunct for spinal arthrodesis has gained considerable momentum among spine surgeons. Despite carrying Food and Drug Administration approval for only single level anterior lumbar interbody fusion from L4-S1, the majority of BMP administration is in “off label” settings. Over the last decade, BMP utilization has increased in all facets of spine surgery with the only exception being the anterior cervical spine, in which a downward trend resulte...

  10. Fusion

    CERN Document Server

    Mahaffey, James A

    2012-01-01

    As energy problems of the world grow, work toward fusion power continues at a greater pace than ever before. The topic of fusion is one that is often met with the most recognition and interest in the nuclear power arena. Written in clear and jargon-free prose, Fusion explores the big bang of creation to the blackout death of worn-out stars. A brief history of fusion research, beginning with the first tentative theories in the early 20th century, is also discussed, as well as the race for fusion power. This brand-new, full-color resource examines the various programs currently being funded or p

  11. Clinical significance of perioperative methylprednisolone on anterior cervical decompression operation%甲泼尼龙在颈椎前路减压术中的应用

    Institute of Scientific and Technical Information of China (English)

    刘建东; 卢承志; 林斌; 周亮; 张文龙; 姚猛飞

    2013-01-01

    Objective To investigate the effects of methylprednisolone (MP) on patients with cervical spondylotic myelopathy (CSM) underwent anterior decompression.Methods Fifty patients scheduled for elective anterior decompression were randomly divided into two groups of 25 each:control group (C) and methylprednisolone group (MP).Group MP received methylprednisolone 30 mg/kg and group C received same volume of normal saline instead of methylprednisolone as control Blood samples were taken from vein for determination of plasma TNF-α,IL-6 and SOD concentrations before induction of anesthesia (T1),1 h after (T2),6 h after (T3) and 24 h (T4) after termination of operation.All of these was estimated by enzyme-linked immunosorbent assay (ELISA).Results There was no significant difference between two groups in plasma TNF-α,IL-6 and SOD level at T1.The level of TNF-α,IL-6 at T2-T4 and SOD at T2-T3 was significantly increased compared with that before operation in both groups.However,the plasma concentrations of TNF-α and IL-6 were significantly lower at T2-T4 while the concentration of SOD was significantly higher at T2-T3 in group MP than those in group C.Conclusion Methylprednisolone can reduce the increased amplitude of plasma levels of TNF-α and IL-6,whereas enhance the increased amplitude of the plasma SOD levels in anterior cervical decompression operation.In other words,Methylprednisolone posseses the effect to decrease ischemical reperfusion injury and down-regulate inflammatory response during operation.%目的 探讨甲泼尼龙(MP)在脊髓型颈椎病(CSM)前路减压术中的应用价值.方法 选择行颈椎前路减压术的CSM 50例,随机分为甲泼尼龙组(MP组)和对照组(C组),每组25例.MP组给予MP 30 mg/kg,C组予与等容量生理盐水.分别于麻醉诱导前(T1),术后1 h(T2),术后6 h(T3),术后24 h(T4)抽取静脉血,用酶联免疫吸附法(ELISA)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超氧化

  12. Axial Neck Pain after Cervical Laminectomy with Instrumented Fusion%颈椎椎板切除融合术后轴性疼痛

    Institute of Scientific and Technical Information of China (English)

    韩雨; 张永刚; 张雪松; 陆宁; 毛克亚; 崔庚; 王征

    2011-01-01

    目的:目前已证实颈椎椎板切除融合术是治疗多阶段的脊髓型颈椎病和后纵韧带骨化病的一种安全和有效的方法.然而,颈椎椎板切除融合术后经常发生颈部轴性疼痛.本研究的目的是观察C7棘突保留与否与颈椎椎板切除融合术后轴性疼痛的关系.方法:对2006年1月~2008年12月在我院行颈椎椎板切除融合术的67个病人进行回顾性分析.将这67个病人之中保留了C7棘突的29名病人称为A组,未保留C7棘突的38名病人称为B组,对两组病人的轴性症状、颈椎曲度和颈椎曲度指数(cervi cal curbatureindex,CCI)进行评估和比较.结果:在A组中有51.7%的病人发生了早期的轴性症状,10.3%的病人发生了晚期的轴性症状,B组分别为60.5%和42.1%.B组中42.1%的病人和A组中10.3%的病人在手术后晚期有轴性症状,A组的轴性疼痛发生率低于B组,有统计学意义(p=0.001).结论:保留C7棘突可以降低颈椎椎板切除融合术后轴性症状的发生率.%Objective: It has been demonstrated that cervical laminectomy with instrumented fusion is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament.However, axial neck pain is frequently encountered after cervical laminectomy with instrumented fusion.The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminectomy with instrumented fusion.Methods: A total of 67 consecutive patients that underwent cervical laminectomy with instrumented fusion between Janurary 2006 and December 2008 were reviewed.The authors evaluated and compared axial neck pain 、 lordotic angle and cervical curbature index (CCI) in patients that underwent C7 spinous process preserving surgery (groupA n = 29) and in patients in which the C7 spinons process was sacrificed (groupB, n = 38).Results: Early axial pain occurred in 51.7% of

  13. Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

    Directory of Open Access Journals (Sweden)

    Su N

    2016-08-01

    Full Text Available Nan Su, Qi Fei, Bingqiang Wang, Dong Li, Jinjun Li, Hai Meng, Yong Yang, Ai Guo Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People’s Republic of China Objectives: The purpose of the present study was to explore and analyze the long-term outcomes and factors that affect the prognosis of expansive open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy (CSM. Methods: We retrospectively reviewed 49 patients with multilevel CSM who had undergone expansive open-door laminoplasty with lateral mass screws fixation and fusion in our hospital between February 2008 and February 2012. The average follow-up period was 4.6 years. The clinical data of patients, including age, sex, operation records, pre- and postoperation Japanese Orthopedic Association (JOA scores, cervical spine canal stenosis, and cervical curvature, were collected. Increased signal intensity (ISI on T2-weighted magnetic resonance imaging and ossification of the posterior longitudinal ligament were also observed. Paired t-test was used to analyze the treatment effectiveness and recovery of neuronal function. The prognostic factors were analyzed with multivariable linear regression model. Results: Forty-nine patients with CSM with a mean age of 59.44 years were enrolled in this study. The average of preoperative JOA score was 9.14±2.25, and postoperative JOA score was 15.31±1.73. There was significant difference between the pre- and postoperative JOA scores. The clinical improvement rate was 80.27%. On follow-up, five patients had complaints of neck and shoulder pain, but no evidence of C5 nerve palsy was found. Developmental cervical spine canal stenosis was present in all patients before surgery. Before surgery, ISI was observed in eight patients, while ossification of the posterior longitudinal ligament was found in 12 patients. The average of preoperative cervical

  14. Anterior surgical treatment of cervical spondylosis of spinal cord and nerve root type%脊髓型及神经根型颈椎病的前路手术治疗

    Institute of Scientific and Technical Information of China (English)

    刘向阳; 杨宝来; 张辉

    2015-01-01

    Objective To analyze the curative effect of anterior operation in treatment of spinal cord and nerve root type cervical spondylosis.Methods Choose our hospital 16 cases of cervical spinal cord and nerve root type of cervical spondylosis patients as the observation object (December 2014 to February 2012), in fact, the implementation of anterior surgery for treatment, observe the effect of surgery.Results The average intraoperative blood loss was (90.12±15.34) ml, the average JOA score was (14.58±1.34), the cure rate was93.75%. Conclusion Spinal cord and nerve root type of cervical spondylosis anterior surgery treatment effect is remarkable, safe and reliable, it is worth promoting.%目的:分析前路手术治疗脊髓型及神经根型颈椎病的疗效。方法选择2012年2月~2014年12月我院收治的脊髓型及神经根型颈椎病患者16例作为研究对象,对其实施前路手术进行治疗,并观察手术效果。结果患者术中平均出血量为(90.12±15.34)mL,JOA平均评分为(14.58±1.34)分,治愈率为93.75%。结论脊髓型及神经根型颈椎病的前路手术疗效显著,安全可靠,值得临床推广应用。

  15. Activ C cervical disc replacement for myelopathy

    Directory of Open Access Journals (Sweden)

    L McGonagle

    2011-01-01

    Full Text Available Background: Cervical disc replacement is becoming an increasingly popular treatment option for cervical myelopathy. It retains motion at the affected segment, unlike anterior cervical discectomy and fusion. The aim of this study is to assess the outcomes of a series of patients who underwent Activ C disc replacement for cervical myelopathy. Materials and Methods: A series of patients at the above Trust with clinical and radiological evidence of cervical myelopathy who were suitable for cervical disc replacement from 2007 to 2009 were included. Implants were inserted by one of two consultant surgeons {IMS, MO′M}. Patients were assessed preoperatively and at six, 12 and 24 months, postoperatively, with a visual analogue score (VAS for neck and arm pain severity and frequency, the Neck Disability Index questionnaire (NDI and the Centre for Epidemiologic Studies Depression questionnaire (CES-D. Results: Ten patients underwent surgery between May 2007 and July 2009, 6 women, and 4 men. Average age was 54 years (40-64. Disc levels replaced were: four at C4-5; eight at C5-6; seven at C6-7. Three patients had one disc replaced, five patients had two discs replaced, and two patients had three discs replaced. The VAS for neck pain improved from 5.9 pre-operatively to 1.4-24 months postoperatively and the VAS arm pain improved from 5.4 to 2.6. The NDI improved from 51% preoperatively to 26.8% at 24 months postoperatively. The CES-D showed a slight increase from 19.5 preoperatively to 21.7 at 24 months, postoperatively. Conclusion: Cervical decompression and disc replacement improves pain and function in patients with cervical myelopathy. This benefit is maintained at 24 months post op, with no cases requiring revision.

  16. 颈前路植骨融合内固定治疗Ⅱ、ⅡA型Hangman骨折%Anterior fusion with the internal fixation system in the treatment for Hangman’s fracture of type Ⅱ and ⅡA

    Institute of Scientific and Technical Information of China (English)

    黄惠梅; 蔡镇德; 林松庆; 林晓东

    2014-01-01

    Objective To observe the clinical effect of anterior fusion with the internal fixation system in the treat-ment for unstable Hangman’s fractures of type Ⅱ,ⅡA. Methods 16 cases of Hangman fractures of type Ⅱ,ⅡA were involved in this study, who all underwent anterior fusion with internal fixation system after skull traction. Re-sults All patients were followed up for 12~24 months. There was no sign of injury to spinal cord, nerve roots and cervical arteries, no leak of cerebrospinal fluid, no infection, and no occurrence of sore throat and dysphagia. Three months after the operation, all patients were cured with bony union and restoration of cervical curvature, the spine movement maintained excellently. There was no sign of screw loosening and breakage. Spinal cord function was im-proved from D grade to E grade in 4 cases. Occipitocervical pain was attenuated in all patients. There were 7cases underwent anterior fusion from iliac bone, all of the incisions healed well, and there was no pain of the dornor site. Conclusions Anterior cervical fusion with internal plate fixation for treatment of unstable Hangman’s fracture can se-cure instant stability, with the advantages:complete decompression, solid fixation, satisfactory fusion.%目的:观察颈前路植骨融合钢板内固定治疗Ⅱ、ⅡA型Hangman骨折的临床疗效。方法对16例Ⅱ、ⅡA型Hangman骨折患者术前颅骨牵引后行颈前路植骨融合钢板内固定术。结果16例均获随访,时间12~24个月。均未出现脊髓、神经损伤,无椎动脉损伤及脑脊液等并发症,无切口感染,未发生咽喉疼痛、吞咽困难。术后3个月患者均获骨性愈合。颈椎生理曲度恢复,屈伸及旋转活动良好,无内固定系统松动、断裂现象。4例脊髓神经D级者全部恢复到E级。枕颈部疼痛均较术前明显改善。7例行取髂骨术者切口愈合良好,术区无遗留疼痛。结论颈前路植骨融合钢板

  17. National trends in outpatient surgical treatment of degenerative cervical spine disease.

    Science.gov (United States)

    Baird, Evan O; Egorova, Natalia N; McAnany, Steven J; Qureshi, Sheeraz A; Hecht, Andrew C; Cho, Samuel K

    2014-08-01

    Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.

  18. 颈椎前路手术早期并发症防治探讨%The study on prevention and treatment of postoperative complications in early stage of anterior cervical spine surgery

    Institute of Scientific and Technical Information of China (English)

    李强; 陈向阳; 冯虎; 邓斌; 蒋允昌; 乔建恭

    2013-01-01

    目的 回顾分析颈椎前路手术早期常见并发症的发生原因,提出防治策略.方法 对2006-06-2011-08我科开展的416例颈椎前路手术进行回顾性分析.结果 本组共发生早期并发症共29例,总发生率为6.97%.常见并发症为:咽喉部不适吞咽疼痛6例,颈脊髓损伤4例,喉上、喉返神经损伤5例;食管瘘2例;脑脊液漏2例;涎漏2例;气道阻塞3例;髂骨供骨区并发症4例.除喉头水肿、脑脊液漏患者死亡各1例外,其余发生并发症患者均逐渐康复.结论 颈椎前路手术术后早期可能会发生多种并发症,充分的术前准备,熟悉颈前路相关解剖,熟练的手术操作,规范的术后管理,能够减少并发症.%Objective To analyze the causes for early postoperative complications in early stage of cervical surgery by anterior approach and to explore corresponding prevention and treatment measures. Methods A retrospective analysis was performed on 416 cases treated with anterior cervical surgery from June 2006 to August 2011. Results In these cases 29 postoperative complications associated with surgery were found, with an incidence of 6.97%,of which 6 cases were throat pain, 4 cases were aggravated spinal cord injuries,5 cases were laryngeal, recurrent laryngeal nerve injuries,2 cases were esophageal fistula,2 cases were cerebrospinal fluid leakage,2 cases were saliva leakage,3 cases were respiratory tract block,4 cases were complications in the vessels area that supply the iliac bone. One patient with respiratory tract block and one patient cerebrospinal fluid leakage died,but then the rest were recovered gradually. Conclusion Various early postoperative complications may occur in the anterior cervical spine surgery. Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach,skilled surgical technique and perfect postoperative management may prevent the complications in anterior cervical spine surgery.

  19. Hybrid手术治疗脊髓型颈椎病的临床疗效分析%Clinical efficacy analysis of hybrid spinal fusion surgery in the treatment of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    马迅; 梅军; 冯皓宇; 张丽; 关晓明

    2013-01-01

    Objective To investigate the clinical efficacy,operative essentials and indications of hybrid spinal fusion surgery for cervical spondylotic myelopathy.Methods From August 2008 to December 2011,thirty-eight patients with cervical spondylotic myelopathy underwent hybrid spinal fusion surgery in our hospital.There were 27 males and 11 females,aged from 33 to 70 years (average,51 years).A total of 86 segments were treated (fusion 48 vs.non-fusion 38).Twenty-eight patients underwent a two-level surgery,and ten patients received a three-level surgery.The Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) were used to evaluate pre-and post-operative neurological function and pain,respectively.The pre-and post-operative range of motion of the cervical spine was measured according to Xrays.Moreover,the surgical complications were recorded and analyzed.Results Thirty-seven patients were followed up for 15 to 55 months (average,29.1 months).The improvement of neurological function was obtained in 36 patients.The JOA score was improved from preoperative 10.5±1.57 to 14.3±1.97 at final follow-up,with an improvement rate of 58.46%,and the results were excellent in 16 cases,fair in 20 cases and poor in 1 case.The VAS was improved from preoperative 7.3±1.04 to 3.2±1.41 at final follow-up.The Cobb angle changed from preoperative 25°±3.21°to 20°±2.56°at final follow-up.After operation,the neurological function was not restored in 1 case; hoarseness and bucking occurred in 2 cases; sore throat occurred in 22 cases; anterior displacement of prosthesis (PCM) occurred in 3 cases.Other patients had no complications,such as displacement,loosening and heterotopic ossification.Conclusion In hybrid spinal fusion surgery,the lesions segments are decompressed fully,the severely degenerative segments are fused,and the motion of the non-fusion segments is reserved.As a result,not only the stability of the cervical spine is achieved,but also an obvious

  20. CT、MR、X线联合观察骨赘填充颈椎cage的短期融合率%The short-term fusion rate of osteophyte filled cervical cage evaluated by a combination of CT, MR and X-ray film

    Institute of Scientific and Technical Information of China (English)

    刘宁; 孙宇

    2010-01-01

    Objective To observe the short-term fusion rate of using osteophyte filled cage in ante-rior cervical disectomy and fusion. Methods From May 2007 to May 2009, 103 patients receiving anterior cervical disectomy, spine fusion by different surgeons were performed with cages containing exclusively au-tologous osteophyte collected from both anterior and posterior vertebral edges adjacent to the intervertebral space. There are 69 males, 34 females, from 25 to 77 years of age, average 53.6 years. 60 patients received one level fusion. 33 and 10 patients received two-level and three-level fusion respectively. Patients were re-viewed 3 months after operation and fusion was evaluated by X-ray film, reconstructive CT and MR. Results 1. Only 1.9% (2/103) of patients' X-ray films indicate non-fusion (internal fixation failure) while 31.7% (32/ 103) of patients' CT and 30.1% (31/103) of patients' MR indicate non-fusion or being confusing to make a diagnosis. 2. The diagnostic coherence between CT and MR as to evaluate fusion is good (kappa=0.686, P= 0.00). 3. The total fusion rate was 77.7%(80/103) while the highest fusion rate achieved by single surgeon was 90%(18/20). The total one level fusion rate was 80%(48/60) while the highest rate by single surgeon was 88.2%(15/17). The total two-level fusion rate was 78.6%(26/33) while the highest rate by single sur-geon was 90%(9/10). The total three-level fusion rate was 60%(60/100) while the highest rate by single surgeon was 100%(3/3). No statistic significant difference in fusion rate was found between any two of the three groups. Conclusion The method of using osteophyte filled cage can acquire ideal short-term fusion rate in one and two-level anterior cervical disectomy, fusion and plate fixation.%目的 观察单纯采用椎体骨赘填充cage行颈前路椎体间融合的短期融合率.方法 2007年5月至2009年5月,不同医生对103例行颈前路椎间盘切除减压、融合、钛板内固定手术的患者单纯采集

  1. 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.

  2. Value of preoperative cervical discography

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jong Won; Kim, Sung Hyun; Lee, Joon Woo [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)] (and others)

    2006-07-15

    The aim of this study was to describe the method and the value of cervical discography as correlated with the MR findings. Twenty-one discs in 11 consecutive patients who underwent cervical discography were analyzed. MR and CT discography (CTD) were performed in all patients. Discography was performed after swallowing barium for visualizing the pharynx and the esophagus to prevent penetration. We also analyzed the preceding causes of the subjects' cervical pain. The results of the pain provocation test were classified into concordant pain, discordant pain and a negative test. MRI was analyzed according to the T2-signal intensity (SI) of the disc, disc height, annular bulging and disc herniation. The CTD was analyzed for degeneration or radial tear of the disc, epidural leakage of the contrast agent and pooling of the contrast agent at the periphery of the disc. The pain provocation tests were correlated with the MR and CTD findings. We used the chi-square test to analyze the results. Concordant pain was observed in 14 cases, discordant pain in 3 cases and there were negative tests in 4 cases. There were no complications related to the procedure. Four patients had undergone anterior cervical fusion and four patients that developed after traffic injuries. The decreased T2-SI and annular bulging on MRI, disc degeneration and peripheral pooling of the contrast agent on CT were significantly correlated with pain provocation. When the diagnosis of disc disease is difficult with performing MRI, cervical discography with using swallowed barium solution to reduce the penetration of the esophagus or hypopharynx may play be helpful. The decreased T2-SI and annular bulging on MRI correlated significantly with a positive result on the pain provocation test.

  3. 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

  4. Anterior approach for lower cervical spine fractures and dislocations combined with spinal cord injury%下颈椎骨折脱位并脊髓损伤的前路手术治疗

    Institute of Scientific and Technical Information of China (English)

    贺宝荣; 许正伟; 郝定均; 郭华

    2013-01-01

    Objectives:To discuss the clinical outcome of anterior surgical treatment for lower cervical spine fractures and dislocations combined with spinal cord injury.Methods:From January 2006 to January 2011,196 patients suffering from lower cervical spine fractures and dislocations combined with spinal cord injury in our hospital were reviewed retrospectively.168 cases were data integrity and obtained follow-up,there were 123 males and 45 females with an average age of 38.7 years old(range,18-71 years).21 cases were in ASIA grade A,46 cases in B,60 cases in C,41 cases in D.According to the degree of dislocation,79 cases were in Ⅰ,42 cases in Ⅱ,31 cases in

  5. Clinical outcome of cervical disc replacement and adjacent cage fusion for multi-segmental cervical disc herniation%颈椎间盘置换与相邻节段融合的治疗选择

    Institute of Scientific and Technical Information of China (English)

    任先军; 初同伟; 蒋涛; 王卫东; 王建; 李长青

    2011-01-01

    目的 探讨椎间盘置换与相邻节段融合治疗多节段颈椎间盘突出症的临床疗效.方法 对39例多节段颈椎间盘突出症患者,Ⅰ期同时完成病变节段人工椎间盘置换和邻近节段Cage融合.本组39例多节段椎间盘突出症患者,双节段颈椎间盘突出29例,三节段颈椎间盘突出9例,四节段颈椎间盘突出1例.病变节段C3~4、C4~5,2例,C4~5、C5~6 15例,C5~6、C6-79例,C4~5、C6~7 3例,C3~4、C4~5、C5~6 4例,C4~5、C5~6、C6~7 5例,C3~4、C4~5、C5~6、C6~7 1例.临床症状以脊髓压迫为主者18例,以神经根性症状为主者21例,术后随访观察椎间盘假体稳定性、假体活动度、Cage融合状态及Cage位移等.依据日本骨科学会(JOA)评分,Odom标准评定神经功能改善情况,采用颈椎残障功能量表(neck disability index,NDI)评定术后临床症状改善和日常功能状态.结果29例双节段颈椎间盘突出症患者,选择1个节段的椎间盘置换和1个节段Cage植骨融合;9例三节段颈椎间盘突出症患者,7例行1个节段的人工椎间盘置换、2个节段Cage植骨融合;2例选择2个节段的人工椎间盘置换、1个节段Cage植骨融合.1例四节段颈椎间盘突出症患者行2个节段的人工椎间盘置换、2个节段Cage植骨融合.术后随访6个月~3年半,人工椎间盘稳定,椎间盘假体平均活动度为9.3°,Cage全部融合,无Cage松动沉陷.患者神经功能有明显改善,JOA评分由术前9.1分增加至13.2分;NDI评分由术前41.8分降至29.5分;Odom评分临床成功率(优/良/可)达到85%(33例).结论颈椎间盘置换与相邻节段融合为颈椎间盘突出症的治疗提供了新的选择方式,兼顾了颈椎的稳定和运动功能,其远期疗效有待于临床随访.%Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39

  6. Comparing precision of distortion-compensated and stereophotogrammetric Roentgen analysis when monitoring fusion in the cervical spine

    OpenAIRE

    Leivseth, Gunnar; Kolstad, Frode; Nygaard, Øystein P; Zoega, Björn; Frobin, W; Brinckmann, P.

    2005-01-01

    Two methods to measure sagittal plane segmental motion in the cervical spine are compared. Translational and rotational motion was measured in nine cervical motion segments of nine patients by distortion-compensated (DCRA) as well as by stereophotogrammetric Roentgen analysis (RSA). To compare measurement precision of the new DCRA protocol with the established RSA technique under realistic clinical conditions and to discuss advantages and disadvantages of both methods in clinical studies. RSA...

  7. Return to Play After Cervical Disc Surgery.

    Science.gov (United States)

    Kang, Daniel G; Anderson, Justin C; Lehman, Ronald A

    2016-10-01

    Criteria for return to sports and athletic activities after cervical spine surgery are unclear. There is limited literature regarding the outcomes and optimal criteria. Determining return to play criteria remains a challenge and continues to depend on the experience and good judgment of the treating surgeon. There is strong consensus in the literature, despite lack of evidence-based data, that athletes after single-level anterior cervical discectomy and fusion (ACDF) may safely return to collision and high-velocity sports. The athlete should be counseled and managed on a case-by-case basis, taking into consideration the type of sport, player-specific variables, and type of surgery performed. PMID:27543397

  8. Surgical Management of Subaxial Cervical Spine Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Hasan Emre Aydın

    2015-04-01

    Full Text Available These days, as a consequence of the improvement in technology and increase in the use of motor vehicles, spine injuries have become common. Spine traumas, which often occur after motor vehicle accidents, are observed mostly in cervical regions, particularly in the subaxial cervical region, which is also known as the subcervical region, and neurological damage occurs in 70% of the patients. Despite still being controversial, the common ranging for neurological evaluation is the American Spinal Injury Association ranging, which includes the motor and sensory loss and accordingly, the impairment rate. In subaxial cervical traumas, acute neurological deterioration is an indication and therefore requires urgent surgical treatment. The choice of anterior or posterior approach substantially depends on the traumatization mechanism, affected tissues, and neurological deterioration occurring after. The state of patient and instability are the most two important factors affecting the treatment decision. Although the anterior approach is accepted as a routinely available and easily applicable surgical technique, it lacks in the burst fractures involving the three colons, which shows a stabilization disorder. The anterior plate screw technique and posterior lateral mass screw application applied in our clinic are reviewed in literature and are discussed in two cases. Although the best clinical results are achieved in cases where only anterior surgery is performed and in cases where instability is excessive, in unstable compression and blow-out fractures, even if neurological deficit and three colon involvement are not observed in the patient, the requirement of posterior fusion is observed.

  9. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient.

    Science.gov (United States)

    Murayama, Kazuhiro; Inoue, Shinichi; Tachibana, Toshiya; Maruo, Keishi; Arizumi, Fumihiro; Tsuji, Shotaro; Yoshiya, Shinichi

    2015-08-01

    Descriptive case report.To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one.Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown.A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5.We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications.We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery. PMID:26266365

  10. 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

  11. 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. PMID:26933361

  12. 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. PMID:26933361

  13. 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.

  14. Cervical facet dislocation adjacent to the fused motion segment

    Directory of Open Access Journals (Sweden)

    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.

  15. Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

    Directory of Open Access Journals (Sweden)

    Hong-Li Wang

    2014-01-01

    Full Text Available Background: Cervical spondylotic amyotrophy (CSA is a rare clinical syndrome resulting from cervical spondylosis. Surgical treatment includes anterior cervical decompression and fusion (ACDF, and laminoplasty with or without foraminotomy. Some studies indicate that ACDF is an effective method for treating CSA because anterior decompression with or without medial foraminotomy can completely eliminate anterior and/or anterolateral lesions. We retrospectively evaluated outcome of surgical outcome by anterior cervical decompression and fusion (ACDF. Materials and Methods: 28 CSA patients, among whom 12 had proximal type CSA and 16 had distal type CSA, treated by ACDF, were evaluated clinicoradiologically. The improvement in atrophic muscle power was assessed by manual muscle testing (MMT and the recovery rate of the patients was determined on the basis of the Japanese Orthopedic Association (JOA scores. Patient satisfaction was also examined. Results: The percentage of patients, who gained 1 or more grades of muscle power improvement, as determined by MMT, was 91.7% for those with proximal type CSA and 37.5% for those with distal type CSA (P < 0.01. The JOA score-based recovery rates of patients with proximal type and distal type CSA were 60.8% and 41.8%, respectively (P < 0.05. Patient satisfaction was 8.2 for those with proximal type CSA and 6.9 for those with distal type CSA (P < 0.01. A correlation was observed among the levels of improvement in muscle power, JOA score based recovery rate, patient satisfaction and course of disease (P < 0.05. Conclusion: ACDF can effectively improve the clinical function of patients with CSA and result in good patient satisfaction despite the surgical outcomes for distal type CSA being inferior to those for proximal type CSA. Course of disease is the fundamental factor that affects the surgical outcomes for CSA. We recommend that patients with CSA undergo surgical intervention as early as possible.

  16. 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

    Directory of Open Access Journals (Sweden)

    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

  17. 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

  18. 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

  19. Advantage of one - stage operation through combined anterior and posterior approach for the treatment of pinching cervical spondyiotic myelopathy%“钳夹型”脊髓型颈椎病一期前后路联合手术治疗的优点

    Institute of Scientific and Technical Information of China (English)

    翟明玉; 许少刚; 王春萍; 梅伟

    2012-01-01

    [目的]分析一期前后联合手术治疗“钳夹型”脊髓型颈椎病的治疗效果.[方法]本组72例,男56例,女16例;年龄23 ~ 78岁,平均57岁.病程6~15个月,平均8个月.所有病例全部采用后路椎管扩大及前路减压融合固定术.[结果]术后随访13个月~4年,平均28个月,术后疗效按JOA评分标准评定,术后1周及1、3、6个月评分均较术前增加(P<0.05);术后1周分别测量术前及术后颈椎生理曲度及椎节高度值,均较术前增加(P<0.05).[结论]钳夹型脊髓型颈椎病采用一期前后联合手术治疗是可行的;神经减压及时、充分、彻底;对改善生理曲度及椎节高度较为理想;术后稳定性好,患者康复快;不但缩短了住院时间,避免了二次手术的痛苦,而且节约了医疗费用.%[Objective] To study the feasibility and therapeutic effects of one - stage operation through combined anterior and posterior approach for the treatment of pinching cervical spondylotic myelopathy. [ Methods ] There were 72 patients, 56 were male and 16 were female, ranging in age from 23 to 78 years (average, 57 years) . The disease course ranged from 6 to 15 months ( average, 8 months) . All patients received anterior decompression and fusion , and posterior laminectomy to enlarge the spinal cannal . [Results] All the patients were followed up from 13 to 48 month. According to JOA assessment system, the score was increased at one week, one, three and six months after operation ( P < 0. 05 ) . The cervical curve and intervertebral height in postoperative group was significantly greater than those of preoperative group (P <0. 01 ) . [ Conclusion] The immediate and long - term stability of the diseased segments may be obtained by the combined anterior and posterior internal fixation in the patients with pinching cervical spondylotic myelopathy. This technique is benefit to the patients for the functional recover of the spinal cord and early rehabilitation. It is an

  20. Relationship of lumbar interbody fusion with anterior column structure and biomechanics%椎间植骨融合效果与腰椎前柱组织结构及生物力学的关系

    Institute of Scientific and Technical Information of China (English)

    谢鸿儒; 王欢

    2011-01-01

    BACKGROUND: Lumbar spine fusion is one of the most common operations for low back pain in spinal surgeons, but the clinicalspine fusion rate is still low-level. How to availably promote spine fusion, raise fusion rate and clinical effect, and decreasecomplications is a problem for the spinal surgeon to work out.OBJECTIVE: To summarize the relation between lumbar interbody fusion and anterior column, and to analyze the influence ofstructural and biomechanical changes on fusion rate.METHODS: A computer online retrieval of CBM/CNKI/Medline for articles and reviews about lumbar interbody fusion published1995-2009 was performed.RESULTS AND CONCLUSION: The stability and integrality of the anterior column have notable effects on interbody fusion. Inanterior lumbar interbody fusion and the fixations of anterior column fracture, we would better protect the structure and bloodsupply of the anterior column, and resume the integrality and stability of the anterior column to maintain the biomechanicsenvironment of the lumbar, aiming to achieve the better fusion effect.%背景:腰椎融合后,椎间植骨融合率低,是临床上亟待解决的问题.目的:阐述椎间植骨融合效果与腰椎前柱的关系,分析其组织结构及生物力学发生改变后对椎体间植骨融合效果的影响.方法:电子检索CBM/CNKI(2000/2010)和计算机Medline数据库(1995/2010)收录的腰椎椎间植骨融合的相关综述和论文报告,找出并分析其中与前柱结构及生物力学相关的研究进展.结果与结论:腰椎前柱的完整性及生物力学的稳定性对椎间植骨融合的效果有显著的影响.在腰椎前路间盘切除及腰椎前柱爆裂骨折撑开内固定中,应该着重保护好椎体前柱结构及血运,尽量恢复腰椎前柱结构的完整性及稳定性,维持腰椎正常的生物力学环境,以期达到理想的椎间融合效果.

  1. 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

  2. [Laminoplasty for cervical spondylotic myelopathy].

    Science.gov (United States)

    Fransen, P

    2014-10-01

    Cervical spondylotic myelopathy (CSM) is a common condition. Uninstrumented laminectomy may be complicated by postoperative instability, whereas anterior or posterior decompression with fusion may be associated with stiffness and adjacent segment disease. Cervical laminoplasty, initially oriented towards pediatric patients and ossification of the posterior longitudinal ligament, becomes an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion. Eighteen patients (12 men, 6 women), mean age 64.2 who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 year and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.55; Preoperative mean Nurick score was 1.88. Preoperative MRI was carried-out in 16/18 patients. Intramedullary hyperintensity in T2 was observed in 6 patients. The operation was performed on 2 levels (4 patients) 3 levels (11 patients) and 4 levels (3 patients). We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.28 and Nurick was 0.71. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5, and Nurick was 0.25. One infection, one dural tear and one transient episode of C5 paresthesia were observed. We conclude that spinal cord decompression by open-door laminoplasty for CSM allows significant clinical improvement observed progressively in the two years following surgery. PMID:25239380

  3. 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.

  4. Clinical significance of MRI/{sup 18}F-FDG PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, Kenzo; Nakajima, Hideaki; Watanabe, Shuji; Yoshida, Ai; Baba, Hisatoshi [University of Fukui, Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, Eiheiji, Fukui (Japan); Okazawa, Hidehiko [University of Fukui, Department of Biomedical Imaging Research Center, Eiheiji, Fukui (Japan); Kimura, Hirohiko [University of Fukui, Departments of Radiology, Faculty of Medical Sciences, Eiheiji, Fukui (Japan); Kudo, Takashi [Nagasaki University, Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki (Japan)

    2012-10-15

    {sup 18}F-FDG PET is used to investigate the metabolic activity of neural tissue. MRI is used to visualize morphological changes, but the relationship between intramedullary signal changes and clinical outcome remains controversial. The present study was designed to evaluate the use of 3-D MRI/{sup 18}F-FDG PET fusion imaging for defining intramedullary signal changes on MRI scans and local glucose metabolic rate measured on {sup 18}F-FDG PET scans in relation to clinical outcome and prognosis. We studied 24 patients undergoing decompressive surgery for cervical compressive myelopathy. All patients underwent 3-D MRI and {sup 18}F-FDG PET before surgery. Quantitative analysis of intramedullary signal changes on MRI scans included calculation of the signal intensity ratio (SIR) as the ratio between the increased lesional signal intensity and the signal intensity at the level of the C7/T1 disc. Using an Advantage workstation, the same slices of cervical 3-D MRI and {sup 18}F-FDG PET images were fused. On the fused images, the maximal count of the lesion was adopted as the standardized uptake value (SUV{sub max}). In a similar manner to SIR, the SUV ratio (SUVR) was also calculated. Neurological assessment was conducted using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. The SIR on T1-weighted (T1-W) images, but not SIR on T2-W images, was significantly correlated with preoperative JOA score and postoperative neurological improvement. Lesion SUV{sub max} was significantly correlated with SIR on T1-W images, but not with SIR on T2-W images, and also with postoperative neurological outcome. The SUVR correlated better than SIR on T1-W images and lesion SUV{sub max} with neurological improvement. Longer symptom duration was correlated negatively with SIR on T1-W images, positively with SIR on T2-W images, and negatively with SUV{sub max}. Our results suggest that low-intensity signal on T1-W images, but not on T2-W images, is correlated

  5. Clinical significance of MRI/18F-FDG PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy

    International Nuclear Information System (INIS)

    18F-FDG PET is used to investigate the metabolic activity of neural tissue. MRI is used to visualize morphological changes, but the relationship between intramedullary signal changes and clinical outcome remains controversial. The present study was designed to evaluate the use of 3-D MRI/18F-FDG PET fusion imaging for defining intramedullary signal changes on MRI scans and local glucose metabolic rate measured on 18F-FDG PET scans in relation to clinical outcome and prognosis. We studied 24 patients undergoing decompressive surgery for cervical compressive myelopathy. All patients underwent 3-D MRI and 18F-FDG PET before surgery. Quantitative analysis of intramedullary signal changes on MRI scans included calculation of the signal intensity ratio (SIR) as the ratio between the increased lesional signal intensity and the signal intensity at the level of the C7/T1 disc. Using an Advantage workstation, the same slices of cervical 3-D MRI and 18F-FDG PET images were fused. On the fused images, the maximal count of the lesion was adopted as the standardized uptake value (SUVmax). In a similar manner to SIR, the SUV ratio (SUVR) was also calculated. Neurological assessment was conducted using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. The SIR on T1-weighted (T1-W) images, but not SIR on T2-W images, was significantly correlated with preoperative JOA score and postoperative neurological improvement. Lesion SUVmax was significantly correlated with SIR on T1-W images, but not with SIR on T2-W images, and also with postoperative neurological outcome. The SUVR correlated better than SIR on T1-W images and lesion SUVmax with neurological improvement. Longer symptom duration was correlated negatively with SIR on T1-W images, positively with SIR on T2-W images, and negatively with SUVmax. Our results suggest that low-intensity signal on T1-W images, but not on T2-W images, is correlated with a poor postoperative neurological outcome. SUVmax

  6. 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

  7. Advantages of slow anesthesia induced by amnesia and analgesia for anterior cervical surgery%健忘镇痛慢诱导用于颈椎前路手术的优势

    Institute of Scientific and Technical Information of China (English)

    任国玲; 高丽霞; 单学栋; 韩凤梅

    2011-01-01

    Objective To investigate the feasibility and advantages of slow anesthesia induced by amnesia and analgesia for anterior cervical surgery. Methods A total of 52 patients receiving surgery of anterior cervical spine were averagely divided into groups A and B before operation. Patients of Group A developed slow anesthesia induced by amnesia and analgesi-a through endotracheal intubation, and those of group B underwent quick induction of anesthesia through tracheal intubation. The cough response during tracheal intubation and the tolerance of incubating conditions were recorded respectively. At the same time, the postoperative impression of tracheal intubation was followed up. Results Both group A and B had successful operation procedures. The patients in group A were intubated without changing the head positions; their own muscle tension effectively protected the cervical spine; and the patients were well tolerant to intubation after surgery. Whereas, the patients of group B had to have their cervical spine well-protected by others, and were not tolerant to intubation removal. In this group, 19 cases had restlessness during intubation taking-off and drug had to be applied for intubation tolerance. Conclusion Slow anesthesia induced by amnesia and analgesia is a simple, convenient and practical approach for anterior cervical surgery, which can effectively protect the cervical spine and patients well tolerate intubation.%目的 探讨健忘镇痛慢诱导用于颈椎前路手术的可行性和优势.方法 将52例颈椎前路手术患者平均分为2组:A组行健忘镇痛慢诱导气管插管全麻,B组行快诱导气管插管全麻.分别记录患者气管插管过程中的呛咳反应、带气管插管患者耐管情况,随访患者术后对气管插管的印象.结果 A组和B组都顺利完成手术,A组患者插管不改变头位,在自身肌张力保护下插管,有效保护颈椎病变部位,且术后能很好耐受带管.B组插管时令专人保护颈椎,

  8. Study on the Effect of Anterior Operation for Treatment of Cervical Fracture and Dislocation%前路手术治疗颈椎骨折脱位的效果研究

    Institute of Scientific and Technical Information of China (English)

    孙忠林

    2015-01-01

    Objective Anterior surgery treatment effect to cervical spine fracture and dislocation is to be studied.MethodsChoose 44 patients with cervical spine fracture and dislocation who were received and treated in hospital from November 2013 to December 2014 and separate them into two groups according to their hospitalization sequence with 22 patients in study group and 22 patients in control group, patients in study group are given anterior surgery treatment, while patients in control group are given posterior surgery treatment, and then compare treatment effects between two groups.Results Patients’ treatment efficacy, ASIA rating and complication incidence in study group are much more favorable than counterparts in control group, there is a treatment differential between two groups, and such a differential has statistic value (P<0.05).Conclusion Anterior surgery treatment is of efficacy in treatment of patients with cervical spine fracture and dislocation, it is conducive to patients’ recovery and reducing complication incidence, thus, such a surgery treatment is quite worthwhile to be promoted and applied clinically..%目的:探讨前路手术治疗颈椎骨折脱位的效果。方法选取2013~2014年12月我院收治的44例颈椎骨折脱位患者,按照入院的先后顺序分为22例研究组和22例参照组,研究组采用前路手术,参照组采用后路手术,观察两组患者的治疗效果。结果研究组患者的治疗总有效率、ASIA评级、并发症的发生率明显优于参照组,差异显著,有统计学意义(P<0.05)。结论前路手术治疗颈椎骨折脱位的效果显著,患者的恢复情况好,有效降低并发症的发生率。

  9. 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.

  10. Therapeutic strategy for traumatic instability of subaxial cervical spine

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

    Background A simple, safe and effective therapeutic strategy for traumatic instability of the subaxial cervical spine, as well as its prognostic assessment, is still controversial.Methods The therapeutic options for 83 patients of traumatic instability of the subaxial cervical spine, whose average age was 35 years, were determined, according to the Allen-Ferguson classification, general health and concomitant traumatic conditions, neurological function, position of compression materials, concomitant traumatic disc herniation/damage, concomitant locked-facet dislocation, the involved numbers and position, and the patients' economic conditions. An anterior, posterior or combination approach was used to decompress and reconstruct the cervical spine. No operations with an anterior-posterior-anterior approach were performed.Results The average follow-up was three years and nine months. Distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 cases of anterior, posterior and combination operations, respectively. The average score of the Japanese Orthopaedics Association, visual analog scale and American Spinal Cord Injury Association (ASIA) motor index improved from 11.2, 7.8 and 53.5, respectively, before operation, to 15.3, 2.6 and 67.8, respectively, at final follow-up. For incomplete spinal cord injury (SCI), the average ASIA neurological function scale was improved by 1-2 levels. Patients with complete SCI had no neurological recovery, but recovery of nerve root function occurred to different extents. After surgery, radiological parameters improved to different extents. Fusion was achieved in all patients and 12 developed complications.Conclusions The best surgical strategy should be determined by the type of subaxial cervical injury, patients' general health, local pathological anatomy and neurological function.

  11. 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

  12. 8例前路颈椎间盘摘除后颈椎动态稳定器植入术的围手术期护理%Perioperative nursing of 8 patients with dynamic cervical implant after anterior cervical discectomy

    Institute of Scientific and Technical Information of China (English)

    蔡张滢; 吕畅; 周松梅

    2012-01-01

    总结了8例经颈前路椎间盘摘除颈椎动态稳定器(dynamic cervical implant,DCI)植入术的围手术期护理措施.术前完善各项影像学检查,做好仰卧位训练、呼吸功能锻炼和气管推移训练;术后做好呼吸道管理及并发症的观察,早期进行功能康复指导,注意保障患者安全.本组术后神经功能均有明显改善,随访时日本骨科学会脊髓功能评分平均分由术前12.1分上升至15.8分.%This paper summarizes the perioperative nursing of 8 patients with dynamic cervical implant(DCI) after anterior cervical discectomy. The key points in nursing were preoperative imaging examinations, supine position training, breathing exercise and tracheal shift training,as well as postoperative airway management,observation of complications,early functional exercise guidance and patient safety management. All patients showed improvement in neural functions after operation without complications. The JOA score of spinal function increased from 12.1 to 15.8.

  13. 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

  14. Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

    Directory of Open Access Journals (Sweden)

    Pierce Nunley

    2016-01-01

    Full Text Available Introduction. The lateral lumbar interbody fusion (LLIF surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system. Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA. There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year. Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253 of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%. Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient.

  15. C5 Nerve root palsies following cervical spine surgery: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3-24 postoperative months. Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level  decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF. Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL, narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies. Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0-30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.

  16. 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.

  17. Cervical dysplasia

    Science.gov (United States)

    ... by your provider. Make sure to get the HPV vaccine when it is offered to you. This vaccine prevents many cervical cancers. ... Early diagnosis and prompt treatment cures most cases of cervical ... severe cervical dysplasia may change into cervical cancer.

  18. 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

  19. 人工颈椎间盘植入治疗颈椎病%Artificial cervical disc replacement in cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    王贵怀; 陈思源; 杨俊

    2009-01-01

    Objective Anterior cervical fusion has been a routine method for the surgical treatment of cervical spondylosis, but concerns for the possibility of acceleration of adjacentsegment disease after fusion have been growing. The artificial cervical disc replacement provides the opportunity to preserve motion after neural decompression while providing stability, which opens a new pathway for the surgical therapy of cervical spondylosis. Method We summarized the results of 16 patients of cervical herniated disc treated by artificial cervical disc replacement after cervical microdecompression and arthroplasty from December 2005 to March 2008. The average followup time was 17 momths. Results All patients got improved neurological function postoperatively. The cervical flextion and extention X - film showed good curvature and motion. 1 patient developed temporary hoarseness and recovered within 1 week. There was no other complications. Conclusions Cervical microdecompression with Bryan disc replacement is a good choice for adequate patient of cervical degenerative disc disease.%目的 颈椎病前路融合术后颈椎活动度下降与邻近节段椎间盘退变加速越来越受到人们的重视,人工颈椎间盘置换术可在进行脊髓减压并提供稳定的同时保持手术节段颈椎的活动度,为颈椎病的外科治疗开辟了新的途径.方法 自2005年12月至2008年3月,对16例颈椎病患者进行显微减压后椎间植入Bryan人工颈椎间盘,平均随访时间17个月.结果 所有患者术后症状均明显缓解,脊髓功能明显改善,颈椎活动度良好,1例术后发生短暂声音嘶哑,无手术死亡率.结论 人工颈椎间盘植入为颈椎病的外科治疗开辟了新的手段,在提供颈椎稳定的同时保持手术节段颈椎的良好活动度,把握严格的适应证和手术技术能取得满意的效果.

  20. Vertebral artery injuries in cervical spine surgery

    OpenAIRE

    Schroeder, Gregory D.; Hsu, Wellington K.

    2013-01-01

    Background: Vertebral artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a vertebral artery injury. Methods: This is a review paper. Results: Upper posterior cervical spine surgeries put the vertebral artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the artery at the least ri...

  1. Effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy%颈椎前路手术对脊髓型颈椎病患者椎间盘组织中炎性细胞因子的影响

    Institute of Scientific and Technical Information of China (English)

    李翔; 戴志唐; 常新; 戴璐

    2011-01-01

    目的 探讨颈椎前路手术对脊髓型颈椎病(CSM)患者椎间盘组织中炎性细胞因子的影响.方法 35例脊髓型颈椎病患者(CSM组)和30例颈椎外伤患者(对照组)均行颈椎前路手术治疗,观察治疗效果.采用固相分离放射免疫分析法(SPRIA)测定两组颈椎间盘组织中白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α水平.结果病程≤6个月组优良率为81.8%,病程>6个月组优良率为38.5%,两组优良率比较差异有统计学意义(P<0.05);CSM患者术前JOA评分为(9.73±2.12)分,术后JOA评分为(14.21±2.52)分,术后JOA评分显著高于术前(P<0.05);CSM组颈椎间盘中IL-6、IL-8、TNF-α水平均显著高于对照组(P<0.05).结论 颈椎前路手术是治疗CSM的一种较有效手术方法;IL-6、IL-8、TNF-α在颈椎间盘退变和CSM发病中起重要作用.%Objective To explore the effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy (CSM).Methods Thirty cases of CSM ( CSM group) and 30 cases of cervical trauma (control group) were given the anterior cervical spine surgery.The CID IL-6,IL8 and tumor necrosis factor (TNF)-α levels were detected by solid phase radioimmunoassay.The patients of CSM were followed up for the clinical efficacy and courses of disease were analyzed.Results The excellent rate in course of disease ≤ 6 months group and the course of disease > 6 months group was 81.8% and 38.5% respectively (P < 0.05 ).The preoperative and postoperative JOA scores in patients with CSM were (9.73 ±2.12) and (14.21 ±2.52) respectively (P<0.05).The CID IL-6,IL-8 and TNF-α levels in CSM group were significantly higher than in control group (P < O.05 ).Conclusion The anterior cervical spine surgery is an effective surgical treatment for CSM.The IL-6,IL-8 and TNF-α may play important roles in cervical disc degeneration and CSM.

  2. 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.

  3. Multilevel decompressive laminectomy and transpedicular instrumented fusion for cervical spondylotic radiculopathy and myelopathy: A minimum follow-up of 3 years

    OpenAIRE

    Kadir Kotil; Emine Ozyuvaci

    2011-01-01

    Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicul...

  4. 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

    OpenAIRE

    Marcelo Luis Mudo; Andrea Vieira Amantea; Andrei Fernandes Joaquim; Mirto Nelso Prandini; Sérgio Cavalheiro

    2009-01-01

    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 ...

  5. SELECTION OF SURGICAL APPROACH TO TREAT TRAUMATIC INSTABILITY OF SUBAXIAL CERVICAL SPINE

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

    Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods according to the allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included.Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group.Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.

  6. 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

  7. 颈椎前路手术的早期并发症及其预防和处理%Prevention and management of early complications in anterior cervical spine surgery

    Institute of Scientific and Technical Information of China (English)

    余鹏; 汤逊; 徐永清; 周田华; 石健; 李阳; 李伟嘉

    2012-01-01

    [ Objective]To analyze the prevention and management of early complications associated with anterior cervical spine surgery. [Method] From Jan 1997 to Mar 2003,559 cases were treated with anterior cervical surgery, and received analysis on complications during the occurrence, the patient's disease,sex,age,systemic complications,surgical,anesthesia,nursing and paralysis of the multi-factor analysis. By analyzing causes of complications, the countermeasures developed. [ Result 1 Total 141 complications occurred in 118 patients and the incidence was 25.22%,including dysphagia in 53 cases,superior laryngeal nerve or recurrent laryngeal nerve injury in 11 cases,hematoma in 4 cases,increased spinal cord injury in 3 cases,esophageal fistula in 1 case,cerebrospinal fluid leakage in 4 cases,bone hematoma and infections in 5 cases, hyponatremia in 39 cases,pulmonary infection in 12 cases,deep vein thrombosis in 5 cases,death in 4cases. [Conclusion] Adequate preoperative preparation and assessment,thorough understanding of anatomy related to the anterior approach and the operation carefully, postoperative careful observation and care are essential for preventing the early postoperative complications of anterior cervical spine surgery.%[目的]分析颈椎前路手术早期的各种并发症,探讨相关的影响因素及应对策略.[方法]回顾分析本院1997年1月~2011年3月559例经颈椎前路手术的各种早期并发症发生情况,对患者的病种、性别、年龄、全身并发症情况、手术、麻醉、护理及瘫痪情况多因素进行分析,分析相关并发症的可能发生原因,介绍处理方法.[结果]118例患者141例次出现术后早期并发症,发生率25.22%,其中,术后吞咽困难53例,喉上神经或喉返神经损伤11例,颈部切口血肿4例,脊髓损害加重3例,食道瘘1例,脑脊液漏4例,取骨区血肿或脂肪液化感染5例,低钠血症39例,肺部感染12例,下肢深静脉血栓形成5例,死亡4

  8. Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament

    OpenAIRE

    Chen, Yu; Guo, Yongfei; Chen, Deyu; Wang, Xinwei; Lu, Xuhua; Yuan, Wen

    2008-01-01

    Between January 2000 and December 2003, a total of 83 patients (64 men and 19 women, average age: 56.4 years, range: 42–78 years) who underwent posterior laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament (OPLL) were included in this study to investigate the long-term outcome of this surgical option and clarify which factors affect the prognosis. After an average 4.8-year follow-up, the mean Japanese Orthopaedic Association (JOA) score significantly in...

  9. 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.

  10. Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty

    Institute of Scientific and Technical Information of China (English)

    YANG Da-long; DING Wen-yuan; ZHANG Ying-ze; ZHANG Wei; XU Jia-xin; SHEN Yong

    2013-01-01

    Background Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments.The efficiency of posterior longitudinal ligament (PLL) resection in anterior cervical decompression and fusion has been demonstrated.However,no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty.This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.Methods We performed a prospective investigation of clinical and radiological outcomes in patients after Bryan cervical disc arthroplasty.Sixty patients who underwent Bryan cervical disc arthroplasty were included.The PLL was removed in 35 patients (investigational group) and preserved in 25 patients (control group).All of the patients were followed up for more than 18 months.Clinical (Japanese Orthopedic Association score and Visual Analogue Scale pain score) and radiological (functional spinal unit (FSU) angle,range of movement (ROM),and diameter of the spinal cord) parameters were compared between the two groups before and after surgery (18 months).Results Clinical outcomes in the investigational group were significantly superior to those in the control group.There were no significant differences in the FSU angle and ROM (P=-0.41 and 0.16,respectively) between the two groups.However,the increase in diameter of the spinal cord in the investigational group was significantly greater than that in the control group (P <0.01).Conclusions Removal of the PLL can improve the clinical outcomes of Bryan cervical disc arthroplasty.This procedure does not have a large effect on imbalance and motion of the cervical spine.

  11. 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

  12. 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

  13. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    An, Howard S; Al-Shihabi, Laith; Kurd, Mark

    2014-07-01

    Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

  14. 颈椎单节段融合术后相邻各节段运动补偿的规律研究%Research of the motion compensation after single segmental cervical spine fusion surgery

    Institute of Scientific and Technical Information of China (English)

    张睿; 周文钰; 顾洪生; 刘伟强; 白波; 王大平

    2014-01-01

    目的 了解颈椎单节段融合术后上、下相邻及非相邻节段的运动补偿规律.方法 通过三维运动采集系统,捕捉到6具新鲜人尸体颈椎单节段融合术前后C2~T1各节段的运动角度数据.结果 经过归一化处理后,分析得出颈椎单节段融合术后各节段的运动变化规律,发现融合术后其他各节段运动幅度均有不同程度的增加,尤其是下相邻节段,差异有统计学意义(P<0.05).结论 颈椎单节段融合术后邻近节段的代偿性运动幅度增加是导致其退变的重要原因.%Objective To know the motion compensation regulation of each segments after single segmental cervical spine fusion surgery.Methods With the help of 3D motion information collecting system,the movement angle of each segment was recorded before and after single segmental cervical spine fusion surgery.Results All the statistics are dealed with normalization,we got the statistics of the motion compensation regulation of each segments after single segmental cervical spine fusion surgery,range of motion of each segment increased diversely,especially the lower adjacent segment,with statistical significance(P<0.05).Conclusion Compensatory enhancement of the range of motion of adjacent segments is one of the important reasons lead to the degeneration.

  15. 节段型严重颈椎后纵韧带骨化症前路、后路手术的疗效比较与选择策略%Anterior or posterior approach for segmental severe ossification of posterior longitudinal ligament of the cervical spine: the efficacy and selection strategy

    Institute of Scientific and Technical Information of China (English)

    雷涛; 申勇; 王林峰; 丁文元; 张为; 张迪

    2013-01-01

    Objective To investigate the efficacy and selection of anterior and posterior approaches for segmental severe ossification of posterior longitudinal ligament (OPLL)of the cervical spine.Method From January 2007 to May 2011,59 patients with segmental severe OPLL underwent surgical treatment,including 41 males and 18 females,with an average age of 55.7 years.Among them,24 patients underwent anterior corpectomy and fusion,and 35 patients underwent laminectomy and lateral mass screw fixation.In two groups,the operation time,intraoperative blood loss,change of cervical curvature,neck axial symptoms,and JOA (Japanese Orthopaedic Association) score were recorded and compared.Result All patients were followed up for 12 to 18 months (average,15.4 months).The average JOA score in anterior approach group increased from preoperative 7.33 ± 1.09 to 13.63±0.82 at final follow-up,with an average improvement rate of 65.16% ±7.50%; the average JOA score in posterior approach group increased from preoperative 7.20 ± 1.05 to 12.23 ± 1.11 at final follow-up,with an improvement rate of 51.46%±9.64%; and the difference between two groups was statistically significant.Immediately after the operation,the segmental curvature of the operative site was 5.38°±1.14° in anterior approach group and 3.89°±1.65° in posterior approach group,and the difference was statistically significant.At final follow-up,the rate of neck axial symptoms was 20.83% in anterior approach group and 51.43% in posterior approach group,and the difference was also statistically significant.Conclusion For severe OPLL with not more than 3 segments of ossification,the anterior approach can remove the ossified mass directly,get a better neurological recovery,provide a good biomechanical alignment,and decrease the postoperative axial symptoms.However,posterior laminectomy and lateral mass screw fixation also can obtain enough decompression and maintain the segmental curvature.%目的 探讨前路和

  16. Single level cervical disc herniation: A questionnaire based study on current surgical practices

    Directory of Open Access Journals (Sweden)

    Abrishamkar Saeid

    2009-01-01

    Full Text Available Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeon