Twenty-five cases of hyperextensive injuries to the cervical spine seen between Aug 1975 and 1884 were analyzed with regard to the clinical patterns of neurological damage and the reentgenogra-phic features of skeletal and soft-tissue injuries. Acute central cord syndrome was presented in sixteen cases, and in four cases who had a partial cord injuries, two of them had a typical Brown-Se'quard syndrome. The patients had an anterior cord syndrome; three had serious cord injuries, one of them died of myocardial failure on the fourth day after injury. In this series, a hyperextensive mechanism of cervical spine may gave rise to different types of spinal cord injury, but central cord syndrome was most frequently encountered. Conservative treatment was generally used, and the results of treatment were satisfactory in most cases. Diagnosis of hyperextension injuries and the relationship between cervical spine and cord injury were discussed.

Ten fresh cadaver specimens of cervical spine were divided into two parts in midsagittal plane after frozen. The sagittal diameters of spinal canal in hyperextention, neutral and hyperflexion positions were measured. Among the three position, the diameter was largest in hyperflexion position and the smallest in hyperextension. The changes in sagittal diameters appeared most markedly in C5-6,C6-7 and C4-5. Clinical significance was discussed in this paper.

Cervical spinal cord injuries often result from motor vehicl e accidents, falls, athletic injuries or fired projectiles. Most such injuries o ccur to persons in adolescence or early adulthood. It is a common cause of paral ysis, respiratory failure and even death. Besides direct traumatic injuries to t he continuity of cervical spine, fractures, dislocations and followed secondary injuries are also the main causes for spinal cord dysfunction. In recent years, great achievements have been made in the management of spinal cord injury in our country, such as much improved emergency management to minimize adverse sequela e, progress in surgical intervention and improvement in internal fixation techni que to provide stabilization of the cervical spine and allow optimal rehabilitat ion, clinical application of NGF and neural protection drugs. This paper reviews such development and predicts future development in treatment of spinal cord in jury in China

Objective To study the clinical features,surgical treatments and the prognosis of the103patients with the metastatic tu mors in the spine.Methods From Jan.1996to Dec.2001,103cases were treated by operation in our department,there were62males and41females,aging from33to79years old(average,59years).The lesions were located at cervical spines in34cases,thoracic spines in39,lumbar spines in25and sacrum in5.The patients underwent anterior,posterior,combined or staged antero-posterior operations based on the location of lesions in the spine.Most of the patients were adopted vertebral recon-struction and internal fixation depending on the conditions.Preoperative clinical evaluation included of gen-eral condi tions,X-ray films,CT scan,MRI and ECT in order to decide the endurance of the patient to the sur gi cal treatment.The operation was only considered when the patient could have the ex pected survival time more than6months.Operative indications,surgical methods and prognosis were analyzed and summa -rized.Re sults The postopera tive follow-up ranged from6months to5years.No death related to the op-eration.Eighty-five of 103cases had partial or even complete relief of local pain and radiculopathy,54cases were im proved in neu rological status caused by spinal cord compression.The postoperative survival rates at6months,one year,two years,three years and four years intervals were97.1%,90.3%,44.7%,29.1%and8.7%respectively,9patients survived more than4years.Conclusion Local pain was the predomi nant symptom in metastatic tu mor of spine,and some of them suffered from spinal cord and nerve compromise.The surgical treatments for the spinal metastatic diseases were indicated depending spinal instability,progressive neurological deteriora tion,in tractable pain,or the need for histological diagnosis.The most im por tant factor being consid-ered was the patient's condition when operative treatment was decided.The anterior,posterior,combined or staged antero-poste rior operations were influenced by location of lesions in the spine,en durance of the patient,life ex pectan cy and so on.Surgical interven tion could stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status of the patients,thus improve the life qualities in limited life expectancy pa-tients.[

BMPs(bone morphogenetic proteins.)were first identified as proteins that were able to induce ectopic osteogenesis and were shown to enhance the osteogenic differentiation of both osteoblast-like and osteoprogenitor cells.Clearly the use of BMPs in orthopaedics is still in its formative stage,but the data suggest an exciting and promising future for the development of new therapeutic applications.Identification of a precise mechanism for the factors in the progression may be helpful for clinical treatments.

Cervical spondylotic amyotrophy is receiving increasing attention in recent years as a class of specificity of cervical spondylosis,this paper refers a large number of reference reported in the literature,and gives an accurate summary of the disease from the basic definition of disease,pathogenic factors,clinical manifestations,diagnostic criteria and prognostic point of view,and provides a theoretical foundation for clinical diagnosis and treatment of cervical spondylotic amyotrophy.

Objective To study the effect of fetal transplants on the fu nctional recovery after spinal cord transection in new born and adult rats. Meth ods The spinal cord tissue at E14 of a rat fetal was transferred into the hemise ction cavity at lumbar spinal cord in the newborn and adult rats. 4, 8, 12 weeks after the operation, spinal cord tissue morphology, combined behavioral score ( CBS), somatosensory evoked potentials (SEP), and motor evoked potentials (MEP) w ere examined. Results The transplanted tissue survived in the host spinal cord. There was a statistical difference in CBS between the newborn graft group and th e adult graft group. The peak latencies of early waves in SEPs and MEPs of the n ewborn graft group were superior to those of the adult graft group (P

Spinal cord injury occurs with an average annual incidence of 15 40 cases per million of population. The costs of treatment and rehabilitation in the living period of patients with spinal cord injury are very high. Prevention, therapy and rehabilitation of spinal cord injury have become a major subject in medical science. The aim of this article is to summarize the statistics of incidence, etiological factors, clinical characteristics and complications in patients with spinal cord injury.

Objective To define the indications of direct transpedicular lag screw to treat traumatic spondylolisthesis of axis (Hangmans fracure) and to evaluate the result of the technique. Methods From February 1998 to December 2000, 22 patients with acute traumatic spondylolisthesis of axis were treated. Ten of them achieved anatomic reduction by skull traction but no acceptable stability was ensured by traction alone. Among the ten patients, eight had integral and normal shaped C2 vertebral bodies (6 male, 2 female; age ranged from 18 to 42 years with an average of 28.2 years; 5, 2 and 1 patients classified as type Ⅰ, Ⅱ and Ⅱa injuries respectively according to Levine-Edwards classification and graded as D spinal injury in 2 cases and E in 6 cases according to Frankel scale) were further fixed with transpedicular lag screw. Under general anesthesia, the patients were laid in prostrate decubitus in a prepared head-neck-chest ventral plaster plate with skull traction in place to maintain reduction and lateral image intensification was applied to confirm the reduction. A posterior midline incision from C1-C3 was performed, and soft tissue was released to expose clearly the lamina, lateral mass, superior and medial aspect of the C2 pars interarticularis (isthmus plus pedicle). Points of entry for screw insertion were located at the entrance at the posterior aspect of lateral mass. The drill bit is parallel to both of the medial and superior border of C2 pars interarticularis (usually 25?-30? cephalad to the transverse plane and 30?-35? medial to the sagittal plane). The screw hole in the posterior cortex was overdrilled with a 3.5 mm drill bit for interfragmentary compression. 3.5 mm screws (25-30 mm, determined by depth gauge) were drived in after the cortex being tapped with a 3.5 mm tap. The whole procedure was done under monitoring of "C" arm fluoroscopy for safety and accuracy. Results It costs an average of 70 minutes to finish the procedure with mean blood loss of 250 ml. Hospital stay was about 18 days. A mean follow up time of 14 months (11 to 18 months) didnt confirm any early or late postoperative complications, all cases gained bony union 3 months later with complete neurological function recovery. The range of neck rotation was restored normal with no C2,3 instability or screw loosing found. Conclusion With appropriate indications, transpedicular lag screw fixation provides good reduction and stability to Hangmans fracture. This technique can only be applied to the fractures which are reductable.

Objective To evaluate retrospectively whether posterior longitudinal ligament(PLL)adhere to dura mater in the patients with cervical spondylotie myelopathy(CSM)or not before the anterior cervical operation.Methods From December 2005 to January 2007,of 18 patients with CSM the adhesion between PLL and dura mater was found in the anterior cervical operation.The patients included of 11 males and 7 females,with mean age of 65.4 years (range 55-72 years).All the patients were measured by CT and MRI before operation.There were 12 cases of dual-segmental cervical intervertebral disc herniation,6 of tri-segmental disc herniation.The former cases were treated with one level corpectomy and titanium mesh or iliac grafting and cervical anterior plate,and the latter with an additional cervical cage in the intervertebralspace.The floatation method was used to deal with the adhesion.The fitness between the two radiological methods was analyzed by matched-pairs Kappa eoemcient test.Results The nerve functions of all the patients were improved after anterior cervieal decompression.The mean score of JOA was increased from 9.6 of pre-operation to 12.1 of post-operation.There were 4 cases with injury in dura mater,which healed after appropriate dealing with the leakage of cerebrospinal fluid.None of lacerated dura was directly repaired during the operation.The condition of the coarse touch and bur between intervertebral disc and dura mater were found in CT transverse scanning.The thickening of the PLL and the unsymmetrical space between inferior and superior subdural cavity was found in MRI.The coefficient test proved that the difference of the CT and MRI was significant in finding the adhesion.Conclusion MRI iS better than CT in finding the adhesion between the PLL and dura mater in CSM before operation,besides the floatation method should be good to deal with the adhesion.