Objective To investigate cause,diagnosis,treatment and prevention of vertebral artery injury in cervical spine surgery.Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed.There were 6 males and 1 female,aged from 23 to 65 years (average,48.9 years).The reasons of cervical spine surgery were as follows:cervical spondylotic myelopathy (5 cases),traumatic subluxation of C4 and C5 (1 case),and cervical spinal stenosis due to skeletal fluorosis (1 case).All cases had unilateral vertebral artery injury,including 4 cases in the left side and 3 cases in the right side.The cause,treatment and prognosis of vertebral artery injury in 7 patients were analyzed.Results Four patients suffered from vertebral artery injury during anterior cervical spine surgery; 2 cases were caused by excessive lateral trepanation,1 by excessive lateral discectomy using a curette,and 1 by Kerrison punch during decompression in a patient with anomalous vertebral artery due to traumatic subluxation of C4 and C5.Three patients suffered from vertebral artery injury during posterior surgery; 2 cases were caused by a drill bit during drilling lateral mass of C4 and 1 by a rongeur during removing posterior C1 arch in a patient with cervical spinal stenosis due to skeletal fluorosis.After vertebral artery injury,all patients were immediately treated by hemostatic tamponade,and then the incisions were closed.However,1 patient occurred delayed cervical hemorrhage 4 weeks after operation.Then he underwent vertebral artery angiography,balloon embolization and evacuation of hematoma.All cases had no cerebral infarction.However,two of them had postoperative temporary dizziness.Conclusion Vertebral artery injury in cervical spine surgery is a rare but serious complication,which is associated with surgical mistakes and anatomical variations.Hemostatic tamponade and embolization are effective for this complication.

Objectives To investigate influencing factors and pattern of posterior shifting of the spinal cord after cervical laminoplasty.Methods Forty three patients with compressive cervical myelopathy,including 32 males and 11 females,aged from 33 to 78 years (average,57.9 years),treated with open-door laminoplasty from C3 to C7 between February 2008 and October 2010,were enrolled in this study.There were 30 cases of cervical spondylotic myelopathy with developmental cervical stenosis and 13 cases of ossification of the posterior longitudinal ligament.Twenty one cases underwent modified open-door laminoplasty using anchor method,and the other 22 cases underwent laminoplasty with preservation of the unilateral muscular ligament complex.According to midsagittal T2-weighted MRI in the neutral position,several parameters indicating shift distance of the spinal cord and dural sac were measured at each level before operation and at 3 months after operation:shift of anterior margin of the spinal cord (SAMSC),shift of posterior margin of the spinal cord (SPMSC),shift of anterior margin of the dural sac (SAMDS) and shift of posterior margin of the dural sac (SPMDS).The line connecting the top of dens and posterior inferior angle of T1 was defined as E line and the length was E.The length of perpendicular line from each base point to E line was Px (x =1-6).The parameter (100×Px/E) was used to represent local curvature at each level,and the curvature index (CI)was used to represent the global curvature of the cervical spine.Then correlation analyses of the parameters above were performed.Results There was no significant change in SAMDS at different level after surgery,however SAMSC,SPMSC and SPMDS changed significantly and synchronously.At the level of C5 and C6,SPMSC was maximum,but not correlated to CI.Actually,SPMSC was correlated to the local curvature and highly correlated to SPMDS at the same level.Conclusion After cervical laminoplasty,posterior shifting of the spinal cord was highly correlated to posterior shifting of the dural sac at the same level,weakly correlated to local curvature and not correlated to the global curvature of the cervical spine.

Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression,so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection.Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed.According to the decompression range,the patients were divided into C2-C7 group and C1-C7 group.There were 25 cases in the C2-C7 group,19 males and 6 females,with an average age of 56.3 years (40-71 years),4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine.All of the 25 patients underwent open-door laminoplasty:20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure).There were 20 cases in C1-C7 group,12 males and 8 females,with an average age of 58A years (44-75 years).All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty,including anchoring procedure in 1 case,titanium miniplate procedure in 4 cases,and titanium cable procedure in 15 cases.Standardized vertebral-cord distance (SVCD) at each level from atlas to level C~ was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position pedormed 3-12 months postoperatively at each individual level.As the main outcomes,the SVCD values obtained at the same level of the two groups were compared between the two groups.Shapiro-Wilk normality test was performed on the SVCD values at C1.2 and C2 levels of two groups.The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups.Results The SVCD obtained at the level of the anterior arch of atlas (C1),the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm,8.35±1.27 mm,and 8.22 ±1.43 mm,respectively.The SVCD at the same levels was 11.02±1.60 mm,9.72±1.24 mm,and 9.12±1.11 mm,respectively.SVCDs differed significantly in the above range between the two groups.However,from level C2,3 to C6,7,there was no significant difference in SVCDs between the two groups.The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006,P＜0.001) with a recovery rate of 57.0％±32.2％.The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177,P＜0.001) with a recovery rate of 51.9％±32.1％.Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body,but it would not increase the decompression effect at level C2.3 or below.When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body,extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression.

Objective　To investigate the clinical efficacy of anterior cervical surgery by comparative analyzing hand dysfunction using brief Michigan hand questionnaire(Brief MHQ)in Hirayama disease patients.Methods　From Aug 2011 to Dec 2016,27 patients of hirayama disease who underwent surgery were enrolled in this study.The study group consisted of 27 men.The mean follow-up period was 41.1 months.The levels of surgery included 18 cases of C4-C7,6 cases of C3-C6,2 cases of C4-C6 and 1 case of C5-T1.Brief MHQ were evaluated for the 27 patients.According to the Wilcoxon analysis,the unchanged domains were analyzed with the multifactor Logistic regression analysis by preoperative duration of symptoms,age of onset,and number of affected extremities.Dynamic flexion-extension lateral X-rays were performed at baseline and at final follow-up.Results　No failure of internal fixation was detected on dynamic flexion-extension lateral X-rays.Five domains of preoperative Brief MHQ had lower scores,including Function,Satisfaction,Aesthetics,Activities of daily living,Work domain.With the exception of Aesthetics and Pain domain,all the other four domains showed significant improvement after surgery.The total score was 38.44±5.83 at base-line and 43.19±4.47 at follow-up.The score of Function was 5.19±1.36 at baseline 6.37±1.15 at follow-up;The score of Satisfaction was 5.56±1.22 at baseline 6.60±1.05 at follow-up;The score of Activities of daily living was 6.33±1.84 at baseline 7.60±1.47 at follow-up;The score of Work was 6.85±1.75 at baseline 7.67±1.33 at follow-up.The risk factors of postoperative outcomes reported in the literature included duration of disease at the time of surgery,age of onset,and extremity involvement.According to the Logistic regression,pre-operation duration was the risk factor for Aesthetics domain and the cut-off time was 1.75 years.Conclusion　Four domains of Brief MHQ score were improved significantly after anterior surgery for patients with hirayama disease.Brief MHQ was useful to evaluate the hand dysfunction and clinical efficacy in patients with hirayama disease.

Objective:To compare the technique between concave distraction and convex resection in the treatment of congenital cervicothoracic scoliosis and evaluate its curative effect.Methods:Data of congenital cervicothoracic scoliosis patients from January 2010 to January 2020 were collected, among which 5 were males and 3 were females. The patients' age was 12.5±4.5 years old (range 6-20 years old). One case had C 7 wedged vertebra, 4 cases had T 1 hemivertebra and unbalanced vertebra, 2 cases had T 2 hemivertebra and 1 case had fused facet joint and wedged lamina in T 1. All patients had different degrees of vertebra fusion. Convex resection technique (one stage anterior and posterior combined hemivertebrae resection and annular osteotomy) was used to treat 4 cases before 2015; Concave distraction technique (A combination of anterior and posterior release, intervertebral space and facet space distraction, cage placed and fusion) was used to treat 4 cases after 2015 and 2 of them had 2 segments distraction. Perioperative neurological, vascular and wound related complications were recorded. The main parameters were structure Cobb angle, cephalic and caudal compensatory Cobb angle, mandibular incline, neck tilt, shoulder balance and head shift were measured pre-operation, post-operation and at the last follow-up. Results:All patients' surgeries were completed successfully. In convex resection group, the duration of surgery was 201±100 min (range 113-300 min) per vertebra, the estimated blood loss was 294±153 ml (range 100-450 ml) per vertebra, the hospital stay was 14±3 d (range 11-18 d) and follow up time was 51±11 months (range 36-60 months). In concave distraction group, the duration of surgery was 117±14 min (range 101-129 min) per vertebra, the estimated blood loss was 119±36 ml (range 85-167 ml) per vertebra, hospital stay was 17±3 d (range 14-20 d) and follow up time was 28±21 months (range 12-60 months). Convex resection group had longer operation time and more blood loss per vertebra than concave distraction group. In convex resection group, structural Cobb angle was 45.1°±21.0° pre-operation and 22.7°±15.3° post-operation, which was corrected significantly ( Z=6.53, P=0.038). The correction rate was 54.8%±30.9%. Cephalic compensatory Cobb angle was 22.1°±8.2° pre-operation and 8.2°±5.8° post-operation, which was corrected significantly ( F=6.01, P=0.049). The correction rate was 66.8%±15.1%. Mandible incline was 7.8°±3.1° pre-operation and 3.5°±1.5° post-operation, which was corrected significantly ( F=8.02, P=0.018). The correction rate was 51.0%±29.7%. In concave distraction group, structural Cobb angle was 32.2°±27.2° pre-operation and 16.3°±16.7° post-operation, which was corrected significantly ( F=7.43, P=0.024) . The correction rate was 59.0%±24.7%. Caudal compensatory Cobb angle was 18.9°(17.2°, 32.1°) pre-operation and 9.5°±10.3° post-operation, which was corrected significantly ( Z=6.00, P=0.049). The correction rate was 64.0%±24.1%. Clavicle angle was 3.9°±2.3° pre-operation and 0.3°±0.4° post-operation, which was corrected significantly ( F=1.75, P=0.040). The correction rate was 97.0% (48.5%, 99.8%). There was no significant difference in the correction rate of all radiographic parameters between the two groups. At the last follow-up, the patients' appearance of head, neck and shoulder were improved compared with those before surgery. In convex resection group, 2 patients showed nerve root stimulation symptoms postoperatively on convex side. One patient developed C 5 nerve root palsy which weakened deltoid muscle and the other patients presented with reduced triceps muscle strength. In concave distraction group, one patient developed C 5 nerve root palsy on convex side. All these symptoms recovered by conservative treatment 3 months after operation. Conclusion:It is safe and effective to treat congenital cervicothoracic scoliosis with convex resection technique and concave distraction technique. The concave distraction technique has the advantages of more safety, less operating time, less blood loss and easier to perform and has a wider application prospect.

Objective:To explore the safety, feasibility, and short-term outcome ofdistraction on the concave side in the treatment of patients with congenital cervical scoliosis.Methods:Between August 2015 and December 2019, 11 patients with congenital cervical scoliosis underwent distraction technique on concave side, among which 5 were males and 6 were females. Age was 9.9±3.1 years old (range 6-16 years old). The primary cervical spine deformity was hemi-vertebra with different degrees of vertebra fusion. 7 cases were in C 3, 3 cases were in C 4 and 1 case was in C 5. Anterior-posterior combined approach was used. Firstly, discectomy and soft tissue release on concave side were made through anterior approach, then distraction on concave side and fusion with internal fixation were made through posterior approach and at last fixation and fusion in anterior approach were made. In this study we measured structure Cobb angle, compensatory Cobb angle, mandibular incline, shoulder balance and the angle difference of trapezius muscle preoperation and post operation. Perioperative neurological,vascular and wound related complicationswere recorded. Results:All patients' surgeries were completed successfully. Eight patients received single site distraction and 3 patients received distraction in two sites. The duration of surgery was 466±141 min (range 150-659 min), the estimated blood losswas 387±191 ml (range 100-660 ml) and follow up time was 12.2±9.5 months (range 3-24 months). Structural Cobb angle was 28.9°±13.1° pre-operation and 7.4°(3.0°, 27.7°) post-operation at 3 months, which was corrected significantly ( Z=-2.934, P=0.003). The correction rate was 58.1±26.1% (range 18.8%-97.6%). Structural Cobb angle was 13.2°±12.3°at 1 year post operation and had no significant difference compared with 3 months post operation ( t=1.960, P=0.107). Compensatory Cobb angle was 18.3°±6.1° pre-operation and 9.4°±7.3° post-operation at 3 months, which was corrected significantly ( t= 5.071, P<0.001) and the correction rate was 51.3%±28.3% (range 2.4%-94.7%). Compensatory Cobb angle was 8.9°±7.7° at 1 year follow up and was corrected significantly ( t=5.253, P=0.003) compared to 3 months after surgery and the correction rate was 61.4%±26.9%. Two patients developed C 5 nerve root dysfunction and 1 patient developed numbness on the index and middle fingers after surgery. All of them occurred on the concave side and recovered by conservative treatment. Conclusion:The application of distraction on the concave side in the treatment of congenitalcervical scoliosis is with good feasibility and clinical safety. Short-term follow-up showed excellent resultswith a promising future.

OBJECTIVESTo investigate the effect of C(2-7) laminoplasty on postoperative anterior cord space (ACS) compared with C(3-7) laminoplasty, and to provide evidence for reasonable enlargement of decompression range cephalad.

METHODSFifty-seven Patients underwent cervical laminoplasty from February 2008 to October 2011 were studied retrospectively, which were divided into two groups by decompression range: Group C(3-7) and Group C(2-7). The pre-and post operative JOA scores,VAS scores of neek and shoulder pain, and cervical alignment were compared in each group. The postoperative ACS at each level from C(2-3) to C(7)-T(1) measured on MRI were compared between the two groups.

RESULTSThe postoperative JOA scores increased significantly in both groups. VAS scores and cervical alignment showed no significant difference. ACS at C(2-3) and C(3-4) was 6.13 mm (95%CI: 5.71-6.55) and 6.60 mm (95%CI: 6.10-7.11) respectively in Group C(3-7), which increased 2.5 mm and 2.1 mm respectively in Group C2-7 at the same segment, there was significant difference (P < 0.01). However, there was no significant difference of ACS at C(4-5) and any other caudal levels between the two groups.

CONCLUSIONSCompared with conventional C(3-7) laminoplasty, the extensive decompression cephalad to C(2) leads to larger ACS at C(2-3) and C(3-4). When the mid-sagittal diameter of anterior compression is more than 6.10 mm at C(3-4), C(3-7) laminoplasty may cause insufficient decompression, and enlargement of decompression range cephalad should be considered.

Cervical Vertebrae ; surgery ; Decompression, Surgical ; statistics & numerical data ; Humans ; Laminoplasty ; Magnetic Resonance Imaging ; Postoperative Period ; Retrospective Studies ; Treatment Outcome

BACKGROUNDOpen-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy (CSM). This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM.

METHODSWe retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011. Both objective and subjective assessments were evaluated before surgery, 3 months after surgery, and 1 year after surgery. We then analyzed the profiles of and correlation between objective and subjective short-term outcomes.

RESULTSThe Modified Japanese Orthopaedic Association (mJOA) score was significantly improved at 3 months (P < 0.01) and 1 year (P < 0.01) after surgery. Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery, while motor function contributed more to the recovery rate at 1 year after surgery. On the subjective assessment (the short form (SF)-36 ), there was no significant improvement at 3 months after surgery (P > 0.05), while physical function (PF), role-physical (RP), and social function (SF) were notably improved at 1 year after surgery (P < 0.01). Improved mJOA score correlated with improvements in PF, RP, bodily pain, general health (GH), vitality (VT), and SF (P < 0.05) at 3 months after surgery; PF, GH, VT, and SF were associated with improved mJOA scores at 1 year after surgery.

CONCLUSIONSPatients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function, followed by a gradual transition to motor function improvement. At the early stage of recovery, improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36, while at the later stage, mJOA score improvement was associated with improvements in both mental and physical domains of the SF-36.

Female ; Humans ; Laminoplasty ; standards ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases ; surgery