A 40-year-old Asian female presented with a 2-month history of right shoulder pain and right triceps weakness. MRI revealed an extramedullary, extradural, dumbbell-shaped spinal cord tumor with C6 to C7 iso- and hyperintensity on T1 and T2 weighted imaging, respectively. Histological examination revealed monomorphous spindle cells with a storiform pattern. Immunohistochemistry was positive for CD34, CD99, and negative for EMA, SMA, and S100; solitary fibrous tumor (SFT) was confirmed.
Adult ; Cervical Vertebrae/*pathology/radiography/surgery ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Solitary Fibrous Tumors/*pathology/radiography/surgery ; Spinal Cord Neoplasms/*pathology/radiography/surgery ; Tomography, X-Ray Computed

BACKGROUNDAirway management is crucial in clinical anesthesia. Many complications associated with airway management result from unexpected difficult airway, but predicting a difficult airway is a major challenge. We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis, a population with a high incidence of difficult airway.

METHODSWe randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013. Preoperatively, patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images. Difficult airway was defined as Cormack-Lehane grades III-IV. Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway. A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction.

RESULTSWe identified three clinical predictive factors using the ROC curve: mouth opening, sternomental distance, and neck mobility. We created a clinical model using three factors: gender, age, and mouth opening, with odds ratios (OR) of 0.370, 1.034, and 0.358, respectively. Using the clinical and radiological parameters, we formulated a combined model with five risk factors: gender, mouth opening, atlanto-occipital gap, the angle from the second to sixth cervical vertebraes in the neutral position, and the angle difference of d (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR: 0.107, 0.355, 0.846, 1.057, and 0.952, respectively). The sensitivity and specificity of the combined model were 80.0% and 65.7%, respectively, and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.

CONCLUSIONThe efficacy of the combined model including both clinical and radiological indicators was better than any single clinical predictor or the clinical model in patients undergoing elective surgery for cervical spondylosis.

Adult ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Radiography ; Risk Factors ; Spondylosis ; diagnostic imaging ; surgery

BACKGROUNDCervical disc arthroplasty is an alternative surgery to standard cervical decompression and fusion for disc degeneration. Different types of cervical disc prosthesis are used in China. The aim of this study was to evaluate the radiographic outcomes of cervical arthroplasty using the ProDisc-C prosthesis.

METHODSRadiographic evaluation, including static and dynamic flexion-extension lateral images, was performed at baseline and at final follow-up.

RESULTSTwenty six patients who had single-level ProDisc-C arthroplasty were followed up for a mean period of 63 months (56-76 months). The range of motion at the operated level was 9.3°±3.7° at baseline and 7.3°±3.5° at final follow-up, with a significant difference (P < 0.05). Seventeen of 26 levels (65.4%) developed heterotopic ossification: three were classified as grade II, 13 were classified as grade III, and 1 as grade IV, according to McAfee's classification. Forty nine adjacent segments were evaluated by lateral X-ray and 18 (36.7%) segments developed adjacent segment degenerations.

CONCLUSIONSProDisc-C arthroplasty had acceptable radiographic results at 5-year follow-up. The range of motion was preserved. However, more than 60% of the patients developed heterotopic ossification.

Adult ; Arthroplasty ; methods ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Humans ; Intervertebral Disc Degeneration ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography

PURPOSE: The cervical dynamic rotational plating system may induce bone graft subsidence, so it may cause loss of cervical lordosis. However there were few studies for alignments of cervical spines influencing the clinical results after using dynamic rotational plates. The purpose is to evaluate the effect of graft subsidence on cervical alignments due to the dynamic rotational cervical plates and correlating it with the clinical outcomes of patients undergoing anterior cervical fusion. MATERIALS AND METHODS: Thirty-three patients with disease or fracture underwent anterior cervical decompression and fusion using a dynamic rotational plate. The presence and extent of implant complications, graft subsidence, loss of lordosis were identified and Visual Analog Scale score (VAS score), Japanese Orthopaedic Association score (JOA score), clinical outcomes based on Odom's criteria were recorded. RESULTS: Fusion was achieved without implant complications in all cases. The mean graft subsidence at 6 months after the surgery was 1.46 mm. The lordotic changes in local cervical angles were 5.85degrees which was obtained postoperatively. VAS score for radicular pain was improved by 5.19 and the JOA score was improved by 3. Clinical outcomes based on Odom's criteria showed sixteen excellent, ten good and two satisfactory results. There was no significant relationship between clinical outcomes and changes in the cervical angles. CONCLUSION: Dynamic rotational anterior cervical plating provides comparable clinical outcomes to that of the reports of former static cervical platings. The loss of lordosis is related to the amount of graft settling but it is not related to the clinical outcomes.
Adult ; Aged ; Cervical Vertebrae/*radiography/surgery ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion/*adverse effects/instrumentation ; Treatment Outcome

Anterior cervical discectomy and fusion (ACDF) is currently the standard treatment for cervical disc disease. Some patients wish to be treated with a less invasive method, because of their social/physical situations. Here we present one method of treatments for socially/physically active patients. Three patients had triceps weakness and mild posterior neck pain. The offending lesions were at the C6-7 level. All were middle-aged soldiers with families. If conventional ACDF were performed, they would have to retire from the military according to the regulation. They had to be able to perform military drills after the treatment if they were going to be able to keep their jobs. Because of their social/physical situations, all wanted to choose method with that they could treat the disease and keep their jobs. For these reasons, the posterior cervical endoscopic discectomies were performed. Ruptured fragments were successfully removed in all. The arm pain improved by more than 90% in two patients by 7 days and in the other patient by 2 months, respectively (excellent outcome by Macnab's criteria). None of the operations caused instability. All of the patients are currently able to successfully perform their military drills without difficulty. The posterior cervical endoscopic discectomy may be a promising alternative for the physically/socially active patients.
Adult ; Cervical Vertebrae/radiography/*surgery ; *Diskectomy ; Endoscopy ; Humans ; Intervertebral Disk/radiography/surgery ; Magnetic Resonance Imaging ; Male ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome

A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.
Accidents, Traffic ; Adult ; Cervical Vertebrae/*injuries/radiography/surgery ; Fracture Fixation, Internal ; Humans ; Laminectomy ; Male ; Spinal Cord Injuries/etiology/*radiography/surgery ; Tomography, X-Ray Computed

PURPOSE: We performed 65 cases of posterior fusion surgery for cervical and/or high thoracic lesions using a polyaxial screw-rod system. PATIENTS AND METHODS: A total of 486 screws were implanted in 65 patients. RESULTS: Fixation of the screws was carried out over an average of 2.9 spinal segments. Upon evaluation by postoperative CT scans, twelve (2.5%) screws had suboptimal trajectories but two of these revealed radiculopathy in one patient and required screw repositioning. No vascular sequelae resulted. There has been no segmental motion in any of the cases to date. As for other complications, there was one case of dural tearing and two cases of lateral mass fractures. There were no infections or other wound healing problems or hardware failures. No patients had neurological deterioration after surgery. There were statistically significant improvements in the mean Neck Disability Index (NDI) scores and Visual Analogue Scale (VAS) scores in the preoperative and late postoperative follow-up evaluations. Although further studies are required to establish the long-term results of fusion rates and clinical outcomes. CONCLUSION: We cautiously suggest that the posterior polyaxial screw-rod system can be safely used as a primary or additional fusion method in this risky region. The successful and safe use of this method is dependent on a precise preoperative surgical plan and tactics for ensuring safe screw fixation.
Adult ; Aged ; Aged, 80 and over ; *Bone Screws ; Cervical Vertebrae/radiography/*surgery ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function ; Reproducibility of Results ; Spinal Diseases/physiopathology/*surgery ; Spinal Fusion/instrumentation/*methods ; Thoracic Vertebrae/radiography/surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: In cervical anterior approach, transverse skin incision is preferred due to cosmetic reasons. Precise skin incision is required to reach the surgery segment while minimizing soft tissue injury. Skin incision site is frequently identified using C-arm fluoroscopy or the carotid tubercle. Accordingly, this study was conducted to investigate the efficacy of skin incision using the carotid tubercle as a marker. METHODS: This study was retrospectively conducted on 114 patients who underwent anterior cervical surgery by the same surgeon from April 2004 to June 2012. The rate of the appropriate insertion of K-wire, which was inserted into the disc after anterior approach, into the surgery segment was compared between 62 patients where skin incision site was identified using C-arm fluoroscopy before skin incision and 52 patients where skin incision site was identified using carotid tubercle palpitation before surgery. RESULTS: The needle was shown to have been inserted into the planned site in 106 patients out of the total 114 patients. The appropriate insertion of the needle was shown in 59 patients of group I (95.2%) and in 47 patients of group II (90.4%). Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of one-segment surgery was shown to be 89.7% in group I and 82.6% in group II. Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of two-segment surgery was shown to be 100% in group I, and 96.4% in group II due to one case of the failure at C3-4 and C5-6. The success rate of three- and four-segment surgeries was shown to be 100% in both groups. CONCLUSIONS: The identification of skin incision site via carotid tubercle palpation was useful for surgeries involving two or more segments. Furthermore, it could be useful for one-segment surgery if surgical site is identified using vertebral body or soft tissues such as longus collis rather than insertion into the disc.
Adult ; Anatomic Landmarks/anatomy & histology/radiography ; Cervical Vertebrae/*anatomy & histology/radiography/*surgery ; Female ; Fluoroscopy/*methods ; Humans ; Male ; Middle Aged ; Palpation/*methods ; Retrospective Studies

OBJECTIVETo discuss surgical procedures and curative effect of ankylosing spondylitis with cervical spine fracture.

METHODSFrom January 2003 to October 2011, 8 patients with ankylosing spondylitis with cervical spine fracture were respectively treated by surgical treatment (7 cases) and conservative treatment (1 case), 8 cases were male with an average of age 41 years old (ranged, 27 to 49). All patients were confirmed by CT and MRI,and 6 cases combined with spinal cord injury. One case was treated with skull-neck-thorax model, 7 cases were treated by surgery. The procedures included anterior approach (5 cases), posterior approach (1 case), and combined anteroposterior approach (1 case). Fracture fusion condition were evaluated according to CT at the final following up, improvement of spinal cord injury were assessed according to Frankel classification.

RESULTSEight patients were followed up from 4 to 38 months with an average of 34 months. Seven cases obtained bone healing, 3 patients without spinal cord injury remained intact after operation, 5 patients with spinal cord injury improved at different degree after operation. Frankel classification of 7 patients were improved 1 degree, and 1 case delayed union for following up.

CONCLUSIONAnkylosing spondylitis with cervical spine fracture is a special kind of trauma, which have a high rate of neurological deficits. Surgery should be performed as early as possible, and procedures were chosen depending on particular case.

Adult ; Cervical Vertebrae ; diagnostic imaging ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fractures ; diagnostic imaging ; surgery ; Spondylitis, Ankylosing ; diagnostic imaging ; surgery

OBJECTIVETo explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion.

METHODSFrom January 2002 to July 2011, the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65), the course of disease ranged from 1 month to 4 years (mean, 15 months). All patients manifested numbness and weakness of four limbs, unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function.

RESULTSTen patients were followed up, and the duration ranged from 15 to 32 months, with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20 +/- 1.55 preoperative to 13.60 +/- 1.90 postoperative (t = -11.8, P < 0.001), and excellent in 3 cases, good in 6 cases and moderate in 1 case.

CONCLUSIONAnterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Epidural Space ; diagnostic imaging ; surgery ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography