OBJECTIVETo discuss on the effect of cervical spondylotic myelopathy before and after surgery and assess its indications and efficacy.

METHODSFrom June 2002 to June 2006, 125 patients with cervical spondylotic myelopathy were analyzed retrospectively involving 58 anterior routine and 67 posterior routine, of which 71 cases of males, 54 cases of females, aged from 28 to 69 years (average 53.4 years). The course was 0.5 to 48 months (means 14 months). According to JOA score system preoperative and postoperative nerve function were analyzed, summarized anterior and posterior cervical spine surgery.

RESULTSAll patients were followed up for from 6 to 30 months (average of 18 months). According to JOA score criteria: anterior cervical surgery preoperative JOA score was (8.78 +/- 2.43) points, postoperative JOA score was (14.68 +/- 2.37) points, the results were excellent in 40 cases, good in 10 cases, effective in 6. Posterior surgical group preoperative JOA score was (8.49 +/- 2.58) points, postoperative JOA score was (14.26 +/- 2.83) points, the results were excellent in 42 cases, good in 12 cases, effective in 8. Invalid operation occurrenced in 6 cases included 2 of anterior, 4 of posterior. The postoperative symptoms had worsed in 1 case of posterior operation. The two groups had no statistical difference in efficacy, but there were differences statistically in the same approach comparing preoperative and postoperative.

CONCLUSIONBoth anterior and posterior approaches have fine effect to the treatment of cervical spondylotic myelopathy (CSM). But the selection of the indication is very important, the patients with the pressure from anterior, the short-level changes, and the main symptoms of pyramid trac compression, adopt anterior approach on principle. While the patients with the pressure of spinal cord from posterior, multilevel changes, main symptoms of sensory disturbances, and accompanied by cervical spine canal stenosis mainly is introduced posterior approach.

Adult ; Aged ; Cervical Vertebrae ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spondylosis ; physiopathology ; surgery

OBJECTIVETo explore clinical presentations and the operational opportunity of traumatic cervical disc herniation.

METHODSFrom June 2002 to June 2009,40 patients with traumatic cervical disc herniation were treated. There were 24 males and 16 females, with an average age of 43.2 years old ranging from 30 to 56 years. There were 36 patients with single intervertebral disc herniation and 4 patients with double. The injury level of those patients were at C3,4 in 16 cases, C4,5 in 10 cases, C5,6 in 12 cases and C6,7 in 6 cases. Among them, 18 patients showed spinal cord signal changes by MRI, 5 patients suffered from nothing but neck and shoulder pain, 8 patients with nerve root stimulation; 10 patients with spinal cord compression, and 17 patients had both nerve root stimulation and spinal cord compression symptoms. Conservative treatment were applied to 13 patients with neck and shoulder pain and nerve root stimulation, 5 cases of which were transferred to operation in case of poor effects, and Odom criteria were used to assess operational effects. Twenty-seven patients with spinal cord compression accepted operation from 1 to 27days after their trauma, 16 of which were operated in 5 days (early operational group with an JOA score of 11.3 +/- 2.8), other 11 cases were operated from 5 to 27 days (delayed operational group with an JOA score of 11.4 +/- 2.9 ), then functional assessment of spinal cord were assessed according to JOA criteria.

RESULTSThree patients who were transferred from conservative treatment recovered excellently according to Odom criteria and the other 2 were good at final followed-up. JOA score of early operational group increased from (11.3 +/- 2.8) to (15.3 +/- 1.8) one week after operation (P < 0.01), and (15.9 +/- 1.4) at final followed-up (P < 0.01). JOA score of delayed operational group increased from (11.4 +/- 2.9) to (14.0 +/- 2.6) one week after operation (P < 0.01), and (15.3 +/- 1.5) at final followed-up (P < 0.01). The recovery ratio of JOA score of early operational group were (74.6 +/- 16.8)% 1 week after operation,and increased to (85.6 +/- 13.6)% at final followed-up; while that of delayed operational group were (50.9 +/- 17.5)% and (68.2 +/- 21.5)%, and there were significant difference between early operational group and delayed operational group both at 1 week postoperation and final followup (P < 0.05).

CONCLUSIONThere are some difference in pathological segment and imaging manifestation between traumatic cervical disc herniation and cervical spondylosis. Early operation is favorable to the recovery of neurological function in patients with spinal cord compression.

Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Male ; Middle Aged

OBJECTIVETo investigate the biomechanical effect of anterior screw fixation on the type II fractured odontoid process.

METHODSTwenty fresh human C1-C2 vertebrae specimens were harvested and randomly divided into three groups. The angle of type II fracture line was 0 degree in group I (n=6), 17 degrees in group II (n=8) and 25 degrees in group III (n=6). The fractures were treated by anterior screw fixation. Insertion torque,maximal axial pullout force and stiffness of the bone-screw were tested.

RESULTSThere was no significant difference of screw insertion torque and the pull-out strength between each group. The displacement of the odontoid fragment had an association to the angle of the fracture line,the displacement of the small angle was significantly higher than that of the large one (P < 0.5). No significant difference of structure stiffness of the bone-screw was found between each group.

CONCLUSIONAnterior screw fixation is feasible for type II odontoid fracture with certain fracture line extends from anteroinferior to posterosuperior.

Biomechanical Phenomena ; Bone Screws ; Cervical Vertebrae ; injuries ; Fracture Fixation, Internal ; methods ; Humans ; Spinal Fractures ; physiopathology ; surgery

OBJECTIVETo research the clinical application of lower cervical pedicle screw fixation procedure.

METHODSFrom September 2011 to July 2013,32 patients underwent posterior pedicle screw-rod system fixation were retrospective analyzed includinig 20 males and 12 females with an average age of 56.4 years old ranging from 21 to 78 years. Among them, 10 patients were traumatic cervical spinal injury, 9 patients were cervical spinal canal tumors, 7 cases were posterior longitudinal ligament ossification of cervical vertebrae, 6 cases were multiple segmental cervical spondylopathy. Preoperatively, X-ray, computed tomography, magnetic resonance imaging and magnetic resonance angiography of the vertebral artery were performed in all patients. After the operation and during the follow-up,X-ray and computed tomography were performed to confirm the pedicle screw position. The accuracy of the pedicle screw placement was evaluated by 4 grades classification from Lee. The spinal cord function was assessed by ASIA impairment scale for traumatic patients and JOA score for non traumatic patients.

RESULTSTotally 144 pedicle screws performed on 32 patients from C3 to C7 involving 132 screws of grade 0,5 screws of grade 1,5 of screws grade 2 and 2 screws of grade 3 according to postoperative CT. There were 12 screws penetrating the pedicle cortex including 8 screws at lateral,2 screws at caudal, 1 screw at medial and 1 screw at cranial. The follow-up time was 12 to 33 months with an average of (21.0±1.5) months. The spinal cord function was not improved in 6 complete cervical spinal cord injury patients,but their paraplegic level descended 1 to 3 segments. Four incomplete cervical spinal cord injury patients' ASIA impairment scale was increased by 1 to 2 grades in average. The JOA score of 22 atraumatic patients increased from preoperative 11.5±0.8 to 15.9±0.6 of postoperative at 6 months (P<0.01). There were no screw loosening,screw pullout and screw-rod breakage.

CONCLUSIONThe lower cervical pedicle screw fixation can provide excellent 3D stability of the vertebral column. The operation risk and Complication could be minimized by adequate preoperative evaluation for appropriate cases and individual pedicle screw placement. It deserved the clinical expansion.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Cord Injuries ; physiopathology ; surgery

OBJECTIVETo evaluate the effect of a modified open door laminoplasty using anchor method on reducing the occurrence of axial symptoms and loss of cervical curvature.

METHODSFrom October 2004 to May 2007,56 patients with cervical spondylotic myelopathy underwent this procedure and been followed up (group A). Another 50 patients who underwent conventional unilaterally open-door laminoplasty served as control (group B). The operation time, blood loss, JOA scores and the incidence of newly developed or deteriorated axial symptoms were recorded. Preoperative and postoperative curvature angle which was presented on the tangent of posterior vertebral body margins of C2 and C7 in the cervical spine were measured on cervical radiographs.

RESULTSThe operative time was (116 +/- 27.9) min in group A and (120 +/- 18.9) min in group B,showing no statistically significant difference (P > 0.05). The operative blood loss was (148 +/- 68.3) ml in group A and (152 +/- 63.4) ml in group B (P > 0.05). According to JOA scores, the average recovery rates were (61.1 +/- 24.5)% in group A and(53.3 +/- 23.3)% in group B (P < 0.05). Postoperative development or deterioration of axial symptoms occurred in 41.1% of patients in group A and 76.0% of patients in group B,showing statistically significant difference (P < 0.05). There was no significant difference between preoperative (6.3 degrees +/- 5.1 degrees) and postoperative (6.6 degrees +/-4.5 degrees) cervical curvature angle in group A,whereas the mean value of postoperative angle(4.8 degrees +/- 3.5 degrees) was significantly smaller than that of preoperative one(5.9 degrees +/- 5.1 degrees) in group B (P < 0.05).

CONCLUSIONThe modified open door laminoplasty using anchor method was effective on reducing the occurrence of axial symptoms and loss of cervical curvature and to the benefit of early functional training.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Postoperative Period ; Spinal Curvatures ; physiopathology ; surgery ; Spinal Osteophytosis ; physiopathology ; surgery ; Suture Anchors

OBJECTIVETo investigate the clinical effects of anterior transpediclar screw (ATPS) fixation in treating lower cervical spine fracture and dislocation.

METHODSFrom January 2009 to December 2011, 18 patients with lower cervical spine fracture and dislocation were treated with ATPS technique, including 12 males and 6 females, aged from 17 to 47 years old with an average of 38.2 years. Severity score of lower cervical spine injuries (SLIC) ranged from 6 to 9 points with an average of 7.5 points. According to ASIA grade of spinal cord injury, 2 cases were classified in grade A, 8 cases in grade B, 6 cases in grade C and 2 cases in grade D. X-ray and CT scan were done after surgery in order to evaluate the safety of ATPS and observe the stability and fusion of injured segment. Spinal cord function was evaluated according to ASIA grade at 3 months after operation and last follow-up.

RESULTSAll patients were followed up for 6 to 15 months with an average of 9.5 months. Three months after operation, in aspect of spinal cord function, 8 cases improved 1 grade, 2 cases improved 2 grades; and at final follow-up, 7 cases improved 1 grade, 4 cases improved 2 grades. All patients obtained bony fusion 6 to 8 months after operation with an average of 6.5 months. After operation, 1 case had transient hoarseness and recovered 2 months later;2 cases felt swallowing discomfort, but the symptoms disappeared after about 3 weeks by inhalation. No internal fixation breakage and loosening as well as nerve, blood vessel and esophageal injuries were found.

CONCLUSIONAs for three columns injury caused by lower cervical spine fracture and dislocation, treatment with anterior transpediclar screw reconstruction can achieve the effect of decompression thoroughly and restore the cervical spine height and physiological curvature. Moreover, this kind of treatment has good stability and can create the favorable conditions for the recovery of spinal cord function.

Adolescent ; Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Recovery of Function ; Spinal Fractures ; physiopathology ; surgery

OBJECTIVETo investigate clinical features and treatments of cervical spinal injury in aged patients.

METHODSFrom July 2006 to October 2011, 27 patients with cervical spinal cord injury were divided into experiment group, including 20 males and 7 females with an average age of 69 years old (ranged 65 to 78 years old). The other 22 patients with the same degree of cervical spianl cord injury and the same period hospitalization were chosen to regard as control group, including 16 males and 6 females with an average age of 47 years old (ranged 38 to 65 years old). All of them had clear history of trauma, and were admitted to hospital within one week. Clinical data and result of follow up were evaluated between two group. The function of the spinal cord was measured by Frankel classification at admission and final follow-up.

RESULTSAll patients were followed up for 1 year except 6 died in aged group, among which 3 paients with complications were died during hospitalization and others were out of hospital. Twenty-three cases had accompanied diseases and 24 cases occurred complications in aged group. Contrast to control group, this difference was statistically significant. At the final follow-up, there were 2 cases at Frankel grade E in aged group and 6 cases in control group.

CONCLUSIONIn comparison with control group, there are more accompany diseases and higher complications and mortality rates in aged group, while poor improvement of spinal cord function. This patients were mainly treated with operation, but operation method should simplify and mainly focus on effective decompression and reconstuction stability and avoid expansion operation. It's nesscerry to pay more attention to prevent and treatment of respiratory complication.

Adult ; Aged ; Cervical Vertebrae ; injuries ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; mortality ; therapy ; Spinal Injuries ; physiopathology ; surgery

OBJECTIVETo report a case series of six neglected cervical spine dislocations without neurological deficit, which were managed operatively.

METHODSThe study was conducted from August 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research, India. The patients were in the age group of 30 to 50 years. All patients were operated via both anterior and posterior approaches.

RESULTSDuring the immediate postoperative period, five (83.33%) patients had normal neurological status. One (16.67%) patient who had C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.

CONCLUSIONThere is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks. Posterior followed by anterior approach saves much time. If both approaches are to be done in the same sitting, there is no need for instrumentation posteriorly. But if staged procedure is planed, posterior stabilization is recommended, as there is a risk of deterioration in neurological status.

Adult ; Cervical Vertebrae ; injuries ; Female ; Humans ; India ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Spinal Injuries ; physiopathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the diagnosis, surgical procedure and clinical outcome of cervical intraspinal benign neoplasm.

METHODSTwenty-two cases confirmed pathologically were reviewed included 16 males and 6 females with an average age of 43.8 years old ranging from 18 to 56 years. Symptoms mainly included neck pain, numbness and weakness of the extremities, urinary and fecal incontinence, pyramid signs, etc. All underwent X-ray, CT and MRI, 11 cases were diagnosed as neurilemomas, 4 neurofibromas, 3 spinal meningiomas, 2 intraspinal cysts and 2 lipomas. The tumors were removed completely in 18 cases, above 60% in 3 cases and 25% with biopsy in 1 case. Cervical stability in 11 cases was restored after removal of tumors.

RESULTSAll were followed-up for from 6 to 84 months(means 12.5 months). Symptoms improved in 20 cases and stable in 1 case and worsened in 1 case postoperatively according to JOA scoring system. Two patients recurred and were treated with second surgery. JOA scoring was (6.52 +/- 1.10) before operation, (11.42 +/- 0.79) after operation, there was statically significance (t = 21.38, P < 0.001). The average recover ratio of total was (46.7 +/- 2.46)%, cervical stability was (62.37 +/- 3.58)%, the other methods was (41.21 +/- 4.63)%. The results of JOA were excellent in 18 cases, good in 2, fair in 1 and poor in 1.

CONCLUSIONThe surgical exairesis for cervical intraspinal benign neoplasm has low post-operative recurrence. The main reason of recurrence is not removed the tumor completely. MRI is regarded the effective method which is helpful in differential diagnosis and surgery guidance.

Adolescent ; Adult ; Cervical Vertebrae ; pathology ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Spinal Neoplasms ; pathology ; physiopathology ; surgery ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo summarize the therapeutic experience of Bryan prosthetic cervical disc replacement at the 3rd years after operation and to analyze the clinical effect, incidence rate of heterotopic ossification, conditions of prosthetic fusion in order to investigate the countermeasures.

METHODSFrom December 2005 to December 2008, 54 patients with cervical syndrome (34 males and 20 females, the age was from 39 to 69 years with an average of 50.5) were treated with single level Bryan prosthetic cervical disc replacement. The patients were followed for 24-36 months with an average of 30 months. The symptoms and nerve function were evaluated according to JOA and Odom's scoring. The anterior-posterior and lateral cervical X-ray films were also taken regularly every three months for the observation of heterotopic ossification and prosthetic fusion. Meanwhile, the X-ray films of the forward bending, extending, left and right lateriflection were taken before operation and at the 1st years after operation for the measurement of the stability and rang (ROM) of replaced levels.

RESULTSThe pain symptom and neurological function of all 54 patients were improved obviously. JOA score increased with an average of 76.1%, and ROM of replaced levels also improved obviously. The incidence rate of heterotopic ossification and prosthetic fusion went up year by year, 3.7% (2/54) for the first year, 16.7% (9/54) for the second year and 22.2% (12/54) for the nearly third year.

CONCLUSIONBryan prosthetic cervical disc replacement has better mid-stage results than conventional methods. Modified surgical methods and early rehabilitation exercise may reduce the relatively high incidence rate of heterotopic ossification and prosthetic fusion.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; surgery ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Prostheses and Implants ; Treatment Outcome