Humans ; Joint Dislocations/surgery* ; Spinal Fractures/surgery* ; Anesthesia, General ; Cervical Vertebrae/injuries* ; Spinal Fusion

Cervical Cord ; Cervical Vertebrae/surgery* ; Humans ; Spinal Cord Injuries/etiology* ; Thyroidectomy/adverse effects*

Klippel-Feil syndrome is characterized by congenital fusion of two or more cervical vertebrae, a low hair line at the back of the head, restricted neck mobility, and other congenital anomalies. We report a 16-year-old young man with Klippel-Feil syndrome, Sprengel deformity of the right scapula, thoracic kyphoscoliosis, and mandibular prognathism with an anterior open bite. He was treated with orthodontic treatment and maxillofacial surgery. An anticipated difficult airway due to a short neck with restricted neck movements and extrinsic restrictive lung disease due to severe thoracic kyphoscoliosis increased his anesthesia risk. Due to his deviated nasal septum and contralateral inferior turbinate hypertrophy, we chose awake fiber optic orotracheal intubation followed by submental intubation. Considering the cervical vertebral fusion, he was carefully positioned during surgery to avoid potential spinal injury. He recovered well and his postoperative course was uneventful.
Adolescent ; Anesthesia ; Cervical Vertebrae ; Congenital Abnormalities ; Female ; Genioplasty ; Hair ; Head ; Humans ; Hypertrophy ; Intubation ; Klippel-Feil Syndrome ; Lung Diseases ; Mandible ; Nasal Septum ; Neck ; Open Bite ; Orthognathic Surgery ; Osteotomy ; Prognathism ; Scapula ; Spinal Injuries ; Surgery, Oral ; Turbinates

OBJECTIVETo summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.

METHODSFrom January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.

RESULTSThe average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.

CONCLUSIONCervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Tomography, X-Ray Computed

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 study the relationship between cervical pedicle and compressed spinal cord.

METHODSOne hundred and five patients (53 male,52 female,age from 29 to 80 years) with cervical spondylotic myelopathy who needed surgery were included from December 2011 to January 2013 in Shengjing Hospital. Plain MRI scan was used for cross section of C4 - C7 vertebral bodies parallel to the axis of bilateral pedicle, and the images were sent to the workstation. PACS system was applied to measure the anatomical parameters related to the security of cervical pedicle screw, including the shortest distance from medial left/right cervical pedicle to the cervical spinal cord (LH/RH), and the smallest angle between the longitudinal axis of left/right cervical pedicle and the screw which was assumed to just touch the cervical spinal cord (LSA/RSA). All these data in each segment were classified according to compression or not:with compression and without compression. Twelve cases were selected and measured by MRI and 3D cervical CT for spinal canal width D, namely the straight-line distance between the medial margins of cervical pedicle. And the results of two methods were compared to see whether there were statistical differences.

RESULTSAt C4, LH was (7.2±1.3) mm, RH was (6.7±1.4) mm, and the average was (6.9±1.4) mm; at C5, LH was (7.7±1.4) mm, RH was (6.7±1.4) mm, and the average was (7.2±1.5) mm; at C6, LH was (8.2±1.5) mm, RH was (6.9±1.3) mm, and the average was (7.5±1.5) mm; at C7, LH was (8.2±1.4) mm, RH was (7.3±2.1) mm, and the average was (7.7±1.8) mm. At C4, LSA was 34.4°±4.2°, RSA was 34.4°±5.2° and the average angle was 34.4°±4.7°; at C5, LSA was 35.9°±5.2°, RSA was 34.6°±5.4° and the average angle was 35.3°±5.3°; at C6, LSA was 37.4°±4.8°, RSA was 34.8°±4.8° and the average angle was 36.1°±5.0°; at C7, LSA was 39.2°±5.8°, RSA was 37.1°±5.2° and the average angle was 38.1°±5.6°; There were no statistically significant differences between segments with and without compression in H, SA and D (all P>0.05).

CONCLUSIONSThere is security space between the medial vertebral pedicle and compressed spinal cord. There is individual variation in security space. It is very necessary to identify security space before surgery by MRI, emphasize individual procedure and avoid spinal cord injury.

Adult ; Aged ; Aged, 80 and over ; Bone Screws ; Cervical Vertebrae ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck ; Pedicle Screws ; Spinal Cord Compression ; surgery ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spine

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 explore the clinical effects of anterior decompression and fusion with a nano-hydroxyapatite/ polyamide 66 (n-HA/PA66) cage in treating lower cervical fracture and dislocation.

METHODSFrom January 2008 to December 2010, the clinical data of 42 patients with lower cervical fracture and dislocation were retrospectively analyzed. There were 29 males and 13 females aged from 20 to 65 years old. The mean age was 46.8 years. Five cases got injuried in C3, 14 cases in C4, 12 cases in C5, 7 cases in C6 and 4 cases in C7. According to Frankel grade, 4 cases were classified in grade A, 11 cases in grade B, 13 cases in grade C, 9 cases in grade D and 5 cases in grade F. Twenty-eight cases were treated with anterior corpectomy and fusion and 14 cases with anterior discectomy and fusion. Frankel grade was used to do neurologic assessment and visual analogue scale (VAS) was used to evaluate the improvement of clinical symptoms. Segmental height and sagittal lordosis were measured by radiographs and cage location. Cage appearance and fusion status were assessed by 3D-CT images.

RESULTSAll patients were followed up for 3 to 5.2 years with an average of 4.1 years. Frankel grade had obviously improved than preoperative (Z = -4.845, P < 0.001). There were 2, 3, 11, 8, 11 cases classified in grade A, grade B, grade C, grade D and grade E respectively. At the third day after operation and latest follow-up,VAS was (2.6 +/- 1.8),(1.3 +/- 1.0) scores respectively. Both had improved than preoperative (P < 0.05). Up to the latest follow-up, there was only one patient (2.4%) with slight cage translocation (less than 2 mm), however, no cage prolapsed, or collapse, or breakage were found. Both segmental height and lordosis improved significantly after surgery (P < 0.001). And there was not significant difference in both parameters between each postoperative time points (P > 0.05). The mean distance of cage subsidence was 1.5 mm and the rate of cage subsidence (> 3 mm) was 4.8%.

CONCLUSIONThe n-HA/PA66 cage can not only restore and maintain the fusion segmental height and radian, but also promote the osseous fusion and profit the radiographic assessment after operation. Thus, it was an ideal material for prop graft.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods

Cervical Vertebrae ; injuries ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Paralysis ; etiology ; Postoperative Complications ; etiology

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