Pseudofractures of the cervical vertebral body

A lucency traversing obliquely across the inferior-posterior aspect of cervical vertebral bodies may be a normal variant due to osteophytes of the uncinate processes or transverse processes with a resultant Mach band phenomenon. This could be misinterpreted as a fracture of the vertebral body in a patient with a history of cervical injury. A review of normal lateral cervical vertebral films obtained on patients with no traumatic history showed this phenomenon to occur in 27% of adults. It was not observed in children. The proper interpretation is easily made when one considers the location and the fact that a cervical fracture does not occur in such a location as an isolated event.     

The cervical split: A pseudofracture

A horizontal lucent line projecting over a cervical vertebral body on lateral radiographys and simulating a fracture is described. This pseudofracture line results from the lucency between contiguous proliferative osteophytes at the uncinate process/vertebral articulation. Associated disc space narrowing was seen in all of our eleven cases. The origin of this pseudofracture line, cases illustrating this phenomenon, and additional projections helpful for clarification are presented.     

Skeletal pseudofractures

Diagnosis of pseudofractures by the radiologist can be challenging in the emergency setting. This review describes the common pseudofractures, which are attributable to normal variants and anomalies, Mach band formation, subjective contour formation, extraneous materials, and previous injuries.     

骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折

目的探讨骨水泥混合与注射一体化装置行经皮椎体成形术治疗椎体压缩性骨折的操作技术、临床疗效。方法2002～2004年间共计治疗了108例诉有严重疼痛的椎体压缩性骨折患者,其中骨质疏松性压缩性骨折85例,椎体恶性肿瘤31例。穿刺入路采用双侧椎弓根穿刺法,所有患者均在透视监视下双侧注射聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA),注射设备为骨水泥混合与注射一体化装置。术后随访患者6个月。结果共计注射116个椎体(腰椎69个,胸椎47个),双侧穿刺和骨水泥注射成功率100％,99例患者(91．7％)术后疼痛明显缓解,6个月内疼痛无复发95例(95．6％),9例患者(8．3％)术后疼痛无缓解。发生骨水泥外漏12例(11％),有临床症状5例(4．6％)。结论骨水泥混合与注射一体化装置行经皮椎体成形术创伤小、并发症少,而且止痛疗效显著,是一种非常有前景的治疗椎体压缩性骨折的介入手术方法。     

Dysphagia due to cervical osteophytes

A case of a 64-year-old man is presented with painless dysphagia and loud noise on swallowing due to large anterior cervical osteophytes demonstrated on plain radiographs and magnetic resonance imaging accompanied by a brief review of the literature.     

Imaging of the absent cervical pedicle

The absent cervical pedicle is an interesting congenital anomaly which has been described in several previous case reports. Of primary importance is its recognition to avoid confusion with more clinically significant abnormalities such as fracture or an enlarged neural foramen. Although many cases can be diagnosed from the plain radiographic findings alone, it is occasionally necessary to employ another imaging modality for more definitive evaluation. We describe two cases of absent cervical pedicle imaged with computed tomography and magnetic resonance imaging.     

Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35±0.79 to 2.12±1.17, postoperatively (P<0.01). The mean disc height decreased from 6.81±1.08 to 5.98±1.07 mm (P<0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria.This work was supported by a grant from the Wooridul Spine Foundation.     

臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术的临床观察

目的：观察臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术的临床效果。方法：随机将90例患者分为3组,Ⅰ组臂丛加颈浅丛神经联合阻滞;Ⅱ组臂丛神经阻滞;Ⅲ组颈浅丛神经阻滞。结果：Ⅰ组麻醉效果明显优于其他两组。结论：臂丛加颈浅丛神经联合阻滞用于锁骨骨折内固定术具有很好的临床效果。     

椎弓根螺钉技术在下颈椎不稳中的安全使用方法

目的探讨颈椎椎弓根技术在下颈椎疾病的安全使用方法。方法回顾性分析2001年10月-2006年3月76例下颈椎疾病行颈椎椎弓根固定患者,其中49例为颈椎骨折脱位, 23例为颈椎病,4例为椎管内肿瘤。患者术前均行X线和CT等检查,术中在C形臂X线监视下置钉,术后行X线和CT检查了解螺钉位置。结果76例螺钉均成功置入,术中无脊髓、椎动脉损伤。术后CT显示,342枚螺钉中有37枚(10.8%)螺钉穿破椎弓根,其中29枚螺钉穿破椎弓根外侧皮质,3枚螺钉穿破椎弓根上侧皮质,5枚螺钉穿破椎弓根下侧皮质。所有患者近期及远期随访未发现与椎弓根螺钉相关的神经血管及内脏器官损伤的并发症。有1枚螺钉断裂,但患者没有明显的临床症状,其余未发现螺钉松动或断钉及颈椎不稳症等。所有患者固定良好,并均已达骨性融合。术后随访脊髓神经功能均有不同程度改善。结论颈椎椎弓根固定提供了三柱的稳定和最坚强的后方固定,为了防止并发症的发生,熟悉颈椎椎弓根的解剖和手术操作技巧以及采用个体化综合置钉是决定手术成功的重要因素。     

屈曲牵张性下颈椎损伤治疗策略

目的 总结分析屈曲牵张性下颈椎损伤治疗策略.方法 选择2002年1月～2007年6月共68例屈曲牵张性下颈椎损伤患者,其中男43例,女25例;年龄18～72岁,平均43岁.按照Allen分型:Ⅰ度7例,Ⅱ度19例,Ⅲ度29例,Ⅳ度13例.所有患者入院后均行轻度屈曲位颅骨牵引制动(3～4 kg).单纯后路手术26例,采用椎弓根螺钉、侧块螺钉或经关节螺钉固定,I期前后联合手术42例.术后随访其疗效.结果 随访6-65个月,平均34个月.2例后路切口感染,经过清创换药等治疗愈合,2例术后短期内神经症状加重,通过甲基强的松龙等治疗后恢复.神经功能除A级18例没有恢复外,均有1级以上改善.其中有11例B级患者术后有4例达C级,有5例达D级;C级10例中有6例恢复至D级,4例达E级,D级15例全部达E级.未见内置物松动、脱落及断裂者,植骨在3～4个月内融合,未发现不融合者.未出现与手术固定技术直接相关的并发症.结论 屈曲牵张性下颈椎损伤治疗需根据Allen分型决定治疗策略.对于Ⅰ度和Ⅱ度损伤采用后路手术;而对于Ⅲ度和Ⅳ度损伤,只要全身情况允许可采用Ⅰ期前后联合手术治疗.     

Evaluation of occult cervical spine fractures on radiographs and CT

The aim of this study was to evaluate occult cervical spine fractures on radiographs and CT. We reviewed radiographs of 68 patients with cervical spine fractures at a level 1 trauma center. Twenty-six patients showed occult fractures on initial radiographs. Of seven odontoid fractures, two were diagnosed only after thinner repeat CT reconstructions. Five facet fractures were best seen on CT reconstructions. Three occult hangman's fractures were seen by CT. A C1 fracture was diagnosed on CT only. Two fractures through the C2 body were seen only by CT. Eight fractures were obscured by patient's shoulders, including five clay shoveler's fractures, a C6 facet fracture, a bilateral C6 pedicle fracture, and a C7–T1 fracture–dislocation. Odontoid, facet, and lower cervical spine fractures are most commonly occult on radiographs. CT, especially high-quality CT reconstructions for odontoid and facet fractures, can improve the diagnosis of cervical spine fracture. No support was provided for this study. The study was performed in the Department of Radiology, University Hospital at Stony Brook, Stony Brook, NY, USA     

Spontaneous progression of vertebral intraosseous pneumatocysts to fluid-filled cysts

Intraosseous pneumatocyst is a relatively rare condition, and its natural course is not known. We report two cases of intraosseous pneumatocyst of vertebra with resorption of gas and its replacement with fluid shown on follow-up cross-sectional imaging. The mechanism influencing the course of these appearances is unclear. However, the benign nature of intraosseous pneumatocyst needs to be recognized and biopsy avoided. Received: 21 November 2000 Revision requested: 28 December 2000 Revision received: 28 February 2001 Accepted: 7 March 2001     

Non-ejection cervical spine injuries due to +Gz in high performance aircraft

The potential for significant neck injuries exists in today's high performance fighter aircraft. The G-loads required to produce injury need not be excessive, nor is experience level necessarily protective. Eight cervical spine injury cases, due to or aggravated by +Gz in F-15 and F-16 aircrew members are reviewed. These include two compression fractures (C5/C7), three left HNP's (C5-6/C6-7), one fracture of the spinous process (C7), one interspinous ligament tear (C6-7), and one myofascial syndrome (C6). Mechanisms of injury and evaluation are discussed. Exercise conditioning may play an important role in prevention and protection. The role of screening X-rays and improving equipment remain as areas where further work needs to be done.     

颈椎椎间盘突出症与压迫性脊髓软化症(MR 表现与分期)

探讨颈椎椎间盘突出症所致压迫性脊髓软化症的ＭＲ表现和分期。方法回顾性分析２００例颈椎椎间盘突出症的ＭＲＩ表现。结果２２例出现脊髓信号改变。结论ＭＲ是诊断压迫性兴 软化症最好的方法。     

颈托联合真空垫在射波刀颈椎转移灶体位固定中的应用分析

目的探讨颈托联合真空垫个性化体位固定在射波刀颈椎转移灶体位固定中的临床应用价值。方法以放射治疗部位为颈椎为标准, 选取拟行射波刀立体定向放射治疗颈椎转移灶的患者68例。男性41例, 女性27例, 年龄43～78岁, 平均年龄51.5岁。按随机数字表法分为3组, A组患者采用颈托联合真空垫个性化体位固定, B组采用真空垫体位固定, C组采用小头模固定。首次治疗完成后询问患者治疗过程中固定模具的舒适度。完成放疗后, 收集并分析3种固定技术平移和旋转方向的平均偏移量、最小公差距离(dxAB)、最小旋转偏差角度(drAB)、错误节点比例(false nodes)以及舒适度。结果 3组患者首次治疗过程中位置偏差在头尾(inf_sup)、左右(left_right)、腹背(ant_post)、俯仰(pitch)、横滚(roll)、平旋(yaw)方向上比较, 差异有统计学意义(F=7.13、2.56、3.41、4.21、2.71、8.14, P<0.05)。与B组和C组比较, A组的dxAB, drAB和false nodes数据明显...     

经高位咽后入路行上颈椎手术的治疗选择

目的 观察经高位咽后入路行上颈椎前路手术的适应证选择及临床效果. 方法 本组男32例,女9例;年龄12～67岁,平均41岁.Hangman骨折21例,C2椎体骨折2例,先天性齿状突不连伴难复性寰枢椎脱位12例,C1,2椎体结核4例,C3骨巨细胞瘤2例.全部患者均采用高位前方咽后入路显露C1～C3,Hangman骨折和C2椎体骨折复位后行C2,3椎间盘切除植骨融合内固定;先天性齿状突不连行前路松解复位、后路寰枢融合;结核行病灶清除,肿瘤行切除重建.创伤患者脊髓损伤按美围脊髓损伤学会(ASIA)标准评定,非创伤患者依据日本骨科学会(JOA)评分、Odom标准评定神经功能. 结果 41例患者均成功显露C1前弓～C3椎体,骨折患者行复位减压融合内固定;结核、肿瘤患者行病灶切除重建.创伤患者脊髓功能正常者无神经功能损害,不全瘫患者神经功能均有部分恢复.非创伤患者神经功能有明显改善,JOA评分由术前8.9分增加至12.5分;Odom评分临床成功率(优/良/可)达到94%.3例出现舌下神经牵拉症状,2例出现面神经刺激症状,无伤口感染. 结论 前方高位咽后入路可充分显露上颈椎,完成复位减压和稳定重建,并最大限度重建颈椎生理功能.     

Upper cervical spinal cord compression due to bony stenosis of the spinal canal

Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1–C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.     

Lower trunk brachial plexus compression neuropathy due to cervical rib in young athletes

Compression by a cervical rib may result in neurologic and/or vascular symptoms. Two patients are reported with thoracic outlet syndrome (TOS) secondary to cervical rib. Both patients had vague shoulder pain as well as neurologic manifestations due to compression neuropathy of the lower trunk of the brachial plexus. One patient was suspected initially to have carpal tunnel syndrome.