Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors

Objective:The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors.Methods:This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach.Results:The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean = 41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%.Conclusion:Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method.Level of Evidence:Level IV, Therapeutic Study     

颈前路椎间盘切除椎间融合器融合术加颈后路单开门术治疗脊髓型颈椎病

[目的]探讨颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病在临床上的应用价值。[方法]应用Cervical Cage行颈椎前路椎间盘切除椎间融合术，同时，颈椎后路行单开门椎管扩大成形术11例，平均随访6个月。按40分法和JOA评分对手术前后脊髓功能进行评分，并测量颈椎术前术后前柱高度及椎管宽度和进行相关性分析．[结果]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，明显改善脊髓型颈椎病的脊髓功能。40分法平均37分，改善率83％；JOA评分16．5分，改善率91％；前柱高度平均增加1．28mm；椎管宽度平均增加2．22mm。[结论]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，有效恢复了颈椎前柱高度、增加椎管宽度，明显改善了脊髓型颈椎病的脊髓功能。     

Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients

Background

Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information.

Methods

We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion–extension study for evaluation of potential cervical spine injury. All flexion–extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion–extension studies on clinical decision making was also reviewed.

Results

One thousand patients met inclusion criteria for the study. Review of the flexion–extension radiographs revealed that 80 % of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion–extension views had minimal effects on clinical decision making.

Conclusion

Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients.     

陈旧颈椎骨折的前路手术治疗

目的 探讨陈旧颈椎骨折脱位的前路手术治疗的效果。方法 对我院1995～1999年间行前路手术治疗的42例陈旧颈椎骨折脱位患者均行植骨融合和钢板内固定。其中22例单间隙融合，20例椎体次全切除；其中12例行自体髂骨植骨，30例行CHA植骨。所有患者术前均行颈椎X线片、CT及MRI了解骨折脱位情况，术后摄颈椎X线片了解植骨融合状况，颈椎曲线恢复保持情况和内固定稳定性。对所有患者进行JOA评分并计算其改善率。结果 所有患者随访3.5～7.2年(平均4.2年)，术后功能的JOA评分均有改善，无术后症状恶化、全身和局部并发症发生。固定椎保持稳定，颈椎曲线得以保持，无明显植骨不愈合表现。1例双节段植骨患者头侧螺钉断裂，但植骨已融合。余者内固定均稳定。结论 前路手术对治疗陈旧颈椎骨折脱位有较好的效果。严格掌握适应证，充分恢复伤椎高度及曲线，牢固的内固定是手术治疗成功的关键。     

椎动脉CT血管造影在颈椎肿瘤患者中的应用及临床意义

目的:探讨椎动脉CT血管造影(CTA)在颈椎肿瘤患者中的应用及临床意义.方法:自2007年1月至2009年4月,对肿瘤累及一侧或双侧横突、椎间孔,与椎动脉关系密切的27例患者实施椎动脉CTA,男12例,女15例.年龄7～69岁,平均39.3岁.累及C1或C2者12例,累及下颈椎者15例.结果:1例多骨型纤维异常增殖症患者右侧椎动脉第二段自右侧C5横突孔进入.肿瘤累及右侧椎动脉者10例,累及左侧椎动脉者11例,累及双侧椎动脉者6例.未受累椎动脉通畅.14例患者的肿瘤包绕17支椎动脉,其中11例的14支受累椎动脉直径变细;8例患者肿瘤推挤10支椎动脉,其中6例8支受累椎动脉直径变细;5例肿瘤仅邻近椎动脉,未对椎动脉产生影响.椎动脉第一段受累者4例.第二段受累者10例,第三段受累者9例,同时累及第二和第三段者4例.根据肿瘤的性质实施姑息性切除、经瘤刮除或边缘切除,术中2例累及椎动脉第二、三段的脊索瘤患者一侧椎动脉破裂,行椎动脉结扎,术后无神经功能损害.结论:颈椎肿瘤常累及椎动脉,术前椎动脉CTA能够了解椎动脉与肿瘤和相邻骨结构的关系.评估受累椎动脉及对侧椎动脉通畅情况,指导术中暴露和处理受累椎动脉,避免术前椎动脉栓塞和术中预防性椎动脉结扎带来的潜在风险.     

Fibular flap reconstruction of the cervical spine for repair of osteoradionecrosis

Background contextAlthough cervical spine reconstruction with osteocutaneous fibular flap microvascular grafting has been described, simultaneous reconstruction of the cervical vertebral column and laryngectomy have not been described.PurposeTo present a unique case of combined cervical spine and laryngectomy reconstruction.Study designCase report.MethodsWe modified a previously reported procedure reconstituting the cervical spine and pharynx with a single fibular flap in a case of posterior pharyngeal ulceration and osteomyelitis/osteoradionecrosis without spinal deformity.ResultsWe present a case of simultaneous cervical stabilization and pharynx reconstruction with a fibular graft in a life-saving treatment of osteoradionecrosis complicated by acute cervical kyphosis and spinal cord compression in a 55-year-old patient with extensive head and neck cancer history and recent recurrence of hypopharyngeal cancer.ConclusionsRigid anterior plate fixation and subsequent posterior fixation were required after corpectomy and total laryngectomy in our patient with extensive surgical scarring and radiation history because of severe spinal deformity secondary to osteoradionecrosis. We achieved successful preservation of neurologic function and resolution of pain.     

From anterior to lateral operations on the cervical spine

Summary New developments in the techniques of lateral operations upon the cervical spine are described; anterior operations are still considered the method of choice in the surgical treatment of traumatic deformities of the spine with the exception of irreducible unilateral locking of articular processes, traumatic primary paraspinal disc extrusions compressing the anterior rami of the spinal nerves and the vertebral artery, and total vertebral corporectomy. The latter is achieved by a combined anterior and lateral operation using the same anterolateral approach.With this new development all surgical traumatic lesions of the cervical spine can be treated by means of anterior and/or lateral operations.Cervical disc extrusions and spondylosis are now invariably treated by lateral operations. Medial osteophytes and disc extrusions are removed by means of a lateral trans-disc space approach under direct vision of, and in a plane parallel to the dural theca.Interbody fusion is performed by inserting a cortical bone graft via the lateral opening into the emptied disc space.Spinal cord deficit caused by traction on the cord produced by ankylosing kyphosis is treated by posterior hemicorporectomy using of a lateral approach. New entities described are primary and secondary paraspinal disc extrusions and kinking of the anterior rami of the cervical or brachial plexuses by the lateral ends of the transverse processes in the presence of anterior dislocation or kyphotic deformity of the cervical vertebrae.Lateral operations are also applied for the repair of brachial plexus lesions, involvement of the vertebral artery and dumb-bell tumors.In tumors of the cervical vertebral bones removal of vertebral bodies and their replacement by grafts can be performed by combined anterior and lateral operations.Complete cervical vertebrectomy has been performed in 2 cases by means of combined anterior, lateral and posterior operations. In all cases of complete removal of a vertebral body an associated posterior operation may be applied for stabilization of the cervical spine by means of fusion or wiring.

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Zusammenfassung Bericht über neue Entwicklungen in der Technik der Operationen an der Halswirbelsäule von lateral her. Ein vorderer Zugang zur Halswirbelsäule bei der Operation kann immer noch als die Methode der Wahl gelten, wenn traumatische Deformierungen der Wirbelsäule chirurgisch angegangen werden sollen mit Ausnahme einer einseitigen Luxation der Gelenkfortsätze, die nicht reduzierbar ist sowie von primären paraspinalen traumatischen Bandscheibenvorfällen, die die Rami anteriores der Spinalnerven und die A. vertebralis komprimieren. Schließlich muß als Ausnahme auch die totale Entfernung eines Wirbelkörpers gelten. Für die letzte kann eine Kombination der Operation von vorne und seitlich her erreicht werden, indem man den gleichen anterolateralen Zugang wählt.Mit dieser neuen Entwicklung können alle traumatischen Läsionen der Halswirbelsäule vom vorderen und/oder lateralen Zugang her operiert werden.Cervikale Bandscheibenvorfälle oder Spondylosis werden heute einheitlich von lateral her operiert. Mediale Osteophyten und Bandscheibenvorfälle werden von einem lateralen durch den Diskusraum gehenden Zugang unter direkter Sicht und in einer Ebene parallel zur duralen Theca entfernt.Fusionen zweier Wirbelkörper werden mit Hilfe eines kortikalen Knochenspanes von einem lateralen Zugang her in den inzwischen ausgeleerten Zwischenwirbelspalt vorgenommen.Spinale Symptome, die durch einen Zug am Rückenmark infolge einer ankylosierenden Kyphose hervorgerufen werden, behandelt man durch eine Hemicorporectomie des posterioren Anteils, und dies von einem lateralen Zugang.Als neue Einheiten werden primäre und sekundäre paraspinale Bandscheibenextrusionen beschrieben sowie die Knickbildungen an den Rami anteriores der cervicobrachialen Plexus, die über die lateralen Enden der Processus transversi entstehen, weil eine Dislokation nach vorwärts oder eine Deformität im Sinne einer Kyphose an den cervicalen Wirbeln besteht. Laterale Operationen werden auch für die Wiederherstellung von Läsionen des Plexus brachialis sowie für Prozesse, die auf die A. vertebralis einwirken und schließlich für Sanduhrtumoren angewandt.Bei Knochentumoren der cervicalen Halswirbelsäule können die Corpora der Wirbel entfernt und durch Knochenplastik ersetzt werden, wobei der Zugang kombiniert von vorne und lateral ist. Eine komplette Vertebrectomie im Halsgebiet wurde in 2 Fällen durch kombinierten Zugang von vorne, lateral und hinten ausgeführt. In allen Fällen einer kompletten Entfernung des Wirbelkörpers kann gleichzeitig eine zusätzliche Operation von hinten ausgeführt werden, um die Halswirbelsäule zu stabilisieren. Das kann sowohl durch Fusion wie durch Verdrahtung erreicht werden.

     

Acceleration injury of the cervical spine by hypertranslation of the head

Summary This paper starts from the concept that acceleration injury of the cervical spine is caused by hypertranslation of the head with respect to the trunk, and not by hyperflexion or hyperextension. This first part of the paper studies the effect of normal head translation upon cervical spine posture and motion. Lateral radiographs of the neck in chin-out and chin-in positions reveal that this translation produces maximal motion at the cranio-vertebral junction C0–2, from full extension in chin-out position to full flexion in chin-in position. Motion decreases from C2–3 downward. Below C6 the direction of motion is reversed. The normal range of head translation is small, notably with a fixed thoracic spine. The hypothesis is developed that hypertranslation of the head will almost immediately result in damaging hyperflexion or hyperextension of the craniovertebral junction.     

Effect of plate position on clinical outcome after anterior cervical spine surgery

BACKGROUND CONTEXT: Anterior cervical plates are commonly used to provide immediate stabilization after a variety of cervical spine procedures. It has been assumed that the ideal position for anterior cervical spine plates is centered in the horizontal plane without significant angulation and without overlap of adjacent unfused levels. Nevertheless, postoperative radiographs often demonstrate actual plate position to be lateralized, rotated, or encroaching on the adjacent disc space. There have been no reported systematic studies examining the effect of variations in plate position in a large clinical population. PURPOSE: To evaluate the association between plate position and short-term clinical outcomes after anterior cervical discectomy and instrumented fusion (ACDF). STUDY DESIGN/SETTING: Review of prospectively collected clinical outcomes measures and radiographs. PATIENT SAMPLE: Patients undergoing ACDF surgery by a group of spine surgical specialists at a single institution. OUTCOME MEASURES: Direct and calculated plain radiographic measurements, visual analog scores for neck and arm pain, and SF-36 scores. METHODS: The study population included 200 patients undergoing a one-, two-, or three-level ACDF with instrumentation. Thirteen separate direct measurements and two calculated values of plate position on immediate postoperative radiographs, including lateralization, rotation, and proximity to adjacent disc spaces, were performed in blinded fashion by 3 independent reviewers. Statistical correlation with prospectively collected patient outcomes measures, including VAS for neck and arm pain and SF-36 scores, was performed. RESULTS: In the study population, average plate position was 3.3 mm from the cephalad disc space, 6.4 mm from the caudal disc space, 3.9 degrees angulation in the frontal plate, and 26% laterally displaced from the midline. At average 18.6 months of follow-up, no significant association was identified between any plate position measure and clinical outcomes. CONCLUSIONS: The use of anterior cervical plating by experienced spine surgeons is associated with variation in terms of plate position on postoperative radiographs. Within the range of positions analyzed in this study, no significant association was found between lateralized or rotated plates or plates placed in proximity to adjacent disc spaces and worse short-term clinical outcomes. It should be emphasized that these results and conclusions are based on relatively short-term clinical follow-up and that the long-term effects of variation in implant position remain unknown.     

Dumbbell-shaped chondrosarcoma that primarily developed in the cervical spine: a case report

There have been few reports describing dumbbell chondrosarcomas that primarily developed in the cervical spine; and among these cases even fewer can easily be diagnosed as chondrosarcoma. We report a 58-year-old man who complained of right cervical pain and swallowing difficulty without a particularly apparent cause. Magnetic resonance imaging (MRI) and computed radiography (CT) suggested a diagnosis of dumbbell tumor. ^99mTc HMDP bone scintigraphy and ²⁰¹Tl scintigraphy were negative, and surgery was performed assuming the presence of a neurogenic tumor. Intraoperative histopathological examination showed similar results. The postoperative histopathological diagnosis, however, was chondrosarcoma (grade II). Retrospective discussion regarding the diagnosis of the patient revealed that gadolinium-enhanced MRI was not appropriate for a precise diagnosis and that CT was more effective. We have thus experienced a patient with a rare dumbbell chondrosarcoma that primarily developed in the cervical spine for which a preoperative diagnosis was difficult.     

棘突-侧块锁定法改良颈后路单开门术的临床应用

目的设计并评价棘突-侧块锁定法改良后路单开门椎管扩大成形术的疗效。方法在尸体上行单开门椎管成形术。在门轴一侧的侧块及棘突基底处分别钻孔,开门后用普通钛质皮质骨螺钉通过棘突孔和侧块孔将其固定,使椎板维持在开门状态。经尸体上试验成功后于2009-01-2013—06对13例脊髓型颈椎病行该手术。结果13例获得6—36个月,平均14．6个月的随访。无患者出现颈项部及肩背部疼痛和肌肉痉挛;僵硬感和活动受限;未见螺钉松动和再“关门”现象。也无其他并发症发生。结论棘突-侧块锁定法改良后路单开门椎管扩大成形术,操作简单,维持“开门”确切,近中期疗效满意。     

颈椎矢状面活动度影像学改良测量方法的初步应用

目的 提出一种改良颈椎矢状面活动度(ROM)影像学测量方法,并与传统测量方法进行比较.方法 纳入接受颈椎前路椎间盘切除融合术(ACDF)治疗的72例颈椎病患者为研究对象,其中脊髓型颈椎病(CSM)43例,神经根型颈椎病(CSR)29例.利用术前颈椎仰伸位与屈曲位侧位X线片,由2名脊柱外科医师分别采用传统测量法和改良测量法对颈椎ROM进行测量.分析2种测量方法的观察者内一致性、观察者间一致性,并对2种测量方法的结果进行相关性分析和比较.结果 按性别、年龄、病种分层,2种方法测量的颈椎ROM差异均无统计学意义(P>0.05),且2种方法测量的颈椎ROM均随年龄的增大而下降.传统方法和改良方法均具有高度观察者内一致性(组内相关系数分别为0.961、0.991)和观察者间一致性(组内相关系数分别为0.964、0.993),且改良方法的观察者内一致性和观察者间一致性高于传统方法.2种方法的测量结果呈高度正相关(r=0.987,P<0.01).对2种方法前后2次测量结果的差值进行比较,结果显示,2种方法不同测量者之间2次测量结果的差值差异均无统计学意义(P>0.05);而对无论哪名测量者,不同方法之间2次测量结果的差值差异均有统计学意义(P<0.01).结论 改良方法测量颈椎ROM具有高度观察者内一致性和观察者间一致性,采用改良方法能够提高颈椎ROM测量的精准度.     

Anterior interbody fusion using the cervical spine locking plate

Surgical Principles The Cervical Spine Locking Plate system (CSLP) is designed to perform anterior fusions of the cervical and upper thoracic spine. The screws are locked in the H shaped plate providing intrinsic angle stability. Early osseous integration is enhanced by titanium plasma spray coating and by the hollow and perforated design of the screws. These features enhance the primary and secondary stability of the fixation. Therefore the penetration of the posterior cortex of the vertebra with the screws is not necessary, which is a decisive asset compared to conventional plate systems. This essentially diminishes the intraoperative risks. The primary stability is superior to that of conventional plate systems as the screws are tightly locked into the plate in convergence.     

Treatment problems in unilateral locked facet syndrome of the cervical spine

Summary In a retrospective study of 22 patients with unilateral locked facet syndrome of the cervical spine, diagnostic and treatment problems were analysed. Diagnosis was delayed in ten patients; in two-thirds of the patients minor or major therapeutic problems were encountered. The treatment protocol advised manipulative reduction and-before 1986-posterior fusion by bone blocks and interspinous wiring; after 1986 ventral intercorporeal fusion by plates was recommended. Closed reduction manoeuvres risk dislocation of intervertebral discs, overdistraction of the spinal cord or injury to the vertebral artery. Unreduced and unfused dislocations are likely to develop chronic instability. Dorsal wiring is an inadequate form of stabilization and ventral plates or dorsal hooks are preferred. To prevent treatment problems a treatment protocol is proposed according to which open reduction following anterior discectomy, operative decompression of endangered nerve roots and stable one-level fusion is done. In non-acute injuries neural structures are decompressed; posterior fusion is done without attempts at reduction.     

Monostotic fibrous dysplasia of the spine: report of a case involving a cervical vertebra

Monostotic fibrous dysplasia of the spine is a rare entity. Only 26 cases, of which 11 were located in the cervical spine, are to be found in the literature. We report a 56-year-old male patient with cervicobrachialgia of half year’s duration. Radiographs showed a diffuse destruction of the vertebral body and the spinous process of C₄. A biopsy of the spinous process confirmed histopathologically a fibrous dysplasia. Due to minor symptoms, no surgical treatment was performed or is planned unless in case of increasing pain, an acute instability or neurological symptoms.     

Fracture dislocations of the cervical spine: a review of 106 conservatively and operatively treated patients

We compared clinical outcomes following conservative treatment of subaxial fracture dislocations of the cervical spine and posterior fusion using bone grafts and interspinous Rogers wiring (Bohlman modification). We reviewed 106 patients: 51 were treated primarily surgically, and 55 treated conservatively served as historical controls. Those patients who neurologically recovered at least one Frankel grade had on average less displacement on discharge (1.3 mm vs 3.1 mm, p=0.04). Although anatomical outcomes were better in the operatively treated group (1.6 mm vs 2.9 mm displacement at end of follow-up, p=0.001), there was no difference in neurological recovery. Late neck pain correlated with residual displacement (p=0.04) and was more common in the conservatively treated patients (p=0.01). Time in hospital was shorter in the group with posterior fusions, and complication rates were similar to those found after conservative treatment. A significant number of the conservatively treated patients developed kyphotic deformity, and 29% needed later surgery because of chronic instability or unacceptable anatomical results.     

Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma

Objective：We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.Methods：Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen （15 mg/kg） intravenously after cervical spine immobilization.Then,all the patients underwent plain radiography and computerized tomography of the cervical spine.The outcome measure was the presence of traumatic cervical spine injury.Sixty minutes after acetaminophen infusion,posterior midline cervical tendemess was reassessed.Results：Of 1 309 patients,41 had traumatic cervical spine injuries based on imaging.Sixty minutes after infusion,posterior midline cervical tenderness was eliminated in 1 041 patients,none of whom had abnormal imaging.Conclusion：Patients with cervical spine trauma do not need imaging if posterior midline cervical tendemess is eliminated after acetaminophen infusion.This analgesia could be considered as a diagnostic and therapeutic intervention.     

Comparison of three-dimensional helical axes of the cervical spine between in vitro and in vivo testing

Background Context

The range of motion is a well-accepted parameter for the assessment and evaluation of cervical motion. However, more qualitative data of the kinematics of the cervical spine are needed for the development and success of cervical disc arthroplasty.

颈椎间盘突出症微创介入治疗进展

背景 颈椎间盘突出症是在颈椎间盘退变的基础上,因轻微外力或无明确诱因导致椎间盘突出而致脊髓和神经根受压产生相应症状的临床症候群.随着生活节奏的加快,患者人数不断增加.目前对颈椎间盘突出症的治疗方法较多,基本分为保守治疗、手术治疗及微创介入治疗3大类.目的 阐述介入治疗的创伤小、能同时治疗多个节段和并发症少等优点.内容 ...     

The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients

Background and objectiveThe National Emergency X-Radiography Utilization Study (NEXUS) criteria are used to assess the need for imaging to evaluate cervical spine integrity after injury. The aim of this study was to assess the sensitivity of the NEXUS criteria in older blunt trauma patients.MethodsPatients aged 65 years or older presenting between 1st July 2010 and 30th June 2014 and diagnosed with cervical spine fractures were identified from the institutional trauma registry. Clinical examination findings were extracted from electronic medical records. Data on the NEXUS criteria were collected and sensitivity of the rule to exclude a fracture was calculated.ResultsOver the study period 231,018 patients presented to The Alfred Emergency & Trauma Centre, of whom 14,340 met the institutional trauma registry inclusion criteria and 4035 were aged ≥65 years old. Among these, 468 patients were diagnosed with cervical spine fractures, of whom 21 were determined to be NEXUS negative. The NEXUS criteria performed with a sensitivity of 94.8% [95% CI: 92.1%–96.7%] on complete case analysis in older blunt trauma patients. One-way sensitivity analysis resulted in a maximum sensitivity limit of 95.5% [95% CI: 93.2%–97.2%].ConclusionCompared with the general adult blunt trauma population, the NEXUS criteria are less sensitive in excluding cervical spine fractures in older blunt trauma patients. We therefore suggest that liberal imaging be considered for older patients regardless of history or examination findings and that the addition of an age criterion to the NEXUS criteria be investigated in future studies.