国人髌骨假体设计参数的解剖学观测

目的：测量国人髌骨假体的解剖学参数。 方法：取成人干燥髌骨标本73块,左38块,右35块,测量髌骨假体骨床厚度,髌骨关节面厚度,髌骨外侧关节面宽度,髌骨内侧关节面宽度,髌骨内外侧关节面相交处长度,髌骨内外侧关节面的交角。实验结果用SPSS 10.0软件进行统计处理和分析。 结果：左右侧标本之间髌骨假体骨床厚度分别为(13.69±1.33),(13.35±1.19) mm;髌骨关节面厚度为(5.64±1.40),(5.63±1.26) mm;髌骨外侧关节面宽度为(24.54±2.27),(24.51±2.36) mm;髌骨内侧关节面宽度为(19.04±2.10),(18.54±1.81) mm;髌骨内外侧关节面相交处长度为(28.34±2.49),(27.44±2.20) mm;髌骨内外侧关节面的交角为(135.7±7.8)°,(136.5±7.6)°,各参数相比,差异均无显著性意义(P > 0.05)。 结论：实验中各参数可为国人髌骨骨床和截骨厚度的选择及髌骨假体设计参数提供参考。     

经鼻内窥镜泪囊鼻腔造口自体组织移植再造泪道的应用解剖

背景: 经鼻内窥镜下泪囊鼻腔造口自体组织移植再造泪道术是临床上治疗严重道阻塞的新方法,需要积累临床应用解剖学资料。 目的：研究泪道的显微外科应用解剖,为经鼻内窥镜泪囊鼻腔造口自体组织移植泪道再造手术提供解剖学依据。 设计、时间及单位：2006-07/2007-06在武警总医院眼科实验室完成。 材料：经体积分数为10%甲醛防腐处理的成人头颅解剖标本20个,男14个,女6个,共40侧泪道的标本。 方法：沿眉弓上缘及枕骨粗隆上10 mm连线水平锯开颅盖,去除脑组织,10% 硝酸脱钙1周左右,使标本既不改变形态结构,又能用手术刀切割。正中矢状面切开面颅,切除鼻中隔,暴露鼻腔外侧壁。 主要观察指标：泪囊窝的长径和前后径,泪囊窝中1/3部在泪前嵴、泪囊窝骨壁中垂线和泪后嵴的厚度,骨性鼻泪管上口、中部和下口横截面积,泪阜-鼻腔水平距、30°斜距和45°斜距,泪阜到鼻泪管上口距离,泪阜到鼻泪管上口连线与鼻底平面的夹角。 结果：泪囊窝的长径为(17.85±1.72) mm,泪囊窝的前后径为(6.74±1.28) mm,深度为(3.09±0.78) mm。泪囊窝中1/3部在泪前嵴、泪囊窝骨壁中垂线和泪后嵴的厚度分别为(4.03±0.89),(0.61±0.36),(0.63±0.24) mm,泪前嵴最厚,泪囊窝骨壁中垂线处和泪后嵴均较薄,两者比较差异无显著性意义(P > 0.05)。骨性鼻泪管上口、中部和下口横截面积分别为(29.04±3.40),(26.19±2.96),(43.50±5.60) mm2,显示中段最为狭窄(P < 0.05)。泪阜-鼻腔水平距、30°斜距和45°斜距分别为(17.23±0.70),(14.51±1.72),(17.34±2.38) mm,30°斜距最短,30°斜距和45°斜距比较差异无显著性意义(P > 0.05)。泪阜到鼻泪管上口距离为(11.86± 1.84) mm,泪阜到鼻泪管上口连线与鼻底平面的夹角为(49.9±1.8)°(48.0°~54.0°)。 结论：泪阜到鼻腔及泪囊的距离和泪阜-鼻泪管上口连线与鼻底平面的夹角对鼻腔外侧壁造口部位选择、隧道的倾斜角度和自体移植组织长短的确定有指导意义。造骨孔应该从泪囊窝中央或中央稍偏后部起始,然后向前和下方扩大,隧道下斜45°角为最佳。全泪道再造所取移植组织的长度应大于21.22 mm。     

髋臼前柱骨折钢板中内固定的最佳进针点*☆

背景：近年来切开复位内固定成为骨盆骨折和髋臼骨折的一种重要治疗手段,但是在内固定过程中有时会发生螺钉穿入关节内、损伤盆腔内重要血管或神经等严重并发症。 目的：测量髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。 材料：取成年男性半骨盆标本20个,由山东大学医学院解剖学教研室提供。 方法：分别测量20个半骨盆标本髋臼前、后缘到髂前下棘、髂耻隆起和耻骨结节的距离,确定和制作髋臼前柱系列断面,并测量各断面上各进钉点的安全进钉角度,将测量数据输入到SPSS 10.0软件进行统计学分析。 主要观察指标：髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。 结果：髋臼前缘到髂前下棘、髂耻隆起和耻骨结节的距离分别为(25.4±1.4),(11.8±0.7),(37.4±1.5) mm,后缘到髂前下棘和髂耻隆起的距离分别为(15.5±0.9),(29.1±1.6) mm。在各断面距离骨盆界线0.5 cm点、1.0 cm点和1.5 cm点上螺钉的安全进钉角度的最大值分别为(8.2±2.2)°,(14.9±3.4)°和(26.1±4.5)°。 结论：在前柱髋臼区使用钢板内固定时,可以采用3种方法避免螺钉穿入关节内。第1种方法是使用短螺钉,螺钉方向随意;第2种方法是使用长螺钉(长度5 cm)内紧贴骨盆界线进钉,方向平行于四方区;第3种方法为根据不同的进钉点选择不同的进钉角度和长度。     

舟骨-大-小多角骨新型融合器的稳定性*

背景：传统的舟骨-大-小多角骨局限性腕关节融合方法包括克氏针、U形钉、AO/ASIF钢板等,术后均需长时间的石膏外固定。而美国设计的新型融合器主要应用于欧美人,并不适合于亚洲人种。 目的：模拟舟骨-大-小多角骨局限性腕关节融合,测试课题组根据中国人舟骨-大-小多角骨背侧关节凹陷的解剖形态研发出的新型融合体的稳定性。 设计、时间及地点：观察性实验,于2006-04/2007-03在南通大学骨科生物力学实验室完成。 材料：40具未经防腐处理的新鲜尸体前臂标本,X射线平片证实无腕关节病变或排列异常。 方法：所有标本均模拟舟月骨分离的腕关节不稳定模型,并行新型融合器融合,再模拟屈50°、伸35°、尺偏30°、桡偏10°各50 000次极限运动。所有标本均于运动前后行CT扫描、三维重建。 主要观察指标：测量桡舟角、桡舟间距、舟骨长度、大-小多角骨宽度及大-小多角骨倾斜角运动前后的变化。 结果：运动前桡舟角、桡舟间距、舟骨长度、大-小多角骨宽度及大-小多角骨倾斜角分别为(38.725±2.230)°,(18.988±1.216)mm,(1.686±0.191)cm,(27.360±1.571)mm,(114.975±2.293)°;运动后以上指标分别为：(38.800±2.388)°,(19.215±1.443)mm,(1.683±0.209)cm,(27.718±1.910)mm,(115.300±3.023)°。运动前后相比,所有指标的变化差异均无显著性意义(P > 0.05)。 结论：应用新型融合器行舟骨-大-小多角骨局限性腕关节融合后,舟骨-大-小多角骨融合体稳定性可靠,腕关节可在背伸35°、掌屈50°、桡偏10°、尺偏30°范围内进行早期功能锻炼。     

螺旋CT扫描下测量颈椎椎弓根尺寸及螺钉置入角度

背景：在所有固定颈椎的技术上，椎弓根螺钉内固定可提供最大稳定性，但如进钉角度不正确易伤及颈髓、神经根和椎动脉。 目的：测量下颈椎椎弓根尺寸和螺钉置入角度。 设计、时间及地点：以正常人颈椎为对象的对比观察，于2004-12/2008-05在惠州市中心人民医院放射科完成。 对象：选择惠州市中心人民医院骨科收治怀疑颈椎损伤患者60例，男30例，平均(42.9±18.9)岁；女30例，平均(42.2±14.9)岁。排除颈椎病理改变。CT下画经过椎弓根内外侧2条平行线与中线分别成50°和25°角，测量2条平行线间的垂直距离。 方法：60例患者行颈椎CT扫描，扫描范围C2~T1，扫描电压140 kV，电流200~250 mA。 主要观察指标：测量C3~C7椎弓根外径、内径和内壁皮质骨厚度，椎弓根轴长度、椎弓根进钉点到中线的垂直距离、椎弓根长轴与中线的夹角及椎弓根螺钉的有效距离。 结果：颈椎椎弓根平均内径为1.3~3.3 mm，平均外径为4.0~7.0 mm，最小的椎弓根宽度在女性C3椎体，最小的椎弓根外径为3.2 mm，最大椎弓根宽为C7，男性为11.1 mm，女性为6.6 mm。平均内壁皮质骨厚度为1.5~1.9 mm，平均椎弓根轴长度29.3~33.7 mm，平均椎弓根长轴与中线的夹角40.6°~49.6°，颈椎弓根钉进钉点到中线的垂直距离平均为20.2~23.7 mm。椎弓根螺钉的有效距离(与中线成50°角)平均值3.8~6.6 mm，最小值2.2 mm，与中线成25°角的平均值2.8~4.4 mm，最小值1.4 mm。 结论：颈椎椎弓根螺钉的置入应行CT测量，螺钉角度接近50°，进钉时保持向内的倾斜角度，防止损伤脊髓和椎动脉。     

C7神经移位经背侧入路椎管外吻合腰神经前根重建截瘫下肢迈步功能的应用解剖

背景：利用周围神经移位重建截瘫平面以下的肢体运动及尿便功能方面已经做了很多有意义的工作,在选择移位神经及如何重建截瘫患者迈步方面没有定论。 目的：为C7神经移位经背侧入路椎管外吻合腰神经前根重建提供解剖学基础。 方法：在12例成人尸体标本上,经背侧入路观测椎管外L2,L3 ,L4神经前根的显露、排列及可切取长度、C7神经转移路径距离及胫神经可切取长度。 结果与结论：经背侧入路椎管外L2,L3,L4神经前支可辨认,L2,L3,L4神经前支的可切取长度为(1.81±0.35),(2.20±0.37),(1.45±0.31) cm;胫神经可切取长度(63.87±4.23);C7至梨状肌下孔的距离为(65.65±2.98) cm;C7至L2 ,3,4神经前支距离分别为(50.83±5.58),(53.15±5.82),(55.93±6.51) cm。胫神经可切取长度能够满足C7至梨状肌下孔的距离及C7至L2,L3,L4神经前支距离。结果提示,C7神经作为动力神经源,胫神经可选择为桥接神经,经背侧入路椎管外吻合L2,L3,L4神经前根重建截瘫迈步功能的具有可行性。     

成人下颈椎椎体与关节突关节倾角的X射线测量数据

背景：颈椎关节突关节倾角的文献多采用X射线侧位片椎体下缘线测量法,结果有较明显差异。对不同节段关节突关节倾角差异及因年龄的结构退行性变对其影响的研究较少。 目的：测量成人下颈椎(C3~7)关节突关节的倾角,并探讨年龄因素对倾角的影响。 设计、时间及地点：随机分组,测量实验,于2007-03/06在汕头大学医学院附属粤北人民医院完成。 对象：选取2000-01/2006-12汕头大学医学院附属粤北人民医院骨科120例成年人颈椎侧位X射线平片,男58例,女62例;年龄16~75岁。 方法：120例成人颈椎侧位X射线平片按年龄分为3组：16~30岁组(n=38),31~50岁组(n=43),51~75岁组(n=39)。以传统的椎体下缘线和自行设计的椎体中线方法测量C3~7关节突关节倾角,比较2种方法不同年龄段的测量数据。 主要观察指标：椎体下缘线法和椎体中线法测量颈椎C3~7关节突关节倾角数值。 结果：①两种方法测量的下颈椎关节突关节倾角在30°~72°,各节段均值均大于50°,以C5为中心分布,C7>C3>C4>C6>C5。②两种方法测量的倾角均随年龄增大而减小,C5变化最明显。16~30岁组各节段关节突关节倾角差异均无显著性意义(P > 0.05);椎体下缘线法测量31~50岁组C4~C6节段关节突关节倾角小于椎体中线法(P < 0.01);在51~75岁组,椎体下缘线法测量C3~C6节段关节突关节倾角小于椎体中线法(P < 0.05~0.01)。 结论：两种方法测量的倾角均随年龄增大而减小,椎体中线法受颈椎年龄因素退变的影响较小,是相对客观的一种测量方法。     

基于三维CT多平面重建股骨近段髓腔的形态学实验

背景：股骨近段髓腔的形态学特点对于股骨假体的匹配和远期稳定性至关重要。但目前还没有基于三维CT多平面重建股骨近段髓腔的形态学研究。 目的：分析国人近段股骨髓腔的总体三维形态学特点,用以指导假体设计和手术操作。 方法：50件(25对)正常国人的股骨标本,由吉林大学基础医学院解剖学教研室提供。对股骨标本进行CT扫描和多平面重建,在矢状面、冠状面及横断面重建图像中选择标准化层面分别测量股骨前弓角、近段股骨髓腔长度、股骨距轴线与近段股骨髓腔轴线的夹角(股骨距矢状面倾角)、干骺端髓腔内壁倾角以及股骨颈前倾角。应用Pearson二元相关分析明确以上参数的相关性。 结果与结论：近段股骨髓腔长度为(175.6±8.6)mm;股骨前弓角为(10.6±1.8)°;在经股骨距内缘层面、中份层面和外缘层面股骨距矢状面倾角分别为(12.7±1.2)°,(6.3±0.9)°,(0.3±0.06)°;干骺端髓腔内壁倾角为(18.8±2.7)°;股骨颈前倾角为(11.0±2.3)°。相关分析表明股骨前弓角和股骨颈前倾角呈显著正相关(r=0.749,P=0.014)。在矢状面上,由内侧向外侧股骨距轴线与近段股骨髓腔轴线逐渐趋向一致。虽然在外观上近段股骨在干骺端部位存在后弓,但近段股骨髓腔的轴线为直线,近段股骨髓腔无后弓。提示进行初次人工全髋关节置换,直柄假体更能够适应国人近段股骨髓腔的形态。干骺端髓腔内壁的较大倾角使其成为股骨近端应力承载的最重要部位,因此干骺端髓腔内壁倾角应作为假体选择和术前计划的重要参数。     

成人颈椎椎弓根螺钉在儿童腰椎应用的可行性*

背景：由于1~3岁幼年儿童椎体发育未完全成熟,各种解剖径线相对较成人小得多,尚无幼儿专用的椎弓根螺钉固定器械,现有能够利用的直径最小的椎弓根螺钉是用于成人颈椎侧块或椎弓根固定的钉棒系统。 目的：观察将成人颈椎椎弓根螺钉应用到成年猪颈椎与幼猪腰椎固定后的生物力学对比。 方法：将6具完整新鲜成年猪颈段C3~C6脊椎标本和6具完整8周龄新鲜幼猪腰段脊柱标本自椎间盘及关节处离断,游离成单个椎体,共54个椎体108侧椎弓根。按照标准操作将成人颈椎椎弓根螺钉分别安置在成年猪颈椎标本和幼猪腰椎标本的椎弓根上,应用生物力学方法测试螺钉的最大轴向拔出力。 结果与结论：颈椎标本最大轴向拔出力高于腰椎标本,但差异无显著性意义(P > 0.05);L1椎弓根螺钉的拔出力均值明显小于L3椎弓根螺钉的拔出力均值(P < 0.05);C5椎弓根螺钉的拔出力均值明显大于C3椎弓根螺钉的拔出力均值(P < 0.05);颈椎和腰椎标的骨密度差异有显著性意义(P < 0.01),椎体椎弓根力学数值与椎体骨密度之间存在线性正相关。说明取得了成人颈椎椎弓根螺钉在轴向拉力方面适应于幼儿腰椎的初步实验依据。     

颞骨冠状切片和高分辨率CT定位圆窗区的邻近结构

背景：作者前期实验曾探讨了圆窗区及周围结构在横断面上的配布特点,虽有资料对颞骨中耳及邻近解剖结构的冠状位影像学特点进行了描述,但由于无统一的冠状扫描基线,导致相关研究结果存在差异。 目的：对比分析成人头部标本颞骨冠状切片和高分辨率CT冠状扫描图像上圆窗区及其周围结构的差异。 方法：15例(30侧)成人头部标本,以与眦耳线相垂直的直线为基线,获得间隔为1.00 mm,厚度为1.00 mm的CT冠状扫描图像,扫描后的头部标本按原定位截取以耳颞区为中心的组织块,并制成厚为1.00 mm的连续冠状薄层切片。标本切片与CT图像对照,对颞骨内听小骨、骨性半规管、前庭、耳蜗、圆窗、圆窗龛、蒲氏间隙以及面神经颞骨内段等结构进行观察。 结果与结论：圆窗龛的内外径、深度分别为(1.36±0.26)和(1.55±0.26) mm,面神经迷路段至弓状隆起的距离为(4.19± 0.52) mm,面神经水平段距鼓室盖、距耳蜗、距锤骨头、距盾板、距砧骨短脚间的距离分别为(5.27±0.92),(1.36±0.28),(3.19±0.85),(5.30±0.58)和(2.86±0.54) mm。提示耳颞区火棉胶冠状薄层断面标本能良好显示圆窗区及其周围结构的解剖位置和毗邻关系,可直接与高分辨率CT冠状`扫描图像进行对照分析,其结果对耳科疾病的影像诊断及手术治疗有参考价值。     

Fatty infiltration of the cervical extensor musculature,cervical sagittal balance,and clinical outcomes: An analysis of operative adult cervical deformity patients

PurposeTo assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients.MethodsOperative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests.Results22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (R_s: 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (R_s: −0.565, −0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (R_s: −0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (R_s: 0.551, p = 0.014).ConclusionsDeformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature’s role amongst CD patients.     

Axial Neck Pain after Cervical Laminoplasty

Objective

It has been demonstrated that cervical laminoplasty is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. However, recent reports have suggested that axial neck pain is frequently encountered after cervical laminoplasty. The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminoplasty.

Methods

A total of 31 consecutive patients that underwent cervical laminoplasty between March 2002 and December 2008 were reviewed. The authors evaluated and compared axial neck pain and lordotic angle in patients that underwent C7 spinous process preserving surgery (group 1, n = 16) and in patients in which the C7 spinous process was sacrificed (group 2, n = 15).

Results

Severe or moderate early axial pain occurred in 56.2% of patients in group 1 and in 86.6% in group 2. Severe or moderate late axial pain occurred in 12.5% in group 1 and in 73.3% in group 2. Eighty-Six percent of patients in group 2 and 43% in group 1 experienced aggravation of their axial neck pain during the early postoperative period. Aggravation of axial neck pain during early postoperative period was less common in group 1 but not statistically significant (p = 0.073). Sixty-six percent of patients in group 2 and 12% in group 1 had aggravated axial neck pain at late postoperative period and aggravation of late axial neck pain was significantly less common in group 1 (p = 0.002).

Conclusion

The present study demonstrates that C7 spinous process preserving laminoplasty decreases the incidence of aggravated axial neck pain after cervical laminoplasty.     

Photogrammetric analysis: An objective measure to assess the craniocervical range of motion after cervical laminoplasty surgeries

Surgical decompression using laminoplasty is commonly performed for multilevel stenosis with cervical spondylotic myelopathy. However, the long-term effects on the craniocervical range of motion (ROM) after surgery are not well understood. This study represents the first entry into the literature of photogrammetric analysis for clinical measurement of craniocervical ROM. All patients underwent a French-door laminoplasty from 1995 to 2016 and were evaluated radiologically and with postoperative photographs (photogrammetric analysis) to measure craniocervical ROM and axial rotation. Radiographic parameters were occiput to C2 angle, C1–2 angle, C2–7 angle/cervical lordosis (CL), T1-slope (T1S), and TS-CL were measured. Chin-brow vertical angle (CBVA) was utilized for flexion and extension, while nose-turn angle (NTA) was used to assess axial rotation. Forty-four patients (mean age: 65.7 years, 50% female) had a mean follow-up of 37.9 months. Mean values in neutral, flexion, and extension were occiput to C2 = 30°, 15°, and 43°; C1–C2 = −32°, −25°, −32°; and C2–C7 = −4°, 11°, −20°, respectively. Mean CL was within 1 SD of the established −17° (±13.86°). Mean T1S and TS-CL were 33° and 30° in the neutral position, respectively. Mean radiographic full range of motion from flexion to extension was 53°. NTA towards patients’ left was 48° and the right side was 45°. Mean CBVA, was −4°, mean flexion 37°, and extension −45°; full range was 81°. Global craniocervical ROM has proven to be well preserved for many years following cervical laminoplasty. Photogrammetric analysis is a cost-effective and radiation-free method, accurate for quantitative assessment of craniocervical and cervical ROM.     

Multiple Cervical Spinous Process Fractures in a Novice Golf Player

Avulsion of spinous process, also called Clay-shoveler''s fracture, is most prevalent among those engaged in hard physical labor. To the best of the author''s knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient''s pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler''s fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.     

Significance of flexion range of motion as a risk factor for kyphotic change after cervical laminoplasty

Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP), and several studies have investigated its predictors. In these studies, a kyphotic Cobb angle of 0°–5° between C2 and C7 at a certain postoperative time-point was often used to detect kyphotic deformity. However, studies considering the amount of cervical lordosis loss compared to the preoperative measurement are scarce. This study aimed to elucidate risk factors for kyphotic change after CLP by comparing patients with and without marked loss of cervical lordosis postoperatively. The study population was divided into seven patients with and 92 patients without a loss of >10° of the C2-7 angle during the follow-up period compared to the preoperative measurements [cervical lordosis loss (CLL) group and no CLL (NCLL) group, respectively]; demographic characteristics, surgical information, preoperative radiographic sagittal parameters of the cervical spine, and posterior paravertebral muscle morphology evaluated by magnetic resonance imaging were compared between two groups. A univariate analysis revealed that the CLL group had significantly greater flexion range of motion (fROM) than the NCLL group (43.0° vs. 25.8°, P < 0.001); however, no statistical significance was identified for other parameters. The fROM had a high capacity to discriminate between the CLL and NCLL groups (area under the receiver-operating characteristic curve, 0.880; P < 0.001; 95% confidence interval, 0.589–0.974) with an optimal cutoff point of 37°. This study suggests that greater fROM is a risk factor for the development of kyphotic changes after CLP. For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated.     

Solitary xanthogranuloma of the upper cervical spine in a male adult

We present the rare case of solitary xanthogranuloma in the upper cervical column mimicking a Brown-Sequard syndrome. A 29-year-old man complained with right hemiparesis and left hypoesthesia after a car accident. Computed tomography and magnetic resonance images revealed a lobulated homogenously well-enhancing mass in between posterior arch of the atlas (C1) and spinous process of the axis (C2) resulting in a marked spinal canal narrowing with cortical erosions. The patient was managed by complete resection of the tumor with partial laminectomy with lower half of C1 posterior arch and upper half of C2 spinous process. The authors advise complete removal of the xanthogranuloma and consideration as a differential diagnosis of lesions among upper cervical lesions.     

What have we learned from C5 palsy – A short communication

A study group on C5 palsy retrospectively reviewed 1001 cervical operations at their institutions in order to understand the incidence, prognosticators, pathogenesis, and outcome of C5 palsy after cervical operations. Three studies are summarized. C5 palsy was higher after posterior versus anterior operations. C4-C5 foraminotomy and age were the strongest predictors of C5 palsy after posterior surgeries and anterior cervical decompression-fusion, respectively. Among patients undergoing C4-C5 posterior laminoforaminotomy with instrumented fusion, cord shift on postoperative imaging was thought to be implicated in the pathogenesis of C5 palsy. Among affected patients, 81.4% recovered. Median time to resolution of C5 palsy was between 6 months to 1 year.     

Anterior reduction and fusion for acute unilateral cervical facet dislocation without severe spinal cord injuries

PurposeThis study aimed to evaluate safety and effectiveness of simple anterior reduction and fusion for acute lower cervical unilateral facet dislocation without severe spinal cord injuries.Materials and methodsOne hundred and two patients with unilateral cervical facet dislocations without severe spinal cord injuries who were surgically treated by the only anterior approach were analyzed. The treatment effects were evaluated based on the Visual Analogue Scale (VAS) scores, the Cobb angle of kyphosis, the Neck Disability Index (NDI) and Odom’s criteria. Neurological recovery of patients was assessed by the Frankel grading.ResultsThe mean duration of follow-up was 12.4 ± 4.2 years (range, 10 to 17 years). VAS scores, Kyphosis angle and NDI scores were significantly changed from preoperative values of 7.4 ± 0.8, 11.3° ± 6.8° and 29.3 ± 5.1 to last follow-up values of 1.3 ± 0.8, −6.1° ± 7.5° and 8.8 ± 3.6 (P = 0.000). Of patients, 92 (90.2%) had good to excellent outcomes, 9 (8.8%) had satisfactory outcomes, and 1 (1.0%) had poor outcomes. Patients have obtained satisfactory neurological recovery. Three patients needed additional posterior reduction.ConclusionThe anterior reduction and fusion is effective and safe for acute unilateral cervical facet dislocation, and can achieve good long-term clinical effects.     

C7 Fracture as a Complication of C7 Dome-Like Laminectomy : Impact on Clinical and Radiological Outcomes and Evaluation of the Risk Factors

ObjectiveCervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. MethodsPatients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2–7 angle, C2–7 sagittal vertical axis, and C7–T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. ResultsC7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2–7 angle and kyphotic C7–T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula ''Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)'', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). ConclusionC7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.     

Motor-evoked potentials from multiple target muscles in multiple sclerosis and cervical myelopathy

Motor-evoked potentials (MEP) from abductor digiti minimi (ADM), biceps brachii (BB) and tibialis anterior (TA) muscle were analysed in 101 patients with multiple sclerosis (MS) and in 72 patients with compressive cervical myelopathy (CM). In definite MS the results were abnormal in 82% and in probable or possible MS in 64% of patients. In CM results were abnormal in 56% when the compression site was at the C4/C5 interspace or higher (CM_C1-C4-), and in 100% when the compression fell between the C5 and C7 level (CM_C5-C7). The pattern of normal responses from BB with abnormal responses from ADM was found in 37% of patients with CM_C5-C7, in 10% of patients with MS (p = 0.01) and in 19% of patients with CM_C1-C4+. Abnormal MEP from both ADM and BB were significantly more frequent in MS than in CM (p = 0.002). Although “specific patterns” of MEP abnormality could be significantly correlated with patient groups and anatomical compression sites, they cannot be taken as a reliable diagnostic clue in the individual case. In particular, abnormal responses from BB were frequently also found in CM_C5-C7. These discrepancies cannot be explained on the basis of a localized mechanical mechanism and raise the question of the pathogenesis in CM.