颈椎前路内固定术后中远期食管并发症

 目的 探讨颈椎前路内固定术后中远期食管并发症的发生率及其诊疗策略。方法 对2001年1月至2011年12月2316例行颈椎前路内固定手术患者发生的中远期食管并发症情况进行回顾性分析。食管中远期并发症包括术后2周以上发生的食管穿孔、食管气管瘘、食管皮下瘘、食管憩室、食管胸膜瘘及食管狭窄等。结果 共4例患者发生中远期食管并发症,发生率为0.17%(４/２３1６),其中食管穿孔发生率为0.09%(2例)。病例1为31岁男性患者,自体髂骨移植融合加钢板内固定(C5)术后7年发现食管憩室合并食管穿孔。手术取出内固定,清创后切除憩室,胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例2为46岁男性患者,自体髂骨移植融合加钢板内固定(C5)术后3年发现食管憩室。手术取出内固定,切除食管憩室,胸骨舌骨肌及肩胛舌骨肌肌瓣修补食管。病例3为58岁女性患者,自体髂骨移植融合加钢板内固定(C6)术后5年出现食管憩室。手术取出内固定,切除食管憩室,胸锁乳突肌肌瓣修补食管。病例4为56岁女性患者,钛网植骨融合加钢板内固定(C6)术后3年出现食管穿孔。手术取出内固定,清创后胸锁乳突肌肌瓣修补食管。4例患者术后食管并发症均获得成功治疗,恢复良好。结论 颈椎前路内固定术后中远期食管并发症的发生率较低,X线片、消化道造影及消化道内镜检查是主要的诊断方法,手术是其主要的治疗手段。     

Placement of anterior cervical instrumentation without intraoperative radiography.

Adequate fixation with several commonly used anterior cervical plate systems requires that the screws penetrate both the anterior and posterior cortices of the vertebral bodies. This report emphasizes the shortcomings of plain film and fluoroscopic examinations in confirming screw position through the posterior vertebral cortex in three patients with lower cervical trauma or tumor. These cases and radiographs of isolated vertebrae from the cervicothoracic region demonstrate the inadequacy of plain film/fluoroscopy for determination of the position of anterior cervical plate screws in relation to the posterior cortex. Only axial images such as those obtained with computed tomography are able to show the exact relationship of the screws to the posterior cortical curvature in C7 and T1.     

Spinal cord injury as a complication of elective anterior cervical fusion.

The true incidence of spinal cord injury as a complication of elective anterior discectomy and interbody fusion is not known. It would appear that the risk of encountering this complication increases if the surgical procedure includes instrumentation within the spinal canal. In 5 of the cases reported herein the cause for spinal cord injury was identifiable; in the remaining 5, the mechanism of injury is either obscure or not reported. All 10 patients reported had their surgery performed using the drill and dowel technique. The role of the posterior osteophyte in spondylosis and the rationale for routinely entering the spinal canal in order to decompress the spinal cord and nerve roots are examined. Since the majority of refractory disk problems that require surgery can be satisfactorily managed by discectomy and interbody fusion alone, routine instrumentation within the spinal canal may be an avoidable hazard in the majority of instances. The pathogenesis and prognosis of the anterior cord syndrome is reviewed, a possible etiology is suggested, and the anatomy, the autonomy and the importance of the anterior spinal artery system are noted. Its vulnerability in the treatment of degenerative disk disease and a possible mechanism for its occult impairment is mentioned.     

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Purpose

The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation.

Methods

The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years.

Results

The mean kyphotic angle improved from 32.4° pre-operatively to 7.2° in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5° at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages.

Conclusion

Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.     

Hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine

Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2–3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months’ follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified. Received: 6 March 1998 Revised: 31 July 1998 Accepted: 17 August 1998     

Cervical alignment after single-level anterior cervical corpectomy and fusion using autologous bone graft without spinal instrumentation for cervical pyogenic spondylitis

European Journal of Orthopaedic Surgery & Traumatology - Subsidence in anterior cervical corpectomy and fusion (ACCF) for cervical degenerative disease (CDD) are constantly observed during the...     

Delayed obturator artery rupture: a complication of high-voltage electrical injury

Electrical burns cause damage to the cardiovascular system through different mechanisms. Immediate cardiac arrhythmia is one of the common consequences. A large vessel blow out due to an electrical burn is rarely documented. It is often undetected due to its "silent" symptoms. This article reports a delayed obturator artery rupture in a 32-year-old male patient 6 weeks after he sustained severe high-voltage electrical burns. The vessel injury was treated with computed tomography (CT)-aided embolization. The patient recovered to an ambulatory status 10 weeks after the injury.     

Zenker diverticulum: a rare complication after anterior cervical fusion

Esophageal injury is a rare but serious complication occurring after anterior cervical spine surgery. Pharyngoesophageal, or Zenker, diverticulum is an acquired outpouching of the pharyngeal musculature just proximal to a functional esophageal stricture, clinically manifesting as dysphagia, aspiration, and weight loss. We report a case in which a patient developed a pharyngoesophageal diverticulum, accompanied by retropharyngeal abscess, first identified 2 years after a 3-level anterior cervical fusion with allograft and anterior plating. The inferior portion of the cervical plate was dislodged anteriorly. In addition, the patient harbored pulmonary and mediastinal infection at the time of presentation. Despite incision and drainage of the abscess with repair of the diverticulum, the patient died in the early postoperative period. Prompt recognition and frequent follow-up, as well as patient education, may prevent this catastrophic complication.     

保护膈肌的小切口胸腰段脊柱侧凸前路矫形

目的:探讨用保护膈肌的小切口行胸腰段脊柱侧凸前路矫形技术的可能性及临床应用效果。方法:胸腰段特发性脊柱侧凸患者17例(男3例,女14例),年龄12～19(平均14.6)岁,术前Cobb角44°～76°(平均56°),其中4例伴有胸腰段后凸10°～18°,其余病例矢状面正常。内固定节段T11～L312例,T11～L43例,T11～L22例。手术时取凸侧在上的侧卧位,在保护膈肌的前提下在膈肌上下各作长约8cm的切口,暴露至脊柱。内固定器械采用CDH。切除椎间盘后在脊椎上置钉。将矫形棒从膈肌角处小洞中穿过,应用去旋转技术完成腰椎前凸化,同时采用凸侧加压技术进一步矫正侧凸畸形。结果:手术时间为210~270min,平均240min,术中出血310～520ml,平均400ml。术后Cobb角4°～16°(平均10°,纠正率为80%),4例胸腰段后凸畸形术后矢状面恢复形态良好。无术中术后并发症,2例出现手术侧下肢皮温升高。随访3～11个月,无内固定并发症,2例出现6°的额状面纠正度丢失。结论:保护膈肌的小切口胸腰段脊柱侧凸前路矫形是可行的,在减少手术创伤的同时能够达到与传统入路相似的临床疗效,没有明显的并发症增加,具有较大的临床实用价值。     

Microsurgical anterior cervical discectomy without fusion

Objectives  

Microsurgical anterior exposure and removal of cervical herniated disk without fusion of the involved motion segment to relieve radicular pain and to restore function.     

零切迹颈椎前路椎间融合固定系统治疗颈椎病及无骨折脱位颈脊髓损伤

目的：探讨零切迹颈椎前路椎间融合固定系统（简称 Zero-P 系统）治疗颈椎病及无骨折脱位颈脊髓损伤患者的临床疗效。方法对行颈椎前路手术的14例颈椎病患者（16节段）和5例无骨折脱位颈脊髓损伤患者（5节段）采用 Zero-P 系统进行减压固定。观察手术时间、术中出血量、术后早期并发症;颈椎病患者采用 JOA 评分评价疗效。结果手术时间为55～120（75±16）min;术中出血量为50～450（150±85）ml。术后11例出现吞咽困难,2～5 d 基本恢复,未出现其他早期并发症。患者均获随访,时间3个月～3年6个月,末次随访时14例颈椎病患者 JOA 评分改善率为72．7％,其中优9例,良3例,中2例;5例颈脊髓损伤患者Frankel 分级均为 E 级。影像学资料提示术后椎间融合良好,未出现临近节段椎间盘退变。结论仅需处理椎间盘的颈椎前路手术采用 Zero-P 系统进行减压固定,可以取得早期良好的临床疗效,但应注意患者的选择。