颈椎前路融合术治疗下颈椎不稳定

目的评价颈椎前路融合术治疗下颈椎不稳定的临床效果。方法2000年10月至2004年10月,对67例X线片显示颈椎不稳定并伴有相应临床症状的颈椎病患者进行了前路融合手术,其中男性38例,女性29例;平均年龄33岁。颈椎不稳的X线判定标准为颈椎最大前屈和最大后伸侧位X线片测量相邻节段水平位移超过3.5mm或相邻椎体间成角大于11°者。手术方法为椎间植骨+钢板固定或融合器植骨融合。结果所有患者平均随访11个月,不稳椎节均得到融合稳定。大部分患者的术前症状获得了不同程度的改善,脊髓功能JOA评分由术前10.15增至术后14.95,差异有统计学意义(P<0.05);并发症包括术后钢板螺钉松动拔出2例,行翻修手术后恢复满意。结论对下颈椎不稳定患者,合理选择颈椎前路融合方法可获得满意的临床效果。     

Anterior cervical spine fusion for unstable fractures

We present in this report the operative method we have used in 7 cases of fracture-dislocation of the lower cervical spine. The technique includes partial resection of the fractured vertebral body, removal of the adjacent discs, excision of posteriorly displaced bone and disc and anterior interbody fusion between the three vertebrae. The latter is performed using a cortico-cancellous graft taken from the iliac crest and further stability is achieved by a small AO plate. All the cases started motion 48 hours after operation without further external support. Although 6 of the cases showed neurological improvement, this cannot be at this stage attributed to the surgical treatment. Nevertheless, none was made worse by the operation.     

前后路矫形融合术治疗胸腰段/腰段青少年特发性脊柱侧凸(PUMC Ⅰb/Ⅰc/Ⅱd1型)

目的比较前后两种入路及手术方法治疗特发性胸腰段／腰段脊柱侧凸的疗效。方法青少年特发性脊柱胸腰段／腰段侧凸（PUMC Ⅰb，Ⅰc，Ⅱd1型）患者28例，分为两组。A组16例，平均14．88岁，行前路短节段矫形融合术；B组12例，平均15．50岁，行后路、椎弓根系统矫形融合术。两组均采用第三代坚强矫形内固定器械。比较两组术前一般资料和术中情况，并通过X线参数，比较两种手术的矫形效果和躯干平衡的矫正情况。结果两组术前资料无显著差异，术后均无严重手术并发症，融合效果满意。A组手术时问、术中出血及输血量、内固定材料花费明显少于B组；A组平均融合4．25个节段，B组平均融合5．95个节段。随访时间12-47个月，A组术后冠状面矫正率是82％，随访时72％；B组术后冠状面矫正率是74％，随访时70％。矢状面矫形效果均满意，两组无显著性差异；A组术后即刻躯干偏移矫正不如B组，但随访时，两组无差异。两组在矫正顶椎旋转和顶椎偏移方面无显著差异。结论前路矫形和后路椎弓根系统矫形融合术治疗轻中度胸腰段／腰段青少年特发性脊柱侧凸，均可获得满意的矫形效果，但前路融合可缩短手术时间和减少术中出血、输血量，并能保留较多运动节段。     

Indications for lumbar fusion in degenerative spine disease

The incidence of lumbar fusion surgeries has risen exponentially over the last 2 decades. Although a very useful and necessary surgery for specific conditions, spinal fusions have undeservingly earned a negative reputation. With stringent patient selection, lumbar fusions are highly efficacious. This article is intended to inform the reader of the indications for lumbar spinal fusion and discuss conditions that potentiate successful outcomes.     

Anterior fusion for rotationally unstable cervical spine fractures

STUDY DESIGN: A retrospective analysis of 32 rotationally unstable cervical fractures treated by brace, halo vest, or posterior surgical constructs plus fusion is compared with a second, prospective study of 18 similar fractures treated by early anterior discectomy, fusion, and plating. OBJECTIVES: To characterize an often unrecognized fracture pattern and compare various methods of management to identify the most effective treatment. SUMMARY OF BACKGROUND DATA: The rotationally unstable cervical spine fracture (compression-extension Stage 1) involves a hyperextension and lateral flexion injury, resulting in a unilateral pedicle, facet complex, and/or lamina fracture under compression and anterior annular disruption under tension. This fracture pattern allows a rotatory spondylolisthesis of the spine around the axis of the intact lateral mass and facet complex. METHODS: A retrospective review was made of 284 cervical fractures, identifying 32 compression-extension Stage 1 fractures that were treated by a variety of techniques. The results of that study led to a second (prospective) study, in which 18 similar fractures were treated by early anterior discectomy, fusion, and plating. RESULTS: Nonoperative treatment was uniformly unsuccessful. Posterior stabilization and fusion procedures led to unsuccessful results in 45%, related either to late kyphosis because of disc collapse or the inability of midline stabilization procedures to control rotational instability. Anterior fusion resulted in solid union without residual deformity in all cases. All four patients in the prospective study with incomplete cord lesions showed improvement in cord function, as did seven patients who had radiculopathy. CONCLUSION: Although posterior bony injury is the usual radiographic finding, the anterior disc and anterior longitudinal ligament disruption are the more significant injuries and lead to late collapse and kyphotic deformity. Early anterior fusion is recommended in compression- extension Stage 1 cervical spine injuries.     

Indications for lumbar spine fusion in the adult.

More than 20,000 lumbar spine fusions are performed annually in the United States. Results of surgery unfortunately are inconsistent and may reflect unsatisfactory patient selection. Indications for lumbar arthrodesis may arise in degenerative disk disease, deformity, distal extension of previous arthrodesis, trauma, spondylolisthesis, and spinal stenosis (in association with diskectomy or decompression). There are several techniques in the assessment of potential candidates for low lumbar arthrodesis.     

Thoracic herniation after lumbar spine fusion

We report on a 65-year-old male patient with rapid onset of incomplete paraparesis, based on a massive thoracic herniation following adjacent instability of the thoracolumbar spine after lumbar fusions with transpedicular instrumentation.     

Use of flumazenil for intraoperative arousal during spine fusion.

The intraoperative arousal test is used to detect potential damage to the spinal cord during spine fusion. We determined whether a continuous midazolam infusion, the effects of which are antagonized by flumazenil when the arousal test is needed, is associated with good control of the timing of arousal and with no adverse reactions. In a randomized study of 20 patients (10 in each group), we compared arousal with flumazenil during midazolam-narcotic anesthesia with an arousal test done during halothane-nitrous oxide anesthesia, both under conditions of controlled hypotension. Motor responses to verbal command were obtained 39.1 +/- 36.0 s (mean +/- SD) after the injection of flumazenil in eight patients. Two patients form this group awoke spontaneously 6 and 8 min after terminating the administration of nitrous oxide and midazolam but remained sedated up to the time of the test itself. In the halothane group, arousal occurred 26 +/- 8.3 min after halothane administration was terminated and 10.1 +/- 3.3 min after nitrous oxide was stopped. Two of the patients in this group moved, owing to early arousal 5 and 8 min before the scheduled time and needed reinstatement of anesthesia. In four patients in the halothane group, we had to wait 3-11 min after the scheduled time before satisfactory arousal was achieved. One of the patients in the halothane group showed a motor deficit of the lower limbs during the wake-up test that disappeared after decreasing the spine correction. There were no adverse reactions except for occasional shivering in the recovery period.(ABSTRACT TRUNCATED AT 250 WORDS)