颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系

目的 :探讨颈椎后纵韧带骨化症(OPLL)患者行颈后路单开门椎管扩大成形术后颈椎矢状位参数变化与手术疗效的关系。方法:选取2009年1月~2013年1月在我院接受颈后路单开门椎管扩大成形术的OPLL患者68例,随访12~30个月。记录手术前后JOA(Japanese Orthopaedic Association)评分、颈肩臂疼痛VAS(visual analog scale)评分,计算神经功能JOA改善率(improvement rate,IR)。术前、术后和随访时行颈椎正侧位X线片、CT三维重建和MRI检查,测量术前及随访时的颈椎矢状位参数,包括C2-C7 Cobb角、C2-C7矢状面轴向距离(sagittal vertical axis,SVA)和T1倾斜角。结果:末次随访时JOA评分及VAS评分较术前明显改善(P0.001),神经功能恢复为优者21例,良30例,中14例,差3例,优良率为75%。末次随访时C2-C7 Cobb角由术前的15.4°±9.5°增大到17.4°±10.2°,但差异无统计学意义(P=0.166);C2-C7 SVA由术前的21.0±15.3mm增大到27.0±15.7mm,差异有统计学意义(P=0.009);T1倾斜角由术前的30.2°±10.1°增大到33.7°±8.0°,差异有统计学意义(P=0.044)。术前T1倾斜角与C2-C7 Cobb角正相关(r=0.569,P0.01),与C2-C7 SVA正相关(r=0.544,P0.01)。C2-C7 Cobb角与C2-C7 SVA无显著相关性(r=0.05,P=0.798)。末次随访时C2-C7 Cobb角较术前增大24例,较术前减小44例,两组JOA评分和VAS评分变化、神经功能改善率无统计学差异;C2-C7SVA增加46例,减小22例,两组JOA评分和VAS评分变化、神经功能改善率亦无统计学差异(P0.05)。结论 :颈后路单开门椎管扩大成形术治疗OPLL短期疗效确切,手术前后颈椎矢状参数的变化与患者的临床疗效无显著相关性。     

下颈椎前路减压融合术后颈椎矢状位平衡的变化

目的 :探讨下颈椎前路减压融合术后颈椎矢状位平衡的变化。方法 :回顾性分析2012年1月~2016年12月在上海市东方医院脊柱外科因颈椎病接受颈前路椎间盘切除减压椎间融合手术(ACDF)患者的资料,共纳入326例,其中男175例,女151例;年龄34~81岁(56.0±9.4岁)。随访12~30个月(18.5±6.4个月),根据融合节段数分为四组:单节段融合组69例,双节段融合组85例,三节段融合组90例,四节段融合组82例。在术前及术后12个月随访时的颈椎侧位X线片上测量颈椎矢状位参数:C0-2 Cobb角、C2-7 Cobb角、C2-7矢状垂直距离(C2-7 SVA)和T1倾斜角(T1S),并记录手术前后JOA评分及颈肩臂疼痛VAS评分,计算术后12个月时各组参数改变量。单因素方差分析比较参数及评分指标改变量组间差异,Pearson相关性探讨术前及术后12个月颈椎矢状位参数变化关系。结果 :四组患者一般资料无统计学差异(P0.05)。术前和ACDF术后12个月,单节段融合组C0-2 Cobb角为21.07°±8.21°和20.92°±5.99°,C2-7 Cobb角为15.29°±8.64°和17.69°±11.25°,C2-7 SVA为20.94±10.77mm和20.61±10.23mm,T1S为23.02°±8.64°和24.05°±9.35°,术前与术后比较均无统计学差异(P0.05);双节段融合组C0-2 Cobb角为20.38°±7.49°和24.20°±7.96°,C2-7 Cobb角为13.04°±8.07°和15.85°±10.53°,C2-7 SVA为18.57±11.88mm和23.73±9.87mm,T1S为24.28°±6.71°和28.65°±7.64°,术前与术后比较均有统计学差异(P0.05);三节段融合组C0-2 Cobb角为16.76°±6.24°和20.54°±6.58°,C2-7 Cobb角为11.46°±7.83°和15.12°±10.42°,C2-7 SVA为19.36±8.40mm和25.25±12.20mm,T1S为26.56°±9.47°和30.39°±7.31°,术前与术后比较均有统计学差异(P0.05);四节段融合组C0-2 Cobb角为15.44°±6.50°和18.39±6.26°,C2-7 Cobb角为11.54°±8.30°和19.61°±5.53°,C2-7 SVA为22.39±12.60mm和27.68±11.17mm,T1S为24.70°±6.30°和31.22°±6.45°,术前与术后比较均有统计学差异(P0.05)。术前和术后12个月,四组组内T1S与C2-7 Cobb角、C2-7 SVA均呈正相关,C2-7 Cobb角与C2-7 SVA均呈负相关;术后12个月,四组间C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA及T1S改变量比较差异均有统计学意义(P=0.010、0.001、0.003、0.002)。结论 :下颈椎前路减压单节段融合后颈椎矢状位平衡无明显变化;双节段及长节段融合后颈椎矢状位平衡显著改变,但下颈椎矢状位序列维持动态稳定。     

上颈椎术后颈椎矢状位参数变化及影响因素

目的:分析寰枢椎脱位患者上颈椎术后颈椎矢状位参数变化及影响因素。方法:对2011年3月至2022年7月行上颈椎手术的15例寰枢椎脱位患者进行回顾性分析,统计所有患者的基本信息及术前与末次随访的矢状位参数,包括枕颈角(C0-C2 Cobb角)、下颈椎曲度(C2-C7 Cobb角)、T1倾斜角、颈椎矢状面轴向垂直距离(C2-C7 SVA),并进行统计学分析。结果:末次随访时患者的C2-C7 Cobb角为15.18°±12.41°,小于术前的24.30°±15.57°;末次随访时患者的T1倾斜角为28.09°±15.20°,大于术前的24.14°±15.59°,差异均有统计学意义(P均<0.05)。末次随访时患者C0-C2 Cobb角和C2-C7 SVA增大,但与术前相比差异无统计学意义(P均>0.05)。ΔC2-C7 Cobb角与术前C2-C7 Cobb角的大小有关,差异有统计学意义(P<0.05)。术前C2-C7 Cobb角>20°的患者术后均出现不同程度的下颈椎曲度减小。结论:接受上颈椎手术的寰枢椎脱位患者术后可能出现下颈椎曲度减小,术后下颈椎曲度的丢失与术前C...     

颈椎后路单开门椎管扩大成形术对颈椎矢状平衡的影响

目的观察颈椎后路单开门椎管扩大成形术对颈椎矢状平衡的影响及各矢状平衡参数与临床恢复效果的相关性,探索可以预测术后疗效的平衡参数。方法回顾性分析2012-01-2013-04于长征医院脊柱外科行颈椎后路单开门椎管扩大成形术51例患者的影像学资料及临床资料,其中男性34例,女性17例,平均年龄52.8岁。比较术前、术后各矢状平衡参数及临床疗效指标的变化,探究各矢状平衡参数之间及其与临床恢复指标的相关性。结果随访时间为7-24个月,平均16.4个月。术前JOA评分平均8.9分,术后平均13.1分,平均神经功能改善率为51.8%。术前矢状平衡参数:C_0-C_2 Cobb角为(21.4±1.1)°,C_2-C_7 SVA为(25.3±1.2)mm,T_1-Slope为(25.1±1.2)°;术后末次随访时:C_0-C_2 Cobb角为(24.2±1.0)°,C_2-C_7 SVA为(29.2±1.5)mm,T_1-Slope为(28.5±1.4)°,三项参数术后较术前变化均有统计学意义。术前NDI、VAS及SF-36评分分别为(22.1±5.2)分、(2.9±1.2)分和(41.3±6.5)分;术后末次随访时以上评分分别为(11.7±5.1)分,(1.3±0.9)分,(52.4±6.8)分,三种评分术后较术前变化均有统计学意义。术后C_0-C_2 Cobb角增加值及术后T_1-Slope增加值均与C_2-C_7 SVA增加值呈正相关,术前C_2-C_7 SVA与术后JOA评分呈负相关。结论颈椎后路单开门椎管成形术对于颈椎矢状平衡产生明显的影响,术后颈椎有发生前倾趋势。对于术前存在高C_2-C_7 SVA的患者,术后发生颈椎矢状平衡失衡的危险性增加,严重的颈椎矢状平衡失衡可导致患者颈部疼痛、功能障碍及生活质量下降。     

不同类型颈椎病患者颈伸肌肌容量与颈椎矢状位参数的差异及相关性研究

目的 :探讨不同类型颈椎病患者之间颈伸肌肌容量与颈椎矢状位序列的差异及相关性。方法 :回顾性分析2016年5月～2018年7月就诊于北京大学国际医院的颈椎病患者563例,其中男性304例,女性259例,平均年龄53.3±19.6岁,根据颈椎病的类型分为A组(脊髓型颈椎病,n=208)、B组(神经根型颈椎病,n=194)和C组(颈型颈椎病,以轴性症状为主且无神经受压的临床症状或体征,n=161)。所有患者行颈椎MRI及颈椎侧位X线片检查。通过PACS (picture archiving and communication systems)系统在颈椎侧位X线片上测量颈椎矢状位参数序列:C2-7 Cobb角、C0-2 Cobb角、C7斜率(C7 slope,C7S)和C2-7矢状垂直轴(C2-7 sagittal vertical axis,C2-7 SVA)。通过Image J软件对MRI轴位像上C3～7上终板水平浅层颈伸肌截面积(superficial extensor area,SEA)、深层颈伸肌截面积(deep extensor area,DEA)与相应颈椎椎体截面积(vertebra body area,VBA)的比值进行了测量和分析,以SEA/VBA及DEA/VBA作为颈伸肌肌容量。采用ANOVA单因素方差分析对组间矢状位参数,颈伸肌肌容量进行对比(组间两两对比采用Games-Howell法),采用Pearson相关性分析对颈伸肌肌容量与矢状位参数关联性进行分析。结果:C2-7 Cobb角A组(8.64°±6.19°)显著低于B组(12.55°±6.27°,P0.05)及C组(13.08°±5.77°,P0.05);C7S A组(28.09°±10.16°)显著高于B组(22.26°±7.55°,P0.05)及C组(21.63°±8.96°,P0.01);C2-7 SVA A组(21.77±12.38mm)显著高于B组(17.80±10.82mm,P0.05)及C组(15.54±6.82mm,P0.01)。SEA/DEA比值各组之间无显著统计学差异,A组患者DEA/VBA比值明显低于B、C组(P0.05),其中以C3-5水平差异最为显著(P0.05)。Pearson相关分析显示A组C3 DEA/VBA比值与C2-7 SVA (r=-0.379,P0.05)及C7S (r=-0.311,P0.05)呈弱负相关,C4水平DEA/VBA比值与C2-7 SVA (r=-0.478,P0.01)及C7S(r=-0.466,P0.01)呈中度负相关,而SEA/VBA比值与矢状位参数未表现出显著统计学相关性。结论:脊髓型颈椎病患者的颈椎矢状位序列较其他类型颈椎病表现出显著的失平衡改变,脊髓型颈椎病患者的深层颈伸肌体积显著低于其他类型的颈椎病,深层颈伸肌近头端附着区域的体积与C2-7 SVA及C7S之间存在一定程度的负相关性。     

椎体次全切除术与椎管扩大椎板成形术术后颈椎矢状位平衡的对比研究

目的对比分析椎体次全切除植骨融合术与椎管扩大椎板成形术术后颈椎矢状位平衡的变化。方法收集2010年2月—2013年1月本院收治的100例因脊髓性颈椎病伴椎管狭窄症并接受颈椎椎体次全切除植骨融合术(前路组,n=53)或颈椎椎管扩大椎板成形术(后路组,n=47)患者的临床及影像学资料,通过对比术前及末次随访时日本骨科学会(JOA)评分、C_(2~7) Cobb角、矢状面轴向垂直距离(SVA)、T_1倾斜角(T_1-slope)的变化,分析不同术式术后患者矢状位平衡的变化。结果所有手术均顺利完成,随访(25.5±3.2)个月。2组患者术前JOA评分、C_(2~7) Cobb角、SVA、T_1-slope差异无统计学意义(P0.05)。末次随访时JOA评分、C_(2~7) Cobb角、SVA均较术前明显改善,且组间差异有统计学意义(P0.05);前路组中,术前高T_1-slope患者与低T_1-slope患者术后颈椎后凸发生率差异无统计学意义(P0.05);后路组中,高T_1-slope患者颈椎后凸发生率显著高于低T_1-slope患者,差异有统计学意义(P0.05)。结论颈椎前路椎体次全切除术对术后颈椎矢状位平衡的影响优于颈椎后路椎管扩大椎板成形术;当术前患者T1-slope较高时,为减少术后矢状位平衡失代偿,可尽量选择前路手术。     

后路寰枢椎融合术后颈椎矢状面参数变化及相关因素分析

目的:测量后路寰枢椎融合手术对颈椎矢状面参数的变化,并对其相关影响因素进行评估。方法:回顾性研究2015年1月～2017年12月收治的寰枢椎脱位病例18例,男8例,女10例,年龄25～72岁,平均49.6±13.7岁。所有寰枢椎脱位患者均行单纯后路复位C1～C2固定融合术,随访时间为5～17个月,平均7.4±3.7个月。测量患者术前和末次随访时的枕颈角(C0～C2角)、下颈椎前凸角(C2～C7角)、颈椎前凸角(C0～C7角)、颈椎矢状面轴向垂直距离(C2-C7 sagittal vertical axis,C2-C7 SVA)、C1～C2角、T1倾斜角(T1 slope,T1S)、颈部倾斜角(neck tilt,NT)和胸廓入口角(thoracic inlet angle,TIA)等颈椎矢状面参数。在末次随访时,术后C2～C7角比术前减小的病例归为下颈椎前凸曲度减小组(5例),而术后C2～C7角比术前增加或不变的病例纳入下颈椎前凸曲度增加组(13例)。采用卡方检验做下颈椎前凸曲度减小与性别、年龄(以60岁为界限)、术前T1S(以25°为界限)、术前C2-C7 SVA(以15mm为界限)、术前TIA(以70°为界限)、术前C2-C7角(以20°为界限)、术前C0-C2角(以20°为界限)、术前C0-C7角(以45°为界限)和术后C1-C2角(以20°为界限)等临床因素相关性的单因素分析。采用Logistic回归对术后下颈椎前凸曲度减小的相关因素进行多因素分析。结果:所有患者术前和末次随访时的C0～C2角分别为21.6°±16.4°和28.3°±8.6°、C2～C7角分别为15.3°±12.9°和16.4°±11.1°、C0～C7角分别为36.8°±19.7°和44.9°±13.2°、C1～C2角分别为12.4°±17.6°和17.5°±7.3°、C2～C7 SVA分别为13.4±14.7mm和15.1±11.7mm、T1S分别为22.8°±8.2°和23.5°±7.3°、NT分别为50.8°±9.5°和51.9°±8.9°、TIA分别为73.6°±11.1°和75.4°±10.0°,以上这些颈椎矢状面参数在术前与末次随访的比较均无显著性差异(P0.05)。对两组患者术前和末次随访的颈椎矢状面参数进行比较,前凸减小组的术前C2～C7角明显大于前凸增加组(27.6°±10.5°vs 10.5°±10.5°,P0.05),余参数比较无统计学差异。单因素卡方分析显示术后下颈椎前凸曲度减小与术前C2～C7角≥20°有关(χ~2=4.923,P=0.026),多因素Logistic回归分析显示术前C2～C7角≥20°并不是独立危险因素(OR=0.147,P=0.225)。结论:后路寰枢椎融合术后有可能发生下颈椎前凸曲度减小,而术前C2-C7角≥20°是术后下颈椎前凸曲度减小的危险因素。     

无症状成人颈椎矢状位曲度分析及其与全脊柱矢状位参数的关系

目的:探讨正常亚洲黄种人群颈椎矢状位曲度及其与全脊柱矢状位参数的关系。方法:采用影像学分析对132名成人无症状志愿者进行研究,所有志愿者行全脊柱正、侧位X线检查及中立位颈椎侧位片,测量颈椎矢状位参数包括C0-C2角(Occiput-C2 angle)、C2-C7角(C2-C7 angle)、C2-C7矢状面轴向距离(sagittal vertical axis,SVA)、头部重心(center gravity of head,CGH)~C7 SVA(CGH-C7 SVA)、C2-CGH SVA,和胸椎矢状位参数:T1倾斜角(T1 slope)、胸椎后凸角(thoracic kyphosis,TK),脊柱-骨盆的方向性参数:腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)及全脊柱矢状位参数:脊柱骶骨角(spinal sacral angle,SSA)、C7-S1的矢状面轴向距离(C7-S1 SVA)。使用Toyama等颈椎矢状位序列分型方法将所有志愿者分为三组:前凸组,后凸组,变直或鹅颈畸形组,并比较三组人群各参数间差异。使用皮尔逊相关分析和单因素ANOVA分析相关数据。结果:C0-C2角的平均值是15.13°±6.69°,C2-C7角的平均值是12.03°±7.64°。C2-C7 SVA平均值是18.67±7.96mm,CGH-C7 SVA的平均值是22.95±12.18mm,CGH-C2 SVA的平均值是7.08±5.38mm,T1 slope平均值是26.33°±7.01°。三组志愿者中,前凸组共43名(占32.6%),变直或鹅颈畸形组共74名(占56.1%),后凸组15名(占113%)。C2-C7角与T1 slope(r=0.422)相关,T1 slope与TK(r=0.434)、TK与LL(r=0.574),LL与SS(r=0.459),SS与PI(r=0.727)相关。三种志愿者中C2-C7角,CGH-C7SVA,Tl slope,TK在三组间两两比较均有显著统计学差异。结论:部分无症状成人亦存在颈椎的变直或鹅颈畸形甚至后凸改变。颈椎后凸表现可能更多的是一个局部问题而非整体脊柱骨盆参数异常。     

颈椎后路单开门椎管扩大椎板成形术对颈椎矢状面平衡的影响

目的探索颈椎后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化。方法收集2014年1月至2017年12月山西白求恩医院脊柱外科收治的108例接受颈椎后路单开门椎管扩大椎板成形术(C_3～C_7)患者的影像学及临床资料进行回顾性分析。比较术前及术后第24个月随访时C_(0～2) Cobb角、C_2椎体矢状面垂直轴线至C_7椎体后上缘的距离(C_(2～7) sagittal vertical axis,C_(2～7) SVA)、C_(2～7) Cobb角、T1-Slope 4项矢状面平衡影像学参数,对日本矫形外科协会颈椎功能评分(Japanese orthopaedic association,JOA)、颈椎功能障碍指数(neck disability index,NDI)、健康调查简表(the MOS item short from health survey,SF-36)、疼痛视觉模拟评分(visual analogue score,VAS)的变化以及轴性症状进行评定。结果患者术后24个月JOA及SF-36评分分别由术前的(11.16±2.28)分、(42.76±5.63)分增加至(14.08±2.17)分、(51.25±5.82)分,平均神经功能改善率为(46.5±3.8)%;NDI及VAS评分分别由术前的(15.61±5.43)分、(4.64±1.87)分降低至(11.36±7.93)分、(3.31±1.62)分,差异均有统计学意义(P0.005)。C_(0～2)Cobb角及C_(2～7) SVA分别由术前的(11.37±5.54)°、(21.09±5.86)mm增加至(15.36±4.51)°、(25.49±11.52)mm,C_(2～7) Cobb角由术前的(13.93±8.68)°减少至(10.65±8.72)°,差异均有统计学意义(P0.005),T1-Slope则由术前的(26.84±5.10)°变化为随访时(26.31±4.8)°,差异无统计学意义(P=0.186)。随访时C_(0～2)Cobb角的增加与C_(2～7) SVA的变化呈正相关(Pearson=0.420,P=0.015)。随访时的VAS评分高T1-Slope组为(3.13±1.60)分,低T1-Slope组为(2.45±1.31)分,差异有统计学意义(P=0.015);高T1-Slope组明显轴性症状的发生率为64.8%,低T1-Slope组为33.3%。结论颈椎后路单开门椎管扩大椎板成形术对颈椎矢状面平衡有一定影响,颈椎有前倾趋势,但通过上颈椎过度后伸的代偿,颈椎整体可以保持稳定。对于术前高T1-Slope的患者,术后会发生更严重的轴性症状。     

颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术后早期颈椎矢状面平衡的变化

【摘要】 目的：探讨颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的早期临床疗效。方法：回顾性分析2013年8月~2020年9月我院采用颈后路椎管扩大椎板成形术治疗的75例多节段CSM患者，其中42例患者采用颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术（升顶组），年龄31~79岁（57.2±10.7岁）；33例患者采用传统“关节囊悬吊法”单开门椎管扩大椎板成形术（悬吊法组），年龄48~82岁（67.2±9.6岁）。所有患者于术后3～14个月门诊随访。收集两组患者的住院相关基本信息；在术前和末次随访时的颈椎X线片上测量颈椎矢状面平衡参数，包括C0-2 Cobb角、C2-7 Cobb角、C2-7矢状面轴向距离（C2-7 SVA）、C7倾斜角（C7-Slope），同时测量颈椎活动度（ROM）；术前和末次随访时采用改良JOA（mJOA）评分、VAS评分和颈椎功能障碍指数（NDI）评估，计算mJOA评分改善率。结果：两组患者性别、术中出血量和平均随访时间差异无统计学意义（P>0.05）。升顶组患者年龄和术后住院天数均小于悬吊法组（P<0.05）。两组术前C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA、C7-Slope和颈椎ROM均无统计学差异（P>0.05），末次随访时升顶组C7-Slope和C2-C7 SVA小于悬吊法组（P<0.05），C2-7 ROM大于悬吊法组（P<0.05）。两组末次随访时mJOA和VAS评分与术前比较均有明显改善，差异有统计学意义（P<0.05）；两组间同时间点mJOA和VAS评分比较无统计学差异（P>0.05），mJOA评分改善率亦无统计学差异（P>0.05）。两组末次随访时NDI与术前比较无统计学差异（P>0.05），两组间同时间点比较亦无统计学差异（P>0.05）。结论：与传统颈后路单开门椎管扩大椎板成形术相比，颈后路经肌间隙入路“升顶式”椎管扩大椎板成形术治疗多节段CSM早期可获得相同神经功能改善效果，且在维持颈椎矢状面平衡及颈椎活动度方面更具优势。     

Occult ligamentous injury of the cervical spine associated with cervical spine fracture

We report the case of a 20-year-old patient with a C5 cervical spine fracture and an undetected ligamentous lesion between C1 and C2. Cervical spine lesion protocols and the rates of lesions that are not diagnosed with standard evaluation protocols are reviewed, with particular emphasis on comatose patients. Dynamic studies during the surgical procedure for fixation of the fracture are recommended to increase the detection of ligamentous lesions.     

胸椎管狭窄症合并颈椎病的治疗

2014年4月25~26日在北京成功举办了第三届全国胸椎管狭窄症专题研讨会,会上就胸椎管狭窄症与颈椎病的鉴别诊断、多节段胸椎管狭窄症患者的精准定位诊断等问题进行了深入研讨。会议期间与会专家围绕我们提供的1例胸椎管狭窄症合并颈椎病患者进行了热烈讨论,最终达成了部分共识。现将该病例资料及讨论结果报告如下。     

颈椎带锁钢板治疗颈椎退变性疾病

目的 探讨前路减压，植骨，颈椎带锁钢板固定治疗颈椎退变性疾病的疗效。方法 23例脊髓型颈椎病和颈椎后纵韧带骨化患者行颈前路钢板固定融合。术前，术后，随访期间评估患者神经状况。平均随访时间11.3个月。结果 所有患者植骨融合，并发症包括伤口大血肿1例，声音嘶哑1例，患者神经功能均改善。结论 前路减压，植骨，颈椎带锁网板固定治疗颈椎退变性疾病疗效满意。     

Analysis of cervical spine curvature in patients with cervical spondylosis

Computer-aided design techniques were used to analyze the degree of spinal curvature shown on cervical spine radiograms of 28 patients. On films standardized as to size, a geometrical chord was constructed from the 2nd to the 7th cervical vertebrae (C2 to C7), and an arc was drawn along the posterior margin of the vertebrae. The resulting area was used as an index of curvature, and the spinal canal diameter was measured. Severity of myelopathy as well as clinical improvement was related to the geometrical data. There was no clear correlation between severity of the preoperative myelopathy and degree of curvature. Severe myelopathy was seen in association with straight, lordotic, and hyperlordotic spines. Neck pain was most severe in patients with reversed cervical curvature. The degree of curvature, however, seems to relate to the postoperative clinical outcome. Patients with relatively normal curvature showed the greatest improvement in symptoms and signs. Postoperative magnetic resonance scanning confirms that posterior migration of the spinal cord after laminectomy may be inadequate to clear osteophytes in patients with straightened or reversed curvature of the cervical spine. Spinal geometry should be considered in the selection of the best surgical procedure and the extent of laminectomy for patients with spondylotic myelopathy. Significant abnormalities of spinal curvature may account for some instances of poor outcome after laminectomy.     

Vertigo in patients with cervical spine dysfunction

To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed with dysfunctions of the upper cervical spine. Nineteen patients, hereinafter referred to as group B, did not show signs of dysfunction. Cervical spine dysfunctions were documented as published by Bischoff [4]. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervical spine motion segment was affected. Dysfunctions were treated and resolved with mobilising and manipulative techniques of manual medicine. Regardless of cervical spine findings seen at the initial visit, group A and B patients received intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients (26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervical spine is important in diagnosing and treating vertigo, because a non-resolved dysfunction of the upper cervical spine was a common cause of long-lasting dizziness in our population. Received: 27 November 1996 Revised: 14 June 1997 Accepted: 24 June 1997     

Segmental cervical spine movement with the intubating laryngeal mask during manual in-line stabilization in patients with cervical pathology undergoing cervical spine surgery

We quantified the extent and distribution of segmental cervical movement produced by the intubating laryngeal mask (ILM) during manual in-line stabilization in 20 anesthetized patients with cervical pathology undergoing cervical spine surgery. All patients had neurological symptoms preoperatively. The ILM was inserted with the head and neck in the neutral position. Intubation was facilitated by transillumination of the neck with a lightwand. Cervical movement was recorded with single-frame lateral radiographic images taken 1) immediately before induction (baseline); 2) during ILM insertion (insertion); 3) when transillumination was first seen at the cricothyroid membrane (intubation A); 4) when the tube was being advanced into the trachea (intubation B); and 5) during ILM removal (removal). Radiographic images were digitized and the degree of flexion/extension and posterior movement measured for the occiput (C0) through to C5. During ILM insertion, C0-5 were flexed by an average of 1-1.6 degrees (all P < 0.05). During intubation A/B, C0-4 were flexed by an average of 1.4-3.0 degrees (all P < 0.01), but C5 was unchanged. During ILM removal, C0-3 were flexed by an average of 1 degree (all: P < 0.05), but C3-5 were unchanged. During insertion and intubation A/B, C2-5 were displaced posteriorly by an average of 0.5-1.0 mm (all: P < 0.05). During removal, there was no change at C1-5. Neurological symptoms improved in all patients. We conclude that the ILM produces segmental movement of the cervical spine despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability. IMPLICATIONS: The intubating laryngeal mask produces segmental movement of the cervical spine, despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability.     

颈前路减压植骨融合钢板内固定术治疗脊髓型颈椎病

目的 探讨颈前路减压自体髂骨植骨融合钢板内同定术在治疗脊髓型颈椎病中的应用价值.方法 75例脊髓型颈椎病患者,病变累及1个节段23例,2个节段46例,3个节段6例.经颈前路减压,单间隙为开窗式,余为开槽式.加自体髂骨植骨,加带锁钢板内固定.结果 平均随访12个月,植骨于术后4～5月完全骨性融合.术后恢复之椎间高度未发生丢失现象,颈椎生理曲度维持良好.无脊髓、血管损伤,无钢板、螺钉折断、滑脱等并发症,但有4例术后长期存在吞咽时异物感,有1例进食时有明显梗阻感.JOA评分由平均术前8.1分上升至术后14.1分.手术优良率夏为83.3%.结论 颈前路减压植骨融合钢板内固定术治疗脊髓型颈椎病疗效可靠,宜使用低切迹颈前路钢板内固定. 个节段23例,2个节段46例,3个节段6例.经颈前路减压,单间隙为开窗式,余为开槽式.加自体髂骨植骨,加带锁钢板内固定.结果 平均随访12个月,植骨于术后4～5月完全骨性融合.术后恢复之椎问高度未发生丢失现象,颈椎生理曲度维持良好.无脊髓、血管损伤,无钢板、螺钉折断、滑脱等并发症,但有4例术后长期存在吞咽时异物感,有1例进食时有明显梗阻感.JOA评分由平均术前8.1分上升至术后14.1分. 术优良率夏为83.3%.结论 颈前路减压植骨融合钢板内固定术治疗脊髓型颈椎病疗效可靠,宜使用低切迹颈前路钢板内固定. 个     

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.     

颈椎射频消融术后颈椎感染的翻修手术治疗

目的 :分析颈椎射频消融术后颈椎感染的翻修手术效果。方法 :回顾性分析2010年7月~2016年7月在我科接受翻修手术的9例颈椎射频消融术后颈椎感染患者资料。其中男5例,女4例,年龄51.8±4.3岁(34~61岁),均在接受颈椎射频消融术后1周内(3~7d)神经症状再次出现或加重,其中5例患者神经症状加重程度超过射频消融术前,影像学检查和实验室检查提示存在颈椎感染,9例均存在椎间隙感染,3例伴有硬膜外脓肿,1例伴有椎体感染。入院后行翻修手术治疗,均行颈椎前路病灶清除+植骨融合内固定术,其中3例行椎体次全切除植骨融合内固定术,6例行椎间盘切除植骨融合内固定术。测量评估射频消融术前患者手术节段椎间隙的高度和椎间盘退变情况,用VAS评分评估患者翻修手术前后的颈部及上肢疼痛情况,用JOA评分评估翻修手术前后的神经功能情况。结果:射频消融术前,接受射频消融的11个节段椎间隙相对高度为0.19±0.07(0.14~0.25),Pfirrmann椎间盘退变分级为Ⅲ级4个节段、Ⅳ级7个节段。翻修术后所有患者颈部及上肢疼痛VAS评分及神经功能JOA评分较翻修术前明显改善(P0.05)。平均随访2.8年(1~3.6年)。末次随访时,患者颈部及上肢VAS评分由翻修术前的6.3±1.2分和5.8±2.1分改善到1.6±1.0分和1.5±0.9分(P0.05);JOA评分从翻修术前的9.5±3.8分改善到13.5±3.6分(P0.05)。随访期间未出现植骨不融合等其他并发症。结论:颈椎翻修手术是处理颈椎射频消融术后严重颈椎感染的有效方法。严格控制颈椎射频消融术适应证可以有效减少并发症发生。