Clinical presentation of patients with acute cervical spine injury

A retrospective review of 67 patients with acute cervical spine fracture and/or dislocation was conducted at two suburban community hospital emergency departments. The mean age was 39, and two-thirds of the patients were male. Motor vehicle accidents and falls accounted for more than 80% of all injuries. On emergency department evaluation, it was found that there was no history of loss of consciousness in 42 patients (63%), no associated cranio-facial injuries in 31 patients (46%), and a normal sensorimotor examination in 59 patients (88%). Thirty-four patients (50%) were evaluated for cervical range of motion, which was found to be normal in one-third of the cases. The absence of mental status changes, cranio-facial injuries, range of motion abnormalities, and focal neurological findings is, therefore, not uncommon in patients who have sustained cervical spine injury.     

术中CT导航和单纯术中CT扫描辅助下颈椎椎弓根螺钉内固定技术的对比研究

目的探讨使用术中CT导航和单纯术中CT扫描辅助下进行下颈椎椎弓根螺钉内固定的临床效果。方法总结诊断为颈椎病、颈椎外伤、颈椎肿瘤而行CT辅助颈椎椎弓根螺钉内固定的65例老年患者的临床资料。根据术中是否采用CT导航将患者分为术中CT导航组和术中非CT导航组。术后进行经椎弓根螺钉水平的CT平扫,观察椎弓根螺钉置入的精确性。对2组椎弓根螺钉置钉的准确率、翻修率、置钉时间和术中CT的扫描数据进行比较。结果术中CT导航组椎弓根螺钉的穿破率和平均置钉时间显著低于非CT导航组（P〈0.05或P〈0.01）。2组病例均未出现明显的神经、血管损伤并发症。在2组中均没有因内置物位置不佳而行二次手术的病例。结论术中CT导航系统辅助进行颈椎椎弓根螺钉内固定是可行的,能够显著提高后路颈椎椎弓根螺钉置钉的精确性,同时医护人员无X射线暴露。     

颈椎手术后出现吞咽困难的相关因素分析

目的 分析颈椎前路及后路手术后出现吞咽困难的相关因素.方法 颈椎手术患者354例,其中行颈椎前路手术172例（AC组）,颈椎后路手术182例（PC组）;术后随访平均28个月,了解患者术后当天及1、3、6、12个月吞咽困难发生情况.采用单因素及二元Logistic回归模型,分析患者临床资料与与吞咽困难发生的关系.结果 两组术后各时点吞咽困难发生率及严重程度比较,P均＞0.05.单因素分析结果显示,两组吞咽困难发生均与年龄、性别、BMI、翻修手术比例、手术时间、出血量无关,P均＞0.05.二元Logistic回归分析结果显示,性别、年龄、BMI、手术方式（AC或PC）、手术节段数目、最高手术节段水平、翻修手术比例、手术时间、出血量等与术后吞咽困难的发生无显著关联,P均＞0.05.结论 颈椎手术后吞咽困难的发生不受患者性别、年龄、BMI、手术时间、出血量、手术方式、翻修手术比例、手术节段数目、最高手术节段水平等因素的影响.     

Osteomyelitis of the cervical spine: reversible quadraplegia resulting from Philadelphia collar placement

Pyogenic osteomyelitis of the vertebrae accounts for 4% of all osteomyelitis, and is believed to be increasing in incidence. Pyogenic osteomyelitis of the cervical spine is even more uncommon, accounting for 10% of all spinal pyogenic osteomyelitis. Presented is a case of pyogenic osteomyelitis of the cervical spine in which appropriate methods of immobilization of the cervical spine resulted in a surgically reversible acute deterioration of the patient's neurologic status. While immobilization of the cervical spine remains the initial treatment of choice in most patients with suspected disease of the cervical spine, it is not without potential complications.     

An unusual presentation of bilateral facet dislocation of the cervical spine

We report the case of a patient who presented complaining of neck pain after a fall. Initial physical examination was remarkable for an occipital scalp contusion and tenderness to palpation in the mid-cervical spine. Neurological examination demonstrated an absence of response to pinprick below approximately the T4 level. Upper extremities had equal withdrawal to pain and lower extremities were without movement. Initial cervical, thoracic, and lumbar spine films were normal. An emergency myelogram demonstrated a complete extradural block at the C6 level. Cross-table lateral cervical spine films revealed a C5-C6 bilateral facet dislocation. The patient subsequently underwent closed reduction with in-line-traction. He had a prolonged hospital course and was eventually transferred for rehabilitation, with some improvement in neurologic status.     

无创通气在颈椎损伤并呼吸衰竭救治中的评估

目的评估无创通气在颈椎损伤并发呼吸衰竭救治中的作用。方法19例颈椎损伤致高位截瘫并呼吸衰竭的住院患者,比较无创通气前后血气变化,及治疗结果。结果病人应用无创通气后1h和24h的血气均明显改善,但19例患者中有12例在第2～5天符合治疗标准而行气管插管或气管切开人工支持通气,另2例分别在第9、10天行气管切开。只有2例患者成功脱离无创通气,3例因脓毒症、MODF死亡。无创通气并发症包括鼻部压伤和胃胀气。结论无创通气在颈椎损伤并呼吸衰竭救治中并不是最佳选择,及早实施气管插管或气管切开术可避免一些严重并发症的发生。     

Use of plain radiography to screen for cervical spine injuries.

STUDY OBJECTIVE: Standard radiographic screening may fail to reveal any evidence of injury in some patients with spinal injury. The purposes of this investigation were to document the efficacy of standard radiographic views and to categorize the frequencies and types of injuries missed on plain radiographic screening of the cervical spine. METHODS: All patients with blunt trauma selected for radiographic cervical spine imaging at 21 participating institutions underwent a standard 3-view series (cross-table lateral, anteroposterior, and odontoid views), as well as any other imaging deemed necessary by their physicians. Injuries detected with screening radiography were then compared with final injury status for each patient, as determined by review of all radiographic studies. RESULTS: The study enrolled 34,069 patients with blunt trauma, including 818 patients (2.40% of all patients; 95% confidence interval [CI] 2.40% to 2.40%) having a total of 1,496 distinct cervical spine injuries. Plain radiographs revealed 932 injuries in 498 patients (1.46% of all patients; 95% CI 1.46% to 1.46%) but missed 564 injuries in 320 patients (0.94% of all patients; 95% CI 0.94% to 0.94%). The majority of missed injuries (436 injuries in 237 patients [representing 0.80% of all patients]; 95% CI 0.80% to 0.80%) occurred in cases in which plain radiographs were interpreted as abnormal (but not diagnostic of injury) or inadequate. However, 23 patients (0.07% of all patients; 95% CI 0.05% to 0.09%) had 35 injuries (including 3 potentially unstable injuries) that were not visualized on adequate plain film imaging. These patients represent 2.81% (95% CI 1.89% to 3.63%) of all injured patients with blunt trauma undergoing radiographic evaluation. CONCLUSION: Standard 3-view imaging provides reliable screening for most patients with blunt trauma. However, on rare occasions, such imaging may fail to detect significant unstable injuries. In addition, it is difficult to obtain adequate plain radiographic imaging in a substantial minority of patients.     

Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis

Axial traction is widely recommended for stabilization of cervical spine fractures. This procedure may be inappropriate and even dangerous in patients with long-standing ankylosing spondylitis (AS). We present the case of an 80-year-old woman with AS who fell at home and suffered an unstable large C5-C6 fracture/dislocation associated with left-sided weakness and decreased sensation. Medical treatment included placing her neck in a neutral position, despite her preference for neck flexion. This procedure increased her pain and paresthesias; the complications decreased, but did not entirely resolve, when the patient resumed a semi-flexed position. This patient's neurologic sequelae may have been exacerbated by attempts to stabilize her neck in a neutral position. Standard stabilization recommendations should be appropriately altered in some patients with cervical spine AS.     

Treatment of upper cervical spine involvement in rheumatoid arthritis patients

The cervical spine, especially the upper cervical spine, is a common focus of destruction by rheumatoid arthritis (RA). Because of its potentially debilitating and life-threatening sequelae, cervical spine involvement remains a priority in the diagnosis and treatment of RA. Many studies show that early surgical intervention gives a more satisfactory outcome. Surgery aims to establish spinal stability and to prevent neurological deterioration and injury to the spinal cord, leading to improved neurological function. The recent sophisticated screw-rod-plate technique allows one to obtain a solid fixation of the upper cervical spine with a high possibility of bone union even in RA patients. Although surgery of the occipitoatlantoaxial region is a challenge with many possibilities of serious complications, recent advances in the surgical technique, complete understanding of the anatomy, and precise preoperative evaluation have decreased complication rates. Early consultation with a specialized spine surgeon is mandatory once cervical involvement is suspected in an RA patient because once the patient becomes myelopathic, the rate of long-term mortality increases and the chance of neurological recovery decreases.     

Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases

The value of lateral view cervical spine radiography in various positions of the neck was assessed in patients with rheumatoid atlantoaxial subluxation (AAS). We wanted to find out how much information is lost if only neutral position radiographs are used. The series consisted of 65 rheumatoid patients with unstable AAS. Lateral view cervical spine radiographs were taken in the neutral position and during flexion and extension. Neutral position radiographs would have failed to confirm the diagnosis of AAS in 31 cases (48%) and would have failed to record its true severity in 43 cases (66%); their diagnostic sensitivity was 52%. The sensitivity of the neutral radiographs in showing the reversibility of AAS was 48%. Routine cervical spine radiography of rheumatoid patients should include lateral view radiographs taken during flexion and extension. The result may be applied to magnetic resonance imaging, which is usually performed in the neutral position.     

Why Atlas, why not Heracles: reflections on the rheumatoid cervical spine

Rheumatoid involvement of the 24 joints of the cervical spine leads to prominent changes in the occipito-atlanto-axial area. Eight different subtypes of such changes are recognized, depicted, and defined. The frequencies of these 8 subtypes in rheumatoid arthritis and other arthritides are tabulated. A central role in these disorders is played by a small-size, heavy-duty fitting piece or adapter, atlas, between the occiput and C2. The history of the fate of Atlas, who led the fight of godlike titans against the new gods of Olympos, is recapitulated. In particular, for a short moment Atlas was released from his heavy physical ordeal by another strongman, the heavy-weight wrestler of his times, Heracles. The reasons for the current nomenclature and answer to the question "Why Atlas, why not Heracles" are provided.     

痛风性关节炎的 X 线平片、CT 和 MR 的对比研究

目的：对比研究痛风性关节炎的 X 线平片、CT 和 MRI 表现,并探讨临床资料与影像学表现的关系。方法选择33例患者的54个确诊为痛风性关节炎的关节为研究对象,上午空腹查血尿酸,下午记录临床资料,并做平片、CT 和 MRI 检查。影像表现的评价指标包括痛风石、骨质破坏、软组织肿胀、关节积液、滑膜增厚和骨髓水肿。统计分析方法包括卡方检验、独立样本 t 检验和逻辑回归分析。结果卡方检验分析不同检查方法下痛风石阳性的关节数(CT>平片、MR>平片, P<0.01),软组织肿胀(MR>CT>平片,P<0.01),关节积液(MR>CT, P<0.01)。此外,MRI 发现骨髓水肿35例,滑膜增厚50例。独立样本 t检验显示有痛风石的患者病程长于无痛风石的患者(P<0.01)。 Logstic 回归分析痛风石的致病因素,骨质破坏和病程入选(P<0.01)。结论对于痛风的早期诊断,MRI 优于 CT 和平片。痛风石和骨质破坏可能不会影响血尿酸水平。随着病程的延长,痛风石形成的几率也升高。痛风石的形成与骨质破坏可能是相互促进的关系。     

Occipitocervicothoracic fixation using a hook and rod system for patients with rheumatoid cervical spine

We retrospectively examined the outcomes of occipitocervicothoracic fixation using a hook and rod system for rheumatoid patients with cervical myelopathy in which decompression of the spinal cord and spinal fusion were performed simultaneously at multiple levels. There were 10 female patients with rheumatoid arthritis (ages 51–77 years, average 62.8 years; follow-up period 6 months to 3 years and 9 months, average 2 years and 8 months). Atlantoaxial subluxation was found in 5 patients, vertical subluxation in 4 patients, and subaxial subluxation in 8 patients. The progression of the disorder was assessed as class 4 stage 4 in 3 patients and class 3 stage 4 in 7 patients. The average time taken for surgery was 4 h 41 min, and the average volume of blood loss was 729 ml. There were no complications during surgery. One patient died of malignant lymphoma 1 month after surgery, and one patient died of heart failure 2 years and 3 months after surgery. The average Japanese Orthopaedic Association (JOA) score improved from 7.0 preoperatively to 9.5 postoperatively. Preoperative nuchal pain in 3 patients and difficulty in breathing on flexion of the cervical spine in 2 patients were improved after surgery. Good bony union was obtained in 9 patients. The exception being one patient who died of a disease unrelated to the surgery 1 month postoperatively. Occipitocervicothoracic fixation using a hook and rod system is an easy and safe procedure, and can facilitate not only good bony union, but also adequate decompression of the spinal cord with simultaneous laminoplasty because of the secure long fixation extending to the upper thoracic level and bilateral grafting of a considerable volume of bone.