Abumi K, Kaneda K, Shono Y, Fujiya M
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
J Neurosurg. 1999 Jan;90(1 Suppl):19-26. doi: 10.3171/spi.1999.90.1.0019.
This retrospective study was conducted to analyze the results of one-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems in 46 patients.
Causes of cervical myelopathy in these 46 patients included spondylosis or ossification of the posterior longitudinal ligament, rheumatoid arthritis, metastatic or primary vertebral tumors, cervical spinal injuries, and spinal cord tumor. Thirty-three patients underwent this one-stage procedure as primary surgery. In the remaining 13 patients who had previously undergone laminectomies, the one-stage procedure was performed as salvage surgery. Cervical pedicle screws were inserted into the pedicles after probing and tapping. Graft bone was placed on the bilateral lateral masses, and pedicle screws were interconnected longitudinally by either plates or rods. Postoperatively, 26 patients showed improved neurological status (at least one grade improvement on Frankel's functional classification). There were no cases of neurological deterioration postoperatively. Solid bony fusion was obtained in all patients, except in seven patients with metastatic tumor who did not receive bone grafts. Correction of kyphosis was satisfactory. Postoperative radiological evaluation revealed that 10 (5.3%) of 190 screws inserted into the cervical vertebrae had perforated the cortex of the pedicles; however, no neurovascular complications were caused by the perforations.
The pedicle screw fixation procedure, which does not require the lamina to be used as a stabilizing anchor, has proven to be valuable when performing one-stage posterior decompressive and reconstructive surgery in the cervical spine. The risk to neurovascular structures in this procedure, however, cannot be completely eliminated. Thorough knowledge of local anatomy and application of established surgical techniques are essential for this procedure.
本回顾性研究旨在分析46例患者采用椎弓根螺钉固定系统进行颈椎一期后路减压与重建的结果。
这46例脊髓型颈椎病患者的病因包括颈椎病或后纵韧带骨化、类风湿关节炎、转移性或原发性椎体肿瘤、颈椎损伤以及脊髓肿瘤。33例患者将此一期手术作为初次手术。其余13例先前接受过椎板切除术的患者，将此一期手术作为挽救性手术。在探查和攻丝后将颈椎椎弓根螺钉植入椎弓根。将植骨块置于双侧侧块上，并用钢板或棒将椎弓根螺钉纵向连接。术后，26例患者神经功能状态改善（Frankel功能分级至少提高一级）。术后无神经功能恶化病例。除7例未接受植骨的转移性肿瘤患者外，所有患者均获得了坚实的骨融合。后凸畸形矫正效果满意。术后影像学评估显示，190枚植入颈椎的螺钉中有10枚（5.3%）穿出椎弓根皮质；然而，这些穿孔未引起神经血管并发症。
椎弓根螺钉固定手术无需将椎板用作稳定锚定物，已证明在颈椎一期后路减压和重建手术中具有价值。然而，该手术中神经血管结构的风险无法完全消除。对局部解剖结构的透彻了解和成熟手术技术的应用对该手术至关重要。
