Mehdian S M, Freeman B J, Licina P
The Centre for Spinal Studies and Surgery, University Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Eur Spine J. 1999;8(6):505-9. doi: 10.1007/s005860050215.
Ankylosing spondylitis can produce severe fixed flexion deformity in the cervical spine. This deformity may be so disabling that it interferes with forward vision, chewing, swallowing and skin care under the chin. The only treatment available is an extension osteotomy of the cervical spine. Existing techniques of cervical osteotomy may be associated with risk of neurological injury. We describe a variation on an existing technique, which provides a controlled method of reduction at the osteotomy site, eliminating sagittal translation. The method employs a modular posterior cervical system consisting of lateral mass and thoracic pedicle screws linked to titanium rods. Our technique substitutes the titanium rod with a temporary malleable rod on one side, allowing controlled reduction of the osteotomy as this rod bends and slides through the thoracic clamps. Once reduction is complete definitive contoured rods are inserted to maintain the correction while fusion takes place. This method appears less hazardous by eliminating sagittal translation, and may reduce the risk of neurological injury during surgery. It achieves rigid internal fixation, obviating the need for a halo vest in the postoperative period.
强直性脊柱炎可导致颈椎出现严重的固定性屈曲畸形。这种畸形可能会严重致残，影响向前视物、咀嚼、吞咽以及下巴下方的皮肤护理。唯一可行的治疗方法是颈椎截骨延长术。现有的颈椎截骨技术可能伴有神经损伤风险。我们描述了一种对现有技术的改进方法，该方法在截骨部位提供了一种可控的复位方式，消除矢状面移位。该方法采用一种模块化的颈椎后路系统，由侧块螺钉和胸椎椎弓根螺钉与钛棒相连组成。我们的技术在一侧用临时可塑形棒替代钛棒，当该棒弯曲并滑过胸椎夹时，可实现截骨部位的可控复位。一旦复位完成，插入定制的定型棒以维持矫正效果，同时进行融合。这种方法通过消除矢状面移位，似乎危险性较小，并且可能降低手术期间神经损伤的风险。它实现了坚固的内固定，无需在术后使用头环背心。
