Giannini Sandro, Faldini Cesare, Pagkrati Stavroula, Grandi Gianluca, Romagnoli Matteo, Merlini Luciano
Orthopaedic Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
Spine (Phila Pa 1976). 2006 Jul 15;31(16):1805-9. doi: 10.1097/01.brs.0000225971.26117.bf.
Seven patients affected by Duchenne muscular dystrophy with neck hyperextension or poor head control in extension have undergone surgery consisting of posterior cervical interspinous fusion.
To report the results of surgical treatment of neck hyperextension executed simultaneously with the correction of the thoracolumbar scoliosis.
A severely progressive deformity of the spine in patients affected by DMD can involve also the cervical spine presenting a rigid neck hyperextension or poor head control in extension, forcing the patients to assume awkward compensating postures in order to look straight ahead, worsening significantly their quality of life.
The procedure consisted of a posterior approach to the cervical spine, correction of the hyperextension by releasing the fibrotic muscles and ligaments, and stabilization with bone grafts driven into the interspinous spaces, to achieve solid fusion.
No surgical complications were observed, and fusion was achieved in all patients. The mean angle between C2-C7 decreased from an average of 29.8 degrees (7 degrees -56 degrees) before surgery, to an average of 18.5 degrees (6 degrees-30 degrees) at 1 year of follow-up. Range of motion between C1-C2 was preserved.
Surgical treatment of neck hyperextension in these patients contributes to a better sitting position, to an easier nursing, to a better appearance.
7例患有杜氏肌营养不良症且存在颈部过伸或伸展时头部控制不佳的患者接受了后路颈椎棘突间融合手术。
报告在矫正胸腰椎脊柱侧弯的同时对颈部过伸进行手术治疗的结果。
杜氏肌营养不良症患者严重的进行性脊柱畸形也可累及颈椎，表现为僵硬的颈部过伸或伸展时头部控制不佳，迫使患者采取笨拙的代偿姿势以便直视前方，显著恶化他们的生活质量。
该手术包括颈椎后路入路，通过松解纤维化的肌肉和韧带矫正过伸，并通过植入棘突间的骨 graft 进行稳定，以实现牢固融合。
未观察到手术并发症，所有患者均实现融合。C2-C7之间的平均角度从术前平均29.8度（7度-56度）降至随访1年时的平均18.5度（6度-30度）。C1-C2之间的活动范围得以保留。
对这些患者的颈部过伸进行手术治疗有助于改善坐姿、便于护理、改善外观。
