Hong Jae Taek, Sung Jae Hoon, Son Byung Chul, Lee Sang Won, Park Chun Kun
Department of Neurosurgery, Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.
Spine (Phila Pa 1976). 2008 Jul 15;33(16):1739-43. doi: 10.1097/BRS.0b013e31817d2aa2.
We retrospectively reviewed 11 patients who underwent laminar screw fixation in the subaxial cervical spine. In 4 patients, laminar screws were inserted for posterior cervical arthrodesis, and in 7 patients it was used for fixation of the open laminae during laminoplasty.
In this study, the author describes the technique and surgical results of translaminar screw placement in the subaxial cervical spine.
The use of laminar screws for fixation of the second cervical vertebra and upper thoracic vertebrae has been introduced as an important technique in spinal surgery because they can avoid injury to adjacent neurovascular structures. However, there have been no reports of translaminar screw use in the subaxial spine including C7. In this study, we describe the use of translaminar screws for fixation of the subaxial cervical spine in cases of degenerative or traumatic spine disease.
Between June 2006 and March 2007, 34 translaminar screws were placed in 11 patients to treat trauma or degenerative disease: 6 at C7, 6 at C6, 7 at C5, 7 at C4, 7 at C3, and 1 at T1. There were 6 women and 5 men. The ages ranged from 23 to 87 years with a mean age of 61.3 years. All patients were evaluated at 6 weeks, as well as at 3 and 6 months using flexion and extension lateral radiographs. Patients requiring fusion were also evaluated with computed tomography at 3 and 6 months to verify arthrodesis.
The mean follow-up period was 5.7 months, at which time there was no significant complications from laminar screw placement, except for 2 asymptomatic breaches of the dorsal lamina cortex. Sound bone fusion was identified in cases where arthrodesis was the goal. No screw pullout or avulsion was identified in the laminoplasty cases.
The translaminar screw method avoided damaging vascular structures, especially when the vertebral artery courses in the C7 transverse foramen, and it maintains solid stabilization of the subaxial cervical spine. This technique has 2 important advantages to currently used techniques: it is simpler and is not limited by the position of vascular structures. Therefore, it may be applicable to a wider number of patients, especially as it may be used in the subaxial cervical spine.
我们回顾性分析了11例行下颈椎椎板螺钉固定术的患者。其中4例患者，椎板螺钉用于后路颈椎融合术；7例患者，椎板螺钉用于椎板成形术时开放椎板的固定。
在本研究中，作者描述了下颈椎经椎板螺钉置入技术及手术结果。
椎板螺钉用于第二颈椎和上胸椎的固定已作为脊柱外科的一项重要技术被引入，因为它们可避免损伤相邻的神经血管结构。然而，尚无关于包括C7在内的下颈椎使用经椎板螺钉的报道。在本研究中，我们描述了经椎板螺钉在下颈椎退变性或创伤性脊柱疾病病例中的应用。
2006年6月至2007年3月期间，11例患者共置入34枚经椎板螺钉以治疗创伤或退变性疾病：C7置入6枚，C6置入6枚，C5置入7枚，C4置入7枚，C3置入7枚，T1置入1枚。其中女性6例，男性5例。年龄范围为23至87岁，平均年龄61.3岁。所有患者在6周时以及3个月和6个月时均采用颈椎屈伸位侧位X线片进行评估。需要融合的患者在3个月和6个月时还进行了CT检查以确认融合情况。
平均随访期为5.7个月，此时除2例无症状的椎板皮质背侧破裂外，经椎板螺钉置入未出现明显并发症。以融合为目标的病例实现了良好的骨融合。在椎板成形术病例中未发现螺钉拔出或撕脱。
经椎板螺钉方法避免了损伤血管结构，尤其是当椎动脉走行于C7横突孔时，并且它能维持下颈椎的稳固稳定。该技术相对于目前使用的技术有两个重要优点：它更简单且不受血管结构位置的限制。因此，它可能适用于更多患者，特别是可用于下颈椎。
