Hwang In Chang, Kang Dong-Ho, Han Jong Woo, Park In Sung, Lee Chul Hee, Park Sun Young
Department of Neurosurgery, Gyeongsang National University, School of Medicine, Jinju, Korea.
J Korean Neurosurg Soc. 2007 Oct;42(4):311-6. doi: 10.3340/jkns.2007.42.4.311. Epub 2007 Oct 20.
The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis.
Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery.
A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis.
Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.
本研究旨在探讨多轴螺钉-棒系统用于枕颈胸后路融合术的安全性、手术疗效及优势。
回顾性分析2004年10月至2006年2月期间接受颈椎后路固定的32例患者的病历和影像学资料。颈椎后路多轴螺钉-棒固定应用于颈椎和/或上胸椎。手术适应证为骨折或脱位18例，C1-2韧带损伤伴创伤5例，类风湿关节炎（RA）或弥漫性特发性骨肥厚（DISH）导致的寰枢椎不稳4例，脊髓型颈椎病4例，脊柱转移瘤1例。术后1、3、6个月及1年对患者进行随访，根据临床情况和影像学资料进行评估。
32例患者共植入189枚螺钉。平均固定3.3个脊柱节段（范围2至7个）。平均随访时间为20.2个月。该系统可将螺钉置入枕骨、C1侧块、C2椎弓根、C3-7侧块以及下颈椎和上胸椎椎弓根。所有病例术后屈伸位X线片和计算机断层扫描（CT）均显示获得满意的骨融合和复位。2例因深部伤口感染需要翻修手术。1例因坏死改变需要植皮。1例因相邻节段退变出现后凸畸形。未出现其他并发症，如脊髓或椎动脉损伤、脑脊液漏、螺钉位置不当或退出、植入物失败，也没有因椎间孔狭窄导致术后神经根病的病例。
颈椎后路多轴螺钉-棒系统固定是一种安全可靠的技术，似乎比现有方法具有多种优势。为确定该手术的真正益处，还需要进一步的生物力学测试和临床经验。
