Yukawa Yasutsugu, Kato Fumihiko, Ito Keigo, Nakashima Hiroaki, Machino Masaaki
Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-0018, Japan.
Eur Spine J. 2009 Jun;18(6):911-6. doi: 10.1007/s00586-009-0949-1. Epub 2009 Apr 3.
Anterior procedures in the cervical spine are feasible in cases having anterior aetiologies such as anterior neural compression and/or severe kyphosis. Halo vests or anterior plates are used concurrently for cases with long segmental fixation. Halo vests are bothersome and anterior plate fixation is not adequately durable. We developed a new anterior pedicle screw (APS) and plate fixation procedure that can be used with fluoroscope-assisted pedicle axis view imaging. Six patients (3 men and 3 women; mean age, 54 years) with anterior multisegmental aetiology were included in this study. Their original diagnoses comprised cervical myelopathy and/or radiculopathy (n = 4), posterior longitudinal ligament ossification (n = 1) and post-traumatic kyphosis (n = 1). All patients underwent anterior decompression and strut grafting with APS and plate fixation. Mean operative time was 192 min and average blood loss was 73 ml. Patients were permitted to ambulate the next day with a cervical collar. Local sagittal alignment was characterised by 3.5 degrees of kyphosis preoperatively, which improved to 6.8 degrees of lordosis postoperatively and 5.2 degrees of lordosis at final follow-up. Postoperative improvement and early bony union were observed in all cases. There was no serious complication except for two cases of dysphagia. Postoperative imaging demonstrated screw exposure in one screw, but no pedicle perforation. APS and plate fixation is useful in selected cases of multisegmental anterior reconstruction of cervical spine. However, the adequate familiarity and experience with both cervical pedicle screw fixation and the imaging technique used for visualising the pedicle during surgery are crucial for this procedure.
对于存在诸如前路神经受压和/或严重后凸畸形等前路病因的病例，颈椎前路手术是可行的。对于需要长节段固定的病例，同时使用头环背心或前路钢板。头环背心使用不便，而前路钢板固定的耐久性不足。我们开发了一种新的前路椎弓根螺钉（APS）和钢板固定手术，可与荧光透视辅助椎弓根轴位成像配合使用。本研究纳入了6例（3例男性和3例女性；平均年龄54岁）患有前路多节段病因的患者。他们最初的诊断包括脊髓型颈椎病和/或神经根病（n = 4）、后纵韧带骨化（n = 1）和创伤后后凸畸形（n = 1）。所有患者均接受了前路减压、支撑植骨以及APS和钢板固定。平均手术时间为192分钟，平均失血量为73毫升。患者术后第二天即可佩戴颈托下地行走。局部矢状面排列术前为3.5度后凸畸形，术后改善为6.8度前凸畸形，末次随访时为5.2度前凸畸形。所有病例均观察到术后病情改善和早期骨愈合。除两例吞咽困难外，无严重并发症。术后影像学检查显示一枚螺钉有螺钉外露，但无椎弓根穿孔。APS和钢板固定在颈椎多节段前路重建的特定病例中是有用的。然而，对于该手术而言，充分熟悉颈椎椎弓根螺钉固定以及手术中用于观察椎弓根的成像技术并具备相关经验至关重要。
