Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2009 Sep 5;122(17):1985-9.
Reports of applying cervical pedicle screw (CPS) system in the posterior cervical spine surgeries are limited because of its inherent risk of neurovascular injury. The clinical results of cervical spine instability treated with CPS system were retrospectively analyzed, and the clinical efficacy and safety of this management were evaluated.
Twenty-five patients with cervical spine instability undergoing posterior C3 - C7 single/double door laminoplasty and free-hand CPS fixation as well as graft fusion were investigated; of whom, 3 were due to trauma, and 22 degenerative cervical pathogenesis. One hundred and fifty in total, CPSs were implanted in 5 cervical segments for 1 patient, 4 for 2, 3 for 18, and 2 for 4. Japanese Orthopaedic Association (JOA) score and its improvement rate, neck disability index (NDI), segmental stability, pedicle cortex perforation rate and other complication-associated parameters were assessed.
The average follow-up was 16.6 (6 - 30) months. Compared with pre-operative values, JOA score improved by 4.10 +/- 0.84 points on average (P < 0.05) at 6 months post operation, with a mean improvement rate of 61%. While the pre-operative and 6-month post-operative NDI were 32.96 +/- 6.13 and 16.84 +/- 4.40 (P < 0.05), respectively. At 6-month post-operation and the final follow-up, fused segments were stable. Pedicle cortex perforation rate was 8.0%, with no neurovascular complications observed.
Anatomizing the pre-operative radiographic data facilitates the precise operative design prior to surgery; and CPS system is capable of offering safe and satisfying outcomes in the management of cervical spine instability.
由于颈椎椎弓根螺钉（CPS）系统存在神经血管损伤的固有风险，因此应用于颈椎后路手术的报道有限。回顾性分析颈椎不稳患者采用 CPS 系统治疗的临床效果，评估该治疗方法的临床疗效和安全性。
对 25 例颈椎不稳患者行后路 C3-C7 单开门或双开门椎管扩大成形术及徒手 CPS 固定植骨融合术治疗。其中，创伤 3 例，退变性颈椎病变 22 例。共植入 150 枚 CPS，1 例植入 5 个颈椎节段，2 例植入 4 个，18 例植入 3 个，4 例植入 2 个。评估日本骨科协会（JOA）评分及其改善率、颈部残疾指数（NDI）、节段稳定性、椎弓根皮质穿孔率及其他并发症相关参数。
平均随访 16.6（6-30）个月。与术前相比，术后 6 个月平均 JOA 评分提高 4.10±0.84 分（P＜0.05），平均改善率为 61%；NDI 分别为术前 32.96±6.13、术后 6 个月 16.84±4.40（P＜0.05）。术后 6 个月及末次随访时融合节段稳定，椎弓根皮质穿孔率为 8.0%，无神经血管并发症。
术前对影像学资料进行解剖分析有助于术前精确设计手术方案；CPS 系统在治疗颈椎不稳方面能提供安全、满意的效果。
