Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
J Neurosurg Spine. 2012 Mar;16(3):251-6. doi: 10.3171/2011.11.SPINE11458. Epub 2011 Dec 9.
Both ventral and dorsal operative approaches have been used to treat unilateral cervical facet injuries. The gold standard ventral approach is anterior cervical discectomy and fusion. There is, however, no clear gold standard dorsal operation. In this study, the authors tested the stability of multiple posterior constructs, including unilateral lateral mass fixation supplemented by an interspinous cable.
Six fresh human cervical spine specimens (C3-T1) were tested by applying pure moments to the C-3 vertebral body in increments of 0.5 Nm from 0 Nm to 2.0 Nm. Each specimen was tested in the following 8 conditions (in the order shown): 1) intact; 2) after destabilization via injury to the C5-6 facet; 3) with bilateral C5-6 lateral mass screws and rods; 4) after further destabilization by creating a right unilateral lateral mass fracture of C-5 (which rendered secure screw placement into the right C-5 lateral mass impossible); 5) with unilateral left C5-6 lateral mass screws and rod; 6) with unilateral C5-6 lateral mass screws and rod supplemented with an interspinous cable; 7) with a bilateral multilevel dorsal construct C4-6; and 8) after a C5-6 anterior cervical discectomy and fusion (ACDF) procedure with a polyetheretherketone graft and plate.
The bilateral C5-6 lateral mass construct reduced the range of C5-6 motion to 33.6% of normal. The unilateral C5-6 lateral mass construct resulted in an increased range of motion to 110.1% of normal. The unilateral lateral mass construct supplemented by an interspinous cable reduced the C5-6 range of motion to 89.4% of normal. The bilateral C4-6 lateral mass construct reduced the C5-6 range of motion to 44.2% of normal. The C5-6 ACDF construct reduced the C5-6 range of motion to 62.6% of normal.
The unilateral lateral mass construct supplemented by an interspinous cable does reduce range of motion compared with an intact specimen, but is significantly inferior to a C4-6 bilateral lateral mass construct. When using a dorsal approach, the unilateral construct with a cable should only be considered in selected instances.
经腹侧和背侧手术入路均已用于治疗单侧颈椎关节突损伤。金标准的腹侧入路是前路颈椎间盘切除融合术。然而，背侧手术没有明确的金标准。在这项研究中，作者测试了多种后路结构的稳定性，包括单侧侧块固定加棘间线缆。
对 6 个新鲜的人体颈椎标本（C3-T1）进行测试，在 C3 椎体上施加 0.5Nm 增量的纯力矩，范围从 0Nm 到 2.0Nm。每个标本按以下 8 种情况进行测试（按所示顺序）：1）完整；2）通过损伤 C5-6 关节突使颈椎不稳；3）双侧 C5-6 侧块螺钉和棒固定；4）进一步通过造成 C-5 单侧侧块骨折使颈椎不稳（这使得无法将螺钉安全地固定到右侧 C-5 侧块上）；5）单侧左侧 C5-6 侧块螺钉和棒固定；6）单侧 C5-6 侧块螺钉和棒固定加棘间线缆；7）双侧 C4-6 多节段背侧结构固定；8）C5-6 前路颈椎间盘切除融合术（ACDF）后，采用聚醚醚酮移植物和钢板。
双侧 C5-6 侧块固定使 C5-6 运动范围减少到正常的 33.6%。单侧 C5-6 侧块固定使运动范围增加到正常的 110.1%。单侧侧块固定加棘间线缆使 C5-6 运动范围减少到正常的 89.4%。双侧 C4-6 侧块固定使 C5-6 运动范围减少到正常的 44.2%。C5-6 ACDF 结构使 C5-6 运动范围减少到正常的 62.6%。
单侧侧块固定加棘间线缆确实减少了运动范围，与完整标本相比，但明显不如双侧 C4-6 侧块固定。当使用背侧入路时，只有在特定情况下才应考虑使用带线的单侧结构。
