Wilson Peter John, Selby Michael Derrick
Department of Neurosurgery, Prince of Wales Public and Private Hospitals, Sydney, Australia.
Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, Australia.
J Spine Surg. 2017 Dec;3(4):561-566. doi: 10.21037/jss.2017.10.05.
C7 has relatively unique anatomy compared to the remainder of the subaxial cervical spine (C3-C6) and upper thoracic spine. The C7 laminar has been previously reported in feasibility and biomechanical studies as an adequate fixation point in contrast to the lateral mass or pedicles, with few reports of its use in clinical practice. The purpose of this study was to review the safety and efficacy of using the C7 laminar as a fixation point in constructs involving the cervical spine and cervicothoracic junction.
Between February 2013 and July 2016, 10 patients (6 males, 4 females) had 19 C7 intra-laminar screws sited (bilateral in 9 patients, unilateral in 1 patient). Six patients had trauma as an underlying etiology, 2 of which had pseudoarthrosis from prior surgery. Three patients had cervical myelopathy from degenerative disease, 2 of which required anterior and posterior instrumentation for correction of deformity and 1 which had stand-alone posterior fixation. One patient had stabilization for an underlying malignancy.
One patient died 2 weeks following their high cervical injury secondary to complications of respiratory failure. None of the remaining 9 patients were noted to have construct failure at a median follow up of 1 year (range, 6 months to 4 years) and all were noted to have satisfactory positioning of the instrumentation on post-operative imaging. The patient with malignancy died 6 months later from extra-spinal disease, there was one wound breakdown requiring debridement without infection in a revision case, and one patient required laminectomy for post-traumatic syrinx formation.
The C7 laminar provides an alternative fixation point for constructs involving the subaxial cervical spine and cervicothoracic junction, with excellent safety and efficacy in this small series. Larger series are required to more clarify the risk profile of this technique.
与下颈椎（C3 - C6）和上胸椎的其余部分相比，C7具有相对独特的解剖结构。先前在可行性和生物力学研究中报道，与侧块或椎弓根相比，C7椎板是一个合适的固定点，但在临床实践中其应用报道较少。本研究的目的是回顾在涉及颈椎和颈胸交界区的结构中使用C7椎板作为固定点的安全性和有效性。
2013年2月至2016年7月期间，10例患者（6例男性，4例女性）置入了19枚C7椎板内螺钉（9例双侧置入，1例单侧置入）。6例患者的潜在病因是创伤，其中2例有既往手术导致的假关节形成。3例患者因退行性疾病导致颈椎脊髓病，其中2例需要前后联合器械矫正畸形，1例仅行后路固定。1例患者因潜在的恶性肿瘤行固定术。
1例患者因高位颈髓损伤继发呼吸衰竭并发症，在伤后2周死亡。其余9例患者在中位随访1年（范围6个月至4年）时均未出现内固定失败，且术后影像学检查显示所有患者的内固定位置均满意。恶性肿瘤患者6个月后因脊柱外疾病死亡，1例翻修病例出现1次伤口裂开需要清创但无感染，1例患者因创伤后脊髓空洞形成需要行椎板切除术。
在本小样本系列研究中，C7椎板为涉及下颈椎和颈胸交界区的结构提供了一个替代固定点，具有良好的安全性和有效性。需要更大样本量的研究来进一步明确该技术的风险概况。
