Madan Ankit, Thakur Manoj, Sud Sachin, Jain Vaibhav, Singh Thakur Rudra Pratap, Negi Virender
Department of Orthopaedics, Indira Gandhi Medical College, Shimla, Himachel Pardesh, India.
Asian J Neurosurg. 2019 Jul-Sep;14(3):843-847. doi: 10.4103/ajns.AJNS_331_17.
This is prospective study.
The purpose of this study is to assess the functional, neurological, and radiological outcomes of the patients of subaxial cervical spine injuries treated by anterior corpectomy and stabilization with anterior cervical locking plate and cage filled with bone.
The principles in the treatment of unstable cervical spine injuries are reduction and stabilization of the injured segment, maintenance of cervical lordosis and decompression where indicated and ranges from nonoperative to combined anterior and posterior surgical fusion. There is, however, debate on the indications for anterior, posterior, or combined surgery.
The present study of 99 patients includes prospective patients of subaxial cervical spine injuries between February 2014 and February 2016 admitted and operated to Indira Gandhi Medical College, Shimla. Bony fusion, neurological recovery, Neck Disability Index and complication were studied in all patients. The mean follow-up period was 27 months (range 12-42 months).
Of the 99 procedures, 77 (77.8%) involved a single vertebral level, 19 (19.2%) involved two levels, and 3 (3%) involved three levels corpectomy. The mean Neck Disability Index was 7.57 ± 5.42. Definitive Bridwell Grade 1 fusion was seen in 64.6% of the cases. No deterioration of neurological symptoms was seen. Dysphagia was the most common complication in 79 (79.8%) patients. One patient had minimal screw back out.
Anterior cervical corpectomy and stabilization with cage filled with bone and cervical reflex locking plate are good method for subaxial cervical spine injuries with good fusion rates and probably procedure of choice for posttraumatic multiple disc prolapse with reduced hazards of multiple grafts.
这是一项前瞻性研究。
本研究的目的是评估接受前路椎体次全切除并采用前路颈椎锁定钢板及植骨融合器进行稳定手术的下颈椎损伤患者的功能、神经及影像学结果。
治疗不稳定颈椎损伤的原则是对损伤节段进行复位和稳定，维持颈椎前凸，并在必要时进行减压，治疗方法从非手术治疗到前后联合手术融合不等。然而，对于前路、后路或联合手术的适应症仍存在争议。
本研究纳入了99例患者，为2014年2月至2016年2月期间在西姆拉英迪拉·甘地医学院收治并接受手术的下颈椎损伤患者。对所有患者进行了骨融合、神经功能恢复、颈部功能障碍指数及并发症的研究。平均随访时间为27个月（范围12 - 42个月）。
在99例手术中，77例（77.8%）涉及单个椎体节段，19例（19.2%）涉及两个节段，3例（3%）涉及三个节段的椎体次全切除。平均颈部功能障碍指数为7.57±5.42。64.6%的病例实现了明确的Bridwell 1级融合。未观察到神经症状恶化。吞咽困难是79例（79.8%）患者中最常见的并发症。1例患者出现轻微螺钉松动。
前路颈椎椎体次全切除并采用植骨融合器及颈椎锁定钢板进行稳定手术是治疗下颈椎损伤的良好方法，融合率高，可能是创伤后多节段椎间盘突出伴多节段植骨风险降低的首选手术方式。
