Goel Atul, Lunawat Aditya, Shah Abhidha, Dandpat Saswat, Hawaldar Akshay, Darji Hardik, Trivedi Nishit
Department of Neurosurgery, K. E. M. Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India.
J Craniovertebr Junction Spine. 2021 Jul-Sep;12(3):216-222. doi: 10.4103/jcvjs.jcvjs_110_21. Epub 2021 Sep 8.
The clinical outcome following multilevel stabilization in patients who suffered cervical spinal injury and developed severe neurological deficits and then gradually partially recovered is evaluated. The basis of the surgical concept was that cervical spinal degeneration is a result of single or multilevel spinal instability and that spinal trauma exaggerates the instability.
During the period 2015-2020, 14 patients who suffered severe cervical spinal injury and could be included in the classification of spinal cord injury without computed tomography evidence of trauma were surgically treated. There were 11 males and 3 females. The ages ranged from 45 to 67 years, average being 53 years. Cervical canal stenoses related to degenerative spinal changes were observed in all patients. All patients suffered severe neurological deficits and within few days or weeks had shown significant but incomplete neurological recovery. The identification of the levels of unstable spinal segments was done on the basis of radiological and clinical parameters and direct observation of spinal instability in adjoining spinal segments. Transarticular fixation was done by Camille's transarticular fixation technique. Using ASIA score, modified JOA score, and Goel Clinical Grading Scale, the clinical course of the patients was monitored.
All patients showed recovery in the neurological status. Recovery started in the immediate postoperative period and the improvement progressed during the period of follow-up.
Surgery for spinal stabilization can be indicated even in cases that improve in the neurological function.
评估颈椎脊髓损伤后出现严重神经功能缺损并逐渐部分恢复的患者进行多节段稳定手术后的临床结果。手术理念的基础是颈椎退变是单节段或多节段脊柱不稳定的结果，而脊柱创伤会加剧这种不稳定。
在2015年至2020年期间，对14例严重颈椎脊髓损伤且可纳入脊髓损伤分类但无创伤计算机断层扫描证据的患者进行了手术治疗。其中男性11例，女性3例。年龄范围为45至67岁，平均53岁。所有患者均观察到与退行性脊柱改变相关的颈椎管狭窄。所有患者均有严重神经功能缺损，且在数天或数周内显示出明显但不完全的神经功能恢复。根据影像学和临床参数以及对相邻脊柱节段脊柱不稳定的直接观察来确定不稳定脊柱节段的水平。采用卡米尔经关节固定技术进行经关节固定。使用美国脊髓损伤协会（ASIA）评分、改良日本骨科协会（JOA）评分和戈尔临床分级量表对患者的临床病程进行监测。
所有患者神经功能均有恢复。恢复始于术后即刻，且在随访期间持续改善。
即使在神经功能有所改善的情况下，也可考虑进行脊柱稳定手术。
