Sun Shuangxi, Miao Yingying, Xu Tao, Sun Kaiqiang, Lu Yijuan, Sun Jingchuan, Sun Jiuyi, Shi Jiangang
Department of Orthopedic Surgery, The Center Hospital of Weihai City, Weihai, Shandong, China.
Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China.
Orthop Surg. 2025 Feb;17(2):500-512. doi: 10.1111/os.14319. Epub 2024 Dec 12.
Central cord syndrome (CCS) is an incomplete spinal cord injury (SCI) causing severe motor weakness, and timely decompression via surgical intervention facilitates better recovery. Anterior controllable antedisplacement and fusion (ACAF) is a novel decompression technique and achieved satisfactory outcomes in treating cervical degenerated diseases. However, the clinical effects of ACAF on CCS remains unknown. This present study aimed to investigate the clinical outcomes of ACAF for cervical stenosis patients with CCS due to hyperextension injury.
This is a retrospective study, and patients who underwent ACAF due to CCS in our institution from July 2021 to December 2022 were enrolled based on the inclusion and exclusion criteria. All patients underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) before and after surgery. The duration of follow-up was at least 12 months. The radiological parameters included associated pathologies, prevertebral hyperintensity (HI), intramedullary signal intensity (ISI), and Torg-Pavlov ratio (TPR). The cervical stability was also evaluated. Neurological function was assessed using the American Spinal Injury Association (ASIA) grading system and Japanese Orthopaedic Association (JOA) score. The Mann-Whitney U test was used to compare the clinical outcomes preoperatively and postoperatively.
Finally, 13 patients (7 male and 6 female) with the minimum of 12-month follow-up were finally enrolled in this study, with the mean age of 56.6 ± 12.5 years (range, 39-74 years). There were eight patients suffered CCS due to fall, three due to vehicle accident, and two due to diving injuries. The average delay from injury to surgery was 2.23 days (range, 1-4 days), and the mean duration of follow-up was 16.1 ± 3.5 months. In terms of prevertebral HI and ISI, C4-C6 were the most affected region. In addition, 76.9% (10 of 13) patients were observed to have cervical stenosis indicated by TPR. Associated pathologies were herniated nucleus pulposus (HNP) in five patients, OPLL in three cases, and HNP-osteophyte complexes (HNP-OC) in six patients. At the final follow-up, 13 patients were improved to E. The mean JOA score improved to 15.4 ± 1.0, with the recovery rate of 77.0% ± 12.0%. Two patients experienced postoperative dysphagia, two patients had hoarseness, and one patient suffered postoperative hematoma.
ACAF can be a good option for treating CCS patients due to hyperextension injury with underlying cervical spondylosis and stenosis.
中央脊髓综合征（CCS）是一种不完全性脊髓损伤（SCI），可导致严重的运动无力，通过手术干预及时减压有助于更好地恢复。前路可控前移融合术（ACAF）是一种新型减压技术，在治疗颈椎退行性疾病方面取得了满意的效果。然而，ACAF治疗CCS的临床效果尚不清楚。本研究旨在探讨ACAF治疗因过伸性损伤导致颈椎管狭窄合并CCS患者的临床疗效。
本研究为回顾性研究，根据纳入和排除标准，纳入2021年7月至2022年12月在本机构因CCS接受ACAF手术的患者。所有患者在手术前后均接受了X线、计算机断层扫描（CT）和磁共振成像（MRI）检查。随访时间至少为12个月。放射学参数包括相关病变、椎体前高信号（HI）、脊髓内信号强度（ISI）和Torg-Pavlov比值（TPR）。还评估了颈椎稳定性。使用美国脊髓损伤协会（ASIA）分级系统和日本骨科协会（JOA）评分评估神经功能。采用Mann-Whitney U检验比较术前和术后的临床疗效。
最终，13例患者（7例男性，6例女性）纳入本研究，随访时间至少12个月，平均年龄为56.6±12.5岁（范围39-74岁）。8例患者因跌倒导致CCS，3例因车祸，2例因潜水损伤。从受伤到手术的平均延迟时间为2.23天（范围1-4天），平均随访时间为16.1±3.5个月。在椎体前HI和ISI方面，C4-C6是受影响最严重的区域。此外，76.9%（13例中的10例）患者经TPR提示存在颈椎管狭窄。相关病变包括5例患者的椎间盘突出症（HNP）、3例患者的后纵韧带骨化（OPLL）和6例患者的HNP-骨赘复合体（HNP-OC）。在最后一次随访时，13例患者均改善至E级。JOA评分平均提高至15.4±1.0，恢复率为77.0%±12.0%。2例患者术后出现吞咽困难，2例患者出现声音嘶哑，1例患者出现术后血肿。
对于因过伸性损伤合并颈椎退变和狭窄导致的CCS患者，ACAF可能是一种较好的治疗选择。
