Lundy D W, Murray H H
Shepherd Center, Atlanta, Georgia 30360, USA.
J Bone Joint Surg Br. 1997 Nov;79(6):948-51. doi: 10.1302/0301-620x.79b6.7923.
Posterior cervical wiring is commonly performed for patients with spinal instability, but has inherent risks. We report eight patients who had neurological deterioration after sublaminar or spinous process wiring of the cervical spine; four had complete injuries of the spinal cord, one had residual leg spasticity and three recovered after transient injuries. We found no relation between the degree of spinal canal encroachment and the severity of the spinal-cord injury, but in all cases neurological worsening appeared to have been caused by either sublaminar wiring or spinous process wiring which had been placed too far anteriorly. Sublaminar wiring has substantial risks and should be used only at atlantoaxial level, and then only after adequate reduction. Fluoroscopic guidance should be used when placing spinous process wires especially when the posterior spinal anatomy is abnormal.
后路颈椎内固定术常用于治疗脊柱不稳定的患者，但该手术存在固有风险。我们报告了8例患者，他们在颈椎椎板下或棘突内固定术后出现神经功能恶化；其中4例脊髓完全损伤，1例遗留腿部痉挛，3例短暂损伤后恢复。我们发现椎管狭窄程度与脊髓损伤严重程度之间并无关联，但在所有病例中，神经功能恶化似乎均由椎板下内固定术或棘突内固定术位置过于靠前所致。椎板下内固定术存在重大风险，仅应在寰枢椎水平使用，且仅在充分复位后使用。放置棘突钢丝时应使用荧光透视引导，尤其是在脊柱后部解剖结构异常的情况下。
