Albert T J, Klein G R, Joffe D, Vaccaro A R
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Spine (Phila Pa 1976). 1998 Jul 15;23(14):1596-9. doi: 10.1097/00007632-199807150-00017.
A retrospective review of 21 patients in which cervical pedicle screw fixation was used at C7 with or without upper thoracic pedicle screw fixation.
To evaluate the use of pedicle screw placement in the lower cervical spine.
The use of posterior cervical spine fixation, including lateral mass fixation, has become increasingly popular in recent years. However, lateral mass fixation at C7 is often hindered by lack of substantial high quality bone. The end level of long cervical spine constructs is frequently C7 or T1. Dissatisfaction with lateral mass fixation at C7 and T1 led the authors to use lower cervical pedicle screw fixation for several cervical spine disorders.
Twenty-one patients who had undergone cervical pedicle screw fixation at C7 were reviewed retrospectively. There were 12 males and 9 females, with an average age of 52 years. All pedicle screws were placed, after direct palpation of the pedicle, with a right angle nerve hook after laminoforaminotomy at C7.
There were no neurologic complications related to pedicle screw placement, and no patient was symptomatically worse after the operation. Six patients with root pathology improved. Of 14 patients with cervical myelopathy, 12 improved at least one Nurick grade, and 2 had no improvement. There were no failures of fixation or complications related to pedicle fixation at a minimum of 1 year follow-up.
Pedicle screws in C7 placed with laminoforaminotomy and palpation technique appears to be safe and efficacious. Excellent fixation can be achieved.
对21例患者进行回顾性研究，这些患者在C7节段采用了颈椎椎弓根螺钉固定，部分患者还联合使用了上胸椎椎弓根螺钉固定。
评估下颈椎椎弓根螺钉置入的应用情况。
近年来，包括侧块固定在内的颈椎后路固定技术的应用越来越普遍。然而，C7节段的侧块固定常常因缺乏高质量骨质而受到阻碍。颈椎长节段固定的终末节段通常为C7或T1。对C7和T1节段侧块固定的不满意促使作者在多种颈椎疾病中采用下颈椎椎弓根螺钉固定。
对21例在C7节段接受颈椎椎弓根螺钉固定的患者进行回顾性分析。其中男性12例，女性9例，平均年龄52岁。所有椎弓根螺钉均在直接触诊椎弓根后，于C7节段行椎板间孔切开术后，使用直角神经钩置入。
未发生与椎弓根螺钉置入相关的神经并发症，术后也没有患者症状加重。6例神经根病变患者症状改善。14例脊髓型颈椎病患者中，12例至少改善了一个Nurick分级，2例无改善。至少随访1年，未出现内固定失败或与椎弓根固定相关的并发症。
采用椎板间孔切开和触诊技术置入C7节段椎弓根螺钉似乎是安全有效的，能够实现良好的固定。
