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A Retrospective Study of the Surgical Management of Cervical Injury and Disorders Treated with the Anterior Approach

Author: XiaLei
Tutor: WangLiMin
School: Zhengzhou University
Course: Orthopedics
Keywords: Anterior cervical Cervical spondylosis Interbody fusion Locking plate Cage Fixed
CLC: R687.3
Type: Master's thesis
Year: 2005
Downloads: 142
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Abstract

Objective: Anterior cervical surgery is to remove the bony (osteophyte, hypertrophic bony posterior edge) and fibrosing substances (intervertebral protusion, annular fibrosus, and broken nucleus pulposus) for the direct decompression of the spinal cord. The spinal blood supply could be improved or restored after decompression. The cervical spondylosis and cervical injury are often met in clinical practice. The bony and fibrosing compression to the adjacent blood vessels, nerve roots or spinal cord leads to the related symptom and signs. The pathogenetic condition is complicated and the pathological changes are also different. The surgical management is also developing with renovation of the anterior cervical devices. The retrospective evaluation of the surgical management of cervical injury and disorders treated with the anterior approach was performed to explore the indications, effect and application of the different treatment methods and guide the future clinical work.Materials and Methods: 156 cases of cervical injury and disorders treated with the anterior cervical approach in recent 5 years were collected in this study. They included 95 men and 61 women with the average age of 51.6 years (31-68 years) who fell into two categories as follows: cervical injury, 38 patients; cervical spondylosis, 118 patients. 71 patients had single level compression, 78 patients had two level compression, and 8 patients had three level compression. The longest medical history was 6 years and the shortest history was 3 days. Primary surgery was performed in 151 patients and secondary surgery in 5 patients. Anterior cervical decompression and fusion with the tricortical bone graft were used in 31 patients, anterior cervical decompression with drilling and fusion with Cage with bone graft inside in 55 patients,anterior cervical decompression with drilling and fusion with tricortical bone graft fixated with constrained anterior cervical plate in 57 patients, anterior subtotal corpectomy and fusion with titanium mesh with bone graft inside fixated with constrained anterior cervical plate in 13 patients. The volume of blood loss in operation ranged from 50ml to 210ml and no patients received blood transfusion during operation. The operation time was 65 minutes to 170minutes with an average of 95minutes. The anesthesia of cervical plexus field block was used in 111 patients and general anesthesia with endotracheal intubation in 45 patients. The auto iliac bone graft was used in 101 patients and allograft bone in 55 patients.Statistical analysis: 1. Comparison of the scores of the patients before and after the surgery with JOB points scoring method; 2. Comparison of the bone union rate of the autograft with allograft; 3. All the data were processed with SPSS 11.5 software package, statistical level: a =0.05.Results: The follow up period was 6 months to 41 months with an average of 11.3 months. No wound infection was found in this group. 3 patients using the allograft had obvious exudation in the wounds and had the longest wound healing time of 9 days after change dressings. 3 patients with acute compression of cervical spinal cord from cervical injury had dysphagia after surgery and this symptom alleviated one week later. The possible reason was inadequate preoperative pulling exercise of the trachea and esophagus. One patient had aggravated neurological symptom after the surgery. The cerchnus was found in 11 patients after surgery and alleviated 3-8 days later. All the wounds had the first stage healing. The intervertebral bone union was achieved in all patients within an average of 3.1 months (2.5-4.1 months).Spinal cord function comparison of all the patients before and after the surgery: there was significant difference between the scores before and after the surgery (P<0.05).Within one year after operation, spinal cord function scores in cervical injury group increased gradually; but in cervical syndrome group, it decreased at some cases. There was intervertebral height loss in the patients with anterior cervical decompression and bone graft fusion within three years after operation, and some ofthem even had Swan-neck deformity. In anterior cervical decompression and bone graft fusion with constrained anterior cervical plate group, the intervertebral height regained immediately, there were intervertebral height loss with time. The bone union of the autograft was 98.5%; while it was 95.7% in the allograft group. There was no significant difference between two groups (/*>().05). Conclusion:1. A satisfactory result could be achieved for those patients with cervical injury and cervical disorders by using the anterior cervical decompression, bone grafting and internal fixation with the strict indications.a. The key point of this surgery is complete decompression.b. The decompression should be coupled with bone grafting and internal fixation.c. The bone grafting and internal fixation should be performed carefully to reduce the surgical complications.2. There is possibility of intervertebral height loss and Swan-neck deformity in the patients with the anterior decompression and bone grafting after long time follow up.3. Anterior cervical decompression and bone graft fusion with constrained anterior cervical plate has a good surgical result after long time follow up, but has the problem of screw loosening.4. Anterior cervical decompression and bone graft fusion with cage has a good surgical result after long time follow up, but the common cylinder shaped cage might destroy the inferior and superior end plates of vertebral body which could lead to the intervertebral height loss. The rectangle cage can avoid this problem, but it has been applied in patients for short time and needs further evaluation.5. The auto iliac bone is the best choice of the grafting for patients which has such advantages as short bone union time, higher strength. But there are some disadvantages: pain in the donation area, delayed ambulation of patient. There is possibility for patient using allograft to get infection, rejection, wound exudation, delayed healing and wound infection.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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