Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture.

Zhao-Wan Xu,Deng-Xing Lun

doi:10.1186/s13018-014-0077-4

Abstract

BackgroundThere are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population.MethodsThis was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications.ResultsThe average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively.ConclusionsThe open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture.

Highlights

Operative treatment of cervical spinal stenosis remains controversial [1]
Several options are commonly used, including anterior subtotal corpectomy combined with bone graft fusion and internal fixation [2,3], anterior discectomy combined with bone graft fusion and internal fixation [4,5], and posterior laminoplasty with or without internal fixation [6]
There is a lack of clinical study on the surgical strategy for multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture

Summary

Introduction

Operative treatment of cervical spinal stenosis remains controversial [1]. Several options are commonly used, including anterior subtotal corpectomy combined with bone graft fusion and internal fixation [2,3], anterior discectomy combined with bone graft fusion and internal fixation [4,5], and posterior laminoplasty with or without internal fixation [6]. There is a lack of clinical study on the surgical strategy for multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Complete decompression could be achieved for spinal stenosis by posterior laminoplasty, the deterioration on the cervical vertebrae due to surgery could aggravate the instability of cervical vertebrae [2,6]. The purpose of the current study was to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation via posterior route for the treatment of multilevel cervical spinal stenosis complicated by cervical spine fracture. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population

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Conclusion