Cervical Hyperextension Injury Research Articles

A Novel Radiological Scoring System for Anterior Longitudinal Ligament Injuries.

Cervical hyperextension injury is very frequent with anterior longitudinal ligament (ALL) injury, and the ligament damage has a remarkable effect on whether and what type of operation should be performed. This study aims to establish a new scoring system for the accurate diagnosis of ALL damage. The imaging data of the consecutive patients was measured and scored by four radiologists. Intraoperative exploration was performed by three surgeons. The crude and adjusted odds ratios (cOR and aOR) and receiver operating characteristic curve (ROC) were constructed to assess the diagnostic accuracy of the scoring system. A total of 255 patients with cervical spine trauma were included in this study. There was no statistical difference in the relationship between demographics and ALL injuries (P > 0.05). Thickness of prevertebral soft tissue (aOR = 11.922, P = 0.004), intervertebral disk angle (aOR = 13.21, P = 0.002), avulsion fracture of the anterior edge of the vertebral body (aOR = 13.844, P = 0.029), ALL disrupted in T1-weighted sequence (aOR = 18.349, P < 0.001), and high signal area in T2-weighted sequence (aOR = 20.898, P = 0.002) had significantly higher diagnostic accuracy. The scoring system's sensitivity and specificity were 94.0% and 88.1%, respectively, and the accuracy was 90.8%. The study established a new scoring system for ALL injuries based on the analysis of a series of clinical data and statistics. A total of five scoring items, a total score of 7 points, and an ALL injury may be diagnosed when the score is not less than 3 points. This scoring system enables an efficient and accurate diagnosis of all injuries.

The biomechanical effect of preexisting different types of disc herniation in cervical hyperextension injury

ObjectivePreexisting severe cervical spinal cord compression is a significant risk factor in cervical hyperextension injury, and the neurological function may deteriorate after a slight force to the forehead. There are few biomechanical studies regarding the influence of pathological factors in hyperextension loading condition. The aim of this study is to analyze the effects of preexisting different types of cervical disc herniation and different degrees of compression on the spinal cord in cervical hyperextension.MethodA 3D finite element (FE) model of cervical spinal cord was modeled. Local type with median herniation, local type with lateral herniation, diffuse type with median herniation, and diffuse type with lateral herniation were simulated in neutral and extention positions. The compressions which were equivalent to 10%, 20%, 30%, and 40% of the sagittal diameter of the spinal cord were modeled.ResultsThe results of normal FE model were consistent with those of previous studies. The maximum von Mises stresses appeared in the pia mater for all 32 loading conditions. The maximum von Mises stresses in extension position were much higher than in neutral position. In most cases, the maximum von Mises stresses in diffuse type were higher than in local type.ConclusionCervical spinal cord with preexisting disc herniation is more likely to be compressed in hyperextension situation than in neutral position. Diffuse type with median herniation may cause more severe compression with higher von Mises stresses concentrated at the anterior horn and the peripheral white matter, resulting in acute central cord syndrome from biomechanical point of view.

Deep learning algorithm based on analyzing the effect of posterior cervical vertebral canal decompression angioplasty in the treatment of ossification of posterior longitudinal ligament of cervical spine by CT image.

Objective:The paper uses the convolutional neural network algorithm in the deep learning algorithm to explore the therapeutic effect of surgical treatment of hyperextension injuries associated with ossification of the posterior longitudinal ligament of the cervical spine.Methods:In this retrospectively analyzed study 27 patients with hyperextension injury of the posterior longitudinal ligament of the cervical spine were selected from our hospital between August 2018 to July 2020. It included 21 males and 6 females; aged 36-79 years, with an average of 55.9 years.Results:Follow-up time of patients was 3-39 months, with an average of 17.4 months. The JOA score after surgery was significantly better than that before surgery (P<0.01), which was statistically significant; the improvement of JOA in patients undergoing anterior therapy was better than that in patients undergoing posterior therapy, which was statistically significant; the JOA improved in patients with minor violent injuries. The situation is significantly better than severe violent injuries, with statistical significance. The rate of postoperative JOA improvement was significantly correlated with the degree of nerve function retention of the injured spinal cord before surgery (P<0.01), and there was no significant correlation between the degree of spinal stenosis caused by ossification and the postoperative JOA improvement of patients.Conclusion:Convolutional neural network algorithm in the deep learning algorithm based on the cervical spine posterior longitudinal ligament ossification hyperextension injury was significantly improved after surgery. The less preoperative neurological damage, the postoperative neurological function, the degree of improvement, there was no significant correlation between the degree of spinal stenosis and the improvement of postoperative spinal cord function. For patients with ossification of the posterior longitudinal ligament, if there are neurological symptoms, early surgical treatment is recommended to relieve the compression, so as to prevent irreversible neurological damage caused by trauma.

Prediction Optimization of Cervical Hyperextension Injury: Kernel Extreme Learning Machines With Orthogonal Learning Butterfly Optimizer and Broyden- Fletcher-Goldfarb-Shanno Algorithms

In this research, X-ray and MRI images of patients suffering from cervical hyperextension injury are investigated. Also, radiographic images are collected from patients who suffered from trauma but without cervical hyperextension injury. The core engine algorithm of the optimized prediction model is kernel extreme learning machine (KELM), and the input data is 17 factors that may cause cervical hyperextension injury. As the optimization core, we utilized the Butterfly optimization algorithm (BOA). Up to now, few improved variants of BOA have been reported. The original BOA converges slowly and quickly falls into a locally optimal solution. An enhanced BOA based on orthogonal learning, Levy flight, and an exploitation engine is proposed in this paper to relieve these two shortcomings, which is called LBOLBOA. Orthogonal learning is utilized to construct guidance vectors for guiding agents toward the global optimum solution aiming to increase the accuracy of the solutions. Also, Levy flight and Broyden-Fletcher-Goldfarb-Shanno mechanisms are utilized to enrich the intensification propensities of BOA and stagnation avoidance. The proposed LBOLBOA is used to deal with continuous function optimization and machine learning problems, including parameter optimization of KELM. We rigorously verified this variant using a comprehensive set of the benchmark test suite and real-world dataset on cervical hyperextension injury. The results indicate that LBOLBOA can achieve improved performance in dealing with the function optimization and machine learning problems, especially the capability for prediction of cervical hyperextension injury.

Predicting Cervical Hyperextension Injury: A Covariance Guided Sine Cosine Support Vector Machine

This study proposes an effective intelligent predictive model for prediction of cervical hyperextension injury. The prediction model is constructed by combing an improved sine cosine algorithm (SCA) with support vector machines (SVM), which is named COSCA-SVM. The core of the developed model is the COSCA method that combines the opposition-based learning mechanism and covariance mechanism to boost and recover the exploratory competence of SCA. The proposed COSCA approach is utilized to optimize the two critical parameters of the SVM, and it is also employed to catch the optimal feature subset. Based on the optimal parameter combination and feature subset, COSCA-SVM is able to make self-directed prediction of cervical hyperextension injury. The proposed COSCA was compared with other well-known and effective methods using 23 benchmark problems. Simulation results verify that the proposed COSCA is significantly superior to studied methods in dealing with majority of benchmark problems. Meanwhile, the proposed COSCA-SVM is compared with six other machine learning approaches considering a real-life dataset. Results have shown that the proposed COSCA-SVM can achieve better classification routine and higher stability on all four indicators. Therefore, we can expect that COSCA-SVM can be a promising building block for predicting cervical hyperextension injury.

Clinical efficacy of anterior decompression and stability reconstruction in patients with cervical hyperextension injury

Objective: To evaluate the clinical efficacy of anterior decompression and stability reconstruction in patients with cervical hyperextension injury. Methods: Postoperative data from 60 patients with cervical hyperextension injury between April 2009 and December 2016 were analyzed retrospectively; the patients included 50 males and 10 females, aged 21-87 years [average, (57±13) years]. All patients had various degrees of spinal cord injury, and were treated with anterior cervical decompression, fusion, and internal fixation.The preoperative and postoperative neurological function were compared to evaluate the clinical efficacy of the treatment.The t test was applied when preoperative and postoperative data were compared. Results: Of the 60 patients, 5 underwent anterior cervical discectomy and fusion, 26 underwent anterior cervical corpectomy and fusion, and 29 received treatment with the hybrid technique.The average follow-up was (5.1±2.1) years (range, 1.6-9.1 years). The American Spinal Injury Association (ASIA) scores, abbreviated injury scale (AIS grades), and Japanese Orthopedic Association Scores (JOA scores) at the 1 week post operation and final follow-up were significantly better than those obtained preoperatively (all P<0.01). The JOA scores before operation and at the final follow-up was 10(7, 11) and 16(14, 17), respectively.Based on the recovery rate of JOA scores, the rate of cure was 28.3% (17 cases), the rate of significant efficiency was 60.0% (36 cases), the rate of efficiency was 8.3% (5 cases), the rate of inefficiency was 3.3% (2 cases). Among the patients showing cure, 5 were satisfied with the life function, however, the extent of their injury was still of Grade D owing to the incomplete recovery of muscle force.Further, when the 60 patients were divided into A and B groups according to whether they had congenital spinal stenosis or not, respectively, and no significant difference was found in ASIA scores, AIS grades and JOA scores between the groups (all P<0.01). Conclusion: Anterior cervical decompression, fusion and internal fixation is safe and effective for cervical hyperextension injury without continuous-type ossification of the posterior longitudinal ligament.

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study.

ObjectivesLoss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine.MethodsA previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion.ResultsPeak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA).ConclusionCervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain.Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1.

Timing of operative management in patient with traumatic Central Cord syndrome

Objectives: Patients with traumatic central cord syndrome (TCCS) provide some of the most dramatic opportunities for neurological improvement when compared to other subgroups of SCI, particularly evident in young patients with TCCS. The purpose of this study is to review a series of patients with central cord syndrome and to corroborate the consensus about optimal treatment and surgical timing for decompression. Materials and Methods: Patients developing this suffering belong to two relative categories – the first group are relatively young patients with a high-energy injury that leads to fracture/subluxation or dislocation. The second category are older individuals who, due to a low-energy fall or cervical hyperextension injury present with TCCS that occurs in the presence of cervical spondylosis but without obvious injury to the spinal column. The main tool for refinement of the operative window was ASIA motor score. Results: Thirty-two patient were divided in two groups – patients with ASIA motor score less than or equal to 50 p. (mean – 42.4 p.) – 10, and patients with a score higher than 50 p. (mean – 67.45 p.) – 22. Patients with ASIA Mscores less than 50 p. were operated within 24 hours, but 2 patients from these – within 20 days. Patients with ASIA Mscore higher than 50 p. underwent decompression within 72 hours. All patients sustained improvement in neurological status with the exception of these two, who underwent late decompression. Discussion: These cases clearly demonstrate to what range should operative activity be targeted in patients with TCCS. Patients with ASIA Mscore 80 and above, with MRI fracture evidence and those who may have already experienced significant motor improvement between the time of injury and the moment of initial neurological evaluation, may undergo delayed surgical treatment. Conclusions: There was a recommendation based on low-quality evidence that early (as soon as feasible) surgical decompression for patients with TCCS and spondylosis should be recommended when their initial neurological impairment is significant.

A case of fatal cervical discoligamentous hyperextension injury without fracture: Correlation of postmortem imaging and autopsy findings

We present a case of fatal cervical discoligamentous hyperextension injury without fracture. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) disclosed cervical instability and spinal cord injury in the absence of fracture, which was confirmed by autopsy. Cervical discoligamentous injury without fracture may be unnoticeable on PMCT because signs of cervical misalignment change depending on the posture of the neck at the time of postmortem imaging. Because of its greater sensitivity for soft tissue injury, PMMRI is especially useful for detecting pathological changes in cases of death due to cervical discoligamentous injury. In this paper, findings on postmortem imaging for this injury are described in detail and correlated with findings on autopsy.

The effect of timing of surgical intervention on functional recovery of the hand and treatment of hyperextension injury to the cervical spinal cord

Objective To determine the correlations between the time of surgical intervention, effect of surgery and functional recovery of the hand in the treatment of hyperextension injury to the cervical spinal cord. Methods We treated 34 cases of cervical hyperextension injury from February 2005 to August 2009. According to the time of surgical intervention, they were classified into 3 groups. In group A, 17 cases received operation within 6 days, in group B 10 cases had operation from 6 to 14 days, and in group C, 7 cases had operation after 14 days. The 3 groups were compared respectively in terms of their preoperative and postoperative American Spinal Injury Association (ASIA) motor scores and their functional recovery of the hands' intrinsic muscle. Results They were followed up for 12 to 40 months. By ASIA scores for spinal nerve function, group A was significantly better than groups B ( P =0. 025) and C ( P =0. 042) in one month and at the last follow-up after operation but there was no significant difference between group B and C ( P =0. 849) . In strength of the intrinsic muscle in one month after operation, there was no significant difference (P = 0. 101 ) between the 3 groups. In the neural function at the last follow-up, group A was significantly better than group B ( P = 0. 034) and group C ( P = 0. 006), but there was no significant difference ( P =0. 217) between groups B and C, Conclusions Patients with hyperextension injury to the cervical spinal cord should be operated on within 6 days after injury. Early operative decompression is the key to nerve functional recovery and reduction of associated complications. The short-term functional recovery of the hand intrinsic muscle may have no obvious relation to the time of surgical intervention but the long-term recovery may be obviously related to the operative time. Key words: Cervical vertebrae; Spinal cord injuries; Treatment outcome

Research on correlative factor of spinal segment distribution in cervical hyperextension injury

Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows:4 cases were at C2/3, of which onesuffered the forehead trauma; 12 cases were at C3/ 4, of which 10 had the forehead trauma, and one had the zygomatic trauma; 12 cases were at C4/5, of which 5 had the forehead trauma, one had both the zygomatic and the forehead trauma, and one had both the forehead and with the lower jaw trauma; 11 cases were at CS/6,of which 3 had the forehead trauma, 3 had the zygomatic trauma, and 2 had the lower jaw trauma. The location of the spinal cord with single high signal in T2WI did not correspond with the intervertebral disc level in 4 cases. For 10 cases the high signal in T2WI was found at two discontinuous segments. For 2 cases the 1 high signal in T2WI was found at over two segments. For 6 cases the high signal in T2WI was found at over three segments. Conclusions Disc hemiation is the most common underlyding factor in cervical hyperextension injury. The spinal level with high signal in T2WI was correlative to the impacted facial site. The shear force at the inflection point with or without the anterior-posterior compression force accounted for the cervical hyperextension injury. Key words: Cervical spine; Degeneration; Hyperextension injury; Segment distribution of injury; Vertebral dynamic change

Effects of different loading conditions on the stress features of hyperextension injury to the cervical spinal cord

Objective To investigate the mechanical responses by the cervical spinal cord to the hyperextension injury under different loading conditions. Methods A three dimensional finite element model of the cervical spinal cord was built and imported into the preprocessor of the Ansys software for assigning boundary and different loading conditions. Then the extension and pinching conditions were simulated after the solution module was entered. The stress results of 9 different anatomical regions in the cross-section of the cervical spinal cord were read and analyzed in the postprocessor of the Ansys software. Results The localized stress mainly occurred at the anterior horn and posterior horn in the gray matter, the anterior funiculus, the medial part of the lateral funiculus, and the lateral part of the posterior funiculus, with the average magnitude decreasing successively. The magnitude of the stress increased with the severity of the cervical spine injury. The maximum stress increment occurrred at the anterior horn. Significant differences in the stress increment were observed between the anterior horn and the lateral funiculus( P 0. 05). Conclusions The cervical hyperextension injury mainly leads to injury to the motor neuron of the anterior horn. More damage to the motor neuron dominating the intrinsic muscle of hand can lead to poorer prognosis. A greater injury load may cause stress to distribute onto more adjacent white matter. Key words: Spinal cord injuries; Finite element analysis; Biomechanics

Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45–68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6–24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P 0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.

Analysis of Cervical Injuries in Persons With Head Injuries

To determine which clinical factors are useful for predicting concomitant injuries of the cervical spine and cervical spinal cord in persons with head injuries, we examined the nature and mechanisms of cervical injuries. For 109 forensic autopsies of persons with head injuries, the cause of injury, mechanism of cervical injury, survival time, and anatomic injury severity (1990 revision of the abbreviated injury scale [AIS] and injury severity score) were determined. Traffic accidents were the most common cause of injuries (41.3%), followed by slips and falls (24.8%), assaults (17.4%), and falls from height (9.2%). The mean maximum AIS scores and the AIS scores of the head or neck were similar in the 4 groups. Cervical spine injuries and epidural or subdural hemorrhages of the cervical spinal cord were more common in persons dying in traffic accidents and falls from height than in persons dying in slips and falls or assaults. Cervical injuries were significantly more common in persons sustaining frontal impacts than lateral or rear impacts. The most common cervical hyperextension injuries were atlanto-occipital and atlantoaxial dislocation and injuries of the 5th intervertebral disc. Our results suggest that persons with injuries of the head due to high-energy frontal impacts should be carefully examined for concomitant cervical injuries. These findings should be helpful for decreasing preventable deaths from undiagnosed cervical injuries in head-injured persons.

Biomechanics of the Anterior Longitudinal Ligament During 8 g Whiplash Simulation Following Single- and Contiguous Two-Level Fusion

A computational study of anterior longitudinal ligament (ALL) strain in the cervical spine following single- and 2-level fusion during simulated whiplash. To evaluate how cervical fusion alters the peak strain of the ALL in the adjacent motion segments. Although an in vitro study of ALL strain during whiplash has been conducted in healthy cervical spines, no such study has been performed in a cervical spine with fused segments. It has been demonstrated that the loss of motion following fusion results in increased strain in the adjacent motion segments. However, the biomechanics of the adjacent motion segments during high energy acceleration-deceleration simulations have not been widely reported. Accordingly, we investigated the peak strain of the ALL following single- and 2-level fusion during simulated whiplash. A detailed finite element (FE) model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash at 8 g acceleration and peak ALL strains were computed. The results were validated against published experimental data. This validated FE model was then modified to simulate single- and 2-level fusion and tested under identical loading conditions. The mean increase in peak ALL strain at the motion segment immediately adjacent to the level of fusion was 15.5% for single-level fusion when compared with 40.8% in 2-level contiguous fusion (P = 0.019). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. Two-level fusion increased ALL strain in the adjacent motion segments, on average, greater than single-level fusion did. Disc arthroplasty and other techniques that provide stability without loss of flexibility may be beneficial in patients undergoing multiple-level fusion. Detailed FE models such as ours can provide strong correlation with experimentally determined data.

Airbag-induced fatal subaxial cervical spinal cord injury in a low-velocity collision

The effectiveness of airbags as a modern restraining system for car occupants in frontal collisions has been well demonstrated in experimental studies and real accidents; however, they can themselves be responsible for injuries, fatal in some circumstances. We hereby report a lethal cervical spinal cord injury in a patient with ankylosed cervical spine, caused by a hyperextension injury after a motor vehicle collision, in which the airbag had been deployed in the absence of shoulder or lap belt harnesses. This led to fatal injuries resulting from the inflating airbag striking against the face and chin of the victim. Postmortem examination showed a complete transection of the cord in association with the transverse fracture through the body of C5 and the involvement of all three spinal columns. The focus of this report is to emphasize the importance of the proper use of such restraining systems. The potential for cervical spine hyperextension injuries in unrestrained passengers in atypical positions in front of airbags, particularly those with a rigid segment of ankylosed cervical spine and other predisposing factors, are discussed.

Nonsurgical treatment versus surgical treatment of cervical hyperextension injury

目的 回顾性分析比较颈椎过伸性损伤患者行早期(小于24 h)和晚期(大于24 h)手术以及非手术治疗的疗效.方法 自1995年1月～2005年6月间收治并获得随访的132例过伸性脊髓损伤患者中,31例行保守治疗,27例24 h内行手术治疗,74例24 h后行手术治疗,观察各组治疗前、后及随访时的AISA评分以及相关并发症.结果 早期和晚期手术组术后随访临床疗效好于保守治疗组,差异有统计学意义(P＜0.01),早期和晚期手术组间差异无统计学意义(P＞0.05);保守治疗、早期和晚期手术组肺炎的并发症的发生率分别是2/31(6.5%)、1/27(3.6%)和9/74(12.2%).结论 颈椎过伸性损伤患者手术治疗疗效好于保守治疗,晚期和早期手术对神经功能改善无明显差异,但晚期手术并发症相对增多。

Exploration of approach in surgery for cervical hyperextension injury

To explore the reasonable approach in surgery for cervical hyperextension injury. Sixty-seven patients of hyperextension injury of cervical spine, 31 males and 16 females, aged 41 approximately 57, underwent surgery via anterior approach (n = 25), posterior approach (n = 27), or combined approach (n = 13) according to the different operation methods 8 days (3 days approximately 3 weeks) after the injury and then followed up for 6 approximately 12 months. The therapeutic effects were compared. After the operation, the Frankel grade was ascended in all patients of the anterior approach group, and was descended in some patients in the posterior approach and combined approach groups. The ASIA grade of the anterior approach and combined approach groups were both ascended in comparison with that of the posterior approach group (both P < 0.05) however, there was not significant difference between the anterior approach and combined approach groups. Anterior decompression-graft-internal fixation is the preferred consideration to treat hyperextension injury of cervical spine, and posterior one is only the secondary choice. Combined approach should be strictly selected according to the concrete situation.

Operative methods for cervical hyperextension injuries

目的 探讨过伸性颈椎颈髓损伤后三种手术入路疗效的比较.方法我们对2000年9月～2004年10月间收治的47例过伸性颈椎颈髓损伤并接受手术治疗的患者进行回顾性分析,根据手术方式不同分成三组:前路入路组、后路入路组、前后联合入路组,比较其疗效.结果所有患者经6～12个月随访,比较三组间手术前、后的Frankel的分级变化和ASIA评分改变.三组术后神经功能均较术前有明显改善;前路减压、植骨内固定和前后联合入路减压、植骨内固定均较后路减压、植骨内固定术后神经功能恢复好,两两间差异有显著性意义(P＜0.05);前后联合入路减压最彻底,但其预后与单纯前路减压内固定差异无显著性意义(P＞0.05).结论前路减压内固定是过伸性颈椎颈髓损伤首选的手术方式,后路是辅助的手术方法,而前后联合入路应谨慎选用。

Quadriplegia caused by cervical hyperextension injury and intramedullary spinal cord tumour: a case report of autopsy

A 68-year-old male had neck pain and weakness of the left upper extremity after a fall. MRI showed severe cervical canal stenosis and a high signal intensity of the spinal cord on T2-weighted images extending from the medulla oblongata to the C7 level. Neurological examination showed left hemiparesis, bilateral sensory disturbance and a neurogenic bladder. He underwent expansive laminoplasty 5 weeks later. After the operation his neurological deficit improved and 6 weeks later he left the hospital. However, his neurological conditions became worse (quadriparesis) and he was admitted as an emergency 3 weeks later. Although MRI showed decompression of the spinal cord, the area of high signal intensity on T2-weighted images had extended. Quadriparesis was progressive and he died of dyspnea. Autopsy showed the presence of the intramedullary spinal cord tumor (anaplastic astrocytoma; C1-Th4). We could not detect the intramedullary spinal cord tumour on MRI before surgery because of severe canal stenosis and the history of trauma. The high spinal intensity on T2-weighted images was thought to be oedema or myelomalacia. This case illustrates the difficulty of correctly interpreting MRI in patients with severe canal stenosis.