Cervical Implantation Research Articles

Th1, Th17, CXCL16 and homocysteine elevated after intracranial and cervical stent implantation

The presence of Th1 and Th17 cells has been observed as major inducers in inflammation and immune responses associated stenting. However, there is rare data on the impact of Th1, Th17, CXCL16 and homocysteine after cerebral stent implantation. Here, we performed the statistical analysis to first evaluate the variation of the Th17and Th1 cells and their related cytokines, CXCL16 and homocysteine in the peripheral blood of patients with cerebral stenting. The flow cytometry was used to detect the proportion of Th1 and Th17 cells in peripheral blood mononuclear cells (PBMCs). The enzyme-linked immunosorbent assay was used to measure the serum concentrations of IFN-γ, IL-17 and CXCL16. Plasma homocysteine was examined by immunoturbidimetry. The level of Th1, CXCL16 and homocysteine showed an increase at 3 d, followed by the continuous decrease at 7 d and 3 months. The frequency of Th17 cells increased to a peak at three days, and subsequently decreased with a higher level than baseline. Our data revealed that the variation in Th1, Th17, CXCL16 and homocysteine in peripheral blood of patients with stenting may be implicated in inflammation after intracranial and cervical stent implantation. A better understanding of these factors will provide help for further drug design and clinical therapy.

Experience of chronic electrical stimulation application for pain management in thoracic outlet syndrome

Introduction . Pain is the only common symptom in thoracic outlet syndrome. Ensuring a stable analgesic effect remains challenging today. The aim of the study was to evaluate the efficacy of pain relief in thoracic outlet syndrome by continuous electrical stimulation, application. Materials and methods . Results of surgical treatment of 21 patients with thoracic outlet syndrome were analysed. The main clinical symptom in those patients was pain. The intensity of pain was evaluated by a standard visual analog scale. All patients underwent standard surgical techniques with the classic anterior approach including neurolysis of the brachial plexus structures, angiolysis of subclavian vessels, scalenotomy of the supraclavicular area, resection of the extra cervical rib (if necessary) and additional implantation of electrical stimulating system (ESS) “NeySi-3M” (SPE “WEL”, Ukraine) for continuous electrical stimulation of the brachial plexus in the postoperative period. Results . Regression of pain was observed in 95.2% of patients. Conclusions . Chronic electrical stimulation of the brachial plexus allows achieving a stable and safe analgesic effect in thoracic outlet syndrome.

Anterior cervical decompression with double-way connection intervertebral fusion device implantation for typeII or typeIIa Hangman fracture

Objective To analyze the clinical effect of anterior cervical decompression with double-way connection intervertebral fusion device(ROI-C)implantation for typeⅡ or typeⅡa Hangman fracture. Methods A retrospective study was made on 14 patients with type Ⅱor type Ⅱa Hangman fracture treated with anterior cervical ROI-C implantation between February 2011 and March 2014. The patients(11 males and 3 females)were aged between 22 and 46 years(mean, 26.4 years). Nine patients sustained traffic injury, 4 fall injury and 1 crash injury. Nine patients were classified as typeⅡ and 5 typeⅡa according to the Levine-Edwards classification. All were completed cervical anteroposterior and lateral X-ray, CT scan, three-dimensional CT reconstruction and MRI examination after admission. American Spinal Injury Association(ASIA)grade E was noted in all before operation. Clinical posttraumatic neck score, visual analogue scale(VAS)as well as angle deformity and displacement of the axis were recorded before operation and at the latest follow-up. Results All patients were operated successfully. Mean operation time was 61 min(range, 45-116 min). There were no injuries of superior laryngeal nerve, hypoglossal nerve, throat wall and vessel during operation. Laryngeal edema, dysphagia, paralysis of tongue, hematoma and wound infection were not observed after operation. Mean period of follow-up was 24.2 months(range, 4-32 months). All segments and fracture sites showed solid fusion after 3 months. No cages became subsided or displaced, no discs collapsed, and no malunion occurred at the latest follow-up. Data of preoperation and latest follow-up differed significantly with respect to clinical posttraumatic neck score[(53.1±7.2)points vs.(91.1±5.0)points], VAS[3.38(2.43, 4.33)points vs. 0.58(0, 1.29)points], axis displacement[(4.0±1.5)mm vs.(1.3±1.2)mm], and angle deformity of the axis[(9.2±4.7)° vs.(2.1±1.9)°](P<0.05 or 0.01). Conclusion Anterior cervical surgery with ROI-C implantation for typeⅡ or typeⅡa Hangman fracture provides good fusion rate and satisfactory clinical effect. Key words: Cervical vertebrae; Decompression, surgical; Fracture fixation, internal; Hangman fractures

Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation

This case report presents a 37-year-old man with clinical signs of myelopathy almost 9years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed.

Patient Outcomes and Spinal Cord Stimulation: A Retrospective Case Series Evaluating Patient Satisfaction, Pain Scores, and Opioid Requirements.

Spinal cord stimulators (SCS) are used to treat various chronic pain states. Establishing patient outcomes in terms of pain control, opioid medication use, and overall satisfaction is vital in maintaining SCS's role in clinical practice. All patients who underwent SCS implantation between January 2001 and December 2011 at a tertiary academic pain medicine center were included if he or she underwent permanent cervical or thoracolumbar dorsal column SCS implantation and age was 18 or greater. For the 199 patients who met inclusion criteria, data were collected retrospectively. Preimplant information included indication for implantation, Numeric Rating Scale (NRS) score, and dose in oral morphine equivalents (OME). Postimplant NRS score was recorded at 6months and 1year. OME requirement and patient satisfaction were determined at 1year postimplantation. This data set showed an overall decrease in OME requirements and NRS scores at both 6months and 1year. These differences were statistically significant (P<0.01) compared to preimplantation values. Additionally, 84.27% of patients were satisfied with their implants at 1year. Patient outcomes were analyzed further in respect to implant indication; groups included failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), angina, and other. For all groups, there were statistically significant (P<0.01) decreases in NRS scores at 6months and 1year. In the FBSS and CRPS groups, statistically significant (P<0.02) decreases in OME usage existed. Retrospective review of patients with spinal cord stimulators revealed OME reduction at 1year for those patients in the FBSS and CRPS groups; patient satisfaction at 1year and NRS score reduction at 6months and 1year were statistically significant for all groups.

Biomaterial bridges enable regeneration and re-entry of corticospinal tract axons into the caudal spinal cord after SCI: Association with recovery of forelimb function

Severed axon tracts fail to exhibit robust or spontaneous regeneration after spinal cord injury (SCI). Regeneration failure reflects a combination of factors, including the growth state of neuronal cell bodies and the regeneration-inhibitory environment of the central nervous system. However, while spared circuitry can be retrained, target reinnervation depends on longitudinally directed regeneration of transected axons. This study describes a biodegradable implant using poly(lactide-co-glycolide) (PLG) bridges as a carrier scaffold to support regeneration after injury. In order to detect regeneration of descending neuronal tracts into the bridge, and beyond into intact caudal parenchyma, we developed a mouse cervical implantation model and employed Crym:GFP transgenic mice. Characterization of Crym:GFP mice revealed that descending tracts, including the corticospinal tract, were labeled by green fluorescent protein (GFP), while ascending sensory neurons and fibers were not. Robust co-localization between GFP and neurofilament-200 (NF-200) as well as GFP and GAP-43 was observed at both the rostral and caudal bridge/tissue interface. No evidence of similar regeneration was observed in mice that received gelfoam at the lesion site as controls. Minimal co-localization between GFP reporter labeling and macrophage markers was observed. Taken together, these data suggest that axons originating from descending fiber tracts regenerated, entered into the PLG bridge at the rostral margin, continued through the bridge site, and exited to re-enter host tissue at the caudal edge of the intact bridge. Finally, regeneration through implanted bridges was associated with a reduction in ipsilateral forelimb errors on a horizontal ladder task.

Combination of Fusion and Motion Preservation in the Surgical Treatment of Degenerative Cervical Disc Disease

Introduction Our clinical study design was prospective, concurrently enrolled, and single-center trial of the combination of fusion (intervertebral cage with or without ventrofixation) and cervical disc prosthesis implantation in the treatment of patients with multiple level degenerative disc disease. The cervical disc arthroplasty become more and more popular in the surgical treatment of the degenerative cervical disc disease. The goals of the cervical disc arthroplasty are to maintain or restore intervertebral height, spinal balance and mobility, and to avoid adjacent segment degeneration. However, in most of the patients with multisegmental degenerative disc disease, the certain segments show different stage of degeneration and instability. The study was designed to investigate the clinical effects of the combination of cervical fusion and arthroplasty and to observe the stability, range of motion, and the cervical spine sagittal balance in the follow-up period. Patients and Methods Since December 2007 to September 2012, 36 patients with symptomatic cervical radiculopathy and/or myelopathy underwent surgery with this combined method. In 14 cases, the surgery involved two level, in 16 cases was three level, and 6 cases was four level. At the follow-up period, the patients' pain, neurologic function, and the radiographic parameters (range of motion at the level of prosthesis and the adjacent segments, the intervertebral disc height of the adjacent segments, lordosis of the whole cervical spine, and heterotopic ossification) were evaluated. Results Early clinical experiences are promising. The segment of the prosthesis ultimately showed preservation of motion when compared with preoperative levels. The pre-op average ROM was 8.2 degrees (flexion/extension), the post-op average ROM 7.6 degrees. The whole cervical spine lordosis was pre-op 1.7 degrees the post-op 16.2 degrees. We have no implant-related failure. Conclusion The most important potential advantages of this method is that we can treat the multisegmental degeneration in each segment with the proper method including motion preservation and fusion, and restore the sagittal balance of the cervical spine. Although early results are promising, long-term follow-up studies required to prove its efficacy in the surgical treatment of the multisegmental degenerative cases.

Morphometric analysis of diameter and relationship of vertebral artery with respect to transverse foramen in Indian population.

Purpose:To study the location, origin, size and relationship of the vertebral artery and the transverse foramina in the lower cervical spine by computed tomographic angiography (CTA) measurements in the Indian population.Materials and Methods:A retrospective review of multi-detector CT (MDCT) cerebral angiography scans was done between June 2011 and February 2014. A total of 120 patients were evaluated. The diameter of the vertebral artery (AL) and the shortest distance between the vertebral artery and the medial (M), lateral (L), anterior (A), and posterior (P) borders of transverse foramen were studied. In addition, the shortest distance between the vertebral artery and pedicle (h) was also analyzed.Statistical Analysis:The means and their standard deviations (SD) were calculated in both the sexes. The t-tests were performed to look for significant sexual difference.Results:The largest vertebral artery diameter (AL) was at level C7 on the right side (3.5 ± 0.8) and at the level of C5 on the left side (3.7 ± 0.4). Statistically significant difference between males and females were seen at levels C4, C5, and C7. The diameter of the vertebral artery was smaller in females than males. The L value was greater than other parameters (M, A, P) at the same level in all the measurements. The h value was greatest at C6 level and shortest at C5.Conclusion:CTA is necessary before pedicle screw fixation due to variation in measurements at all levels. The highest potential risk of vertebral artery injury during cervical pedicle screw implantation may be at C5, then at C4, and the safest is at C7.

A Novel Nonanchoring Technique for Implantation of Paddle Leads in the Cervical Spine Under Conscious Sedation.

Spinal cord stimulation (SCS) revision surgery remains common, with a negative impact on cost-effectiveness and outcomes. The primary goal of this report was to retrospectively study the need for revision surgery in a cohort of complex regional pain syndrome type I (CRPS-1) patients with newly implanted cervical surgical paddle leads, focusing on a method of implantation to reduce the need for revision surgery. Fifteen patients underwent implantation of paddle SCS leads in the cervical spine with cervical laminotomies under conscious sedation for CRPS-1 from 2008 to 2012. Electrodes were not anchored and 11 of the electrodes were three-column paddle leads. A disinterested third party performed initial chart reviews, supplemented by subsequent telephone interviews. The need for revision surgery was the endpoint. A single surgeon performed all implants with a consistent method. There were no paddle electrode lead revisions required for suboptimal lead placement, fracture, migration, or infection at a median follow-up period of 22 months. This study is the first to report on: 1) cervical electrode implantation with no anchoring; and 2) cervical paddle lead implantation (including three-column paddles) performed under conscious sedation. The specific method of nonanchoring of the paddle implants under conscious sedation may have contributed to low electrode lead revision rates.

Oral midazolam is a safe and effective premedication in adult outpatients undergoing brachytherapy for cancer cervix under general anaesthesia: A prospective randomised, double blind placebo-controlled study.

Anxiety in response to impending surgery is a common emotional phenomenon, but it also leads to perioperative physiological and psychological changes.[1] The major goal of pre-medication is to allay anxiety. An ideal pre-medicant should have a non-invasive route of administration, rapid and reliable onset, rapid elimination, consistent and predictable results and good patient acceptance. At the same time, it should also be free of side effects like haemodynamic instability, respiratory obstruction and delayed recovery.[2] Oral midazolam fulfills many of these characteristics. It has been extensively evaluated in children and is considered the gold standard pre-medicant for this age group but data regarding its use in adults is scarce.[3] This study was planned to evaluate the role of oral midazolam in adult females undergoing intracavitary cervical implantation for brachytherapy under general anaesthesia. Evaluation of sedation and anxiolysis was our primary objective. Safety profile in terms of haemodynamic stability, respiratory depression and recovery time, and amnestic effects were also assessed.

Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage

ObjectiveThe authors conducted a retrospective study to compare the implantation of carbon fiber composite frame cages (CFCFCs) to the implantation of polyetheretherketone (PEEK) cages after anterior cervical discectomy for cervical degenerative disc disease. In addition, the predictive factors that influenced fusion or subsidence were investigated.MethodsA total of 58 patients with single-level degenerative disc disease were treated with anterior cervical discectomy and implantation of stand-alone cages; CFCFCs were used in 35 patients, and PEEK cages were used in 23 patients. Preoperative and postoperative radiological and clinical assessments were performed.ResultsDuring the mean follow-up period of 41 months, fusion occurred in 43 patients (74.1%), and subsidence developed in 18 patients (31.0%). Pain decreased in all patients, and the patients' satisfaction rate was 75.9%. Neither fusion nor subsidence was related to the clinical outcome. There were no significant differences in the clinical and radiological outcomes between the CFCFC and the PEEK cage groups. Smoking history (p=0.023) was significantly associated with pseudarthrosis, and cage height (≥7mm) (p=0.037) were significantly associated with subsidence.ConclusionThe clinical and radiological results were similar between the CFCFC and the PEEK cage groups. Fusion or subsidence did not affect the clinical outcomes. Smoking history and cage height (≥7mm) were predictive factors for pseudarthrosis or subsidence in anterior cervical discectomy and fusion with stand-alone cages.

Impact of Cervical Artificial Disc Implantation on the Biomechanical Function of Adjacent Segments

The range of movement(ROM) of adjacent segments and the change of intervertebral disc stress after implanting artificial cervical disc are investigated. The contact problem for bio-modeling is introduced. A normal cervical spine finite element model is proposed. The bone graft and fusion between C5 and C6 and C5/6 artificial disc implantation were simulated. The range of movement on adjacent segment and the change of intervertebral disc’s stress in such two cases are analyzed. Computational results show that the model includes the ligaments, joint capsule and other soft tissue structures, which is real, fine and high accuracy. When the adjacent intervertebral ROM was increased after interbody fusion surgery, the stress of corresponding intervertebral disc was increased obviously and the stress of upper segment of nucleus pulposus and annulus fibrosus were also increased about 70% ,besides the next-bit segments was increased about 40%. There were no differences among cervical spine ROM except extension (p&gt; 0.05) after the implantation of artificial disc, and the stress on adjacent segments was increased less than 10%. The implantation of artificial cervical disc can release the stress on adjacent segments in a certain extent, and resume cervical activities at the same time.

Anterior cervical discectomy and implantation of an artificial disc (Prestige, Medtronic)

The 45-year-old female patient, professional dancer, presented in our outpatient clinic with right sided pain radiating from the neck into the complete C6 dermatome for more than 6 months. No motor or sensory deficit was found. The MRI of the cervical spine showed degenerative disc disease in the level C5/6 right sided with compression of the nerve root by a foraminal stenosis. Conservative treatments were undertaken without a lasting pain relief. The very well informed patient asked for an artificial disc replacement, which she considered important for continuation her professional dancing career

La réimplantation cervicale de la grossesse, une complication méconnue des interruptions volontaires de grossesse. À propos d’un cas

Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.

Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis

Intrathecal baclofen (ITB) pump catheter placement is traditionally performed through entry into the spinal sac at the lumbar spine. A minority of children with cerebral palsy have severe concomitant neuromuscular scoliosis. In these children, whether surgically treated or not, access to the intradural space via the lumbar spine may prove technically challenging. The authors report on a series of children in whom, for various reasons, an ITB catheter was implanted using a posterior cervical spine approach. The records of 20 children in whom a baclofen catheter had been placed were retrospectively reviewed to assess the demographic details, indications, and outcome of this procedure. This approach was successful in all but one of the children in whom the procedure was abandoned given the presence of significant extradural scar tissue. Of the 20 children, 7 had previously undergone lumbar ITB catheter implantation, although the catheter was subsequently, iatrogenically transected during scoliosis surgery. Nine children had had corrective scoliosis surgery, and the fusion mass obviated access to the lumbar spinal sac. Four children had untreated scoliosis and corrective surgery was being contemplated. Complications included infection requiring explantation (2 patients), catheter migration (1 patient), intolerance to ITB (1 patient), and failure of implantation (1 patient). All patients who tolerated the ITB experienced improvement in spasticity. No complications were associated with the spinal level of catheter insertion. Implantation of an ITB catheter via a cervical approach is safe and feasible and should be considered in children with severe corrected or uncorrected scoliosis, and thus avoiding the lumbar spinal sac.

The Quality of Cervical Cancer Brachytherapy Implantation and the Impact on Local Recurrence and Disease-Free Survival in Radiation Therapy Oncology Group Prospective Trials 0116 and 0128

The objective of the study was to determine the impact of brachytherapy implant quality on outcome among cervical cancer patients treated on Radiation Therapy Oncology Group prospective trials 0116 and 0128. All enrolled patients received concurrent chemoradiation followed by brachytherapy. Individual brachytherapy parameters, including the symmetry of ovoids in relation to the tandem, displacement of ovoids in relation to the cervical os, tandem bisecting the ovoids, tandem in the midpelvis, and appropriateness of packing, were scored for each implant. Multivariate Cox proportional hazards models were constructed for each parameter for local recurrence (LR), regional recurrence, distant recurrence, disease-free survival (DFS), and overall survival. Records for 103 patients were analyzed. The median follow-up time was 24.5 months. Patients with unacceptable symmetry of ovoids to the tandem had a significantly higher risk of LR than patients in the acceptable group (hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.11-6.45; P = 0.03). Patients with displacement of ovoids in relation to the cervical os had a significantly increased risk of LR (HR, 2.50; 95% CI, 1.05-5.93; P = 0.04) and a lower DFS rate (HR, 2.28; 95% CI, 1.18-4.41; P = 0.01). Inappropriate placement of packing resulted in a lower DFS rate (HR, 2.06; 95% CI, 1.08-3.92; P = 0.03). Assessment of the quality of a brachytherapy implant is imperative, as proper placement has an impact on patient DFS. If feasible, inappropriate placements should be corrected before treatment initiation. Brachytherapy applicators for cervical cancer should preferably be placed and assessed by experienced practitioners.

Gastric intramural hematoma caused by argon plasma coagulation: treated with endoscopic incision and drainage (with videos)

Anterior cervical plate implantation is commonly performed. Esophageal perforation from plate displacement occurs in approximately 2% of cases.1 Dysphagia, neck abscess, and/or aspiration pneumonia occurs weeks to years after surgery. Recognition of this complication is critical because mortality can be as high as 20%.2 Causes of esophageal perforation after spinal fixation include screw migration and chronic pressure necrosis by the cervical plate.1,3 Endoscopy allows direct inspection of the esophgus for exposed intraluminal hardware. CT of the neck is elpful to assess for neck abscess and esophagography to valuate for esophageal leakage. Treatment usually inolves hardware removal and reconstruction of the esophaus. Uncomplicated esophageal injuries and contained leaks ay be treated conservatively with antibiotics and extraoral eedings. Surgery is necessary for neck abscess, recurrent spiration pneumonia, and sepsis.2 Prior radiation-induced damage to the esophagus may contribute to erosion and perforation by the cervical plate. d

A new technique for anterior cervical pedicle screw implantation

To introduce and evaluate a new technique, anterior pedicle screw implantation, for anterior cervical reconstruction. Seven patients (five men and two women) with an average age of 65 years were included in this group. After carefully preparation, anterior pedicle screws were implanted under fluoroscopy in all patients. The position of the anterior pedicle screws was evaluated three days postoperatively by X-ray and CT imaging. The mean recovery rate as assessed by the Japanese Orthopaedic Association (JOA) score was recorded at final follow-up. A total of fourteen anterior pedicle screws were implanted in our group. The average follow up period was 8 months. The mean JOA score was 12.5 preoperatively and 14.8 postoperatively. The mean improvement in the JOA score was 50.5% at final follow-up. The average local alignment improved from 4.0 of kyphosis preoperatively to 6.5 of lordosis at final follow-up. Early bony union was observed in four cases that were followed up for more than 3 months. There were no serious complications. No "pedicle perforation" was observed in any of the fourteen anterior pedicle screws, whereas one screw exposure occurred. Anterior cervical pedicle screw implantation is a feasible method for selected cases. It provides another choice for strong anterior cervical reconstruction.

Cervical Interbody Fusion Is Enhanced by Allogeneic Mesenchymal Precursor Cells in an Ovine Model

An experimental study using a sheep cervical spine interbody fusion model. To compare allogeneic mesenchymal precursor cells combined with hydroxyapatite and tricalcium phosphate (HA/TCP) with HA/TCP alone or iliac crest autograft (AG) for cervical interbody fusion. We investigated the effect of mesenchymal precursor cells on cervical fusion because of the shortcomings of using iliac crest (donor site morbidity), bone substitute (poor osteoinductive properties), and bone morphogenic proteins (serious complications). Thirty ewes were divided randomly into four groups of six having C3-C4 anterior cervical discectomy and fusion using a Fidji cage packed with, AG, HA/TCP, HA/TCP containing 5 million MPCs, and HA/TCP containing 10 million MPCs. MPCs were derived from a single batch of immuno-selected and culture-expanded MPCs isolated from bone marrow of out-bred sheep. The fifth group were nonoperated controls. Safety, fusion parameters, and biomechanics were assessed. No cell-related adverse events were observed. No significant differences were found between the five or 10 million MPC groups. Evaluation of fusion by CT scan at 3 months showed that 9 of 12 (75%) MPC-treated animals had continuous bony bridging compared with only 1 of 6 AG and 2 of 6 HA/TCP (P = 0.019 and P = 0.044, respectively). By quantitative CT, density of new bone in MPC-treated animals was 121% higher than in HA/TCP (P = 0.017) and 128% higher than in AG (P < 0.0001). Functional radiology at 3 months revealed that MPC-treated animals had significantly reduced macromotion at C3/4 compared with AG and HA/TCP groups combined (P = 0.007). Implantation of allogeneic MPCs when combined with HA/TCP and an interbody spacer facilitates new bone formation after discectomy without any cell-related complications. The earlier and dense new bone formation observed with MPCs relative to autograft and HA/TCP alone suggest that this approach may offer therapeutic benefit.

Advances in researches on improving the accuracy of cervical pedicle screw implantation 137

椎弓根螺钉内固定技术运用于脊柱外科至今已半个多世纪,由于其符合三柱固定原理,具有良好的生物力学稳定性、所需固定节段少、影响脊柱活动度小等优点,目前已广泛用于胸腰椎疾患的治疗.但是颈椎解剖关系复杂、椎弓根细小、个体变异性大,使用此术式容易损伤颈脊髓、椎动脉和神经根,置钉危险性及难度较胸腰椎都大[1-3].因此,如何提高颈椎椎弓根螺钉置钉准确性一直以来都是脊柱外科研究的热点.近年来,随着传统置钉方法 的改进以及计算机辅助技术的应用,颈椎椎弓根螺钉置钉准确性有了进一步提高,颈后路椎弓根内固定术已经日趋成熟,越来越多的脊柱外科医师开始将该技术用于颈椎稳定性的重建[4-7]。