Dislocation Of Lower Cervical Spine Research Articles

Nursing Intervention Study of Microscope-assisted Anterior and Posterior Fusion for Lower Cervical Spine Fracture and Dislocation

To explore the nursing intervention measures of microscopy-assisted anterior and posterior fusion in the treatment of lower cervical spine fracture and dislocation.46 patients with fracture and dislocation of lower cervical spine who were treated by microscope-assisted anterior and posterior fusion in our hospital from April 2018 to April 2019 were selected for this study, and divided into observation group and control group according to the different nursing interventions applied by the patients during the treatment. There were 23 patients in the two groups, while the patients in the control group were given routine nursing interventions. The patients in the observation group were given comprehensive nursing interventions. The curative effects of the treatment and nursing interventions in the two groups were observed, sorted out, analyzed and summarized. The changes of psychological status, recovery of spinal cord function, occurrence of complications and quality of life before and after nursing intervention were compared between the two groups.(l) Psychological status: Before nursing intervention, there was no significant difference in psychological status between the two groups, and there was no significant difference (P > 0.05); After nursing intervention, the SDS and SAS scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05); (2) Recovery of spinal cord function: before nursing intervention, there was no significant difference in JOA scores of spinal cord function between the two groups, and the difference was not statistically significant (P > 0.05); After nursing intervention, JOA score of spinal cord function in the observation group was significantly better than that in the control group, the difference was statistically significant (P < 0.05); (3) Complication occurrence: Complication incidence in the observation group was lower than that in the control group, the difference was statistically significant (P < 0.05). (4) Quality of life: before nursing intervention, there was no significant difference in QOL scores between the two groups, and the difference was not statistically significant (P > 0.05); after nursing intervention, the QOL scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05).Through the analysis, it was found that the operation of microscope-assisted anterior and posterior fusion therapy was more complicated and the risk of treatment was greater. The comprehensive nursing interventions throughout the preoperative, intraoperative and postoperative period played a vital role in improving the treatment effect of patients, which was not only conducive to the effective recovery of patients’ spinal cord function. At the same time, it can avoid complications in the treatment process, so as to promote the early recovery of the patient’s condition and improve the quality of life. In general, the application of comprehensive nursing interventions in the treatment of lower cervical spine fracture patients has higher application value, which is worthy of clinical vigorous promotion and.

One-stage anterior-posterior decompression and internal fixation for severe fracture-dislocation of lower cervical spine in "beach chair position"

Objective To explore the surgical feasibility and clinical efficacy of one-stage anterior-posterior approaches in treatment of severe fracture and dislocation of lower cervical spine in beach chair . Methods Sixteen male cases of severe fracture and dislocation of lower cervical spine and with a mean age of 49.8 years (range, 36-78 years) treated surgically from May 2012 to May 2016 were analyzed retrospectively by using case series study. The segment of injury was C4-5 in 4 cases, C5-6 in 7 and C6-7 in 5. The degree of spinal cord injury according to the American Spine injury Association (ASIA) score was Grade A in 4 cases, Grade B in 7 and Grade C in 5. Sub-axial injury classification (SLIC) score was 8 points in 9 cases and 9 points in 7. After a general anesthesia, a ring with a hole was hanged on patient's head before the operation. Then, under the protection of hole traction, the upper of operating bed was swung up slowly, so that the patient was restricted in vertical beach chair with traction on the halo in order to immobilize the head and partially reduce the kyphotic deformity. Routine cervical anterior-posterior approach was done with the exposure of damaged section of the front and rear structure. Pedicle screw system or lateral mass screw displacement was conducted. Anterior intervertebral discectomy or fracture vertebral was performed, using collaborative reset prying method before and after the road. In the front of intervertebral cage or titanium net support bone graft, rear pedicle screws or lateral mass screws fixation and bone graft fusion were implemented. The operation time and blood loss were recorded. The healing of the wound was observed. The recovery of neurological function was evaluated according to the ASIA grade. Postoperative review X-ray, CT and MRI were done to evaluate the reset and bone graft in position and fusion. Results All the surgeries were done well without aeroembolism and other related complications. The mean operative time was 153 minutes (range, 150-180 minutes), and the mean amount of blood loss was 543 ml (range, 400-800 ml). Sixteen cases were followed-up from 6 to 24 months (mean 13.7 months). All the incision were healed at I stage. Spinal cord function did not aggravate. The ASIA grade was improved with an average of one to two Grades 6 months after surgery. Postoperative X-ray and CT confirmed that graft object position was favorable and cervical sequence was recovered well. The Cobb angle decreased from (23.6±5.3)°preoperatively to (4.0±0.4)°postoperatively, and the translational displacement of vertebral body was restored into (2.7±0.4)mm (P<0.01) from (10.9±1.6)mm before operation. The cervical spinal canal was not obstructed and the cervical spinal cord was relieved, showed by MRI. Conclusions One-stage anterior-posterior approaches for severe fracture and dislocation of lower cervical spine circumferential reconstruction in beach chair is a beneficial and effective method, without the need of changing positions in a collaborative reduction and fixation. The method can reduce the interference of spinal cord, shorten the operation time and save anterior extra fixation. Key words: Cervical vertebrae; Spinal fractures; Dislocation; Beach chair position

Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation

To explore the clinical value of early and one-stage posterior laminectomy decompression, fracture reconstruction and lateral mess screw fixation combined with anterior cervical corpectomy or discectomy for the treatment of fresh and severe lower cervical spine fracture and dislocation. A total of 156 consecutive cases of severe fracture and dislocation of lower cervical spine were reviewed from January 2008 to January 2015. Skull traction was installed when the patients were enrolled in the hospital, so the operation was performed as early as possible. Firstly, the posterior procedure was applied to the patients prone on a frame. A standard posterior laminectomy, fixation and fusion were performed with lateral mass screws and rods. The cervical spine reconstruction was achieved by laminecomy, partially facetectomy, leverage and distraction. The technique of rotating rod was applied to recover the sequence of the cervical and keep or increase the zygopophysis and lordosis of the cervical on the sagittal plane. After the skull traction removed, a standard anterior approach to the cervical spine was initiated as the second stage of the procedure. Anterior cervical corpectomy or discectomy, spinal cord decompression, antograft and cervical spine auto-locking plate fixation were carried out. The stability, the fusion rate of the injured segments and spinal cord decompression were observed on the regular postoperative X-ray film and CT scan. The function of the spinal cord was evaluated by American Spinal Injury Association (ASIA) classification. A total of 137 cases were followed-up, 19 failed to follow-up and 8 of them were due to death. The follow-up time was from 9.0 months to 35.0 months (mean: 13.7 months). All patients got completely reduction of the cervical spine. The injured segments were stable. There was no patient of bone graft no-fusion. The cervical intervertebral height and lordosis were reconstructed and maintained and all grafts were fused at the end of follow-up period. There was no complication related to internal fixation breakage, loosening or displacement. There was also no neurovascular and esophagus complications during the operation. Twelve patients complained neck pain at the final follow-up. There were 12 cases of wound infection and 12 cases of neck inflammatory. They were healed after anti-inflammatory therapy. There were 13 cases of cerebrospinal fluid leakage, and they were healed after the symptomatic treatment. The neuro-function of most patients was improved, and ASIA classification was improved by 1 to 2 grade. Early and one-stage posterior-anterior decompression and reconstruction for the patients with fresh and severe lower cervical spine fracture and dislocation can achieve good reduction and cervical alignment of cervical spine. The injured segments can gain postoperative immediate stability. It also gives a completely decompression, which is benefit to the patients for nursing, functional exercise, and the functional recovery of the spinal cord.

Impact responses of the cervical spine: A computational study of the effects of muscle activity, torso constraint, and pre-flexion

Cervical spine injuries continue to be a costly societal problem. Future advancements in injury prevention depend on improved physical and computational models, which are predicated on a better understanding of the neck response during dynamic loading. Previous studies have shown that the tolerance of the neck is dependent on its initial position and its buckling behavior. This study uses a computational model to examine three important factors hypothesized to influence the loads experienced by vertebrae in the neck under compressive impact: muscle activation, torso constraints, and pre-flexion angle of the cervical spine. Since cadaver testing is not practical for large scale parametric analyses, these factors were studied using a previously validated computational model. On average, simulations with active muscles had 32% larger compressive forces and 25% larger shear forces—well in excess of what was expected from the muscle forces alone. In the short period of time required for neck injury, constraints on torso motion increased the average neck compression by less than 250N. The pre-flexion hypothesis was tested by examining pre-flexion angles from neutral (0°) to 64°. Increases in pre-flexion resulted in the largest increases in peak loads and the expression of higher-order buckling modes. Peak force and buckling modality were both very sensitive to pre-flexion angle. These results validate the relevance of prior cadaver models for neck injury and help explain the wide variety of cervical spine fractures that can result from ostensibly similar compressive loadings. They also give insight into the mechanistic differences between burst fractures and lower cervical spine dislocations.

One stage internal fixation with posterior transarticular screws and anterior plating for treatment of lower cervical spine fractures and dislocations

Objective To evaluate the effects of one stage internal fixation with posterior transartitular screws and anterior plating for the treatment of lower cervical spine fractures and dislocations.Methods From October 2005 to May 2007, 12 patients with fractures and dislocations of lower cervical spine were treated by one stage anterior-posterior internal fixation. Posterior transarticular screw fixation combined with anterior decompression and bone graft and anterior plating were applied for only dislocations.Anterior decompression and bone graft and anterior plating combined with posterior transarticular screw fixation were applied for the fractures and dislocations. The zygapophysial joints were fused. Results All patients were followed up for 6 to 21 (average, 14. 8) months. No loosening of the transarticular screw or nerve-vessel complication was found. Intervertebral and zygapophysial joints all got bony healing. Conclusion One stage internal fixation with posterior transarticular screws and anterior plating is an ideal method of treating lower cervical fractures and dislocations, having the advantages of simple and safe procedures, reliable fixation and a high rate of bone fusion. Key words: Cervical vertebrate; Fractures; Dislocations; Fracture fixation, internal; Screw

POSTERIOR INTERNAL FIXATION WITH SHAPE-MEMORY TIGHTENING CLAMPS IN THE TREATMENT OF LOWER CERVICAL VERTEBRA ANTERIOR DISLOCATIONS

Objective. To analyze adaptation of shape-memory dynamical clamps to anatomical and morphological features of the cervical spine. Material and Methods. Fifty five patients with lower cervical spine dislocations were operated on by posterior fixation with tightening clamps. In 14 (25.0 %) patients the open reduction of dislocated vertebra and posterior clamp fixation were accompanied by the anterior fusion with a porous NiTi implant, while 42 (75.0 %) patients underwent only posterior operation. The treatment results in patients with spinal cord injury were evaluated using A.H. Martins criteria and ASIA/IMSOP scale. Delayed results were estimated 1–5 years after operation in 42 (75.0 %) patients. Results. Treatment results were assessed as good in 88.1 % of cases. Radiological examination revealed a decrease in disc height at injured and adjacent levels not more than 1 mm; instability, or kyphotic deformity were not registered. Implant area did not include the signs of resorption or osteosclerosis. Neurological disorders caused by posttraumatic spinal cord cyst were observed in one (2.4 %) patient in 1.5 years after surgery. In 4 (9.5 %) patients who underwent anterior and posterior fixation the treatment results were assessed as fair. Patients disability period was 96 ± 38 days. Conclusion. Two-axial fixation with coupled tightening clamps of shape-memory material provides the reliable stabilization of the injured vertebral motion segment. Preliminary posterior fixation for unstable injury facilitates the optimal performing of anterior interbody fusion with porous implants and ensures its absolute stability.

Use of cervical transpedicular fixation for fracture and dislocation of lower cervical spine

Objective To investigate the method and effect of treating fractures and dislocations of lower cervical spine utilizing cervical transpedicular fixation. Methods The 38 cases of fracture and dislocation of lower cervical spine who had been treated in our department from June 2003 to June 2006 were retrospectively analyzed.They were 27 males and 11 females,aged from 22 to 63 years(mean,44.3).Of them. 6 cases presented with fracture and dislocation of unilateral facet, 13 with fracture and dislocation of bilateral facets. 14 with fracture and dislocation of bilateral facets and compression fracture of vertebral body,and 5 with cervical burst fracture and dislocation.All of them had spinal injury in different degrees.According to American Spinal Injury Association(ASIA)grading system,18 cases were rated as grade A,12 as grade B,6 as grade C,and 2 as grade D. Results All the patients were followed up for 10 to 24 months,with a mean foilow-up of 11 months. In 4 to 6 months postoperatively,all the 38 cases achieved bony fusion and stable segmental fixation. Conclusions In treatment of fracture and dislocation of lower cervical spine,cervical transpedicular fxation is an effective and reliable method of rebuilding cervical stability,promoting fusion of bone graft.and maintaining postoperative physiological curvature of cervical spine.It also allows convenient nursing and early functional exercise. Key words: Cervical vertebrae; Fracture; Fracture fixation,internal

Surgery for fracture dislocation of lower cervical spine through combined anterior and posterior approaches

下颈椎骨折脱位是三柱均遭破坏的严重颈脊椎损伤.传统的方法是闭合大重量牵引复位,前路或后路减压、固定、植骨融合术.但对一些未能复位或合并椎间盘损伤压迫脊髓不适合闭合复位者,目前尚无统一的治疗模式.单纯的后路或前路手术,不能达到既减压充分又恢复脊柱序列和重建脊柱稳定性的目的。

Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine

Traumatic facet dislocations and facet-fracture dislocations in the lower cervical spine (C2/C3 to C7/T1) are frequently associated with devastating neurological symptoms. A good outcome can only be achieved if the operator has wide and sound knowledge of reduction techniques and the best possible strategy is devised for the subsequent treatment of these severe lesions. Between 1973 and 1997 a total of 117 of our patients met at least one of the following inclusion criteria: unilateral locked facet dislocation (48%), bilateral locked facet dislocations (23%), unilateral "perched" facet subluxation (14%), bilateral perched facet subluxation (12%), uni- or bilateral dislocation/perched subluxation with facet fractures (3%). Most of the lesions were located at the levels of C5/C6 and C6/7 (n=46 for each). Associated neurological deficits were present initially in 65% of patients: 35% had complete or incomplete spinal cord injuries (tetraplegia), 2% were paraplegic, and 28% had cervical radiculopathies. Closed reduction (e.g. with the aid of a halo ring) should be carried out as soon as possible after lower cervical spine dislocation or facet-fracture dislocation, as both the success rate of reduction and the potential for recovery from neurological deficits are clearly higher when reduction is achieved within the first 4 h after the initial injury.

The selection of the surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury

To investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury. The clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach. All patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery. For lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.

Treatment of old dislocation of lower cervical spine by reduction with high weight traction and internal fixation of anterior fusion

目的 探讨大重量牵引复位前路融合内固定治疗陈旧性下颈椎脱位的价值和注意事项.方法本组 8例,男 5例,女 3例,受伤至入院时间 3周～ 6个月,平均 2.5个月,入院后行颅骨牵引,逐渐增加重量,难以复位者行小关节突切除,复位后行前路植骨融合,钢板内固定术.结果 8例患者均获较好的复位,其中 6例获完全复位;复位牵引重量 10～ 18kg,平均 13.5kg; 6例获得随访,平均随访 14.5个月,按 Frankel分级,除 1例 A级患者无恢复外,其余 5例均有恢复,分别改善 1或 2级;所有患者均获骨性融合. 结论采用大重量颅骨牵引,难以复位者辅以小关节突切除,复位后行前路植骨融合,钢板内固定术治疗陈旧性下颈椎脱位,疗效满意.