| Part One: The study of the clinical effect and imaging data of the treatment of kyphosis deformity with preoperative traction and posterior cervical decompression and arthrolysis and lateral mass screw fixationObjective: The curative effect of laminoplasty for cervical kyphosis is controversial.Traditional laminoplasty has low efficiency in the correction of cervical kyphosis,and degenerative cervical spine is prone to osteophyte formation of small joints or local ligament thickening.However,cervical laminectomy has two major disadvantages: severe dural adhesion after laminectomy and low fusion rate,resulting in curvature loss.This paper introduces the clinical and radiologic results and the effectiveness of preoperative traction plus posterior cervical laminectomy and arthrolysis and lateral mass screw internal fixation.For the successful correction of cervical spine,it is the most important to recover the lordosis as much as possible on the premise of relieving the spinal cord compression caused by kyphosis.It is inconvenient for surgeons to control power and closely monitor the scope of operation.Methods: the clinical data and imaging examination of 17 patients with degenerative cervical kyphosis were studied retrospectively.Among them,there were 10 males and 7 females,aged 43-70 years.All patients received preoperative traction plus posterior cervical decompression and arthrolysis and lateral mass screw fixation(c2-7 7 cases;c3-7 6 cases;c2-6 4 cases).In addition,the clinical and imaging data of the patients who received preoperative traction and posterior cervical laminectomy and arthrolysis and lateral mass internal fixation were analyzed.X-ray and CT were used before and after the operation and during the follow-up to evaluate the postoperative fusion of bone,as well as the Cervical Sagittal Vertical Axis(C-SVA)and C2-C7 Cobb angle.All patients were evaluated by Visual Analogue Score(VAS),Neck Disability Index(NDI),modified Japanese Orthopaedic Association score(m JOA).Results: 17 patients(10 males and 7 females)were followed up for at least 12 months,with an average follow-up time of 22.4 months(13 to 27 months).The average operation time was 165.3 min(120-210 min),and the amount of bleeding was 289.4 ml(200-500 ml).After operation,10 patients had axial symptoms,7 patients had C5 nerve root palsy and no vertebral artery injury.At the last follow-up,VAS,NDI and m JOA were improved from 7.8 ±1.7,37.7±5.4 and 7.4±2.4 to 4.7±1.4,27.2±7.2 and 10.4±2.1,respectively.Postoperative CT showed that all the operative segments were fused and the reduction was not lost.The Cobb angle of C2-C7 changed from 16.0°± 5.7°to-1.4°±5.8°;the vertical axis of C2-C7 sagittal plane(c-sva)changed from 57.5±10.2mm to 24.6±7.9mm.Conclusions: The operator can obtain a better preoperative soft tissue release by using preoperative traction and posterior cervical laminectomy and arthrolysis and lateral mass screw internal fixation.This technique may be a simple and effective method to provide a stable three-dimensional reduction for cervical osteotomy.Part Two: Study on the clinical effect and imaging data of the treatment of degenerative cervical kyphosis with anterior wedge osteotomy,decompression,fusion and internal fixationObjective: To study the surgical treatment of degenerative kyphosis with anterior wedge osteotomy and fusion(ACWODF)and the clinical effect and imaging changes of patients.Methods: The clinical and imaging data of 26 patients with degenerative kyphosis and cervical spondylosis from March 2015 to may 2018 in our hospital were collected and analyzed.All patients received acwodf for deformity correction and were followed up for at least 12 months.Among them,there were 15 males and 11 females,aged 44-67 years.A total of 52 segments were treated with anterior cuneiform osteotomy,decompression,bone fusion and internal fixation(C3 / 4 10 cases;C4 / 5 20 cases;C5 / 6 17 cases;C6 / 7 5 cases).These patients received single segment fusion in 6 cases,double segment fusion in 14 cases,and three segment fusion in 6 cases.Through the anterior approach of the cervical spine,the intervertebral disc was excised through the intervertebral space,and wedge-shaped osteotomy was performed.Part of the bone of the uncinate joint was excised on both sides and soft tissue was loosened.Part of the endplates and bone of the upper and lower vertebral bodies of the intervertebral space were excised by wedge-shaped osteotomy,and the posterior edge of the upper and lower vertebral bodies was excised by stealth,The partial endplates of the upper and lower vertebrae were preserved,the hyperplastic bone of the posterior margin of the vertebrae was completely removed,and the posterior longitudinal ligament was completely removed.During the operation,Caspar type cervical vertebra spreader,peek interbody fusion cage with angle were used.After anesthesia,the position and angle of cervical vertebra were adjusted by X-ray film,so as to pre orthopedic and provide a better position for decompression.The fusion cage was filled with autogenous bone,and the anterior edge of vertebral body was fixed with titanium plate.Ultra thin lamina rongeur and pneumatic drill were used to assist osteotomy.X-ray and CT were used before and after the operation and during the follow-up to evaluate the postoperative fusion of bone,as well as the Cervical Sagittal Vertical Axis(C-SVA)and C2-C7 Cobb angle.All patients were evaluated by Visual Analogue Score(VAS),Neck Disability Index(NDI),modified Japanese Orthopaedic Association score(m JOA).Results: 26 patients(15 males and 11 females)were followed up for at least 12 months,with an average follow-up time of 21.4 months(14 to 28 months).The average operation time was 91.9 min(50-150 min),and the amount of bleeding was 111.1 ml(50-220 ml).15 patients had axial symptoms,8 patients had C5 nerve root palsy and no vertebral artery injury.At the last follow-up,VAS,NDI and m JOA were improved from 3.3 ± 2.1,34.3 ± 7.6 and 8.6 ± 2.7 to 3.1 ± 1.4,14.6 ± 7.7 and 13.1 ± 2.1 respectively.Postoperative CT showed that all operative segments were fused.The Cobb angle of C2-C7 changed from 10.6°±4.1°to-1.6±5.6°;the C2-C7 sagittal vertical axis(C-SVA)changed from 52.0±9.3mm to 24.0±9.0mm.Conclusions: For the treatment of degenerative cervical kyphosis,we use the anterior cervical wedge osteotomy,decompression,bone fusion and internal fixation,which can obtain good clinical effect,obviously improve the kyphosis of cervical spine,and correct the curvature of the whole cervical spine,It can effectively prevent the aggravation of cervical kyphosis,but the patients who receive the operation will have axial symptoms such as neck pain.The anterior cervical wedge osteotomy can effectively relieve the compression of the spinal cord and remove the osteophyte at the posterior edge of the vertebral body.It can be applied to the multi-level combined wedge osteotomy to improve the orthopedic effect.It is suitable for the degenerative kyphosis caused by the degeneration of the intervertebral disc and the osteogenic hyperplasia of the anterior column of the cervical spine.Part Three: A retrospective study on the long-term clinical effect and imaging analysis of the treatment of “skip” multi-segment cervical spondylosis with cervical disc replacementObjective: The aim of this study was to retrospectively analyze the clinical and radiological efficacy of Bryan cervical arti-ficial disc replacement(ADR)for “skip” multi-segment cervical spondylosis(SCS).Methods: We enrolled 49 patients with SCS treated with either Bryan cervical ADR(18 cases)or ACDF(31 cases).Each case was evaluated preoperatively and at more than 48 months postoperatively in follow-up using the JOA,NDI,and VAS.Cervical sagittal curvature,total cervical ROM,and degree of middle segments of motion were also evaluated.MRI was used to assess adjacent segment degeneration(ASD),spinal cord compression,and signal changes.Results: The m JOA,NDI,and VAS scores in the 2 groups improved significantly postoperatively.At the last follow-up,the results of Group Bryan were better than those of Group ACDF with respect to the incidence of axial symptoms(11.1% and 45.2%,respectively),VAS,ROM,and the degree of middle segments of motion.The ROM in Group Bryan was 38.2±4.6° and in Group ACDF was 25.3±4.6°.The middle segments of motion were 8.4±2.0° in Group Bryan and 12.2±2.2° in Group ACDF.There were no patients with ASD in Group Bryan.In Group ACDF,1 case with an internal fixation device developed dislocation,and 2 cases developed degeneration,but there was no need for reoperation.Conclusions: ADR for SCS can effectively improve neurological function and retain the overall activity of the cervical,there-by reducing ASD and the incidence of postoperative axial symptoms.Part Four: Biomechanical analysis of the animal model of cervical kyphosis treated by anterior cervical wedge osteotomy decompression,bone grafting and internal fixationObjective: Anterior cervical vertebra resection and fusion is an effective method for the treatment of cervical spondylotic myelopathy,but the surgical correction of kyphosis and cervical kyphosis is inefficient.We designed to use anterior cervical wedge osteotomy decompression and fusion and internal fixation to correct degenerative kyphosis,which can expand the volume of cervical spinal canal and effectively restore the physiological curvature of cervical spine.To study the influence of the operation on the degeneration of the adjacent segment of the cervical disc by changing the pressure of the adjacent segment of the operation segment of the cervical spine of the kyphosis goat.Methods: six male goats were divided into experimental group and control group.In the experimental group,the cervical vertebrae were treated with anterior cervical wedge osteotomy decompression and fusion(ACWODF),while in the control group,the cervical vertebrae were treated with anterior cervical discectomy,decompression and fusion.After the operation,fresh cervical vertebrae were tested for biomechanics.Three goats in each group were fused with two segments.The pressure changes of flexion,extension,and axial rotation of the upper and lower discs in each group before and after operation were compared.X-ray examination of the influence of the two kinds of operation on the curvature of the whole cervical spine and the curvature of the operative segment.Results: Compared with the conventional decompression and fusion,the anterior cervical wedge osteotomy decompression and fusion had a significant advantage in the recovery of the overall curvature of the cervical spine and the curvature of the operative segments(P<0.01),and the stress changes in most directions.There was significant difference(P<0.01).Compared with conventional fusion,anterior cervical wedge decompression and bone grafting fusion and internal fixation can restore a certain degree of physiological curvature.However,due to the use of larger interbody fusion cage,the stress of adjacent segment disc is significantly higher than that of conventional decompression.Conclusions: Anterior cervical wedge decompression and fusion and internal fixation provide more options for the recovery of physiological curvature of cervical spine in degenerative kyphosis,but there is evidence that this operation can not reduce the incidence of adjacent segment degeneration. |
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