BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with...BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.展开更多
As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described pr...As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.展开更多
In clinical practice,cervical spine surgery inevitably alters the original physiological structure of the cervical spine,thus causing changes in the original biomechanical properties of the cervical spine.The biomecha...In clinical practice,cervical spine surgery inevitably alters the original physiological structure of the cervical spine,thus causing changes in the original biomechanical properties of the cervical spine.The biomechanical properties of the cervical spine are particularly significant as it is an essential structure that supports the head and connects the trunk.Different cervical spine surgery options can have different effects on the biomechanics of the cervical spine.Therefore,this review will discuss recent research advances on the effects of cervical spine surgery on cervical spine biomechanics.We hope that this review will provide some theoretical basis for future studies on the biomechanical effects of cervical spine surgery on the cervical spine.展开更多
<b><span style="font-family:Verdana;">Introduction</span></b><span "=""><span style="font-family:Verdana;">: Degeneration of the cervical spine (C...<b><span style="font-family:Verdana;">Introduction</span></b><span "=""><span style="font-family:Verdana;">: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><span style="font-family:Verdana;">: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA;we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: </span></span><span style="font-family:Verdana;">As </span><span style="font-family:Verdana;">a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 - 75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity</span><span "=""> </span><span style="font-family:Verdana;">we found major prevalence of affection in the PA group. We didn’t report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p < 0.05);and presented improvement compared with presurgical period (p < 0.001)</span><span style="font-family:Verdana;">.</span><span "=""> <b><span style="font-family:Verdana;">Discussion</span></b><span style="font-family:Verdana;">: Patients show significant improvements in outcome measures with either anterior or posterior surgery. Both approaches are highly efficacious in preventing neurologic deterioration and in most cases improve neurological function with appropriate postoperative management like rehabilitation, pain management</span></span><span style="font-family:Verdana;">,</span><span "=""><span style="font-family:Verdana;"> and psychological support. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The patients submitted to surgical medullary decompression presented a favorable outcome despite the age and the higher prevalence of comorbidities;whereby we favor the surgical treatment in all patients in a case-to-case selection to generate a positive impact on functional outcomes.展开更多
Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods According to the Allen-Fergurson'...Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods According to the Allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included. Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group. Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.展开更多
Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods...Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This展开更多
Chordomas are malignant tumors arising from notochordal remnants. They are the most frequent tumors of the spine after plasmacytomas. Only 6% of chordomas are localized to the cervical level. In young patients, chordo...Chordomas are malignant tumors arising from notochordal remnants. They are the most frequent tumors of the spine after plasmacytomas. Only 6% of chordomas are localized to the cervical level. In young patients, chordomas are rare and unpredictable. Despite this, the treatment of choice remains the total resection, as much as possible, followed by proton beam radiation. This case was managed using a precarotid and retrocarotid approach at the same time. The tumor was completely resected with the edges free from disease. The cervical spine was stabilized with an anterior plating C2-C4. Eighteen months after surgery the patient is still free from illness. Multilevel oblique corpectomies are an available and safe option for the treatment of upper cervical chordomas.展开更多
目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈...目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。展开更多
BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a p...BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.展开更多
文摘BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.
文摘As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.
文摘In clinical practice,cervical spine surgery inevitably alters the original physiological structure of the cervical spine,thus causing changes in the original biomechanical properties of the cervical spine.The biomechanical properties of the cervical spine are particularly significant as it is an essential structure that supports the head and connects the trunk.Different cervical spine surgery options can have different effects on the biomechanics of the cervical spine.Therefore,this review will discuss recent research advances on the effects of cervical spine surgery on cervical spine biomechanics.We hope that this review will provide some theoretical basis for future studies on the biomechanical effects of cervical spine surgery on the cervical spine.
文摘<b><span style="font-family:Verdana;">Introduction</span></b><span "=""><span style="font-family:Verdana;">: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><span style="font-family:Verdana;">: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA;we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: </span></span><span style="font-family:Verdana;">As </span><span style="font-family:Verdana;">a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 - 75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity</span><span "=""> </span><span style="font-family:Verdana;">we found major prevalence of affection in the PA group. We didn’t report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p < 0.05);and presented improvement compared with presurgical period (p < 0.001)</span><span style="font-family:Verdana;">.</span><span "=""> <b><span style="font-family:Verdana;">Discussion</span></b><span style="font-family:Verdana;">: Patients show significant improvements in outcome measures with either anterior or posterior surgery. Both approaches are highly efficacious in preventing neurologic deterioration and in most cases improve neurological function with appropriate postoperative management like rehabilitation, pain management</span></span><span style="font-family:Verdana;">,</span><span "=""><span style="font-family:Verdana;"> and psychological support. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The patients submitted to surgical medullary decompression presented a favorable outcome despite the age and the higher prevalence of comorbidities;whereby we favor the surgical treatment in all patients in a case-to-case selection to generate a positive impact on functional outcomes.
文摘Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods According to the Allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included. Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group. Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.
文摘Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This
文摘Chordomas are malignant tumors arising from notochordal remnants. They are the most frequent tumors of the spine after plasmacytomas. Only 6% of chordomas are localized to the cervical level. In young patients, chordomas are rare and unpredictable. Despite this, the treatment of choice remains the total resection, as much as possible, followed by proton beam radiation. This case was managed using a precarotid and retrocarotid approach at the same time. The tumor was completely resected with the edges free from disease. The cervical spine was stabilized with an anterior plating C2-C4. Eighteen months after surgery the patient is still free from illness. Multilevel oblique corpectomies are an available and safe option for the treatment of upper cervical chordomas.
文摘目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。
基金the National Natural Science Foundation of China,No.81860406Guangxi Natural Science Foundation,No.2018GXNSFAA281127Medical Excellence Award Funded by the Creative Research Development Grant from The First Affiliated Hospital of Guangxi Medical University.
文摘BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.