Anterior decompression and interbody fusion with plate
fixation of cervical disc herniation
【Key Words】 disc
Treament of cervical disc herniation with anterior cervical decompression operation
Abstract: [Objective] To investigate the anterior decompression and interbody
fusion with plate fixation of cervical disc herniation and complication prevention. [Methods] 32 patients in March 2001 ~ December 2003 anterior decompression and interbody fusion with plate fixation for cervical disc herniation in patients with clinical
data and follow-up results of surgical treatment were retrospectively analyzed. [Results] 32 patients were followed up patients 3 to 6 months are given a solid fusion, no nonunion occurred, no complications occurred within the plant. Nerve compression
symptoms of restored or improved. [Conclusion] Anterior decompression and interbody fusion with plate fixation for the treatment of cervical disc herniation in an effective way.
Key words: disc herniation; cervical spine; anterior; resection
Since the Smith and Robinson 1955 for the first time introduced the use of cervical anterior approach to treat cervical disc disease, along with improved and new surgical instruments to introduce, at present, in order to avoid intervertebral collapse,
preventing the abnormal cervical pain induced by the activities and speed up the interbody fusion, anterior discectomy and interbody fusion with plate fixation for treatment of cervical disc fusion has become the preferred method of 〔1〕. Our
hospital since March 2001 ~ December 2003 patients treated 45 cases of cervical disc herniation, in which the patients were followed-up 32 cases of surgical indications,
methods, and the prevention of complications are as follows.
A clinical data
11 General Information
This group of men and 21 cases, female 11 cases; aged 40 to 67 years, with an average 506-year-old. Course of 2 months ~ 7 a. Of which 18 cases of central cervical
disc herniation, nerve root type in 14 cases, of which two segments highlight the 24
cases, 5 cases of single paragraphs, highlighting, multi-segmental highlights three cases,
the maximum segment C3, 4, the lowest segment C6, 7, internal fixation materials for the U.S. AST's Window anterior cervical plate. Preoperative cervical spine was taken and the lateral X-ray films of cervical sagittal and coronal MRI. Anteroposterior diameter of vertebral body measurement. According to the preoperative physical examination results and the preoperative JOA score criteria to judge the patient's
12 surgical methods and postoperative care
Preoperative trachea from right to left over the training. Select endotracheal intubation anesthesia general anesthesia or local anesthesia, the patient supine,
shoulder Xiadian thin pillow, so that the neck hyperextension 15 ?, according to pathological vertebral transverse incision in the right position to take the neck, C-arm
fluoroscopy X-ray machine positioning, revealed pathological vertebral body,
intervertebral disc, and the upper and lower segment of each one, using Caspar vertebral distraction device vertebral distraction gap, in both sides of the neck muscles between the removal of vertebral body length, disc, osteophyte proliferation, according
to the situation to decide whether resection of the posterior longitudinal ligament, so that the front of the complete spinal cord decompression and vertebral body resection measuring the size of bone graft required. Take a slightly larger tri-cortical iliac bone,
trimmed into a trapezoidal bottom shorter bone fragments, according to preoperative measurement of the anteroposterior diameter of vertebral body bone height of the decision ladder, choose the appropriate Window anterior cervical plate, according to
the patient's cervical spine physiological curvature of the pre-bending, temporary fixed
after the C-arm X-ray machine perspective the location and extent of steel plate Tiefu choose shorter than the vertebral body anteroposterior diameter of 02 mm self-locking
screw, placing drainage section, close the incision. 3 d after line of the bed wearing a collar, he gradually progressive functional exercises to guide the patient and remove collar. Periodic review of cervical lateral X-ray films are. Observe the location of
implants, intervertebral space height, cervical physiological curvature of fusion of bone graft (Figure 1 ~ 3).
13 efficacy evaluation and the results of
32 cases were followed-up patients, the longest follow-up of 16 months, the shortest
follow-up of 8 months, an average of 11 months, efficacy assessed by JOA score improvement rate and patients subjective psychological feeling. Preoperative JOA score (average); 832, after 6 months JOA score (average): 145. 〔Postoperative
improvement rate: 712. Postoperative improvement rate = (postoperative score -
preoperative score) / (17 - preoperative score) × 100%〕.
Follow-up of 32 patients in 3 patients complained of mild foreign body sensation when swallowing. According to JOA score criteria, excellent in 18 cases, good in 11 cases, fair in 2 cases and poor in 1 case, good rate of 906%. X-ray film in the review found no
postoperative loss of vertebral height of the phenomenon of fusion good.
1 case of intraoperative dural injury covered by the gelatin sponge cured, 2 patients had iliac donor site of the anterolateral thigh numbness, after 8 months basically back
to normal. 3 cases of cervical axial pain, pain medicine through symptomatic treatment
and heat or 4 to 6 months after the marked improvement. Reposted elsewhere in the paper for free download http://
21 surgical methods and efficacy of
211 symptoms of cervical disc herniation occurs mainly due to compression caused
by an extent which rendered outstanding disc pressure factors, proliferation and the proliferation of ligament hypertrophy and osteophyte ligament ossification, in order to alleviate the symptoms of the main method is to remove the oppression, while the
cervical spine before the Lu surgery 〔2〕, while maintaining cervical spine stability
while the largest direct and complete as possible decompression.
212 due to cervical posterior longitudinal ligament in maintaining stability and the
protection of the spinal cord plays an important role 〔3〕, in the removal of the
posterior longitudinal ligament in the author's view is: the hypertrophy of the posterior longitudinal ligament of the spinal cord caused by the oppressors, can be removed
before the road ossification of the posterior longitudinal ligament and the disc removed, the posterior longitudinal ligament is still outstanding forward line of the posterior longitudinal ligament were removed, a thorough decompression.
213 The purpose of fusion is to obtain long-term stability of the cervical spine,
autogenous iliac bone block of tri-cortical bone graft is the anterior cervical interbody fusion of the gold standard. Although Cage titanium anterior cervical discectomy and
fusion has been widely used in clinical, but the authors used trapezoidal bone is conducive to the restoration of cervical lordosis, longer bottom placed on the prevention of cervical bone in front of the post-shift caused by spinal cord compression,
surgery through the patient's follow-up to the hospital and found no cervical kyphosis,
pseudarthrosis gap formation and vertebral body height loss of the phenomenon of long-term efficacy and Cage titanium anterior cervical discectomy and fusion had no significant difference, reducing the patient's hospital stay.
22 Fixation System Selection
The authors use U.S. AST's Window anterior cervical plate has a reasonable mechanical properties, low-profile, maintaining the physiological cervical lordosis,
effectively maintain the stability of the fixed segments. Bone plate screw hole at a fixed set aside a certain amount of sliding after the space, when the vertebral fusion, the screw can be moved with the vertebral body, not under pressure and difficult to loosen
off nails. After the graft effectively secured to prevent movement of bone fragments and reduce the rate of non-healing bone. But there is stress concentration due to fatigue steel Ershi broken disadvantages.
23 prevention and treatment of complications
Surgical complications of anterior decompression and reveal the process is mainly the relative complications and early postoperative complications and lethal nature of
the relative complication of cervical spine reconstruction process 〔4〕. Cervical spine
in front of anatomical structure is revealed intense complications occurred during the main objective reasons. The author's experience are: familiar with the local anatomical structure, pay attention to the process of exposing each shearing fascia organizations
without vessels and nerves, can not blindly clamp bleeding, intraoperative pull hook to avoid the violence and excessive stretch to avoid injury and the laryngeal recurrent laryngeal nerve. Decompression process by use of a single case of segment ring drilling,
others are using the burr in the vertebral body osteophyte excision, when the rear to make use of a curette to reduce the dural injury. Damage to the dural sac covered with gelatin sponge. Postoperative neck hematoma can cause suffocation, a thorough
intraoperative bleeding, postoperative drainage placed to observe the situation and the incision in patients with breathing and blood oxygen saturation can effectively prevent the occurrence of asphyxia. In the cervical spine reconstruction process, the
displacement of bone fragments, bone parts of the formation of false joints there were more reports, plate fixation can effectively prevent the occurrence of bone non-union,
but it is not absolutely reliable, and a variety of bone graft substitutes Applications also
exist in different disadvantages. The reconstruction process using the Caspar vertebral distraction device, such as distraction gap had largely adjacent ligament or muscle tension may also occur axial cervical spine pain.
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[J]. Zhonghua Orthop, 2003,11 (23): 644,649. Reposted elsewhere in the paper for free download http://