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Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture

BACKGROUND: There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel...

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Autores principales: Xu, Zhao-Wan, Lun, Deng-Xing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143576/
https://www.ncbi.nlm.nih.gov/pubmed/25142353
http://dx.doi.org/10.1186/s13018-014-0077-4
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author Xu, Zhao-Wan
Lun, Deng-Xing
author_facet Xu, Zhao-Wan
Lun, Deng-Xing
author_sort Xu, Zhao-Wan
collection PubMed
description BACKGROUND: There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population. METHODS: This was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications. RESULTS: The average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively. CONCLUSIONS: The open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture.
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spelling pubmed-41435762014-08-27 Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture Xu, Zhao-Wan Lun, Deng-Xing J Orthop Surg Res Research Article BACKGROUND: There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population. METHODS: This was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications. RESULTS: The average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively. CONCLUSIONS: The open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture. BioMed Central 2014-08-22 /pmc/articles/PMC4143576/ /pubmed/25142353 http://dx.doi.org/10.1186/s13018-014-0077-4 Text en Copyright © 2014 Xu and Lun; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Xu, Zhao-Wan
Lun, Deng-Xing
Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title_full Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title_fullStr Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title_full_unstemmed Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title_short Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
title_sort surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143576/
https://www.ncbi.nlm.nih.gov/pubmed/25142353
http://dx.doi.org/10.1186/s13018-014-0077-4
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