Pedicle screw fixation for cervical spine instability： clinical efficacy and safety analysis

作     者：LIU Yong HU Jian-hua YU Ke-yi 

作者机构：Department of O)thopaedics Peking Union Medical CollegeHospital Peking Union Medical College & Chinese Academy ofMedical Sciences Beijing 100730 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2009年第122卷第17期

页      面：1985-1989页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：cervical pedicle screw fixation instability 

摘      要：Background Reports of applying cervical pedicle screw （CPS） system in the posterior cervical spine surgeries are limited because of its inherent risk of neurovascular injury. The clinical results of cervical spine instability treated with CPS system were retrospectively analyzed, and the clinical efficacy and safety of this management were evaluated. Methods Twenty-five patients with cervical spine instability undergoing posterior C3-C7 single/double door laminoplasty and free-hand CPS fixation as well as graft fusion were investigated; of whom, 3 were due to trauma, and 22 degenerative cervical pathogenesis. One hundred and fifty in total, CPSs were implanted in 5 cervical segments for 1 patient, 4 for 2, 3 for 18, and 2 for 4. Japanese Orthopaedic Association （JOA） score and its improvement rate, neck disability index （NDI）, segmental stability, pedicle cortex perforation rate and other complication-associated parameters were assessed. Results The average follow-up was 16.6 （6-30） months. Compared with pre-operative values, JOA score improved by 4.10±0.84 points on average （P 〈0.05） at 6 months post operation, with a mean improvement rate of 61%. While the pre-operative and 6-month post-operative NDI were 32.96_-＇_-~.13 and 16.84_＋4.40 （P 〈0.05）, respectively. At 6-month post-operation and the final follow-up, fused segments were stable. Pedicle cortex perforation rate was 8.0%, with no neurovascular complications observed. Conclusions Anatomizing the pre-operative radiographic data facilitates the precise operative design prior to surgery; and CPS system is capable of offering safe and satisfying outcomes in the management of cervical spine instability.