背景:颈椎椎弓根螺钉(CPS)是颈椎手术的重要锚钉。它的放置需要开发一种高度安全且易于处理的方法。考虑到椎管皮质骨的侧端(LE点)对于CPS放置最关键,我们设计了一种U形导线,能够在直视下识别LE点,并通过C臂侧向透视可靠地确认该部位.
方法:一位65岁的男性,他意识到双手麻木,轻度手指灵巧障碍,有半年的步态障碍,由于他在过去2个月的症状进展,他去了我们的医院。
方法:患者表现为两侧上下肢轻度肌无力和肌腱反射亢进,磁共振成像显示C4/5和5/6级中度椎管狭窄。根据局部第三颈椎(C3)/4角度为-10度,C2/7角度为-15度,患者被诊断为脊髓型颈椎病伴颈椎后凸畸形。他的日本骨科协会对颈椎病的评分为10。
方法:我们使用U形导线将CPS置于C3处。在C3-T1范围内放置锚后,进行C4至C7的椎板切除术。随后,进行矫正固定以减少后凸畸形,然后在C3-T1范围内进行植骨并完成颈椎后路减压固定。
结果:将CPSs放置在C3处,无偏差和术后并发症。该手术导致C2/7角为-5度的脊柱后凸畸形得到改善,并在日本骨科协会对颈脊髓病的评分为13。
结论:一根U形线,它可以便宜而容易地准备,是一个有用的工具,尤其是没有经验的外科医生,通过准确捕获LE点进行安全的CPS放置。
BACKGROUND: A cervical pedicle screw (CPS) serves as an important anchor for cervical surgeries. Its placement requires the development of a highly safe and easy-to-handle method. Considering that the lateral end of the cortical bone of the spinal canal (LE point) is the most crucial for CPS placement, we devised a U-shaped wire capable of identifying LE points under direct vision and reliably confirming the site with C-arm lateral fluoroscopy.
METHODS: A 65-year-old male, who had been aware of numbness in both hands, mild finger dexterity disorder, and gait disturbance for half a year, visited our hospital due to the progression of his symptoms in the previous 2 months.
METHODS: The patient presented with mild muscle weakness and tendon hyperreflexia in the upper and lower extremities on both sides, and magnetic resonance imaging revealed moderate spinal canal stenosis at the C4/5 and 5/6 levels. Based on the local third cervical vertebra (C3)/4 angle of -10 degrees and the C2/7 angle of -15 degrees, the patient was diagnosed with cervical myelopathy with cervical kyphosis. He had a Japanese Orthopaedic Association score for cervical myelopathy of 10.
METHODS: We placed CPSs at C3 using a U-shaped wire. After placing an anchor in the range of C3-T1, laminectomy from C4 to C7 was performed. Subsequently, corrective fixation was performed to reduce kyphosis, followed by bone grafting in the range of C3-T1 and complete posterior cervical decompression fixation.
RESULTS: The CPSs were placed at C3 without deviation and intra- or postoperative complications. The surgery resulted in improvement in kyphosis with a C2/7 angle of -5 degrees and recovery in spinal cord disorder with a Japanese Orthopedic Association score for cervical myelopathy of 13.
CONCLUSIONS: A U-shaped wire, which can be prepared inexpensively and easily, is a useful tool, especially for inexperienced surgeons, for safe CPS placement by capture of LE points accurately.