【Abstract】ObjectiveTo summarize the efficacy of surgical treatment of cervical spinal cord injury without fracture dislocation. Methods Eleven cases of surgical treatment of cervical spinal cord injury without fracture dislocation were retrospectively analyzed from February 2006 to March 2012, with 9 males and 2 females, and the average age was 48.2 years (29~66 years). The results were followed up for an average of 12 months (3~18 months). Spinal cord function was evaluated using the American Spinal Cord Injury Association (ASIA) grading criteria, and spinal cord function was improved to different degrees after surgery (P<0.05). Conclusion For cervical spinal cord injury without fracture-dislocation type, the application of surgical treatment modality can obtain better clinical results. Keywords: CSCIWFD; surgery, cervical spinal cord injury without fracture and dislocation (CSCIWFD), also known as cervical spinal cord injury without radiographic abnormality, refers to a type of spinal cord injury in which there is no fracture and dislocation on x-ray and other imaging examinations, but there is neurological damage in clinical practice. CSCIWFD is also known as non-radiographic abnormal spinal cord injury. With the popularization of MRI, orthopaedic surgeons have deepened their understanding of this type of injury, and early surgical treatment has gradually become a better choice. From February 2006 to March 2012, our department surgically treated the above types of cervical spinal cord injuries with satisfactory results, and the results are reported as follows: 1. Clinical data 1.1 General data From February 2006 to March 2012, 11 cases of CSCIWFD were surgically treated and followed up, 9 cases of male and 2 cases of female joints; the average age was 48.2 years old (29-66 years old), 6 cases of the group were traffic injuries, 5 cases were fall injuries, 5 cases were traffic injuries, 5 cases were fall injuries, 5 cases were fall injuries, 5 cases were fall injuries, 5 cases were fall injuries, and 5 cases were fall injuries. injuries and 5 cases were fall or drop injuries. Two of the cases were admitted to the hospital 2 weeks after the injury. The American Spinal Cord Injury Association (ASIA) grading criteria were used to evaluate the degree of spinal cord injury: 1 case with grade A, 2 cases with grade B, 3 cases with grade C, and 5 cases with grade D. The spinal cord injuries in this group were assessed by imaging examinations. Imaging examination, cervical spine X-ray, CT and MRI were performed in this group of cases, and all of them were no fracture or dislocation cases. MRI suggested that there were 7 cases of spinal cord edema, 3 cases of spinal cord hemorrhage or hematoma, and 1 case of spinal cord softness or cavitation. 1.2 Surgical methods Surgery was performed by the same group of doctors. For single-stage and two-stage spinal cord injuries, anterior disc removal or vertebral body subtotal fusion and internal fixation were used, and for three-stage and above spinal cord injuries and cervical spinal stenosis, posterior single-open-door spinal canal enlargement and plasty was used. In this group, four cases underwent single-opening canal enlargement, and the rest underwent anterior surgery. Hormones and dehydration drugs were routinely applied for 3d after the operation, and the drainage was removed within 48h after the operation. Those with better lower limb function were discharged from bed at an early stage and routinely carried cervical braces for external fixation for 3 months. Outpatient and telephone follow-up were used to evaluate the recovery of spinal cord function by applying ASIA spinal cord injury classification. 1.3 Statistical methods SPSS13.0 statistical software was applied to analyze, and the patients' neurological function grading at the time of admission and at the last follow-up were tested by x2 test, and the P-value <0.05 was statistically significant. 2.Results Surgery was completed successfully, and one patient had cerebrospinal fluid leakage in the anterior way after surgery, and was absolutely bedridden for half a month, and the wound healed smoothly after the lumbar puncture of the dura mater was performed to reduce the pressure of the cerebrospinal fluid. Appointment was made for radiographs and telephone follow-up. The follow-up period was from 3 months to 18 months after surgery, with an average of 12 months (3-18 months). The ASIA grade of spinal cord neurological function at the last postoperative review was 1 case of grade A, 0 cases of grade B, 2 cases of grade C, 6 cases of grade D, and 2 cases of grade E. The average follow-up period was 12 months (3-18 months). Except for the case of complete tetraplegia, in which there was no significant improvement in neurological function after surgery, all the other neurological functions improved significantly after surgery. There was a statistical difference compared with the preoperative period (P<0.05). 3, Discussion Since 1982, Pang and Wilberger [1] began to analyze and explore CSCIWFD as a special type. Dang Keng-chang [2] equaled to 1987 began to report this type of spinal cord injury, they believe that this type of injury in adults mostly occurs on the basis of cervical spine degeneration, spinal stenosis is the basis of cervical spinal cord injury, and external force is the direct cause of spinal cord injury. In this group of cases, there was no cervical spine fracture or dislocation in the x-ray and CT examination, which showed different degrees of cervical spine degeneration, spinal canal stenosis (Pavlov's value was less than 0.75), and ossification of posterior longitudinal ligament, etc. MRI could show that the spinal cord injury was caused by the spinal stenosis. MRI can show the severity of spinal cord injury, the segment and number of cervical disc herniation, the degree and extent of spinal canal stenosis, spinal cord edema, hemorrhage severity and extent. With the popularization of MRI in recent years, the understanding of CSCIWFD has gradually deepened. The earliest view is mostly conservative treatment, usually given drugs for nerve nutrition and dehydration, applying hormone treatment, spinal cord function are improved in the early stage, but for the surgery, in the early stage, it is mostly considered that the surgery is risky, and may lead to the aggravation of the spinal cord injury after the surgery. However, with a large number of conservative treatments, some scholars found that the efficacy of conservative treatment is not satisfactory [3], and many patients with spinal cord injury symptoms improve to a certain extent and then begin to progressive aggravation. They found that non-surgical treatment of CSCIWFD can make some recovery of spinal cord function, but the real pathological basis has not been lifted, and the spinal cord trauma caused edema, which was temporarily relieved after treatment. And cervical instability persists. This leads to a slow or even worsening recovery process. Sun Yu [4] and others carried out conservative treatment and surgical treatment for such patients, with an average follow-up of 30.3 months after surgery, and the results showed that the effect of conservative treatment was limited, while surgical treatment had a significant positive impact on the long-term recovery of spinal cord function. Therefore, most scholars now advocate surgical treatment. The aim of surgical treatment is to prevent or minimize further secondary damage to the spinal cord. All cases in our group were treated with surgery. We adopted the following principles in the selection of surgical procedures: i. For single-stage and two-stage spinal cord injuries, anterior surgery was used, with disc removal or vertebral body subtotal dissection, implant fusion and internal fixation. ii. For three or more stages of spinal cord injury and cervical spinal stenosis, posterior single-open-door enlarged spinal canal angioplasty was used. In this group, 7 cases used anterior right cervical approach for bone graft fusion and internal fixation, with good cervical spine fusion and obvious improvement of neurological injury symptoms in the postoperative follow-up. The remaining 4 cases used posterior lateral approach to perform single door canal enlargement plasty, and there was no reclosure or portal axis fracture after surgery, and the neurological symptoms improved significantly. Some scholars suggested performing posterior-anterior combined approach surgery for more complete decompression, but biomechanical studies conducted abroad found that patients who underwent posterior-anterior combined internal fixation had severe postoperative posterior extension instability, so we were more cautious and did not perform posterior-anterior combined approach surgery in this group of cases. Some scholars have also suggested that cervical artificial disc replacement is also an effective strategy for patients with CSCIWFD when the compression segments are limited and the lesion-free segments are unstable [5]. We believe that most patients with CSCIWFD have unstable conditions, and it is difficult to determine preoperatively that the lesion stage must be stable, and if cervical disc replacement is used, we believe that it does not completely guarantee the problem of cervical spine stability, and once the unstable side occurs in the postoperative period means that the surgery is for the purpose of fully achieving the goal, so the use of this procedure needs to be careful. There is no consistent standard for the timing of surgery.Mirza et al[6] reported that decompression and stabilization surgery within 72h after acute cervical spinal cord injury not only results in faster recovery of spinal cord function, but also allows for early mobility away from the bed and facilitates care. Reduce the occurrence of complications.Mckinley et al[7] compared the recovery of spinal cord function in patients with early surgery (within 72h) and late surgery (after 72h), and found that the timing of surgery had no significant effect on the recovery of spinal cord function, but complications such as pneumonia and pulmonary atelectasis were significantly increased by late surgery. We believe that it is better to operate after the injury (within 2-7d), the spinal cord edema is basically stabilized after two days, and the risk of spinal cord injury symptoms aggravation and other risks will be significantly reduced after surgery. Nine of our cases underwent surgery within one week after the injury, and the remaining two cases underwent surgery two weeks later, and the improvement of spinal cord function was obvious in all cases except for the case of complete quadriplegia. In a clinical study of 32 patients with CSCIWFD, Sun Tiansheng et al[8] found that methylprednisolone combined with surgical decompression was significantly better than high-dose methylprednisolone or surgical decompression alone for sensory and motor recovery, and for patients with complete and incomplete spinal cord injury. Therefore, for cases within 8 h after injury, we used preoperative methylprednisolone shock therapy according to the National Acute Spinal Cord Injury Studies (NASCIS) program to facilitate further recovery of spinal cord function. In conclusion, for CSCIWFD as a special kind of cervical spinal cord injury. As long as we choose the appropriate surgical method. If the timing of surgery is well grasped, the use of surgical treatment can achieve better clinical results.