Cervical single-opening spinal canal enlargement shaping for cervical developmental spinal stenosis, cervical posterior longitudinal ligament ossification disease, spinal cord type cervical spondylosis and other diseases have achieved good results in the near and long term, however, because the vertebral plate on the open side was only fixed by soft tissue suspension, some cases in the follow-up had the problem of re-closing and more axial symptoms, we used the cervical posterior fixation titanium plate system to fix the titanium plate on the open side of the spine and lateral block of the vertebral plate, obtained immediate stability, really shaped and expanded the spinal canal, effectively alleviated the axial symptoms, is reported as follows: 1, clinical data 1.1 object The group of 21 cases, 13 cases of male
The age was 36-71 years old, average 52 years old; medical history: 6 months-5 years, average 28 months; all performed X-ray, CT, MRI examination. There were 11 cases of developmental spinal stenosis, 2 cases of ossification of the posterior longitudinal ligament, and the rest were cervical spondylosis. MRI suggested that there were 12 cases of spinal cord compression in 3 segments and 9 cases of compression in more than 3 segments. Posterior cervical spine protrusion was present in all patients. 1.2 Surgical method
In this group, general anesthesia was used, the head was flexed and the knees were flexed in the prone position, the abdomen was suspended, the head side of the surgical bed was elevated by 30° to reduce intravertebral hemorrhage, a median incision was made at the back of the neck, the bilateral vertebral plates at the site requiring surgery were routinely exposed, the spinous processes were trimmed, and the more symptomatic side was selected as the open side for those with different limb symptoms on both sides. When biting open the whole layer there is a clear feeling, hook open the groove at the intervertebral ligament, gradually open the door; and carefully separate the adhesions, use the gun-like biting forceps to clean up the marginal ligament, expand the lateral nerve root canal, especially at C5. For fixation, generally choose C4 and C6, apply the Roy-Cammille method to the lateral block on the portal axis, drill the nail at the midpoint of the lateral block, point from the posterior medial side to the anterior lateral side and drill at an angle of 10° to the lateral side, choose a titanium plate of suitable length to maintain the opening width of about 15 mm, fold the titanium plate into an arc and make the arc to the posterior lateral side, and fix the lateral block with screws; another fixation point At the root of the spinous process, slightly horizontal direction to prevent oblique into the vertebral canal, after flushing, sprayed into a compassionate seal, three days after surgery out of bed activities, and protected with a neck brace for 3 weeks, 1 month after the exercise of the neck. 2, results 2 cases for C4-7 open, 19 cases for C3-7 open, fixed segments are C4, 6. intraoperative and postoperative no spinal nerve root and vertebral artery injury caused by fixed titanium plate, follow-up 3-15 months, average 8 months, JOA score preoperative 6-12 points, average 9.1 points; postoperative 8-16 points, average 13.5 points, no C5 nerve root palsy. One patient with severe compression underwent combined anterior and posterior decompression, and the patient who opened the door first and then underwent anterior C4-5 total cut and graft fixation was once aggravated by postoperative symptoms, and the original heavy side was aggravated, and the review MRI showed that the spinal cord compression was completely released, but there was edema high signal in the medulla, and medication was given, and the improvement was better after 1 month. According to the degree of postoperative neck pain, stiffness and activity restriction of the patient’s postoperative quality was classified as: normal, not affected; mild, slightly affected; moderate, generally affected; and severe, severely affected. Three months after surgery: normal 17 cases, light 3 cases, moderate 1 case, severe 0 cases; six months after surgery: normal 19 cases, light 1 case, moderate 1 case, severe 0 cases. 3. Discussion 3.1 Posterior cervical single-opening spinal canal enlargement and plasty removed the posterior compression of the spinal cord, increased the blood supply to the spinal cord, and the spinal cord was avoided to the posterior side, reducing the anterior compression of the spinal cord, which is an effective method for treating cervical developmental spinal stenosis, continuous posterior longitudinal ligament ossification disease and multi-stage spinal cord type cervical spondylosis; to prevent reclosure, initially Hirabayashi used sutures to lift the vertebral plate Fixed on the paravertebral muscle or small joint capsule on the portal axis side, due to the movement of the neck, the contraction of the paravertebral muscle can make the lifted vertebral plate return to appear to re-close, and at the same time see the local irritation caused by the suture on the soft tissue and joint capsule after the corresponding axial symptoms. 3.2 Axial symptoms of the neck
Mainly manifested as pain and spasm of neck and shoulder muscles, most patients also have symptoms such as stiffness and limitation of movement of the neck, which can exist regardless of the postoperative improvement of the patient’s neurological function, which Kawaguchi called axial symptoms with an incidence of 45-80%. According to Sun Yu, the main factor causing axial symptoms is that the posterior branch of the cervical nerve is stimulated or injured during posterior suspension, and even the nerve and other tissues are sutured together, resulting in muscle spasm or pain. The surgery of posterior cervical fixation of titanium plate is mainly supported by titanium plate, which avoids sutures to the small joint capsule, and there is no suture to the small nerve branch, which avoids the stimulation of the small joint capsule by pulling the sutures when the cervical spine moves, and puts the stimulation to the small joint capsule and the peripheral nerve. The stimulation of the small joint capsule and peripheral nerves is reduced to a smaller degree, allowing early exercise and effectively reducing the occurrence of axial symptoms.