Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

韓 岳(Han Yue，Dept Orthop，Tianjin Hosp，Tianjin 300211)… ∥Chin J Trauma.－2011，27(2).－ 110～

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

韓 岳(Han Yue，Dept Orthop，Tianjin Hosp，Tianjin 300211)… ∥Chin J Trauma.－2011，27(2).－ 110～

ObjectiveTo evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.MethodsA retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females，at average age of 41.2 years(range，18 ～ 60 years).Of all，there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures)，three with axis fracture and dislocation，one with dens fractures plus nonunion，two with C2，3fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation，the point and angle of the implanted pedicle screws were determined by operative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22～26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1 ～2 after operation.ResultsA total of 64 cervical pedicle screws were implanted in all 15 patients，with no vertebral artery injury，spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12 ～ 36 months，which showed bony fusion，with no looseness or breakage of the screws.Neurologic im-pairment was improved in all patients，with no complications associated with the cervical pedicle screw.ConclusionCervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.

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