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| XIA Tian,SUN Yu,PAN Shengfa.Radiological features and treatment strategy of multilevel cervical disconnection syndrome[J].Chinese Journal of Spine and Spinal Cord,2021,(12):1072-1077, 1105. |
| Radiological features and treatment strategy of multilevel cervical disconnection syndrome |
| Received:October 09, 2021 Revised:December 27, 2021 |
| English Keywords:Severe congenital cervical kyphosis Pre-correction by traction Multilevel cervical disconnection syndrome |
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| English Abstract: |
| 【Abstract】 Objectives: To analyze and discuss the radiological manifestation and surgical treatment strategy of multilevel cervical disconnection syndrome(MCDS). Methods: Between March 2004 and June 2021, 7 patients with MCDS were treated in our institute. There were 3 males and 4 females, aging from 5 to 46 years old(median: 12 years old). Among them, dysplasia of vertebral body averaged 3.6±1.3 levels and segments with anterior-posterior disconnection averaged 5.7±1.5 levels. The mean local kyphotic angle was -92.2°±20.2°, mean C2-7 Cobb angle was -68.6°±31.0°, mean T1 slope(T1S) was -12.5°±12.5°. The apex was located at C4 in 1 patient, C5 in 5 patients, and T1 in 1 patient. The mJOA score ranged from 8.5 points to 14 points(average: 12.6±2.1 points), with 1 patient accompanied by dysphagia. The methods and techniques for pre-correction and surgical treatment, radiological parameters when admitted, instant after surgery and during the final follow-up, and the neurological functions and perioperative complications were recorded. Results: For preoperative correction, one patient received skull traction, three received suspensory correction, and three received combined traction. The correction rate was 60.8%. The average fusion level was 6.0±2.1 levels. One patient received anterior soft-tissue release combined with Halo-vest, one received anterior correction and fusion, one received posterior correction and fusion, and 4 received anterior-posterior combined approach. Two patients encountered neurological complication and received revision surgery. The follow-up period ranged from 6 to 84 months(mean: 41.2±32.0 months). During the final follow-up, the mean local kyphotic angle was -27.9°±11.6°, correction rate was 69.7%, mean C2-7 Cobb angle was -13.3°±28.4°, mean T1S was 4.9°±17.9°. mJOA score ranged from 10.5 to 17 points(15.7±2.3 points), and the recovery rate was 78.3%. Comparing the clinical and radiological parameters before and after operation, the mJOA score, C2-7 Cobb angle, local kyphotic angle, and T1 slope were with significant differences. Conclusions: The radiological features of MCDS were dysplasia of vertebral body and multilevel disconnection of pedicle, causing severe kyphotic deformity. Initial treatment should be pre-correction by traction. Surgical treatment should include anterior multilevel corpectomy and correction, combined with posterior long segment fusion. |
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