1. The Resection And Reconstruction Technique Of Atlantoaxial Tumors 2. The Value Of Segmental Pavlov Ratio And The MRI Median Sagittal Measurement In Surgical Selection Of Anterior Approachs For The Treatment Of Two-Adjacent-Level Cervical Spondylotic My

Objective: To investigate the technique of excision and reconstruction of atlantoaxial tumors, and to explore how to prepare operation, prevent the complications, and promote recovering.Method: During Mar. 2005 to Aug. 2007, 12 cases with primary atlantoaxial tumors had been hospitalized. 9 cases underwent CT-guided percutaneous biopsy before operation. Under general anesthesia, these 12 patients underwent total vertebra resection according to"tumor free"principle after tracheotomy. The anterior column of upper cervical spine were reconstructed by 3 ways, 6 by special formed titanium mesh fixed internally, 1 by special formed titanium mesh and titanium plate fixed internally, 5 by auto illac graft and tita nium plate fixed internally. And fixed by occipito-cervical fixation posteriorly, After operation they were supported by parenteral nutrition. These patients were followed-up for 6 to 30 months.Result: 8 cases biopsy results equates with pathological results after operation. Dysphagia occurred in all patients, and disappeared after 10 days to 3 months. No patient was asphyxiated by sputum. No complications of blood vessel, nerve injury, or internal fixation failure happened. Only one case of chordoma had recurrence in situ. All patients had gotten occipito-cervical stability 3 to 6 months after operation.Conclusion: 1) CT-guided percutaneous biopsy plays an import role in indentify the quality of lesion before operation. 2) Surgery approach selection ought to aim at fully exposure, tumor resection out of the capsule can obtain good prognosis.3) stability should be set up immediately, special formed titanium mesh with occipito-cervical fixation and Halo-vest external fixation can set up upper cervical spine stability effectively, is a good method for stability reconstruction of upper cervical spine.4) Preoperation tracheotomy can reduce the bad consequence of respiratory complications.5) Gastric tube can guarantee nutrition supply. Objectives: To compare the efficacy of anterior cervical subtal corpectomy and fusion(ACF) and anterior cervical discectomy and fusion(ACDF) for the treatment of two-adjacent-level involved CSM, and to evaluate the role of segmemtal turgoring degree ofmedian sagittal cerebrospinal fluid(CSF) and Pavlov ratio for the selection of operation.Methods: A retrospective study was carried out and 96 cases of adjacent section of CSM in which the CSF around the spinal cord is turgoring were selected 53 cases undergoing the anterior decompression in ACF(group A), and 43 cases in ACDF(group B). The operative time, blood loss and rate of operative complications were compared, and the improvement of neurological function and its correlation with CSF turgoring degree and Pavlov ratio were evaluated.The follow-up time was 3 to 25 months.Results: There was no significant difference between operative time and rate of operative complications,Blood loss between the two groups was different significantly. The improvement of neurological function between the two groups is no significant difference, and there was no correlation between the improvement of neurological function, CSF turgoring degree and Pavlov ratio.Conclusions: For the CSM patients caused by two adjacent protruding intervertebral discs with the CSF behind the vertebral body which is intermediate the two discs is turgoring, the segmental Pavlov ratio is no use in determining what kind of operation is to be done. Both ACF and ACDF are effective in treat CSM with two-adjacent-disc protrusion. From the point of less surgery trauma, the two-level anterior cervical discectomy and fusion is more rational than cervical subtotal corpectomy and fusion. The role of turgoring degree of median sagittal CSF is need to be investigated further more. Objectives: To investigate the effects of the spinous process which was cut off in the posterior single open door for interbody fusion in the one-stage anterior and posterior depression for CSM patient.Methods During Apr. 2005 to Mar. 2007, 62 cases wirh CSM were treated by one-stage posterior single open door laminoplasty and anterior cervical discecomy and fusion and instrumented by anterior plate. The interbody implant were the spinous process which was cut off in the posterior procedure. 55 cases were followed-up, the improvement of neurological function was evaluated by JOA, and the fusion condition was judged by X-ray. Other 30 CSM cases hospitalized during the same period were also selected, the length, width, and hight of spinous process of C6 and C7 were measured on X-ray.Results: The length, width, and hight of spinous process of C6 and C7 were 24.67±4.69mm, 5.35±1.56mm, 7.04±1.56mm and 34.33±3.99mm, 7.02±1.62mm, 8.90±1.46mm. The follow-up time was 12 to 35 months, JOA score was improved from 12.02±2.86 to 15.45±1.61(P<0.01), all 73 surgery segments have gotten fusion, no graft collapse and internal fixation failure.Conclusions: In one-stage anterior and posterior depression for CSM patients, the spinous process which was cut off in the posterior procedure can be use as the interbody implant for spinal fusion.