Analysis Of Operative Timing And Clinical Curative Effect Of Anterior Surgical Treatment For Cervical Hyperextension Injury

Objective: Cervical hyperextension injury means that when the face is subjected to violence from the horizontal direction,excessive extension of the cervical spine Leads to disc,ligament and spinal cord neuropathy pathological changes.This damage can occur at any age,which is more common in the elderly whose ages are more than 50 years old.The most common manifestation is the central spinal cord syndrome.Its an incomplete spinal cord injury,clinical feature is that the severity of aralysis of upper limbs and lower limbs is different,upper limb is more severe than lower limbs,exercise disorders are more severe than sensory disturbances.The internal function of the inner muscle is diminished,severe cases can occur muscle atrophy,it is difficult to recovery.Below the injury level can occur sensory dysfunction: the pain,warm feeling hypesthesia,but position sensation,sense of touch,vibration sensation and other sensations exist,and some patients may occur varying degrees of sphincter dysfunction.Treatment methods of the injury include surgery and conservative treatment,conservative treatment only apply to patients with no significant neurological damage,patients with neurological impairment require early surgical treatment.Anterior cervical discectomy,cage fusion and internal fixation is is an effective method for the treatment of cervical hyperextension injury.But the best choice of operative timing is still controversial.This article explores operative timing and clinical curative effect of anterior surgical treatment for cervical hyperextension injury,to provide theoretical support for the diagnosis and treatment of such disease.Methods: A retrospective analysis of 41 cervical hyperextension injury cases from February 2014 to February 2016 who were checked in by Spine Surgery of the Second Affiliated Hospital of Dalian Medical University.All patients were underwent anterior cervical surgical treatment,with complete imaging and clinical information.According to different timing of surgery,the patients were divided into 2 groups: less than 3 days group(23 cases)and more than 3 days group(18 cases).The operation time,blood loss and related complications of all patients are collected.According to the American Society of Spinal Cord Injury(ASIA)exercise and sensory function scores,the functional changes of the two groups were evaluated before surgery,1 month and 1 year later after surgery,compare the differences between the two groups.According to preoperative and postoperative of cervical X-ray results,the height of the anterior vertebral column and the Cobb angle were measured,according the changes to evaluate clinical efficacy.Results: The average operation time of 41 patients was 130.35±41.52 min,the blood loss was 150.25±101.67 ml.A total of 91 cervical spine segments(including C3-4 18 segments,C4-5 26 segments C5-6 32 segments,and C6-7 15 segments)were explored.All patients were followed up for 12 months to 15 months.According to the X-ray of 1 year later,all surgical segments have achieved bone fusion,the stability of the cervical spine is good.There was a significant improvement in the ASIA movement and sensory scores between 1 month postoperative and preoperative,as well as between 1 year postoperative and 1month postoperative(P<0.05).There was no difference in ASIA scores between the two groups 1 month postoperative(P>0.05).The ASIA movement and sensory function scores were significantly higher in the less than 3 days group than in the more than 3 days group 1 year postoperative(P<0.05).The mean Cobb angle of fusion segments increased from 8.63±5.75° preoperative to 12.36±8.33° postoperative,the mean height of fusion segments increased from 62.23±15.18 mm preoperative to 68.45±12.73 mm postoperative,the Cobb angle and the height of the fusion segments compared with preoperative condition were significantly improved(p<0.05).Conclusion: Patients with cervical hyperextension injury should be operated within 3 days.Timing of surgery mainly affects the recovery of long-term spinal cord function,had no significant effect on the short-term recovery of spinal cord function.Early surgical treatment can make the spinal cord function get the maximum recovery.Anterior cervical discectomy,cage fusion Combined with internal fixation can make the height of anterior cervical column and Cobb angle get effective recovery,and can fully relieve the spinal cord compression,reconstruct the stability of the cervical spine,also can effectively promote the recovery of neurological function.It is helpful for patients to do early functional exercise,anterior cervical surgery is suitable for clinical treatment.