Ning Xie

Second Military Medical University, Shanghai, Shanghai, Shanghai Shi, China

Are you Ning Xie?

Claim your profile

Publications (19)34.93 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: A retrospective clinical study was conducted and related literatures were reviewed. This study aimed to evaluate outcome of multilevel anterior cervical discectomy and fusion with plate fixation for juvenile unilateral muscular atrophy of the distal upper extremity accompanied by cervical kyphosis. Juvenile unilateral muscular atrophy of the distal upper extremity is a rare disease. Traditional treatment uses a neck collar to immobilize neck motion. However, if the disease is accompanied by cervical kyphosis, conservative treatment is difficult to correct cervical kyphosis and the prognosis is worsened. Therefore, it is important to initially apply surgical treatment for juvenile unilateral muscular atrophy accompanied with cervical kyphosis. From March 2008 to May 2010, four patients were transferred to our spine medical center because of a history of slowly progressive distal weakness and atrophy of their hands and forearms. Four patients were diagnosed with Hirayama disease accompanied with cervical kyphosis based on their clinical representations and radiological findings. After conservative treatment failed, these patients underwent multilevel anterior cervical discectomy and fusion with plate fixation after unsatisfactory conservative treatment. The clinical outcomes were retrospectively evaluated with follow-up ranging from 1.5 to 3 years. The clinical and radiological follow-up indicated satisfactory clinical relief from symptoms, cervical sagittal alignment and cervical spinal canal volume for all the patients. Within six months after surgery, the JOA score improved from a preoperative average of 14 to a postoperative average of 16.3; JOA recovery rates of all patients were more than good level. The muscle strengths of intrinsic muscles, wrist flexors and extensors, and biceps and triceps muscle improved on average by one grade. No complications occurred. Hirayama disease is a rare disease, a proper diagnosis of which can be made relying on significant clinical symptoms and neurological imaging (dynamic MRI). The primary results from this study showed the tendency that multilevel anterior cervical discectomy and fusion with plate fixation is a preferred treatment for patients showing anterior effacement and apparent cervical kyphosis.
    Journal of spinal disorders & techniques 03/2014; · 1.21 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: In an attempt to improve implant-bone integration and accelerate bone fracture healing from resisting osteoclastic resorption point of view, a novel procedure has been employed to develop a mesoporous silica nanoparticles/hydroxyapatite (MSNs/HA) composite coating onto stainless Kirschner wire substrate. Characterizations of the surface microstructures indicated enlarged specific surface area compared to HA-coated wires as control, thus the MSNs/HA composite coated implants are endowed with abilities to locally deliver biomedical substances and enhance fracture healing. Herein, zoledronic acid (ZOL) as a model drug, different doses of which were immobilized in the mesoporous coating toward decreasing osteoclastic resorption activity. The loading capacities of ZOL increased almost eight-folds to that of pure HA coating, and the introduction of MSNs obviously retarded ZOL release to achieve a more sustained release profile. After certain periods of osteoclast like cells co-culturing with ZOL contained wires, tartrat-resistant acid phosphatases (TRAP) staining of polynucleated cells and a pit formation assay were performed to investigate the ZOL dose-dependent anti-resorption activity. The promoted local effect on osteoclasts will be of clinical benefit to support implant integration and bone repair.
    ACS Applied Materials & Interfaces 03/2014; · 5.01 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Bilateral C1-2 transarticular screw and C1 laminar hook fixation was developed on the basis of transarticular screws fixation. The modified technique has showed a better biomechanical stability than established techniques in previous study. However, long-term (minimum follow-up 7 years) outcomes of patients with reducible atlantoaxial dislocation who underwent this modified fixation technique have not still been reported. A retrospective study was conducted to evaluate the outcome of 36 patients who underwent this modified technique. Myelopathy was assessed using the Ranawat myelopathy score and Myelopathy Disability Index. Pain scores were assessed using Visual Analogue Scale. Radiological imaging was assessed and the following data were extracted: the atlantodental intervals, the space available for cord, presence of spinal cord signal change on T2 weighted image, C1-C2 angle, C2-C7 angle and fusion rates. All patients achieved a minimum seven-year follow up. 95% patients with neck and suboccipital pain improved after surgery; in their Visual Analogue pain scores, there was a greater than 50% improvement in their VAS scores with a drop of 5 points on the VAS (P<0.05). 92% of patients improved in the Ranawat myelopathy grade; the Myelopathy Disability Index assessment showed a preoperative mean score of 35.62 with postoperative mean 12.75(P<0.05). There was not any significant atlantoaxial instability at each follow-up time. The space available for cord increased in all patients. Postoperative sagittal kyphosis of the subaxial spine was not observed. After six months after surgery, bone grafts of all patients were fused. No complications related to surgery were found in the period of follow-up. The long-term outcomes of this case series demonstrate that under the condition of thorough preoperative preparations, bilateral C1-C2 transarticular screw and C1 laminar hook fixation and bone graft fusion is a reliable posterior atlantoaxial fusion technique for reducible atlantoaxial dislocation.
    PLoS ONE 01/2014; 9(1):e87676. · 3.73 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: OBJECTIVE: To evaluate the clinical outcomes and radiographic results of patients who underwent single-level cervical arthroplasty using the Prestige LP. METHOD: Thirty-one patients with single-level cervical disc disease received the Prestige LP disc replacement from June 2008 to December 2009. The neck disability index (NDI), Japanese Orthopedic Association score (JOA) and visual analogue scale (VAS) were used to assessed clinical outcomes pre-operatively and post-operatively at 24 months. The overall cervical alignment (C2-7 Cobb angle), the functional segmental unit (FSU) curvature, the range of motion (ROM) of treated and adjacent levels were measured, and the evidence of heterotopic ossification (HO) was observed from static and dynamic radiographs. RESULTS: There was a statistically significant improvement in the NDI from 20.2 ± 7.5 to 6.4 ± 3.5 (P < 0.000), JOA from 12.8 ± 2.2 to 16.6 ± 0.6 (P < 0.000), the neck VAS score from 4.1 ± 2.5 to 1.4 ± 1.1 (P < 0.000), the arm VAS score from 4.6 ± 2.5 to 0.7 ± 1.1 (P < 0.000). The post-operative overall cervical alignment (9.3° ± 7.2°), ROM of treated level (7.6°) and adjacent level (upper level 9.4° ± 3.1°, lower level 9.1° ± 3.5°) are well maintained. The FSU were 0.2° ± 5.4° and 1.9° ± 5.5° at pre-operation and final follow-up with statistical significance (P = 0.011). Heterotopic ossification was evidenced in five operated segment (16 %). CONCLUSIONS: The Prestige LP disc arthroplasty maintains favorable clinical outcomes, preserves the overall cervical alignment, FSU curvature, ROM of treated level and adjacent levels.
    Archives of Orthopaedic and Trauma Surgery 02/2013; · 1.36 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: PURPOSE: To retrospectively evaluate the outcome of C1-2 transarticular screws combined with C1 laminar hooks fixation. METHODS: All patients underwent atlantoaxial fixation during a 5-year period. The surgical technique and treatment procedures were intensively reviewed and clinical symptoms, neurological function and imaging appearance were retrospectively evaluated. RESULTS: The clinical and radiology follow-up indicated a stable arthrodesis and clinical relief from symptoms for all patients. All patients with neurological defects improved an average of 1.33 grade at their most recent clinical assessment, P < 0.05; their average admission ASIA motor score, pin prick score and light touch score improved to an average follow-up ASIA score of 99.80 (99.83 ± 0.38), 111.83 (111.83 ± 0.45), and 111.89 (111.89 ± 0.32), respectively. No neurovascular impairment and case of implant failure were observed. CONCLUSIONS: The C1-2 transarticular screws combined with C1 laminar hooks fixation is a reliable technique for atlantoaxial instability.
    European Spine Journal 08/2012; · 2.13 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Transarticular screw fixation is used in the upper cervical and lumbar spine to achieve posterior spinal stability, and its biomechanical performance has been proven to be similar to that of pedicle screw fixation. However, few studies have reported the use of transarticular screw fixation in the upper thoracic spine. To biomechanically compare transarticular screws with pedicle screws in short-term cyclic loading in the upper thoracic spine. Eight fresh human cadaveric spine specimens (T1-T3) were harvested and tested for 6 cycles in flexion, extension, lateral bending, and torsion in their intact condition. Each specimen was then destabilized and restabilized with 3 fixation methods: the pedicle screw/rod construct, the transarticular screw/rod construct, and transarticular screws alone. The instrumented specimens were reteted with the same protocol. All fixation systems reduced the range of motion significantly with respect to flexion, extension, lateral bending, and axial rotation (P < .01). However, no significant difference was observed between the 3 instrumented groups. This biomechanical study demonstrates in vitro that transarticular screws and pedicle screws have statistically similar biomechanical stability in a noncorpectomy model. Posterior transarticular screws may be an alternative for internal fixation in the upper thoracic spine.
    Neurosurgery 12/2011; 69(2 Suppl Operative):ons141-5; discussion ons146. · 2.53 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Although pedicle screw fixation has been increasingly used in the upper thoracic spine in recent years, controversies exist about the safety and complications such as nerve or vascular intrusion associated with the technique. In this study, an alternative method of transarticular screw fixation was validated. Morphometric analysis was performed on computed tomography (CT) scans of the upper thoracic zygapophysial joints of C7, T1, T2 and T3 in 20 male and 20 female patients in the axial and sagittal planes. The degree of screw angulation was recorded in the sagittal and axial planes and the screw length was measured at the spinal level from C7 to T3. The smallest medial-lateral diameter and anterior-posterior diameter of IAP was found at T3 in the female patients and C7 in the male patients. The screw trajectory length ranged from 14.9 to 20.5 mm in all patients. All the above measurements were significantly different between male and female patients at all levels (P < 0.05). The mean value of screw trajectory angle was 19.3°-20.1° in the axial plane and 44.3°-45.7° in the sagittal plane. There was no statistically significant difference (P > 0.05) between male and female patients in the axial and sagittal angles. The morphometric data of C7-T3 zygapophysial joints indicate the suitable screw diameter and screw length for this technique. Transarticular screw fixation proved to be a potentially safe alternative to pedicle screw fixation in this region.
    European Spine Journal 11/2011; 21(6):1186-91. · 2.13 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Various techniques have been described for posterior atlantoaxial fusion. Sublaminar passage of the wire/cable is cumbersome with a risk of spinal cord injury. Packing morselized bone grafts into the C1-2 facet joints may be difficult and it may cause massive bleeding and neuropathic pain or posterior scalp numbness postoperatively. We introduce a modified method by using C1-2 screw-rod fixation (SRF) to compress a structural iliac bone graft between the posterior elements of C1 and C2 without supplemental wiring construct. From December 2006 to May 2009, 35 consecutive patients with atlantoaxial instability treated by this method were reviewed retrospectively. Clinical and radiographic history was recorded. Patients with neck pain had relieved significantly after surgery and the neurologic status was also improved greatly. Thirty-three (94.3%) patients gained bony fusion at 3 months postoperatively. No vertebral artery and spinal cord injuries were noted. There was no instrumentation failure during the observation period. We conclude that the C1-2 SRF with construct-compression structural bone grafting can be used for C1-2 fusion with relatively simple performance and less time-consuming in selected cases.
    European Spine Journal 08/2011; 21(1):156-64. · 2.13 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND:: Transarticular screw fixation is used in the upper cervical and lumbar spine to achieve posterior spinal stability, and its biomechanical performance is proven to be similar to that of pedicle screw fixation. However, few studies have reported the use of transarticular screw fixation in the upper thoracic spine. OBJECTIVE:: To biomechanically compare transarticular screws with pedicle screws in short-term cyclic loading in the upper thoracic spine. METHODS:: Eight fresh human cadaveric spine specimens (T1-T3) were harvested and tested for six cycles in flexion, extension, lateral bending and torsion in their intact condition. Each specimen was then destabilized and restabilized with three fixation methods: the pedicle screw/rod construct, the transarticular screw/rod construct, and transarticular screws alone. The instrumented specimens were retested using the same protocol. RESULTS:: All fixation systems reduced the range of motion significantly with respect to flexion, extension, lateral bending and axial rotation (P<0.01). However, no significant difference was observed between the three instrumented groups. CONCLUSION:: This biomechanical study demonstrates in vitro that transarticular screws and pedicle screws have statistically similar biomechanical stability in a non-corpectomy model. Posterior transarticular screws may afford an alternative for internal fixation in the upper thoracic spine.
    Neurosurgery 03/2011; · 2.53 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: a series of 9 patients surgically treated with a novel combined pre-and retrovascular extraoral approach to lateral mass of the atlas (LMA) is examined. to describe the efficacy of combined pre- and retrovascular extraoral approach in achieving a wide exposure and aggressive resection of tumors at the LMA. the anatomic complexity and closeness to vital neurovascular structures raise technical difficulties in the surgical access to the LMA. Although various approaches, such as transoral approach, high anterior cervical approach, anterior lateral approach, and far lateral approach, have been reported in literature, wide exposure for the tumors at the LMA remains a unique challenge. for our experience in the surgical exposure of the upper cervical spine, we have developed a combined pre- and retrovascular extraoral approach to the atlas since 2001. Nine patients with neoplastic lesions at the LMA were surgically treated through this combined approach. Reconstruction of stability was achieved by a posterior occipitocervical fusion through a posterior approach under the same anesthesia. this combined approach provided an excellent surgical field exposure to ensure the successful tumor resection while preventing the vertebral artery or nerve from injury. There was no operative mortality or severe morbidity in this series. Complications included 1 instance of transient dysphagia and 2 instances of transient trouble swallowing liquids. The symptoms of local pain and pharyngeal discomfort relieved, and patients suffering from spinal cord compression recovered well with 1 level of the Frankel scale when reevaluated 3 months after operation. With a follow-up period of 16 to 100 months, 1 patient with chondrosarcoma developed local recurrence at the 14th month of postoperation and died of respiratory and circulatory failure 39 months after surgery. No evidence of local recurrence was found in other patients. the combined pre- and retrovascular extraoral approach provides an advantageous alternative to previous reported approaches. For selected cases with tumor lesions at the LMA, this combined approach offers more benefits, through which a wide exposure with well-protected vertebral artery favoring radical excision could be achieved without complications normally associated with transoral surgery.
    Spine 01/2011; 36(2):129-36. · 2.16 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To introduce a fixation device composed of C1-2 transarticular (TA) screws and C1 hooks and explore its indication and clinical outcome for os odontoideum with atlantoaxial dislocation (AAD). From January 2004 to December 2008, 12 patients with os odontoideum (5 men and 7 women, average age 37.7 years [range 14-62 years]) were treated in the authors' hospital. All patients had AAD with local symptoms, and 10 had myelopathy. All patients underwent a posterior atlantoaxial fixation with C1-2 TA screws and C1 hooks. Clinical and radiographic analyses were performed at 3, 6, and 12 months postoperatively and annually thereafter. The follow-up period was 12-66 months (average follow-up period 35.5 months). No neurologic or vascular complications occurred in these cases, and the device was placed well with no loosening or breakage. Plain radiographs and three-dimensional reconstruction of computed tomography (CT) images revealed solid bony fusion with a good alignment of C1 and C2 at 3 months postoperatively. No hardware failure, pseudarthrosis, or instability was noted during the follow-up period. All patients had relief of pain within 3 months, and neurologic symptoms were substantially improved. When appropriate patients are selected, C1-2 TA screws combined with C1 hooks can be used to treat os odontoideum with AAD effectively with a relatively simple procedure resulting in excellent biomechanical strength and high bone fusion rate. Preoperative planning is crucial for the management of os odontoideum with AAD.
    World Neurosurgery 01/2011; 75(3-4):540-6. · 1.77 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To present a small case series reporting the outcomes of surgical treatment for myelopathy caused by cervical ossification of the ligamentum flavum (OLF). The authors assessed 15 cases of myelopathy caused by cervical OLF. Patients were eight women and seven men 37-75 years old (mean age 59.7 years). All patients underwent bilateral laminectomy, and the lesions were removed. The decompression range was confined within the medial sides of the bilateral facets and within the involved segments. Intraoperative specimens were examined histologically to confirm the diagnosis. During the operation, the extent of adherence of the lesions to the dura was recorded. The patients were followed for 3-70 months. Neurofunctional improvements were evaluated with the Japanese Orthopaedic Association (JOA) score. Definite adherences were present in 67.7% of all cases. JOA score showed a 71.5% improvement after operation from a preoperative score of 5-8 (mean 6.4) to a postoperative score of 10-14 (mean 13.5). The operative outcomes were satisfactory without extensive decompression of adjacent segments. A high rate of adherence to the dura was observed in patients with myelopathy caused by cervical OLF. Bilateral laminectomy and removal of the lesions, without extensive decompression of adjacent segments, provides an optimistic prognosis.
    World Neurosurgery 01/2011; 75(3-4):546-50. · 1.77 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: An atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks was used in 5 pediatric patients, who were then followed up for 12 to 17 months to evaluate the technique. To describe a modified posterior C1-C2 fixation technique and preliminary clinical and radiographic results in 5 pediatric patients. Conventional posterior atlantoaxial fixations, such as Gallie and Brooks techniques, are frequently associated with high rates of pseudarthrosis and implant failure. The C1-C2 transarticular screw fixation has been shown to be effective in treatment of pediatric atlantoaxial instability, as well as adult atlantoaxial instability; however, this 2-point fixation merely stabilizes the atlantoaxial motion segment laterally. A 3-point fixation, composed with bilateral C1-C2 transarticular screws and C1 laminar hooks, has been developed. Five patients with atlantoaxial instability, including 4 males and 1 female, aged 6 to 17 (average 10) years, underwent atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks during a 2-year period. The surgical technique and treatment procedures were intensively reviewed, and clinical symptoms and imaging appearance were retrospectively evaluated. Clinical follow-ups were obtained for an average of 14.4 (range: 12-17) months. The clinical and radiologic follow-up indicated a stable arthrodesis and offered clinical relief from symptoms for all patients. No neural or vascular impairment related to this technique was observed. Fixation of the atlantoaxial articulation using bilateral C1-C2 transarticular screws and C1 laminar hooks appears to be a reliable technique for treatment of pediatric atlantoaxial instability.
    Spine 10/2010; 35(24):E1367-72. · 2.16 Impact Factor
  • Wen Yuan, Ning Xie
    Zhongguo gu shang = China journal of orthopaedics and traumatology 10/2010; 23(10):726-8.
  • [show abstract] [hide abstract]
    ABSTRACT: A biomechanical testing protocol was used to evaluate atlantoaxial fixation techniques in a human cadaveric model. To compare in vitro biomechanics of atlantoaxial lateral mass fusion cage combined with C1-C2 pedicle screw technique with those of C1-C2 pedicle screw technique alone and C1-C2 transarticular screws combined with Gallie wires. An atlantoaxial lateral mass fusion cage was designed, knowing that the cage, when rigidly combined with C1-C2 pedicle screws, could offer other fusion spots for atlantoaxial stabilization in cases when the posterior arch of the atlas is absent or removed for decompression and a Gallie fixation is impossible. No comparative in vitro biomechanical test has been conducted previously to evaluate the feasibility of this method. Anatomic measurements of the atlantoaxial lateral masses were taken using computed tomography in normal human subjects. Six fresh-frozen human cadaveric cervical spines (C0-C4) were used in the biomechanical study. Specimens were tested in their intact condition, after destabilization via transverse-alar-apical ligament disruption, and after implantation of 3 fixation constructs: (1) transarticular screws combined with Gallie wires, (2) C1-C2 pedicle screws, and (3) atlantoaxial lateral mass fusion cage combined with C1-C2 pedicle screws. Pure moment loading up to 1.5 Nm in flexion/extension, right-left lateral bending, and right-left axial rotation was applied to the occiput, and relative intervertebral rotations were determined using stereophotogrammetry. Range of motion for the intact, destabilized, and 3 fixation scenarios were determined. The anatomic data indicated that feasible cage design were in 3 sizes: 11/8, 12/9, and 13/10 mm for length/width, and 3.5, 4, and 4.5 mm for height. The biomechanical data indicated that transverse-alar-apical ligament disruption significantly increased C1-C2 motion for all directions. All the 3 fixation techniques significantly reduced motion compared with the intact and destabilized cases. There were no statistically significant differences among the 3 fixation techniques. The biomechanical study indicated that, contrary to expectation, addition of a cage did not increase the stability compared with C1-C2 pedicle screw alone. However, the C1 + C2 + Cage technique may be a viable alternative for atlantoaxial stabilization when the posterior arch of the atlas is absent or removed for decompression and a Gallie fixation is impossible.
    Spine 06/2010; 35(14):E624-32. · 2.16 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine. From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females (mean age 56 years, range: 32 - 76 years). Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy. Follow-up of the 23 cases lasted 24.0 - 143.0 months (mean: 64.7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1 - 2 grades based on Frankel grading system. All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma (MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations. Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction. Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to chemotherapy protocol while the prognosis is comparatively worse.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2010; 48(9):697-701.
  • [show abstract] [hide abstract]
    ABSTRACT: STUDY DESIGN.: A retrospective clinical study was used to evaluate the effect of a new surgical treatment of the hangman's fractures. OBJECTIVE.: To determine the treatment efficacy of combined anterior C2-C3 reduction and fusion and posterior compressive C2 pedicle screw fixation for the management of unstable hangman's fractures. SUMMARY OF BACKGROUND DATA.: The classification of hangman's fractures as proposed by Levine-Edwards was used to classify and guide the treatment of these injuries. Most of these fractures respond to a variety of conservative therapies, but recently, earlier surgery has been increasingly advocated by authors from several countries for the rapid stabilization of these fractures. If surgery is indicated, an anterior approach using a C2-C3 reduction and fusion is preferred usually. Another well-accepted surgical method is the direct transpedicular osteosynthesis by the dorsal approach. However, there was rare report of the combined use of these 2 techniques. METHODS.: A group of 45 surgical patients were all diagnosed with radiograph, magnetic resonance imaging (MRI), and 3D CT scans. Initial and final radiographs were measured for anterior translation and angulation of the C2-C3 complex. Initial external skull traction with extension was used in all patients after admission to reduce the fracture. Then an anterior C2-C3 discectomy followed by an interbody fusion and locking plate fixation was performed. Intraoperative reduction was confirmed by fluoroscopic control. About 29 patients therefore received anterior surgeries only since satisfactory reduction was achieved during the procedure. For the 16 patients who had persistent large residual gaps after the anterior procedure, additional same stage posterior C2 compressive pedicle screws were placed. Clinical and radiologic comparisons were performed in these 2 groups. RESULTS.: The follow-up ranged from 24 to 54 months, with an average 33.6 months. There was radiographic evidence of continuity of the fracture and the bone graft seen at 4.7 months on average. Neck pain and neurologic deficits resolved in nearly all patients after surgery. The anterior translation of anterior-posterior surgery group decreased more significant compared to anterior surgery group, although with no statistical significance. The fractures were closed with a slight gap no more than 2 mm in anterior-posterior surgery group. The residual kyphosis in anterior-posterior surgery group was still a little larger than it in anterior surgery group. No internal fixation failures or infections were observed. CONCLUSION.: We believe that the need for single stage 360 degrees fusion of hangman's fractures can be somewhat predicted by a combination of high resolution imaging. For hangman's fractures with significant deformity and gapping, it is our experience that immediate single-stage anterior-posterior reduction, instrumentation, and arthrodesis achieve superior postoperative reduction and long-term functional outcomes.
    Spine 02/2010; · 2.16 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: A case is described of multi-recurrent cervical chordoma in a man over a 5 year period. The clinical features were of progressive spinal cord compression. The authors report a chordoma at C4 that recurred 3 times in five years. The patient underwent four operations and suffered distant metastases. This case confirms that thorough resection of the tumor during the first surgery and post-operative adjuvant treatment are the best assurance of a good prognosis with a chordoma. Multiple surgeries can stimulate biological activity of a chordoma and make its recurrence and distant metastases much more likely. The authors discuss the diagnosis, surgical treatment and the relationship between the histopathological changes and malignancy of a spinal chordoma after four operations. To our knowledge, this represents the first report of a 4th surgery for cervical chordoma.
    Journal of Nanjing Medical University 01/2009; 23(6):425-429.
  • [show abstract] [hide abstract]
    ABSTRACT: To determine the outcome of combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the management of unstable Hangman's fractures. Sixteen cases of unstable Hangman's fractures were retrospectively reviewed through X-ray, MRI and three dimensional CT scans. Pre- and postoperative radiographs were measured for translation and angulation of C2,3. Skull traction under extension poison was conducted in all the patients right after their admission. Then anterior C2,3 discectomy followed by interbody fusion, either with iliac autograft or with box cage, and locking plate fixation were performed in each case. Because dissatisfied reduction, mainly residual large fracture gap or kyphosis, was found by the C-arm fluoroscopy during operations, posterior compressive C2 pedicle screw fixation was performed in one stage. According to the Levine-Edwards classification, there were 12 cases of type II, 2 of type I a and 2 of type III in this group. Follow-up ranged 6-38 months, averaged 26 months. Fracture union and bone graft fusion were completed in an average of 4 months after operation. Complaints of neck pain and numbness of limbs disappeared in all patients after surgery, but range of neck motion decreased compared with normal people. Translation of C2 decreased from (4.2 +/- 1.4) mm preoperatively to (2.3 +/- 1.1) mm postoperatively, while angulation of C2,3 decreased from 8.6 degrees +/- 2.1 degrees preoperatively to 2.6 degrees +/- 1.0 degrees postoperatively. Both have statistical significance (P < 0.05). No implant failure or infection was observed. The classification of Hangman's fracture should be modified in combination with MRI and CT scans to determine the stability of the fracture. Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation is the treatment of choice for patients with unstable Hangman's fractures.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2008; 46(4):267-9.

Publication Stats

7 Citations
3 Downloads
975 Views
34.93 Total Impact Points

Institutions

  • 2008–2013
    • Second Military Medical University, Shanghai
      • Department of Orthopaedics
      Shanghai, Shanghai Shi, China