C1~C2椎弓根钉内固定治疗C2~C7阻滞椎伴寰枢椎不稳1例报告及文献复习

Surgical Treatment of C2~C7 Cervical Block Vertebrae with Atlantoaxial Instability by C1~C2 Fixation: A Case Report and Literature Review

摘要: 目的：寰枢椎不稳是一种罕见的颈部病变。这种不寻常的情况有时与寰枢椎半脱位有关，这可能导致脊髓高度受压。由于颈椎阻滞导致的寰枢椎不稳定极为罕见。病例介绍：我们报告了一位64岁男性患者诊断为C2~C7阻滞椎伴寰枢椎不稳并有进行性脊髓病变。根据患者情况，术者予行后路C1~C2椎弓根螺钉 + 自体髂骨移植关节融合术。在一年的随访中，患者临床症状得到了显著的改善，术后X线片显示了坚强的骨融合，没有矫正损失或植入失败。讨论：与颈椎阻滞相关的慢性寰枢椎不稳定是罕见的。阻滞椎伴寰枢椎不稳会导致患者枕颈疼痛、脊髓病、瘫痪或死亡。手术减压和稳定是治疗的选择。治疗原则是防止神经系统损害导致的突然瘫痪，改善神经系统状况，稳定颈椎，提高生活质量。手术选择后路C1~C2椎弓根螺钉 + 自体髂骨移植关节融合术。固定的位置取决于脊髓压迫的位置、关节融合的区域和骨质量。

Abstract: Introduction: Atlantoaxial instability is a rare cervical lesion. This unusual condition is sometimes associated with atlantoaxial subluxation, which may cause high spinal cord compression. Atlantoaxial instability due to cervical block vertebrae is extremely rare. Case presentation: We report an unusual case of a 64-year-old male, who was diagnosed as having chronic posterior atlantoaxial instability associated with C2~C7 cervical block vertebrae with progressive myelopathy. The patient underwent posterior C1~C2 pedicle screws and autologous iliac crest strut bone graft arthrodesis. During one year of follow-up, he was clinically significantly improved and postoperative radiographs showed a solid osseous fusion without loss of correction or implant failure. Discussion: Chronic posterior atlantoaxial instability associated with cervical block vertebrae is rare. This condition can cause occipital cervical pain, myelopathy, paralysis, or death. Surgical decompression and stabilization is the treatment of choice. Principles of treatment are to prevent sudden paralysis from neurological compromise, improve neurological status, stabilize the cervical spine, and improve quality of life. Surgical options include posterior C1~C2 pedicle screws and autologous iliac crest strut bone graft arthrodesis. Decision making depends on the location of spinal cord compression, area for arthrodesis, and bone quality.