Analysis of Instability Factors for the Cervical Stenosis with Cervical Spinal Cord Injury without Fracture and Dislocation

Abstract：Objectiv To observe the MRI findings and intra-operative discovery of cervical spinal stenosis accompanied with cervical spinal cord injury without fracture and dislocation( CSCIWFD),and to discuss its instability factors and the func-tion of MRI in assessing cervical instability. Methods Between May 2002 and August 2013,58 patients with cervical spinal stenosis accompanied with CSCIWFD were treated with posterior C3 to C7 expansive open-door laminoplasty combined with one stage anterior decompression,fusion and fixation. There were 21 females and 37 males with an average age of(51. 7 ± 8. 2) years(range,34~71 years). All cases were patients with incomplete spinal cord injury. Among them,26 were central cord syndrome,14 were anterior spinal cord syndrome,6 were Brown-Sequard syndrome,and 12 were mixed type. The mean preop-erative JOA score was(7. 2 ± 2. 3)(range,4 to 13). The mean time interval between injury and admission to hospital was(24 ± 12( hours,and 47 cases were less than 3 days. The injury of soft tissues and bone-ligaments structure and cervical instabili-ty were recorded. Preoperative MRI findings and intra-operative finding were compared. Results Most cervical spinal cord injury site was located in intervertebral space. There was no significant difference between cervical spinal cord injury and local cervical instability incidence rate of corresponding intervertebral space(P﹥0. 05). Most of corresponding intervertebral space of cervical spinal cord injury were accompanied with local cervical instability. Local cervical instability of cervical spinal steno-sis accompanied with CSCIWFD was related to the injury of anterior and posterior longitudinal ligaments and discs( APLLD) and cervical spinal cord and the degeneration of intervertebral disc. Conclusion Although MRI had false negative results in assessing cervical tissues injury,it can provide rich clinical information in assessing cervical instability. Using skull traction un-der general anesthesia to observe intervertebral space broadening was a supplementary method to judge cervical instability.