The imaging features of intervertebral disco-ligamentous complex injury in cervical spine hyperextension injury and their clinical significance

English Keywords:Cervical spine  Hyperextension injury  Disco-ligamentous complex  Image performance  Surgical approach

English Abstract:

  【Abstract】 Objectives: To investigate the imaging features of disco-ligamentous complex(DLC) injury in patients with cervical spine hyperextension injury and their clinical significance.　Methods: From July 2007 to November 2011, 50 patients treated surgically due to cervical hyperextension injury with completed clinical data were retrospectively analyzed. All patients suffered from cervical spine injury. Frankel grades were 4 cases with grade A, 8 cases with grade B, 11 cases with grade C, and 27 cases with grade D. According to the type of preoperative spinal cord compression demonstrated on X-ray, CT and MRI imaging, patients were divided into three groups: herniated nucleus pulposus(HNP) group: simple herniated nucleus pulpous, 14 cases; cervical spondylosis(CS) group: combined with cervical spondylosis, 26 cases; ossification of the posterior longitudinal ligament(OPLL) group: combined with ossification of the posterior longitudinal ligament, 10 cases, and the characteristics of the injued DLC and different surgical approaches for three groups were analyzed. Results: All 50 cases with cervical hyperextension injury had anterior longitudinal ligament and intervertebral disc injury. Among them, 8 patients had posterior longitudinal ligament injury, 5 had facet joint fracture and 3 patients had interspinous ligament injury. All 50 patients suffering from cervical spinal cord compression underwent decompression, fusion and internal fixation. The segments included injured DLC segments and spinal cord compression segments. In HNP group, the consistent rate of DLC level and the spinal cord compression level was 92.85%, all patients underwent anterior approaches; in combined CS group, the DLC injury was noted as single level in 16, two in 6 and three in 4 patients, the consistent rate of DLC injury level and the spinal cord compression level was 84.61%, 23 cases underwent anterior and 3 underwent posterior approaches; in combined OPLL group, the DLC injury was noted as single level in 4 patients and two in 6 patients, with the consistent rate of 60%, 1 case underwent anterior, 5 cases underwent posterior and 4 cases underwent combined approaches. The Frankel grade in 28 cases improved one grade, but 22 cases remained unchanged 3 months after surgery.　Conclusions: The characteristics of DLC injury is associated with the preoperative cervical pathological state, and DLC injury level is not completely consistent with the level of spinal cord compression. Cervical stability reconstruction should include injured DLC segments as well as spinal cord decompression level.