Objective To investigate the radiographic features and surgical approach of severe fixed cervical kyphosis.Methods Seventeen cases of severe fixed cervical kyphosis from January 2007 to January 2012 were studied retrospectively.There were 8 males and 9 females,with an average age of 49.7 years.The etiologies were 3 cases of infection,3 cases of degeneration,3 cases of neurofibromatosis,3 cases of prior laminectomy,2 cases of idiopathic,2 cases of trauma and 1 case of neuromuscular disease.The average length of kyphosis was 4.3 ± 1.2 segments.All patients complained of severe neck pain (visual analogue scale,VAS,7.6±1.5) or progressive cervical kyphosis.There were 4 cases with myelopathy,2 with radiculopathy,3 with difficulty of forward gaze and 1 with difficulty of swallowing.All patients were underwent dynamic flexion-extension radiographs and traction views.CT scans were carried out to identify the sites of fixed kyphosis.Continuous traction was performed after general anesthesia,and the surgical approach was decided according to spinal cord compression,length of kyphosis and the cause of fixed kyphosis.Surgical outcomes were assessed in terms of correction of Cobb angle and Odom criteria.Results All patients were followed-up for 2 to 5 years.According to the CT scans,the sites of fixed kyphosis were identified:anterior bony ankylosis in 7 cases,posterior in 6 cases and both anterior and posterior in 4 cases.The surgical approach were as following:anterior only in 4 cases,posterior only in 2 cases,anterior-posterior in 5 cases,posterior-anterior in 3 cases,anterior-posterior-anterior in 1 case and posterior-anterior-posterior in 2 cases.The Cobb angle was corrected from 49.3°± 14.6° preoperation to 2.1 °±6.8° at the latest follow-up,with an average correction of 47.2°.According to Odom criteria,there were 7 excellent outcome,8 good,2 fair and none poor outcome.Revision surgery was performed in 1 case due to proximal junctional kyphosis.At the latest follow-up,bony fusion was found in all patients.Conclusion CT scan is helpful in identifying the cause of fixed kyphosis.The surgical approach of fixed cervical kyphosis is decided by spinal cord compression,length of kyphosis and cause of fixed kyphosis.Anterior approach is suitable for anterior ankylosis,posterior approach for posterior ankylosis,combined approach for both anterior and posterior ankylosis.%目的 探讨严重僵硬型颈椎后凸畸形的影像学特征及不同类型的手术入路选择.方法 回顾性分析2007年1月至2012年1月,治疗17例严重僵硬型颈椎后凸畸形患者完整资料,男8例,女9例;年龄21～ 72岁,平均49.7岁;炎症3例,退变3例,神经纤维瘤病3例,全椎板切除术后3例,特发性2例,陈旧性颈椎骨折2例,神经肌肉源性疾病1例;后凸累及节段(4.3±1.2)个.患者临床均表现为颈部疼痛,视觉模拟评分(visual analogue scale,VAS)(7.6±1.5)分,颈椎后凸畸形进行性发展,其中合并脊髓病变4例、神经根痛2例、不能平视3例、吞咽困难1例.患者术前均摄颈椎过伸、过屈位及颈椎牵引位X线片,并通过矢状位CT重建片评价颈椎僵硬来源.继续颅骨牵引下,根据脊髓压迫情况、后凸累及节段及僵硬来源等因素分别采用前路、后路及前后路联合手术入路,术后根据颈椎后凸Cobb角恢复及Odom标准评价疗效.结果 术后17例患者均获得随访,随访时间2～5年.根据CT检查结果,17例患者中,僵硬来源于前方骨性强直7例、后方6例、前后方4例.采用前路手术4例,后路2例,前后路5例,后前路3例,前-后-前路1例,后-前-后路2例.术前Cobb角平均49.3°±14.6°,末次随访平均2.1°±6.8°,平均矫正角度47.2°;Odom标准:优7例,良8例,可2例,优良率88.2％(15/17).1例患者术后3个月出现近端交界区后凸,遂行翻修术;17例患者术后均获骨性融合,随访期内无一例发生后凸矫正角度显著丢失.结论 CT有利于判断颈椎后凸畸形的僵硬来源;手术入路的选择取决于脊髓是否受压、后凸累及节段的长短、颈椎后凸畸形的僵硬来源等因素;僵硬来源于颈椎前方骨性强直采用前路手术,来源于后方强直采用后路手术,来源于前后方强直需前后路联合手术.
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