PMC10020498_01
(A-D) Preoperative x-rays of the cervical spine (anteroposterior, lateral, hyperextension, and flexion radiographs, respectively), showing that the vertebral physiological curvature straightened with a certain degree of degenerative change. (E-H) Postoperative x-ray after 5 years, demonstrating the position of the internal fixation plates (yellow arrows) and that the cervical curvature and the range of motion have remained the same.
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F1
In addition, with degenerative changes at the edges of the vertebrae and straightening of the physiological curvature, the cervical spine range of motion was diminished, but remained relatively stable (Figures 1A-D). In addition, a series of x-rays showed that the position of internal fixation was well maintained, without significant loosening or displacement, and the cervical curvature and range of motion were the same as before (Figures 1E-H).
(A,B) Preoperative and postoperative sagittal CT scans, illustrating the changes in the cervical spinal canal diameter. Sagittal T2-weighted MR images: (C) preoperative scan, showing a cervical stenosis and varying degrees of disc herniation at the C3-C7 levels, with particular severeness at C3-C4 and C4-C5 (yellow arrows); (D) 5-year postoperative scan, showing adequate spinal cord decompression. (E) Axial CT scan of the operated segments 5 years after the operation, suggesting a large fusion on the laminar hinge position (yellow arrows) and that the laminar doors have been kept open by the plates. CT, computed tomography; MR, magnetic resonance.
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F2
Sagittal computed tomography (CT) of the cervical spine further showed osteophytes formation at the anterior edges of the vertebrae of C4-C7 and multilevel spinal canal stenosis (Figure 2A). C3-C7 levels with varying degrees of disc herniation and compression of corresponding dural sacs and spinal cord, particularly severe at the C3-C4 and C4-C5 levels (Figure 2B). CSM was diagnosed based on the patient's clinical presentation and imaging findings. CT scans of the sagittal spinal canal showed that the diameter was increased compared to before surgery (Figure 2C). Furthermore, axial CT scans of the operated cervical segments suggested a good fusion at the laminar hinge position, while the laminar doors were firmly kept open (Figure 2E), and the implanted plates were well fused with the posterior lamina, supported by the three-dimensional CT (Figures 3C,D). Finally, the MRI results revealed that the operated spinal canal had expanded sufficiently for the spinal cord to decompress adequately and that the operation had little effect on the symmetry of the posterior cervical muscles after 5 years (Figure 2D).
(A,B) Three-dimensional reconstructions of CT images (A: anterior view, B: posterior view), to allow clear visualization of the operating feature of the internal fixation plates during this novel technique. (C,D) Posterior views of the reconstructed cervical spine structure (C: 1 week postoperatively, D: 5 years postoperatively), showing the fixation and integration of the implanted plate with the posterior lamina. CT, computed tomography.
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F3
Meanwhile, a three-dimensional reconstruction was performed to clearly visualize the posterior structure of the postoperative cervical spine, from which it was observed that the laminae from C3 to C7 were open and evenly fixed on both sides, rather than only on one side, as is traditionally seen (Figures 3A,B). Furthermore, axial CT scans of the operated cervical segments suggested a good fusion at the laminar hinge position, while the laminar doors were firmly kept open (Figure 2E), and the implanted plates were well fused with the posterior lamina, supported by the three-dimensional CT (Figures 3C,D).