Anterior decompression of cervical spinal cord injury with Bailey-Badgley method

Bailey Badgley reported in 1960 that cervical vertebral body resection and bone grafting were used to treat cervical spine fracture and dislocation and other cervical destructive lesions, emphasizing the importance of reduction and fixation for the protection of the spinal cord. Norrell et al (1970), Nakano (1971) and Duan Guosheng et al (1984) reported the removal of the central part of the vertebral body and the compression into the spinal canal, and the fixation of the iliac bone graft for the fixation of the cervical vertebrae. Incomplete lesions and a small number of patients with complete impairments achieved significant neurological improvement after surgery. Treatment of diseases: cervical spine fracture and dislocation Indication Bailey-Badgley method for anterior decompression of cervical spinal cord injury is applicable to: 1. Cervical vertebral body comminuted fracture, the fracture piece protrudes into the spinal canal, and the clinical manifestation is incomplete spinal cord injury. 2. The lower cervical comminuted fracture or fracture dislocation, the dislocation does not exceed 1/3 of the anteroposterior diameter of the vertebral body, the clinical manifestation is complete spinal cord injury, anterior surgery relieves 1 or 2 nerve roots under pressure, which can make it dominate the finger The function is restored. Contraindications 1. Cervical fractures and dislocations are severe, more than 1/3 of the anteroposterior diameter of the vertebral body, which is characterized by complete damage of spinal cord function. 2. Difficulty breathing or tracheotomy. Preoperative preparation 1. Preparation of skin and instruments for bone removal on one side of the tibia. 2. Prepare the X-ray cervical lateral radiograph to determine the fracture site. Surgical procedure Neck incision In the plane of the fractured vertebral body, from the anterior cervical line to the left or right sternocleidomastoid anterior border, the left or right transverse incision is 6-8 cm long, and the recurrent laryngeal nerve can be less pulled when the left incision is made. . The incisions are peeled up and down along the subcutaneous tissue, respectively. 2. Reveal the front of the vertebral body The platysma and deep fascia were cut along the anterior border of the sternocleidomastoid, and the sternocleidomastoid and carotid sheath were pulled to the outside; the thyroid, trachea and esophagus were pulled to the medial side. Often thyroid venous obstruction is revealed and can be sheared after electrocoagulation or ligation. The loose connective tissue is peeled off to the deep part, and the finger can touch the front of the cervical vertebra in the middle line, revealing 3 to 4 vertebral bodies. At this point, the automatic retractor can be replaced, taking care not to damage the esophagus. In the 3~4 plane of the neck, the superior thyroid artery and the superior laryngeal nerve can be encountered, and the upper thyroid artery should be cut off when the 2~3 intervertebral space of the neck is exposed. In the 7-plane of the neck, the inferior thyroid artery and the recurrent laryngeal nerve can be encountered. Carefully pull it down and do not damage the recurrent laryngeal nerve. 3. Fracture vertebral body positioning Cervical vertebrae fractures are compressed by the spinal cord. The compression mainly comes from the posterior superior angle of the compressed vertebral body and the intervertebral disc tissue protruding from the vertebral space above the fractured vertebral body. It can also come from the posterior part of the dislocated vertebral body and the fracture piece protruding into the spinal canal. Therefore, it is often necessary to determine The intervertebral space between the fractured vertebral body and its superior vertebral body. Generally, after the front of the vertebral body is exposed, two syringe needles are applied, respectively, and the depth of the intervertebral space and the adjacent intervertebral space are respectively penetrated to a depth of 1.5 cm. If the depth is too deep, there is a risk of stabbing the cervical spinal cord. The X-ray cervical lateral radiograph is taken next to the operating table, and after the wet film is washed out, the fractured vertebral body and the upper intervertebral space can be determined. 4. Central vertebral body resection Excision of 1.2~1.5cm wide bone in the middle of the vertebral body with comminuted fracture by osteotome or high-speed micro drill. Generally, bone bone can be used to remove 1.5cm deep bone, and then drilled to the back of the vertebral body with a micro drill. The layer of cortical bone can also be done with a micro drill alone. Then use a curette or a special Kerrison forceps to remove the residual thin bone piece and the fracture piece that protrudes into the spinal canal, as well as the nucleus pulposus tissue that has escaped into the spinal canal. The posterior longitudinal ligament is revealed. If the ligament tear is found, the tearing mouth should be enlarged to the epidural space. If the nucleus pulposus fragments are removed, the spinal cord should be completely decompressed and the posterior longitudinal ligament should be hemorrhaged. Apply bipolar coagulation to stop bleeding. 5. Bone window formation According to the width of the middle part of the crushed vertebral body, the adjacent upper and lower intervertebral disc tissues are removed, and then the lower part of the upper vertebral body and the upper part of the next vertebral body are made into the same width of the bone groove, thereby forming a fractured vertebral body Square bone window in the center. 6. Bone graft fusion Take the patient's humerus, or use the bones of the bone, and trim it to fit the size of the bone window. The height of the bone is 1~2mm larger than the height of the bone window, the width is equal, and the thickness is smaller than the depth of the bone window. ~3mm. The patient's head is towed by an anesthesiologist, and the surgeon uses a hammer to force the bone piece into the bone window with a little force. Do not use too much force, so that the front of the bone piece is 1mm below the front of the vertebral body, and the back of the bone piece should not exceed the trailing edge of the vertebral body to avoid compressing the spinal cord. 7. Suture incision The anterior longitudinal ligament flap should be sutured as much as possible to prevent the bone column from coming out. Before withdrawing the automatic retractor and closing the incision, the bipolar electrocoagulation is used to stop the bleeding, because once the neck hematoma occurs, it may cause difficulty in breathing and even suffocation. The drainage of the silicone tube should be deep in front of the vertebral body. The sternocleidomastoid and deep fascia are sutured, and the platysma, subcutaneous tissue and skin are sutured layer by layer. complication 1. Postoperative hematoma. The swelling of the operation should be closely observed within 1 to 2 days after the operation. If it is found that the breathing is difficult and the local hematoma is suspected, the wound should be opened quickly for treatment. 2. Postoperative neurological symptoms worsened. The cause should be analyzed. If there is bleeding or the sacral column is inserted into the deep compression spinal cord, surgery should be performed again. 3. The bone column is prolapsed. When affecting hypopharyngeal function, re-implantation should be taken out. 4. The sound is low and hoarse. Intraoperative injury caused by laryngeal and recurrent laryngeal nerve. The superior laryngeal nerve is accompanied by the vagus nerve and is accompanied by the superior thyroid artery. It enters the larynx to innervate the inferior pharyngeal muscle, the ring muscle and the laryngeal mucosa. After the injury, the sound is low and thick, and the throat has no sensation. The recurrent laryngeal nerve is adjacent to the thyroid gland. The artery moves upwards in the outer edge of the trachea and esophageal sulcus, and enters the larynx to control the movement of the vocal cords. The vocal cords on one side are paralyzed and hoarse. Therefore, the surgeon must be familiar with the vagus nerve and the two major branches of the walking and anatomical relationship, when separating and cutting the upper and lower thyroid artery must pay attention to protect the two nerves, such as due to the retractor tension and excessive hoarseness, should be hoarse Relax the retractor.