scholarly journals Posterior fusion of the subaxial cervical spine: indications and techniques

2001 ◽  
Vol 10 (4) ◽  
pp. 1-8 ◽  
Author(s):  
James K. Liu ◽  
Kaushik Das
Keyword(s):  
Cervical Spine ◽  
Traumatic Injury ◽  
Spinal Instrumentation ◽  
Posterior Fusion ◽  
Neoplastic Disease ◽  
Cervical Instability ◽  
Biomechanical Stability ◽  
Subaxial Cervical Spine ◽  
Fixation Devices ◽  
Stabilization Procedure

The biomechanical stability of the subaxial cervical spine (C3–7) can be compromised by numerous pathological processes, and the restoration of stability may ultimately require fusion and placement of rigid internal fixation devices. A posterior fusion and stabilization procedure is often used to treat cervical instability secondary to traumatic injury, rheumatoid arthritis, ankylosing spondylitis, neoplastic disease, infections, and previous laminectomy. Numerous techniques and advances in spinal instrumentation have evolved over the last 30 years. The authors review the indications and the various methods for stabilizing and fusing the subaxial cervical spine via posterior approaches.

Mechanical Properties of Injured Human Cervical Spine Ligaments and Corresponding Effect on Spinal Kinematics

2011 ◽  
Author(s):  
P. Devin Leahy ◽  
Christian M. Puttlitz
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Dynamic Range ◽  
Traumatic Injury ◽  
Soft Tissue Injuries ◽  
Neurological Impairment ◽  
Cervical Instability ◽  
Cervical Spine Instability ◽  
Tissue Injuries ◽  
Flexion And Extension

The assessment of cervical spine instability following traumatic injury is controversial [1, 4, 5, 8]. Typical definitions of cervical instability are based on the presence of several key detectable injuries using simple radiographs, computed tomography (CT), and magnetic resonance (MR) imaging. Although these imaging modalities have been shown to be relatively reliable for detection of fractures and very large soft tissue injuries, they are largely deficient for determining the presence of smaller soft tissue injuries, such as hyperstrained ligaments [1, 3]. Soft tissue injuries of this nature may be revealed with dynamic range of motion (ROM) assessment, such as a flexion and extension test with radiography. However, these tests are currently inadequate for determining the existence of specific injuries. Cervical soft tissue injuries demand further analysis, given the risk of severe and permanent neurological impairment that may accompany these injuries [2, 5].

scholarly journals The state of the sagittal balance of the injured cervical spine depending on the nature of the damage to the subaxial level

TRAUMA ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 48-57
Author(s):  
O.S. Nekhlopochyn ◽  
V.V. Verbov
Keyword(s):  
Cervical Spine ◽  
Sagittal Balance ◽  
Traumatic Injury ◽  
The State ◽  
Sagittal Profile ◽  
Spine Injury ◽  
Cervical Lordosis ◽  
Subaxial Cervical Spine ◽  
Wide Range ◽  
Type Of Injury

Background. Three main interrelated principles form the basis for modern surgery of traumatic cervical spine injuries, namely decompression, reconstruction and stabilization. Restoration of the sagittal profile is one of the basic tasks of the reconstructive stage. Currently, there are no clear recommendations for surgical management in traumatic injuries depending on the degree of deformation, and the state of sagittal balance of the injured cervical spine in the preoperative period has practically not been studied. The purpose of the work is to study the state of the sagittal profile and the degree of segmental deformation of the cervical spine following traumatic injury at the subaxial level, to determine the relationship between them and the type of injury. Materials and methods. We performed a retrospective analysis of X-ray data from 140 patients with subaxial cervical spine traumatic injury who were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine in the period from 2008 to 2018. We calculated indicators of segmental kyphosis and general cervical lordosis and determined the type of damage according to AO Spine Subaxial Cervical Spine Injury Classification System. Results. We found that the type of the damage affects the degree of segmental deformation (p < 0.001). Type A1, A2 and C injuries show the maximum kyphotic angulation: 13.51° (8.18; 20.07), 21.8° (20.12; 22.96) and 20.01° (17.52; 21.99), respectively. Injuries of type A2 and C statistically significantly differ from other types of lesions. We registered maximum values of deviations from the normal sagittal circuit in patients with injuries types A2 and C: ‒26.77° (‒32.78; ‒20.91) and ‒26.70° (‒36.30; ‒16.77), respectively. The parameters of segmental kyphosis and general cervical lordosis reveal high interdependence (r2 = 0.766, p < 0.001). We found maximum correlation in type A3, A4 and B3 injuries: ‒0.93, ‒0.91 and ‒0.97, respectively (p < 0.001). And types A1 and A2 injuries demonstrated statistically insignificant relationship (p > 0.05). Conclusions. The results show that traumatic injury of the subaxial cervical spine is characterized by a wide range of kyphotic segmental angulation values, which is largely determined by the type of injury. General cervical lordosis tends to flatten in most cases, but the degree of physiological curvature loss correlates with local deformation to some extent.

Spinal instrumentation for interfacet locking injuries of the subaxial cervical spine

2007 ◽  
Vol 14 (1) ◽  
pp. 49-52 ◽  
Author(s):  
Junichi Mizuno ◽  
Hiroshi Nakagawa ◽  
Tatsushi Inoue ◽  
Yasuomi Nonaka ◽  
Joonsuk Song ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Instrumentation ◽  
Subaxial Cervical Spine

Forestier disease associated with a retroodontoid mass causing cervicomedullary compression

2002 ◽  
Vol 96 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Naresh P. Patel ◽  
Neill M. Wright ◽  
William W. Choi ◽  
Duncan Q. McBride ◽  
J. Patrick Johnson
Keyword(s):  
Cervical Spine ◽  
Neurological Symptoms ◽  
Posterior Fusion ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Neurological Improvement ◽  
Forestier Disease ◽  
Subaxial Cervical Spine ◽  
Fine Print

Object. Forestier Disease (FD) is a progressive skeletal disorder affecting predominantly older men. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) and is characterized by massive anterior longitudinal ligament calcification that forms a bridge on the anterior border of the thoracic and subaxial cervical spine. To the authors' knowledge, retroodontoid masses associated with FD have not been described. Methods. Five patients with FD and multilevel subaxial cervical fusion were treated for retroodontoid masses and cervicomedullary junction (CMJ) compression. There were four men and one woman (mean age 73 years, range 54–86 years). All patients suffered progressive neurological symptoms resulting from anterior compression of the CMJ. Four patients underwent combined transoral resection of the ligamentous mass followed by an occipitocervical fusion procedure. One patient with circumferential CMJ compression underwent a posterior decompression and occipitocervical fusion. Histopathological examination of the mass showed hypertrophic degenerative fibrocartilage. Early postoperative neurological improvement was noted in all patients. The follow-up period ranged from 4 to 19 months. At the end of the follow-up period, four patients experienced neurological improvement. One patient died 3 weeks postsurgery of pulmonary complications. Conclusions. The osseous elements of the occipitoatlantoaxial complex are not directly affected by FD. The ligamentous structures of the odontoid process, however, are exposed to significantly altered biomechanics resulting from fusion of the subaxial cervical spine associated with FD. Stress-induced compensatory ligamentous hypertrophic changes at the craniovertebral junction cause CMJ compression and subsequent neurological deterioration. This previously undescribed entity should be considered in patients with FD or DISH who present with progressive quadriparesis. Transoral decompression and posterior fusion are often needed in patients with large masses and severe progressive neurological deficits. Selected patients with smaller masses and milder neurological symptoms may be treated with posterior fusion alone.

scholarly journals GP.01 Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation

2017 ◽  
Vol 44 (S2) ◽  
pp. S7-S7
Author(s):  
D Guha ◽  
R Jakubovic ◽  
VX Yang
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Computational Modelling ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Subaxial Cervical Spine ◽  
Geometric Symmetry

Background: Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative-Closest-Point algorithms register anatomical and imaging datasets, which may fail in the presence of significant geometric congruence leading to inaccurate navigation. We computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. Methods: Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified. Results: Increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical spine relative to the high-cervical and thoracolumbar spine (p<0.001). Inclusion of the base of the spinous process decreased symmetry independent of spinal level (p<0.001). Registration with bilateral vs. unilateral hemilamina did not significantly reduce geometric symmetry. Conclusions: Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error.

scholarly journals The classifications of subaxial cervical spine traumatic injuries. Part 6. Ben L. Allen biomechanical classification

2021 ◽  
Vol 27 (3) ◽  
pp. 3-16
Author(s):  
Oleksii S. Nekhlopochyn ◽  
Ievgenii I. Slynko ◽  
Vadim V. Verbov
Keyword(s):  
Cervical Spine ◽  
Complex Analysis ◽  
Traumatic Injury ◽  
Integrated Approach ◽  
Clinical Situation ◽  
Initial Position ◽  
Optimal Method ◽  
Traumatic Injuries ◽  
Subaxial Cervical Spine ◽  
Wide Range

Traumatic injuries of subaxial cervical spine are characterized by a wide range of possible pathomorphological changes that depend not only on the direction and intensity of the traumatic force impact, but also on the initial position of cervical spine at the moment of exposure. One of the most detailed classifications of cervical spine traumatic injuries, in which the integrated approach to assessing the type of injury considering the mechanism of injury is used, is the system developed by Ben L. Allen and published with co-authors in 1982. It is also known as the Allen-Ferguson classification and despite long history of existence, still has not lost its relevance. In the classification when characterizing the type of traumatic injury, not only visually detected signs, but also inevitably accompanying changes are given. In total, 6 types of damage were classified: compression-flexion, vertical compression, distraction-flexion, compression-extension, distraction-extension and lateral-flexion, which were divided into stages depending on the severity of pathomorphological changes. The authors of the classification note a pronounced correlation between the nature of damage to anatomical structures and neurological disorders in all patterns of damage. When writing this review, a detailed analysis of the original publication was carried out, highlighting the basic biomechanical aspects that underlie the classification and still have not lost their relevance . It is noted that the schematic images of damages found in modern literature often do not correspond to the description proposed by Ben L. Allen et al., Therefore, when preparing the illustrative material, we relied solely on the data of the original article. Along with the description of morphology, for each type and stage of injury, modern data on possible methods of treatment, both conservative and surgical are given. The complex analysis suggests that the classification developed by Ben L. Allen is a convenient tool for assessing pathomorphological changes and allows choosing the optimal method of treating the patients in each specific clinical situation.

Comparison of Cervical Spine Fixation Devices

2009 ◽  
Author(s):  
J. Marcus Hollis ◽  
Viorel Raducan
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Spinal Surgery ◽  
Posterior Fusion ◽  
Safe Operation ◽  
Bone Consolidation ◽  
Motion Segment ◽  
Fixation Devices ◽  
Spine Fixation ◽  
Cervical Spine Fixation

Injury to the cervical spine can be debilitating injury. Fracture the Dens of the C1-C2 motion segment can lead to gross instability of the cervical spine and neurological deficit. It is important to achieve stability operatively. Posterior fusion is considered by some to be a relatively safe operation compared to other procedures. Any spinal surgery which relies on boney stabilization post-operatively must provide a sufficiently small amount of movement initially to allow bone consolidation and healing.

scholarly journals Posterior Fusion for the Subaxial Cervical Spine: A Review of the Major Techniques

2019 ◽  
Vol 16 (2) ◽  
pp. 188-194
Author(s):  
Christopher M. Mikhail ◽  
James E. Dowdell ◽  
Andrew C. Hecht
Keyword(s):  
Cervical Spine ◽  
Posterior Fusion ◽  
Subaxial Cervical Spine

Multiple subluxations and comminuted fracture of the cervical spine in a sheep

2015 ◽  
Vol 43 (01) ◽  
pp. 44-38
Author(s):  
C.-C. Lin ◽  
K.-S. Chen ◽  
Y.-L. Lin ◽  
J. P.-W. Chan
Keyword(s):  
Cervical Spine ◽  
Pain Perception ◽  
Cervical Vertebrae ◽  
Traumatic Injury ◽  
Spinal Reflexes ◽  
Spine Trauma ◽  
Blunt Force Trauma ◽  
Comminuted Fracture ◽  
History Of ◽  
The Right

SummaryA 5-month-old, 13.5 kg, female Corriedale sheep was referred to the Veterinary Medicine Teaching Hospital, with a history of traumatic injury of the cervical spine followed by non-ambulatoric tetraparesis that occurred 2 weeks before being admitted to the hospital. At admission, malalignment of the cervical spine with the cranial part of the neck deviating to the right was noted. Neurological examinations identified the absence of postural reactions in both forelimbs, mildly decreased spinal reflexes, and normal reaction to pain perception tests. Radiography revealed malalignment of the cervical vertebrae with subluxations at C1–C2 and C2–C3, and a comminuted fracture of the caudal aspect of C2. The sheep was euthanized due to a presumed poor prognosis. Necropsy and histopathological findings confirmed injuries of the cervical spine from C1 to C3, which were consistent with the clinical finding of tetraparesis in this case. This paper presents a rare case of multiple subluxations of the cervical spine caused by blunt force trauma in a young sheep. These results highlight the importance of an astute clinical diagnosis for such an acute cervical spine trauma and the need for prompt surgical correction for similar cases in the future.

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