Cervical myelopathy in a patient with Klippel–Feil syndrome treated with a patient-specific custom cervical spine locking plate

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Taylor J. Jackson ◽  
Brett A. Freedman ◽  
Jonathan M. Morris ◽  
Bradford L. Currier ◽  
Ahmad Nassr
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Locking Plate ◽  
Patient Specific

scholarly journals Revision surgery for incomplete resection or recurrence of cervical spine chordoma: a consecutive case series of 24 patients

2021 ◽  
Author(s):  
Peter Obid ◽  
Tamás Fekete ◽  
Philipp Drees ◽  
Daniel Haschtmann ◽  
Frank Kleinstück ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cervical Spine ◽  
Survival Rate ◽  
Local Recurrence ◽  
Proton Beam ◽  
Revision Surgery ◽  
Patient Specific ◽  
Incomplete Resection ◽  
Pharyngeal Wall ◽  
Proton Beam Radiotherapy

Abstract Purpose Chordomas are rare tumors with an annual incidence of approximately one per million. Chordomas rarely metastasize but show a high local recurrence rate. Therefore, these patients present a major clinical challenge, and there is a paucity of the literature regarding the outcome after revision surgery of cervical spine chordomas. Available studies suggest a significantly worse outcome in revision scenarios. The purpose of this study is to analyze the survival rate, and complications of patients that underwent revision surgery for local recurrence or incomplete resection of chordoma at the craniocervical junction or at the cervical spine. Methods 24 consecutive patients that underwent revision surgery for cervical spine chordoma remnants or recurrence at a single center were reviewed retrospectively. We analyzed patient-specific surgical treatment strategies, complications, and outcome. Kaplan–Meier estimator was used to analyze five-year overall survival. Results Gross total resection was achieved in 17 cases. Seven patients developed dehiscence of the pharyngeal wall, being the most common long-term complication. No instability was observed. Postoperatively, four patients received proton beam radiotherapy and 12 patients had combined photon and proton beam radiotherapy. The five-year overall survival rate was 72.6%. Conclusion With thorough preoperative planning, appropriate surgical techniques, and the addition of adjuvant radiotherapy, results similar to those in primary surgery can be achieved.

Synthes Cervical Spine Locking Plate (Mosher Plate).

Neurosurgery ◽  
1993 ◽  
Vol 32 (4) ◽  
pp. 682-683 ◽  
Author(s):  
H. Louis Harkey
Keyword(s):  
Cervical Spine ◽  
Locking Plate

scholarly journals Anterior Cervical Corpectomy and Stabilization using Titanium Mesh Cage and Locking Plate for Muti-level Disease of The Cervical Spine

2002 ◽  
Vol 16 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Hiroyuki Nakase ◽  
Yuki Ida ◽  
Rinsei Tei ◽  
Toshisuke Sakaki ◽  
Testuya Morimoto
Keyword(s):  
Cervical Spine ◽  
Locking Plate ◽  
Titanium Mesh ◽  
Titanium Mesh Cage ◽  
Cervical Corpectomy ◽  
Mesh Cage ◽  
Anterior Cervical Corpectomy

Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Aria Nouri ◽  
Lindsay Tetreault ◽  
Satoshi Nori ◽  
Allan R Martin ◽  
Anick Nater ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Surgical Outcomes ◽  
Cervical Myelopathy ◽  
Spinal Canal ◽  
Resonance Imaging ◽  
Baseline Severity ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

scholarly journals Prevalence of Cervical Stenosis and Myelopathy in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan M Naylor ◽  
Karina Lenartowicz ◽  
Jonathan Graff-Radford ◽  
Jeremy Cutsforth-Gregory ◽  
Benjamin D Elder
Keyword(s):  
Cervical Spine ◽  
Normal Pressure Hydrocephalus ◽  
Cervical Myelopathy ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Decompression Surgery ◽  
Consecutive Series ◽  
Cervical Stenosis ◽  
Shunt Placement

Abstract INTRODUCTION Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. It is possible that some of the patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical stenosis with or without myelopathy in patients with iNPH. METHODS We screened a consecutive series of patients who underwent shunt placement for iNPH for comorbid cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis based on previously published criteria, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS A total of 42 patients with iNPH were included for analysis. Slightly more patients were male (65%), with a mean age of 75 yr (SD 7 yr) for the entire cohort. All patients presented with gait disturbances and underwent cervical spine MRI. 30/42 (71%) had at least cervical stenosis, while 7/42 (17%) had significant (grade 2-3) cervical stenosis with myelopathy requiring surgical decompression. All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSION Clinically significant cervical stenosis is highly prevalent in patients with iNPH, though this finding requires validation in a larger population. Based on these results, cervical imaging should be considered preoperatively or in patients whose gait does not improve after shunt placement.

scholarly journals Patient-Specific 3-Dimensional Printing Titanium Implant Biomechanical Evaluation for Complex Distal Femoral Open Fracture Reconstruction with Segmental Large Bone Defect: A Nonlinear Finite Element Analysis

2020 ◽  
Vol 10 (12) ◽  
pp. 4098
Author(s):  
Kin Weng Wong ◽  
Chung Da Wu ◽  
Chi-Sheng Chien ◽  
Cheng-Wei Lee ◽  
Tai-Hua Yang ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Postoperative Period ◽  
Bone Grafting ◽  
Locking Plate ◽  
Bone Ingrowth ◽  
Titanium Implant ◽  
Patient Specific ◽  
Large Defect ◽  
Plate Removal ◽  
Lightweight Structure

This study proposes a novel titanium 3D printing patient-specific implant: a lightweight structure with enough biomechanical strength for a distal femur fracture with segmental large defect using nonlinear finite element (FE) analysis. CT scanning images were processed to identify the size and shape of a large bone defect in the right distal femur of a young patient. A novel titanium implant was designed with a proximal cylinder tube for increasing mechanical stability, proximal/distal shells for increasing bone ingrowth contact areas, and lattice mesh at the outer surface to provide space for morselized cancellous bone grafting. The implant was fixed by transverse screws at the proximal/distal host bone. A pre-contoured locking plate was applied at the lateral site to secure the whole construct. A FE model with nonlinear contact element implant-bone interfaces was constructed to perform simulations for three clinical stages under single leg standing load conditions. The three stages were the initial postoperative period, fracture healing, and post fracture healing and locking plate removal. The results showed that the maximum implant von Mises stress reached 1318 MPa at the sharp angles of the outer mesh structure, exceeding the titanium destruction value (1000 MPa) and requiring round mesh angles to decrease the stress in the initial postoperative period. Bone stress values were found decreasing all the way from the postoperative period to fracture healing and locking plate removal. The overall construct deformation value reached 4.8 mm in the postoperative period, 2.5 mm with fracture healing assisted by the locking plate, and 2.1 mm after locking plate removal. The strain value at the proximal/distal implant-bone interfaces were valuable in inducing bone grafting in the initial postoperative period. The proposed patient-specific 3D printed implant is biomechanically stable for treating distal femoral fractures with large defect. It provides excellent lightweight structure, proximal/distal bone ingrowth contact areas, and implant rounded outer lattice mesh for morselized cancellous bone grafting.

A rapid prototyping-based methodology for patient-specific contouring of osteotomy plates

2019 ◽  
Vol 25 (5) ◽  
pp. 888-894
Author(s):  
Behnam Gomari ◽  
Farzam Farahmand ◽  
Hassan Farkhondeh
Keyword(s):  
Rapid Prototyping ◽  
Locking Plate ◽  
Patient Specific ◽  
Osteotomy Site ◽  
Content Type ◽  
Tibial Plate ◽  
Important Challenge ◽  
Surgical Application ◽  
Bone Fragments ◽  
Plate Spring

Purpose An important challenge of the osteotomy procedures, particularly in the case of large and complex corrections, is the fixation of the osteotomy site. The purpose of this study is to propose a practical and cost-effect methodology for the plate adapting problem of osteotomy surgery. Design/methodology/approach A novel patient-specific plate contouring methodology, based on rapid prototyping (RP) and multi-point forming (MPF) techniques, was developed and evaluated. In this methodology, a female mold is fabricated by RP, based on the geometry of the osteotomy site and estimation of the plate spring back. The mold is then used to configure a MPF die, which is then used for press forming of the factory-made locking plate. The applicability of the methodology was assessed in two case studies. Findings The results of implementing the methodology on a femoral and a tibial locking plate indicated very good conformity with the underlying bone, in both the frontal and sagittal planes. The surgical application of the pre-operatively contoured tibial plate facilitated the plate locating and screw inserting procedures, and provided a secure fixation for bone fragments. Practical implications The results are promising and provide a proof of concept for the feasibility and applicability of the proposed methodology in clinical practice, as a complementary to the existing surgical preplanning and patient-specific instrument preparations. Originality/value The advantageous features of RP and the MPF were used to provide a solution for the plate adapting problem of osteotomy surgery.

Patient-Specific Finite Element Analysis of Femoral Giant Cell Tumor Reconstructed Using Locking Plate System

2009 ◽  
Author(s):  
Jihui Li ◽  
Felasfa Wodajo
Keyword(s):  
Finite Element ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Locking Plate ◽  
Pathologic Fracture ◽  
Cell Tumor ◽  
Long Bone ◽  
Patient Specific ◽  
Element Analysis ◽  
Reconstruction Methods

Giant cell tumor (GCT) is a benign bone tumor that usually involves the end of long bone in young adults. GCT is locally aggressive, weakens the bone and can lead to pathologic fracture [1, 2]. Clinically, GCT is removed and the defect is reconstructed with bone cement, sometimes enhanced with intramedullary pins. However, there was no significant biomechanical advantage to using a cement plus pin construct over cement alone; clinical outcomes of both reconstruction methods were controversial [3–5]. While locking plates were recently adopted for GCT reconstruction, no biomechanics analysis has been performed to indicate its advantage over the cement alone or cement plus pin reconstruction. In this study we developed patient specific finite element (FE) models to compare the mechanical strengths of GCT reconstructed using cement alone and cement plus locking plate.

scholarly journals AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

2019 ◽  
Vol 9 (1_suppl) ◽  
pp. 77S-88S ◽  
Author(s):  
Srikanth N. Divi ◽  
Gregory D. Schroeder ◽  
F. Cumhur Oner ◽  
Frank Kandziora ◽  
Klaus J. Schnake ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Spinal Column ◽  
Narrative Review ◽  
Patient Specific ◽  
Upper Cervical Spine ◽  
Spine Trauma ◽  
Subaxial Cervical Spine

Study Design: Narrative review. Objectives: To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. Methods: The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. Results: A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. Conclusions: Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons.

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