Allograft Bone Use in Pediatric Subaxial Cervical Spine Fusions

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

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Overview of Subaxial Cervical Spine Fractures and Dislocations

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i48b33281 ◽

2021 ◽

pp. 235-241

Author(s):

AbdulWahab Ahmed Alzahrani ◽

Mohammad Saeed M. Al Fehaid ◽

Abdullah Saleh A. Alaboudi ◽

Mohammed Ahmed Abed I. Abualsaoud ◽

Faisal Abdulmohsen A. Bintalib ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Treatment Options ◽

Axial Skeleton ◽

Subaxial Cervical Spine ◽

Cord Injury ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

Normal Shape ◽

Cervical Spine Fractures

Injuries of the subaxial cervical spine are among the most common and potentially most devastating injuries involving the axial skeleton. The lower cervical spine can suffer minor bony or ligamentous injury that nevertheless results in severe neurologic injury. Plain radiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are all part of the standard imaging regimen. The delayed timing of dislocation reduction and cost-effectiveness are two issues with routine use of MRI in the diagnosis of cervical facet dislocations. Serval treatment options and approaches can be used. However Orthopedic treatment can be used to reduce the fracture or dislocation returns the vertebral canal to its normal shape and dimensions and decompresses the spinal cord. Immediate treatment should be started if there are signs of spinal cord injury or any factor that could lead to such injuries. In this review we will be looking at epidemiology, causes, evaluation and treatment of such cases.

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Surgical treatment for irreducible pediatric subaxial cervical unilateral facet dislocation: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.10.peds15351 ◽

2016 ◽

Vol 17 (5) ◽

pp. 607-611 ◽

Cited By ~ 2

Author(s):

Wei Qu ◽

Dingjun Hao ◽

Qining Wu ◽

Zongrang Song ◽

Jijun Liu

Keyword(s):

Case Report ◽

Cervical Spine ◽

Surgical Treatment ◽

Conservative Treatment ◽

Complete Resolution ◽

Cervical Spine Injury ◽

Spine Injury ◽

Facet Dislocation ◽

Unilateral Approach ◽

Subaxial Cervical Spine

Unilateral facet dislocation at the subaxial cervical spine (C3–7) in children younger than 8 years of age is rare. The authors describe a surgical approach for irreducible subaxial cervical unilateral facet dislocation (SCUFD) at C3–4 in a 5-year-old boy and present a literature review. A dorsal unilateral approach was applied, and a biodegradable plate was used for postreduction fixation without fusion after failed conservative treatment. There was complete resolution of symptoms and restored cervical stability. Two years after surgery, the patient had recovered range of motion in C3–4. In selected cases of cervical spine injury in young children, a biodegradable plate can maintain reduction until healing occurs, obviate the need to remove an implant, and recover the motion of the injured segment.

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Subaxial injury classification system to determine the surgical approach for subaxial cervical spine injuries

Current Orthopaedic Practice ◽

10.1097/bco.0b013e3282fa74b8 ◽

2008 ◽

Vol 19 (4) ◽

pp. 407-410

Author(s):

Marcel F Dvorak

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Classification System ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Injury Classification

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Postoperative Outcomes of Subaxial Cervical Spine Metastasis: Comparison Among The Anterior, Posterior, and Combined Approaches

10.21203/rs.3.rs-156469/v1 ◽

2021 ◽

Author(s):

Panya Luksanapruksa ◽

Borriwat Santipas ◽

Panupol Rajinda ◽

Theera Chueaboonchai ◽

Korpphong Chituaarikul ◽

...

Keyword(s):

Cervical Spine ◽

Survival Time ◽

Perioperative Complications ◽

Postoperative Outcomes ◽

Neurological Recovery ◽

Surgical Approaches ◽

Spine Metastasis ◽

Combined Approach ◽

Subaxial Cervical Spine ◽

Anterior Posterior

Abstract Background: Incidence of subaxial spinal metastases is increasing due to longer life expectancy resulting from successful modern treatments of cancer. The three most utilized approaches for surgical treatment include the anterior, posterior, and combined approach. However, despite increasing surgical volume, data on the postoperative complication profiles of different operative approaches for this patient population is scarce.Methods: The institutional databases of two large referral centers in Thailand were retrospectively reviewed. Patients with subaxial cervical spine metastasis who underwent cervical surgery during 2005 to 2015 were identified and enrolled. Clinical presentations, baseline characteristics, operative approach, perioperative complications, and postoperative outcomes, including pain, neurological recovery, and survival, were compared among the three surgical approaches.Results: This study included 70 patients (44 anterior approach, 14 posterior approach, 12 combined approach). There were no statistically significant differences in preoperative characteristics, including Charlson Comorbidity Index(CCI), Tomita score, and revised Tokuhashi score, among the three groups. There were also no significant differences among groups for medical complications, surgical complications, neurological recovery, verbal pain score improvement, survival time, or ambulatory status improvement. However, the combined approach did show a significantly higher rate of overall perioperative complications (p=0.01), intraoperative blood loss, (p<0.001), and operative time (p<0.001) compared to the other two approaches. Conclusions: The results of this study do not reveal any clear superiority among the three main surgical approaches used to treat subaxial cervical spine metastasis. Patients in the combined approach group had the highest rates of perioperative complications. However, although the differences were not statistically significant, patients in the combined group tended to have better clinical outcomes after follow-up, and the longest survival time.

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