scholarly journals Single-stage anterior–posterior decompression and stabilization for complex cervical spine disorders

2000 ◽  
Vol 9 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Karl D. Schultz ◽  
Mark R. Mclaughlin ◽  
Regis W. Haid ◽  
Christopher H. Comey ◽  
Gerald E. Rodts ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Single Stage ◽  
Morbidity Rate ◽  
Lateral Mass ◽  
Anterior Plate ◽  
Posterior Decompression ◽  
Strut Graft ◽  
Graft Extrusion ◽  
Spine Disorders ◽  
Anterior Posterior

Object To evaluate the applicability and safety of single-stage combined anterior–posterior decompression and fusion for complex cervical spine disorders, the authors retrospectively reviewed 72 consecutive procedures of this type performed at their respective institutions. Methods The indications for decompression and stabilization included: postlaminectomy kyphosis (15 patients), trauma (19 patients), spondylosis and congenital stenosis (32 patients), and ossification of the posterior longitudinal ligament (six patients). All patients underwent anterior cervical corpectomies in which allograft fibula and plates were placed, with 89% of patients undergoing two- or three-level procedures (range one–four levels). Lateral mass plating with autograft (morselized iliac crest) fusion was performed in all patients while the same anesthetic agent was still in effect. A hard cervical collar was used postoperatively in all patients (mean 13 weeks). All patients were followed for a minimum of 2 years (mean 29 months). Fusion was determined to be successful in all 72 patients (100%). Although the short-term morbidity rate reached 32%, the significant long-term morbidity rate was only 5%. At the 2-year follow-up examination, anterior cervical plate dislodgment was seen in one patient, and 16 of the 516 lateral mass screws implanted were observed to have partially backed out. However, there were no cases of nerve root injury, strut graft extrusion, or anterior plate or screw fracture. There were no clinically significant hardware complications and no patient required repeated operation. Conclusions The combined single-stage anterior–posterior decompression, reconstruction, and instrumentation procedure represents a viable option in the treatment of a select group of patients with complex cervical spinal disorders. The technique provides immediate rigid stabilization of the cervical spine, prevents anterior plate failure or strut graft extrusion, and eliminates the need for halo immobilization postoperatively. Furthermore, a higher rate of fusion is achieved with this combined approach than with the anterior approach alone.

Single-stage anterior—posterior decompression and stabilization for complex cervical spine disorders

2000 ◽  
Vol 93 (2) ◽  
pp. 214-221 ◽  
Author(s):  
Karl D. Schultz ◽  
Mark R. McLaughlin ◽  
Regis W. Haid ◽  
Christopher H. Comey ◽  
Gerald E. Rodts ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Single Stage ◽  
Morbidity Rate ◽  
Anterior Plate ◽  
Posterior Decompression ◽  
Content Type ◽  
Graft Extrusion ◽  
Spine Disorders ◽  
Anterior Posterior ◽  
Fine Print

Object. To evaluate the applicability and safety of single-stage combined anterior—posterior decompression and fusion for complex cervical spine disorders, the authors retrospectively reviewed 72 consecutive procedures of this type performed using a uniform technique at a single center. Methods. The indications for decompression and stabilization included: postlaminectomy kyphosis (15 patients), trauma (19 patients), spondylosis and congenital stenosis (32 patients), and ossification of the posterior longitudinal ligament (six patients). All patients underwent anterior cervical corpectomies in which allograft fibula and plates were placed, with 89% of patients undergoing two- or three-level procedures (range one–four levels). Lateral mass plating with autograft (morselized iliac crest) fusion was performed in all patients while the same anesthetic agent was still in effect. A hard cervical collar was used postoperatively in all patients (mean 13 weeks). All patients were followed for a minimum of 2 years (mean 29 months). Fusion was determined to be successful in all 72 patients (100%). Although the short-term morbidity rate reached 32%, the significant long-term morbidity rate was only 5%. At the 2-year follow-up examination, anterior cervical plate dislodgment was seen in one patient, and 16 of the 516 lateral mass screws implanted were observed to have partially backed out. However, there were no cases of nerve root injury, strut graft extrusion, or anterior plate or screw fracture. There were no clinically significant hardware complications and no patient required repeated operation. Conclusions. The combined single-stage anterior—posterior decompression, reconstruction, and instrumentation procedure represents a viable option in the treatment of a select group of patients with complex cervical spinal disorders. The technique provides immediate rigid stabilization of the cervical spine, prevents anterior plate failure or strut graft extrusion, and eliminates the need for halo immobilization postoperatively. Furthermore, a higher rate of fusion is achieved with this combined approach than with the anterior approach alone.

scholarly journals Single-stage Anterior-posterior Decompression and Stabilization with Instrumentation for Cervical Spine Disorders

2009 ◽  
Vol 23 (2) ◽  
pp. 300-304
Author(s):  
Toshihiko Inui ◽  
Hiroshi Hasegawa ◽  
Masahiro Murakami ◽  
Kou Matsuda ◽  
Hiroki Yoneda ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Single Stage ◽  
Posterior Decompression ◽  
Spine Disorders ◽  
Anterior Posterior

Single Stage Anterior-Posterior Reconstruction in Complex Cervical Spine Disorders

Neurosurgery ◽  
1998 ◽  
Vol 43 (3) ◽  
pp. 703-704
Author(s):  
Karl Schultz ◽  
Regis W. Haid ◽  
Christopher Comey ◽  
Gerald Rodts ◽  
Scott Erwood ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Single Stage ◽  
Posterior Reconstruction ◽  
Spine Disorders ◽  
Anterior Posterior

scholarly journals Operative treatment for old traumatic deformity of cervical spine...One staged anterior-posterior decompression and fusion.

1986 ◽  
Vol 34 (3) ◽  
pp. 912-916
Author(s):  
Yasushi Asakawa ◽  
Kunio Sasaki ◽  
Keiichirou Shiba ◽  
Takayoshi Ueta ◽  
Motofumi Komori ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Operative Treatment ◽  
Posterior Decompression ◽  
Anterior Posterior

Dysphagia following combined anterior-posterior cervical spine surgeries

2013 ◽  
Vol 19 (3) ◽  
pp. 279-287 ◽  
Author(s):  
Ching-Jen Chen ◽  
Dwight Saulle ◽  
Kai-Ming Fu ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Bone Morphogenetic Protein 2 ◽  
Barium Swallow ◽  
Anterior Plate ◽  
Cervical Spine Surgery ◽  
Estimated Blood Loss ◽  
Cervical Surgery ◽  
Significant Difference ◽  
Anterior Posterior

Object This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries. Methods The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and/or fiberoptic endoscopic evaluation of swallowing/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed. Results In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2–7 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput–C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No other significant difference between the dysphagia and no-dysphagia groups was identified; differences with respect to history of previous anterior cervical surgery (p = 0.141), use of an anterior plate (p = 0.613), and mean length of anterior cervical operative time (p = 0.541) were not significant. Conclusions The incidence of dysphagia following combined anterior-posterior cervical surgery in this study was comparable to that of previous reports. The risk factors for dysphagia that were identified in this study were increased number of anterior levels exposed, anterior surgery that extended above C-4, and increased surgical correction of C2–7 lordosis.

Low Back and Cervical Spine Disorders

1996 ◽  
Vol 27 (4) ◽  
pp. 729-746
Author(s):  
James Rainville ◽  
Jerry B. Sobel ◽  
Robert J. Banco ◽  
Harvey L. Levine ◽  
Lisa Childs
Keyword(s):  
Cervical Spine ◽  
Low Back ◽  
Spine Disorders

Construct Stability of C2 Replacement Strategies

2003 ◽  
Author(s):  
Christian M. Puttlitz ◽  
Robert P. Melcher ◽  
Vedat Deviren ◽  
Dezsoe Jeszenszky ◽  
Ju¨rgen Harms
Keyword(s):  
Repeated Measures ◽  
Posterior Instrumentation ◽  
Statistical Significance ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Camera Motion ◽  
Anterior Plate ◽  
Intact Specimen ◽  
Strut Graft ◽  
Significant Difference

Reconstruction of C2 after tumor destruction and resection remains a significant challenge. Most constructs utilize a strutgraft with plate or screw fixation. A novel C2 prosthesis combining a titanium mesh cage with bilateral C1 shelves and a T-plate has been used successfully in 18 patients. Supplemental posterior instrumentation includes C0-C3 or C1-C3. Biomechanical comparisons of this C2 prosthesis with traditional fixation options have not been reported. Five fresh-frozen human cadaveric cervical spines (C0-C5) were tested intact. Next, the C2 prosthesis, and strut graft and anterior plate constructs were tested with occiput-C3 and C1-C3 posterior fixation. Pure moment loads (up to 1.5 N-m) were applied in flexion and extension, lateral bending, and axial rotation. C1-C3 motion was evaluated using 3 camera motion analysis. Statistical significance was evaluated using one-way repeated measures ANOVA with Student-Newman-Keuls post hoc pairwise comparisons. All constructs provided a statistically significant decrease in motion in this C2 corpectomy model as compared to the intact condition. There was no significant difference in C1-C3 motion between the 4 constructs, regardless of whether the occiput was included in the fixation. Under these loading conditions, both the C2 prostheisis and strut-graft-plate constructs provided initial C1-C3 stability beyond that of the intact specimen. The occiput does not need to be included in the posterior instrumentation.

scholarly journals A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

2013 ◽  
Vol 19 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Christopher P. Ames ◽  
Justin S. Smith ◽  
Justin K. Scheer ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Interrater Reliability ◽  
Soft Tissue Release ◽  
Spine Deformity ◽  
Intrarater Reliability ◽  
Perfect Agreement ◽  
Moderate Agreement ◽  
Posterior Anterior ◽  
Anterior Posterior

Object Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons. Methods A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients. Results The average intrarater reliability was classified as “almost perfect agreement” for the major osteotomy (0.89 [range 0.60–1.00]) and approach modifier (0.99 [0.95–1.00]); it was classified as “moderate agreement” for the minor osteotomy (0.73 [range 0.41–1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 (“almost perfect agreement”); approach modifier, 0.99 (“almost perfect agreement”); and minor osteotomy, 0.55 (“moderate agreement”). Analysis of only major osteotomy plus approach modifier yielded a classification that was “almost perfect” with an average intrarater reliability of 0.90 (0.63–1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews. Conclusions The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.

Outcomes of Disabling Cervical Spine Disorders in Compensation Injuries

Spine ◽  
1999 ◽  
Vol 24 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Anna Wright ◽  
Tom G. Mayer ◽  
Robert J. Gatchel
Keyword(s):  
Cervical Spine ◽  
Spine Disorders
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