Treatment of severe retromastoid pain secondary to C1–2 arthrosis by using cervical fusion

2000 ◽  
Vol 92 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Langsto T. HOLLY ◽  
Ulrich Batzdorf ◽  
Kevin T. Foley
Keyword(s):  
Nonoperative Management ◽  
Facet Joint ◽  
Complete Relief ◽  
Intractable Pain ◽  
Cervical Fusion ◽  
Content Type ◽  
Fusion Procedure ◽  
Nonoperative Therapy ◽  
Radicular Symptoms ◽  
Fine Print

Object. In this report the authors review their 5-year experience in the diagnosis and management of nine patients with severe retromastoid pain secondary to C1–2 arthrosis. Patients with symptomatic joints unresponsive to nonoperative therapy underwent cervical fusion procedures. Methods. The mean age of the patients was 71 years, and the onset of prior symptoms ranged from 6 months to 18 years. All patients suffered similar discrete nonneuropathic pain without radicular symptoms ipsilateral to the diseased facet joint. Four patients experienced relief from pain with the use of nonoperative therapy. Five patients continued to experience intractable pain and underwent C1–2 fusion. The follow-up period ranged from 6 to 26 months. The cervical fusion procedure was successful in treating the retromastoid pain in all patients. In patients who underwent surgery, complete relief of pain was demonstrated in four and significantly reduced in the fifth. Conclusions. The authors have drawn several conclusions. First, C1–2 arthrosis has a rather unique presentation and is a potential cause of upper posterior neck and head pain predominantly in elderly patients. Second, nonoperative management significantly improved the pain in nearly half of their patients and should be the first line of treatment. Last, C1–2 fusion was successful in treating the pain in patients in whom nonoperative management had failed to resolve symptoms.

A modified drill guide for the anterior cervical fusion (Cloward) procedure

1980 ◽  
Vol 52 (2) ◽  
pp. 284-285 ◽  
Author(s):  
Henry Berry ◽  
William J. Horsey
Keyword(s):  
Surgical Procedure ◽  
Anterior Cervical Fusion ◽  
Drilling Process ◽  
Cervical Fusion ◽  
Content Type ◽  
Fusion Procedure ◽  
Cloward Procedure ◽  
Drill Guide ◽  
Fixation Points ◽  
Fine Print

✓ A modified drill guide for use in the anterior cervical fusion procedure is described. This device permits an inspection of the interbody hole during the drilling process, and incorporates the additional mechanical improvements of replacement fixation points and locking rings of different diameter. These modifications have been found to simplify and improve control over the drilling component of this surgical procedure.

Spondylolisthesis after multiple bilateral laminectomies and facetectomies for lumbar spondylosis

1979 ◽  
Vol 50 (1) ◽  
pp. 45-47 ◽  
Author(s):  
Henry A. Shenkin ◽  
Cecil J. Hash
Keyword(s):  
Intractable Pain ◽  
Multiple Level ◽  
Content Type ◽  
X Ray ◽  
Lumbar Spondylosis ◽  
Fusion Procedure ◽  
Fine Print

✓ The authors report a further 3-year follow-up review of a series of 59 patients suffering with intractable pain due to lumbar spondylosis and treated by multiple-level bilateral laminectomies and facetectomies. Routine postoperative x-ray examination revealed that six of 59 patients had developed spondylolisthesis. Two of the six were symptomatic and required a secondary fusion procedure. Analysis of the patients who had developed vertebral slippage revealed that 6% of the patients with only two levels (L-4 and L-5) removed developed spondylolisthesis, but in those with three or more levels removed 15% showed slipped vertebrae. After an average follow-up period of 6 years, 87% of patients still had a worthwhile result as contrasted with 91% of the same series who had had a good result after a follow-up period averaging 3 years.

Preliminary percutaneous dorsal column stimulation prior to permanent implantation

1972 ◽  
Vol 37 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Yoshio Hosobuchi ◽  
John E. Adams ◽  
Philip R. Weinstein
Keyword(s):  
Dorsal Column ◽  
Screening Procedure ◽  
Intractable Pain ◽  
Content Type ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

Minimally invasive implantation of epidural spinal cord neurostimulator electrodes by using a tubular retractor system

2004 ◽  
Vol 100 (6) ◽  
pp. 1119-1121 ◽  
Author(s):  
Matthew R. Johnson ◽  
Daniel J. Tomes ◽  
John S. Treves ◽  
Lyal G. Leibrock
Keyword(s):  
Spinal Cord ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Intractable Pain ◽  
Tubular Retractor ◽  
Content Type ◽  
Novel Technique ◽  
Pain Syndromes ◽  
Hospital Stays ◽  
Fine Print

✓ The authors describe a novel technique for the implantation of multipolar epidural spinal cord neurostimulator electrodes with the aid of a tubular retractor system. Spinal cord neurostimulation is used as a neuroaugmentive tool for treating chronic intractable pain syndromes. Minimally invasive placement of the multipolar neurostimulator electrodes may allow for shorter hospital stays and less postoperative pain associated with the incision.

Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

1990 ◽  
Vol 72 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Joseph C. Maroon ◽  
Thomas A. Kopitnik ◽  
Larry A. Schulhof ◽  
Adnan Abla ◽  
James E. Wilberger
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Spinal Nerve ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Enhanced Ct ◽  
Disc Herniations ◽  
Microsurgical Approach ◽  
Far Lateral ◽  
Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions

1998 ◽  
Vol 88 (2) ◽  
pp. 255-265 ◽  
Author(s):  
Paul D. Sawin ◽  
Vincent C. Traynelis ◽  
Arnold H. Menezes
Keyword(s):  
Comparative Analysis ◽  
Iliac Crest ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Bone Grafts ◽  
Fusion Rate ◽  
Donor Site Morbidity ◽  
Cervical Fusion ◽  
Content Type ◽  
Fine Print

Object. Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content. The authors present a comparative analysis of autogeneic rib and iliac crest bone grafts, with emphasis on fusion rate and donor-site morbidity. Methods. A review was conducted of records and radiographs from 600 patients who underwent cervical spinal fusion procedures in which autogeneic bone grafts were used. Three hundred patients underwent rib harvest and posterior cervical fusion. The remaining 300 patients underwent iliac crest harvest (248 for an anterior cervical fusion and 52 for posterior fusion). The analysis of fusion focused on the latter subgroup; donor-site morbidity was determined by evaluating the entire group. Fusion criteria included bony trabeculae traversing the donor—recipient interface and long-term stability on flexion—extension radiographs. Graft morbidity was defined as any untoward event attributable to the graft harvest. Statistical comparisons were facilitated by using Fisher's exact test. Conclusions. Demographic data obtained in both groups were comparable. Rib constructs were placed in the following regions: occipitocervical (196 patients), atlantoaxial (35 patients), and subaxial cervical spine (69 patients). Iliac crest grafts were placed in the occipitocervical (28 patients), atlantoaxial (10 patients), and subaxial cervical (14 patients) regions. Fusion occurred in 296 (98.8%) of 300 rib graft and 49 (94.2%) of 52 iliac crest graft constructs (p = 0.056). Graft morbidity was greater with iliac crest than with rib (p < 0.00001). Donor-site morbidity for the rib graft was 3.7% and included pneumonia (eight patients), persistent atelectasis (two patients), and superficial wound dehiscence (one patient). Pneumothorax, intercostal neuralgia, and chronic chest wall pain were not encountered. Iliac crest morbidity occurred in 25.3% of the patients and consisted of chronic donor-site pain (52 patients), wound dehiscence (eight patients), pneumonia (seven patients), meralgia paresthetica (four patients), hematoma requiring evacuation (three patients), and iliac spine fracture (two patients). Even when chronic pain was not considered, morbidity encountered in obtaining iliac crest still exceeded that encountered with rib harvest (p = 0.035). The fusion rate and donor-site morbidity for rib autograft compare favorably with those for iliac crest when used in posterior cervical constructs. To the authors' knowledge, this represents the largest series to date in which the safety and efficacy of using autogeneic bone graft materials in spinal surgery are critically analyzed.

Delayed intracranial migration of cervical sublaminar and interspinous wires and subsequent cerebellar abscess

2002 ◽  
Vol 97 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Kevin L. Stevenson ◽  
Matthew Wetzel ◽  
Ian F. Pollack
Keyword(s):  
Cervical Spine ◽  
Neurological Injury ◽  
Cervical Fusion ◽  
Content Type ◽  
Cerebellar Abscess ◽  
Delayed Complication ◽  
History Of ◽  
Delayed Complications ◽  
The Wire ◽  
Fine Print

✓ Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.

The future in the care of the cervical spine: interbody fusion and arthroplasty

2004 ◽  
Vol 1 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Regis W. Haid
Keyword(s):  
Adjacent Segment Degeneration ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Cervical Fusion ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Fine Print

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

Acute axis fractures: a review of 229 cases

1989 ◽  
Vol 71 (5) ◽  
pp. 642-647 ◽  
Author(s):  
Mark N. Hadley ◽  
Curtis A. Dickman ◽  
Carol M. Browner ◽  
Volker K. H. Sonntag
Keyword(s):  
Treatment Guidelines ◽  
Type Ii ◽  
High Likelihood ◽  
Fracture Feature ◽  
Content Type ◽  
Nonoperative Therapy ◽  
The Difference ◽  
Cervical Spine Fractures ◽  
Fine Print

✓ Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization. The difference is statistically significant (p < 0.001, x2 = 30.20). The present series includes 229 patients with acute axis fractures. Follow-up data were available in 92% of these patients, for a median duration of 4 years 9 months. Treatment guidelines and results are offered for each subtype of axis fracture based on this experience.

Graft subsidence after instrument-assisted anterior cervical fusion

2002 ◽  
Vol 97 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Gary W. Tye ◽  
R. Scott Graham ◽  
William C. Broaddus ◽  
Harold F. Young
Keyword(s):  
Smoking Status ◽  
Reoperation Rate ◽  
Anterior Cervical Fusion ◽  
Neurological Deficits ◽  
Cervical Fusion ◽  
Content Type ◽  
Plate Length ◽  
Graft Subsidence ◽  
Fine Print

Object. Bone grafts used in anterior cervical fusion (ACF) may subside postoperatively. The authors reviewed a recent series in which instrument-assisted ACF was performed to determine the degree of subsidence with respect to fusion length, use of segmental screws, and patient smoking status, age, and sex. Methods. Charts and implant records were reviewed for all 70 patients who underwent instrument-assisted ACF during a 2-year period. The procedures, grafting materials, plate types/lengths, and patient smoking status were recorded. The immediate postoperative and follow-up lateral radiographs were analyzed. The plate lengths and lengths of the fused segments were measured in a standardized fashion. The mean intraoperative and follow-up fusion segment lengths were 54.3 and 51.9 mm, respectively. Greater subsidence occurred in multilevel fusions than in single-level fusions. There were noticeable changes in the position of plates or screws on 14 of 70 follow-up x-ray films. No new neurological deficits related to graft subsidence occurred, and the reoperation rate was 3%. There was no statistical relation between subsidence and the following variables: segmental fixation, smoking status, sex, age, or dowel size when corrected for length of the plate. Hardware migration correlated significantly with plate length in cases of two- and three-level fusions. Conclusions. The length of a fusion segment decreases in the immediate weeks following instrument-assisted ACF. Construct length is the most important determinant of subsidence. When designing multilevel cervical constructs, consideration of the effects of graft subsidence may help to avoid hardware-related complications.

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