Occipitocervical reconstruction with the Ohio Medical Instruments Loop: results of a multicenter evaluation in 30 cases

2003 ◽  
Vol 98 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Sheila K. Singh ◽  
Lynda Rickards ◽  
Ronald I. Apfelbaum ◽  
R. John Hurlbert ◽  
Dennis Maiman ◽  
...  
Keyword(s):  
Spinal Injury ◽  
High Rate ◽  
Os Odontoideum ◽  
Rigid Fixation ◽  
Content Type ◽  
Hardware Failure ◽  
Wide Range ◽  
Medical Instruments ◽  
Fine Print

Object. Stabilization of the craniocervical junction (CCJ) remains a significant challenge. In this multicenter study, the authors present the results of an evaluation of a precontoured titanium implant, the Ohio Medical Instruments (OMI) Loop, for craniocervical fixation. Methods. In this multicenter retrospective study the authors evaluated 30 patients (16 female, 14 male; mean age 53.8 years) with rheumatoid arthritis (15 cases), traumatic occipitoatlantoaxial instability (six cases), congenital vertebral anomalies (two cases), instability due to basilar invagination in the setting of Chiari malformation (two cases), or Down syndrome (one case), tumor (one case), os odontoideum (two cases), and pseudarthrosis/other (one case), who underwent OMI Loop—assisted occipitocervical reconstruction. The mean follow-up period was 25.4 months (range 6–60 months). A solid reconstruction was achieved in 29 of 30 cases; there was only one case of hardware failure requiring reoperation. Noncritical hardware failure occurred in two patients in whom partial occipital screw backout occurred but did not necessitate reoperation. There were no perioperative neurological complications. One patient (3.3%) experienced a delayed postoperative worsening of myelopathy at 1 year that resolved with further surgery. Postoperatively, in 66.6% of patients the degree of myelopathy remained stable (as measured by American Spinal Injury Association [ASIA] scores), whereas 30% improved by one or more ASIA grade. The rate of osseous fusion was 96.6% at a mean follow-up period of 25.4 months. Conclusions. The authors found that the OMI Loop is a versatile precontoured occipitocervical fixation device that can be applied to a wide range of CCJ lesions. It provides excellent immediate rigid fixation of the CCJ, a high rate of osseous fusion, and a low rate of hardware failure.

Posterior atlantoaxial facet screw fixation

1993 ◽  
Vol 79 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Paul Marcotte ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag ◽  
Dean G. Karahalios ◽  
Janine Drabier
Keyword(s):  
Screw Fixation ◽  
Metastatic Tumor ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Rigid Fixation ◽  
Spinal Fixation ◽  
Strut Graft ◽  
Content Type ◽  
Fine Print

✓ Eighteen patients with atlantoaxial instability were treated with posterior atlantoaxial facet screws to obtain immediate rigid fixation of C1–2. Of these 18 patients, instability occurred due to trauma in nine, rheumatoid arthritis in six, neoplasms in two, and os odontoideum in one. Four patients presented with nonunion after failed C1–2 wire and graft procedures. In all cases in this series the screw fixations were augmented with an interspinous C1–2 strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. In every case fixation was satisfactory, and C1–2 alignment and stability were restored without complications due to instrumentation. One patient died 3 months postoperatively from metastatic tumor; the spinal fixation was intact. All 17 surviving patients have developed osseous unions (mean follow-up period 12 months, range 6 to 16 months). Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1–2 that is mechanically superior to wiring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis, and is particularly useful for pseudoarthrosis.

Preliminary results of linear accelerator radiosurgery for acoustic schwannomas

1996 ◽  
Vol 85 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
William M. Mendenhall ◽  
William A. Friedman ◽  
John M. Buatti ◽  
Francis J. Bova
Keyword(s):  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Linear Accelerator ◽  
Local Control Rate ◽  
Magnetic Resonance Images ◽  
High Rate ◽  
Content Type ◽  
Treatment Volume ◽  
Fine Print

✓ In this paper the authors evaluate the results of linear accelerator (LINAC)—based stereotactic radiosurgery for acoustic schwannomas. Fifty-six patients underwent LINAC-based stereotactic radiosurgery for acoustic schwannomas at the University of Florida between July 1988 and November 1994. Each patient was followed for a minimum of 1 year or until death; no patient was lost to follow up. One or more follow-up magnetic resonance images or computerized tomography scans were obtained in 52 of the 56 patients. Doses ranged between 10 and 22.5 Gy with 69.6% of patients receiving 12.5 to 15 Gy. Thirty-eight patients (68%) were treated with one isocenter and the dose was specified to the 80% isodose line in 71% of patients. Fifty-five patients (98%) achieved local control after treatment. The 5-year actuarial local control rate was 95%. At the time of analysis, 48 patients were alive and free of disease, seven had died of intercurrent disease, and one was alive with disease. Complications developed in 13 patients (23%). The likelihood of complications was related to the dose and treatment volume: 10 to 12.5 Gy to all volumes, three (13%) of 23 patients; 15 to 17.5 Gy to 5.5 cm3 or less, two (9%) of 23 patients; 15 to 17.5 Gy to more than 5.5 cm3, five (71%) of seven patients; and 20 to 22.5 Gy to all volumes, three (100%) of three patients. Linear accelerator—based stereotactic radiosurgery results in a high rate of local control at 5 years. The risk of complications is related to the dose and treatment volume.

Use of structural allografts in spinal osteomyelitis: a review of 47 cases

2000 ◽  
Vol 93 (1) ◽  
pp. 8-14 ◽  
Author(s):  
James M. Schuster ◽  
Anthony M. Avellino ◽  
Frederick A. Mann ◽  
Allain A. Girouard ◽  
M. Sean Grady ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Persistent Infection ◽  
Perceived Risk ◽  
Recurrent Infection ◽  
Content Type ◽  
Hardware Failure ◽  
Spinal Osteomyelitis ◽  
Structural Allografts ◽  
Fine Print

Object. The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]). Methods. Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14–83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 ± 9 months (median 14 months, range 6–45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure. Conclusions. It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.

Delayed stenosis following placement of a polyethylene terephthalate endograft in the cervical carotid artery

2003 ◽  
Vol 98 (2) ◽  
pp. 421-425 ◽  
Author(s):  
Tony P. Smith ◽  
Michael J. Alexander ◽  
David S. Enterline
Keyword(s):  
Carotid Artery ◽  
Polyethylene Terephthalate ◽  
High Rate ◽  
Content Type ◽  
Complete Occlusion ◽  
Graft Stenosis ◽  
Arterial Lumen ◽  
Initial Results ◽  
Fine Print

✓ Three patients with carotid artery (CA) pseudoaneurysms were treated using four polyethylene terephthalate endografts (Wallgraft endoprostheses). Two patients received a single graft and one patient with bilateral pseudoaneurysms received two grafts. Complete occlusion of the pseudoaneurysm with patency of the arterial lumen was achieved following endograft placement in all patients. The clinical follow-up interval ranged from 12 to 18 months and included angiography or ultrasonography studies or both. One patient experienced neurological symptoms, and in-graft stenosis ranging from 50 to 100% occurred in three of the four grafts. Although the Wallgraft endoprosthesis produced good initial results for the treatment of cervical CA pseudoaneurysms, as demonstrated on radiography, it was associated with a high rate of stenosis or occlusion in all three patients.

Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases

2005 ◽  
Vol 3 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Feyza Karagöz Güzey ◽  
Erhan Emel ◽  
N. Serdar Bas ◽  
Selim Hacisalihoglu ◽  
Hakan Seyithanoglu ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Neurological Deficits ◽  
Easy Access ◽  
Tuberculous Spondylitis ◽  
Content Type ◽  
The Mean ◽  
Posterior Debridement ◽  
Fine Print

Object. Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. Methods. Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16–125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2° (range 5–42°) preoperatively; this was reduced to 17.3° (range 0–42°) after surgery. There was a 2.8° loss of correction (range 2–5°) after 44.3 months (16–64 months). Kyphosis did not progress beyond 15 months in any patient. Conclusions A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.

Posterior atlantoaxial facet screw fixation in rheumatoid arthritis

1998 ◽  
Vol 89 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Mohammed Aly Eleraky ◽  
Roberto Masferrer ◽  
Volker K. H. Sonntag
Keyword(s):  
Screw Fixation ◽  
Class Ii ◽  
Atlantoaxial Instability ◽  
Rigid Fixation ◽  
Class Iii ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. This retrospective review was conducted to determine the efficacy of transarticular screw fixation in a group of patients who were treated for rheumatoid atlantoaxial instability. Methods. Thirty-six patients (mean age 63 years) with rheumatoid atlantoaxial instability were treated with posterior atlantoaxial transarticular screw fixation supplemented with an interspinous C1–2 strut graft—cable construct to provide immediate three-point fixation to facilitate bone fusion. Previous attempts at fusions by using bone grafting with wire fixation at other institutions had failed in six of these patients. Six patients underwent transoral odontoid resections for removal of large irreducible pannus as a first-stage procedure, which was followed within 2 to 3 days by the posterior procedure. Postoperatively, 33 patients were placed in hard cervical collars and three required halo vests because of severe osteoporosis. Of eight patients categorized as Ranawat Class II preoperatively, all eight returned to normal after surgery; of eight patients in Ranawat Class III-A preoperatively, four improved to Class II and four remained unchanged. All 20 patients classified as Ranawat Class I preoperatively recovered completely. Pain decreased or resolved in all patients, and there were no complications related to instrumentation. At follow-up review (mean 2 years), 33 patients (92%) had solid bone fusions, and three (8%) had stable fibrous unions. Conclusions. Posterior atlantoaxial transarticular screw fixation provides a good surgical alternative for the management of patients with rheumatoid atlantoaxial instability. This technique provides immediate three-point rigid fixation of the C1–2 region, thus obviating the need for halo vest immobilization in most cases.

Use of MR imaging-compatible Halifax interlaminar clamps for posterior cervical fusion

1991 ◽  
Vol 74 (2) ◽  
pp. 185-189 ◽  
Author(s):  
E. Francois Aldrich ◽  
Wayne N. Crow ◽  
Peter B. Weber ◽  
Thomas N. Spagnolia
Keyword(s):  
Mr Imaging ◽  
Bone Grafting ◽  
Ease Of Use ◽  
Rigid Fixation ◽  
Cervical Fusion ◽  
Content Type ◽  
Posterior Cervical Fusion ◽  
Ideal Method ◽  
Fine Print

✓ Twenty-one patients requiring posterior cervical fusion were treated with magnetic resonance (MR) imaging-compatible Halifax interlaminar clamps for internal fixation. Various levels were involved: the C1–2 level in eight cases, the C4–5 level in four, the C5–6 level in three, the C6–7 level in three, the C4–6 level in two, and the C5–7 level in one. Bilateral clamps were used in 18 cases and unilateral clamps in three. Autogenous iliac bone grafting was performed in all cases but one. Follow-up periods ranged from 1 to 18 months (average 9.2 months), with no complications or mechanical failures occurring thus far. Follow-up diagnostic studies revealed rigid fixation and fusion in all cases. The MR imaging-compatibility of the clamps allowed excellent follow-up studies with minimal artifact. Because of their ease of use, rigid stabilization, good results, lack of complications, and compatibility with MR imaging, the Halifax interlaminar clamp with bone grafting provides an ideal method for posterior cervical stabilization.

Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury

2002 ◽  
Vol 96 (3) ◽  
pp. 267-272 ◽  
Author(s):  
Maria Del Rosario Molano ◽  
James G. Broton ◽  
Judy A. Bean ◽  
Blair Calancie
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spine Surgery ◽  
Spinal Injury ◽  
Content Type ◽  
Cord Injury ◽  
Prophylactic Use ◽  
Initial Hospitalization ◽  
Fine Print

Object. The authors attempted to determine if there is a significant relationship between the incidence of medical complications and the prophylactic use of methylprednisolone (MP) during spine surgery in patients with acute spinal cord injury (SCI) who had already received MP on hospital admission (typically in the setting of an Emergency Room/Trauma Center). Methods. The authors studied 73 patients with acute SCI who were admitted to the hospital for at least 7 days postinjury. All patients 1) received a 24-hour regimen of MP in the acute period of hospitalization; and 2) underwent surgery to stabilize the spine and/or decompress the spinal cord. Patients were separated into two groups on the basis of whether they received additional MP therapy during spine surgery. A chart review was conducted retrospectively to determine the incidence of complications up to 6 weeks postinjury. Muscle strength and American Spinal Injury Association grades were determined prospectively throughout the follow-up period. In patients who received two courses of MP following acute SCI (one at initial hospitalization and one during surgery), a significantly increased probability of complications was demonstrated compared with those who received no MP therapy during surgery. This was particularly evident when the incidences of serious complications were compared. Conclusions. Prophylactic use of MP as a neuroprotective agent during spine surgery in patients with acute SCI should be avoided in those in whom MP was administered on admission to the hospital.

Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty

2002 ◽  
Vol 97 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Takeo Goto ◽  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Misao Nishikawa ◽  
Naohiro Tsuyuguchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Spinal Tumors ◽  
Cervical Laminoplasty ◽  
En Bloc ◽  
Content Type ◽  
Hardware Failure ◽  
Fine Print ◽  
Posterior Elements

Object. The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. Methods. The posterior spinal elements, including the lamina(e), spinous process(es), and various attached ligaments, are removed en bloc by incising the lamina in its lateral aspect. Trapezoid-shaped HA spacers are placed between the cut ends of the laminae or between the laminae and lateral masses bilaterally at each level. Malleable titanium miniplates and screws are used for fixation of the spacers. The fixation of transected laminae was judged to be successful. Postoperative care included application of a soft neck collar for 1 week but no further restriction of activity. Surgery-related outcome was assessed in the 21 patients who attended more than 6 months of follow up after laminoplasty. There were 18 men and three women who ranged in age from 27 to 81 years. Cervical stenotic myelopathy was demonstrated in 15 patients who underwent decompressive and expansive laminoplasty, and spinal tumors were documented in six patients who underwent a nonexpansive laminoplasty. Postoperative and follow-up computerized tomography scans demonstrated no hardware failure. Bone formation around the spacers was observed either at 6- or at 9-month follow-up examination in all 21 patients. Fusion of the reconstructed laminae was found to be completed at 12 months in all 18 patients able to attend follow up for this duration. Spinal alignment and the range of motion of the cervical spine were well preserved. In patients with stenotic cervical myelopathy, neurological and anatomical outcome of canal expansion were satisfactory. Conclusions. This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

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