Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study

2003 ◽  
Vol 99 (2) ◽  
pp. 172-180 ◽  
Author(s):  
Pradeep K. Narotam ◽  
Sarah M. Pauley ◽  
Gregory J. McGinn
Keyword(s):  
Cervical Spine ◽  
Bone Growth ◽  
Iliac Crest ◽  
Ct Scans ◽  
Titanium Mesh ◽  
Content Type ◽  
Spine Stabilization ◽  
Flexion Extension ◽  
The Mean ◽  
Fine Print

Object. Reconstruction after anterior cervical decompression has involved the use of tricortical iliac crest bone or fibular strut grafts, but has been associated with significant morbidity. In this study the authors evaluated the efficacy of titanium mesh cages (TMCs) for stability and fusion following anterior cervical corpectomy. Methods. Thirty-seven patients were prospectively evaluated during a 4-year period. The majority presented with spinal cord compression (97%) often due to cervical spondylosis (87%). The TMC was filled with iliac crest bone chips or Surgibone and stabilized by anterior cervical plates (ACPs). The changes in settling ratio, coronal and sagittal angles, and sagittal displacement were determined at 3, 6, and 12 months; immediate postoperative radiographs were used as baseline. Flexion—extension radiographs and computerized tomography (CT) scans (obtained at 1 year) were examined to assess stability, fusion, and bone growth within the TMC. Complications such as settling, telescoping, migration, and pseudarthrosis were not observed. Dynamic radiography revealed spinal stability in all patients. Cage-related complications occurred in 2.7% (TMC malplacement [one patient]), surgery-related complications in 10.8%, and graft-related complications in 21.6%. Evidence of bone growth into the TMC was documented in 16 (95%) of 17 patients on CT scans. The mean cage height—related settling rates were 4.46% at 3 months (31 patients [p = 0.066]), 3.89% at 6 months (28 patients [p = 0.028]), and 4.35% at 1 year (27 patients [p = 0.958]). The mean sagittal displacement changed by 3.9% (23 patients [p = 0.73]). The mean coronal and sagittal angles changed 2.89° (30 patients [p = 0.498]) and 2.09° (29 patients [p = 0.001]) at 1 year, respectively, or at last follow up from baseline. No significant differences in the radiological indices were seen when multilevel vertebrectomy cases were compared with single-level vertebrectomy (p = 0.221), smoking status, or age. Conclusions. Titanium mesh cages, in combination with ACPs, are safe and effective for vertebral replacement in the cervical spine.

Use of cylindrical titanium mesh and locking plates in anterior cervical fusion

2001 ◽  
Vol 94 (1) ◽  
pp. 174-178 ◽  
Author(s):  
Kaushik Das ◽  
William T. Couldwell ◽  
Gerard Sava ◽  
Rudolph F. Tadonio
Keyword(s):  
Cervical Spine ◽  
Iliac Crest ◽  
Locking Plate ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Titanium Mesh ◽  
Content Type ◽  
Locking Plate System ◽  
Fine Print

✓ After performing anterior cervical corpectomy or discectomy for cervical spondolytic myelopathy or radiculopathy, iliac crest bone graft and fibular auto- or allograft is often used to achieve arthrodesis in the cervical spine. The purpose of this study was to evaluate the use of a cylindrical titanium mesh and locking plate system as an alternative technique in achieving anterior cervical fusion and maintaining lordosis. Hospital records and radiographs of 38 patients who underwent anterior cervical discectomies (28 patients) or corpectomies (10 patients) from 1995 to 1997 were reviewed retrospectively. All patients had undergone arthrodesis in which autograft and a cylindrical titanium mesh and anterior locking plate fixation were used after discectomy or corpectomy. There were 20 men and 18 women (mean age 46.1 years; range 34–72 years). Presenting symptoms included radiculopathy (61%), myelopathy (37%), and neck pain (2%). Preoperative and postoperative radiographs were studied, and data were obtained on the following: overall lordosis or kyphosis of the cervical spine, segmental lordosis or kyphosis at each surgically treated level, and evidence of fusion. In all of the patients in whom lordosis was present preoperatively, lordosis was maintained during the follow-up period. The overall fusion rate was 100%. The average change in overall lordosis or kyphosis related to the fixation devices was 1.2° (range 1–5°); the average segmental change was 2.3° (range 0–5°); and the mean follow up was 16 months (range 12–36 months). Anterior cervical fusion with cylindrical titanium mesh and cervical locking plate system is an effective method of achieving arthrodesis and maintaining alignment in the cervical spine. The construct may provide additional load-sharing function, and it avoids the use of cadaveric bone or the need for harvesting tricortical iliac crest autograft.

Cervical laminectomy without fusion in patients with rheumatoid arthritis

1999 ◽  
Vol 90 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Dan Christensson ◽  
Hans Säveland ◽  
Stefan Zygmunt ◽  
Kjell Jonsson ◽  
Urban Rydholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cord Compression ◽  
Spinal Instability ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Fusion Procedure ◽  
Cervical Laminectomy ◽  
Flexion Extension ◽  
Fine Print

Object. The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. Methods. Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion—extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6–24 months) and 43 months (28–72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. Conclusions. The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

A biomechanical comparison of the Rogers interspinous and the Lovely—Carl tension band wiring techniques for fixation of the cervical spine

2000 ◽  
Vol 93 (1) ◽  
pp. 109-116
Author(s):  
Albert V. B. Brasil ◽  
Danilo G. Coelho ◽  
Tarcísio Eloy P. B. Filho ◽  
Fernando M. Braga
Keyword(s):  
Cervical Spine ◽  
Axial Rotation ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Lesion Group ◽  
Percentage Increase ◽  
Content Type ◽  
Flexion Extension ◽  
Biomechanical Evaluation ◽  
Fine Print

Object. The authors conducted a biomechanical study in which they compared the uses of the Rogers interspinous and the Lovely-Carl tension band wiring techniques for internal fixation of the cervical spine. Method. An extensive biomechanical evaluation (stiffness in positive and negative rotations around the x, y, and z axes; range of motion in flexion—extension, bilateral axial rotation, and bilateral bending; and neutral zone in flexion—extension, bilateral axial rotation, and lateral bending to the right and to the left) was performed in two groups of intact calf cervical spines. After these initial tests, all specimens were subjected to a distractive flexion Stage 3 ligamentous lesion. Group 1 specimens then underwent surgical fixation by the Rogers technique, and Group 2 specimens underwent surgery by using the Lovely—Carl technique. After fixation, specimens were again submitted to the same biomechanical evaluation. The percentage increase or decrease between the pre- and postoperative parameters was calculated. These values were considered quantitative indicators of the efficacy of the techniques, and the efficacy of the two techniques was compared. Conclusions. Analysis of the findings demonstrated that in the spines treated with the Lovely—Carl technique less restriction of movement was produced without affecting stiffness, compared with those treated with the Rogers technique, thus making the Lovely—Carl technique clinically less useful.

Intraoperative cervical spine stabilization using the halo ring and the Mayfield three-pin skull clamp

1986 ◽  
Vol 64 (1) ◽  
pp. 157-158 ◽  
Author(s):  
Andrew H. Rhea ◽  
Bruce I. Tranmer ◽  
Cordell E. Gross
Keyword(s):  
Cervical Spine ◽  
Content Type ◽  
Spine Stabilization ◽  
Fine Print

✓ A technique for intraoperative cervical spine stabilization is described. The method involves use of a halo ring and the Mayfield three-pin skull clamp.

Influence of cage design on interbody fusion in a sheep cervical spine model

2002 ◽  
Vol 96 (3) ◽  
pp. 321-332 ◽  
Author(s):  
Frank Kandziora ◽  
Georg Schollmeier ◽  
Matti Scholz ◽  
Jan Schaefer ◽  
Alexandra Scholz ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Mineral ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Bone Matrix ◽  
Iliac Crest Bone Graft ◽  
Disc Space ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to compare the characteristics of interbody fusion achieved using an autologous tricortical iliac crest bone graft with those of a cylinder- and a box-design cage in a sheep cervical spine model. This study was designed to determine whether there are differences between three interbody fusion procedures in: 1) ability to preserve postoperative distraction; 2) biomechanical stability; and 3) histological characteristics of intervertebral bone matrix formation. Methods. Twenty-four sheep underwent C3–4 discectomy and fusion in which the following were used: Group 1, autologous tricortical iliac crest bone graft (eight sheep); Group 2, titanium cylinder-design cage filled with autologous iliac crest bone graft (eight sheep); and Group 3, titanium box-design cage filled with autologous iliac crest graft (eight sheep). Radiography was performed pre- and postoperatively and after 1, 2, 4, 8, and 12 weeks. At the same time points, disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the sheep were killed, and fusion sites were evaluated by obtaining functional radiographs in flexion and extension. Quantitative computerized tomography scans were acquired to assess bone mineral density, bone mineral content, and bone callus volume. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending. Stiffness, range of motion, neutral zone, and elastic zone were determined. Histomorphological and histomorphometric analyses were performed, and polychrome sequential labeling was used to determine the time frame of new bone formation. Over a 12-week period significantly higher values for disc space height and intervertebral angle were shown in cage-treated sheep than in those that received bone graft. Functional radiographic assessment revealed significantly lower residual flexion—extension movement in sheep with the cylinder cage-fixed spines than in those that received bone graft group. The cylinder—design cages showed significantly higher values for bone mineral content, bone callus content, and stiffness in axial rotation and lateral bending than the other cages or grafts. Histomorphometric evaluation and polychrome sequential labeling showed a more progressed bone matrix formation in the cylindrical cage group than in both other groups. Conclusions. Compared with the tricortical bone graft, both cages showed significantly better distractive properties. The cylindrical cage demonstrated a significantly higher biomechanical stiffness and an accelerated interbody fusion compared with the box-design cage and the tricortical bone graft. The differences in bone matrix formation within both cages were the result of the significantly lower stress shielding on the bone graft by the cylinder-design cage.

Inside—outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results

1999 ◽  
Vol 90 (1) ◽  
pp. 1-7 ◽  
Author(s):  
T. Glenn Pait ◽  
Ossama Al-Mefty ◽  
Frederick A. Boop ◽  
Kenan I. Arnautovic ◽  
Salim Rahman ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Metastatic Cancer ◽  
Care Facility ◽  
Spinal Instability ◽  
Term Care ◽  
Content Type ◽  
Long Term Care Facility ◽  
Spine Stabilization ◽  
Traumatic Fracture ◽  
Fine Print

Object. The authors present a series of 16 patients who underwent inside—outside occipital and posterior cervical spine stabilization. Methods. In this technique, the screw was placed from the inside of the occiput to the outside. An articular (lateral) mass plate was contoured to the shape of the occipital bone and the cervical spine and affixed to the occiput with a flat-headed screw or stud placed through a burr hole in the calvaria with the flat head of the screw in the epidural space and the threads facing outward. The bone plate was then secured with a nut to the occipital screw and the cervical plate was attached to the spine with a bone screw that coursed through the plate and into the articular pillar. Our series included six children and 10 adults. In five patients, previous fusion had failed; in two patients spinal instability was secondary to Down's syndrome; two patients' instability was related to developmental anomalies; and in five patients spinal instability was due to the presence of tumor. One patient with rheumatoid arthritis had undergone a transoral procedure. Two patients had suffered traumatic fracture. Three patients died of causes unrelated to the procedure, one patient died of metastatic cancer, and one patient died in a long term care facility of cardiopulmonary complications. One patient with renal failure suffered a hemorrhage from an arteriovenous fistula after being treated with dialysis. In one child, a nut backed off after 3 months. The nut was reseated, and a maturing arthrodesis was present. Conclusions. The authors conclude that the inside—outside occipitocervical fixation is an effective technique for stabilizing the cervical spine.

Atlantoaxial interlaminar distances in cervical flexion in children

2003 ◽  
Vol 98 (3) ◽  
pp. 271-274 ◽  
Author(s):  
R. Shane Tubbs ◽  
Matthew D. Smyth ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Atlantoaxial Instability ◽  
Entire Group ◽  
Content Type ◽  
Significant Difference ◽  
Full Flexion ◽  
The Mean ◽  
Atlas And Axis ◽  
Fine Print ◽  
Posterior Elements

Object. To the best of the authors' knowledge, no quantitative analysis of the atlantoaxial interlaminar distance in flexion (ILD) in children exists in the medical literature. In this study they sought to determine the age-matched relationship between the posterior elements of the atlas and axis in children in cervical spine flexion, to be used as an adjunct to the atlantodental interval in common clinical use. Methods. Lateral radiographs of the cervical spine in full flexion were analyzed in 74 children. The atlantoaxial ILD was defined as the distance between a midpoint of the anterior cortices of the atlantal and axial posterior arches. The mean ILD for the entire group was 19 mm (range 8–30 mm). No significant difference was seen between male and female patients (p = 0.084). When stratified by age, the mean ILD was 12.3 ± 3 mm (15 cases) in children age 3 years or younger and 20.5 ± 4.7 mm (59 cases) in children age older than 3 years. Further stratification of the groups yielded a mean ILD of 10.4 ± 1.4 [eight cases]) in children age 1 to 2 years, and 14.4 ± 4.7 mm (seven cases) in children age 3 years. In children older than 3 years of age the mean ILD was consistently approximately 20 ± 5 mm regardless of age. Conclusions. Rapid, safe, and accurate diagnosis of the cervical spine is essential in critical care. Knowledge of the distance between the posterior elements of the atlas and axis in flexion should enhance the clinicians' (those who clear cervical spines) ability to diagnose accurately atlantoaxial instability on lateral radiographs obtained in flexion.

Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest

1999 ◽  
Vol 91 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Scott Shapiro ◽  
William Snyder ◽  
Kevin Kaufman ◽  
Todd Abel
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Neck Pain ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Iliac Crest ◽  
Lateral Mass ◽  
Reduction Procedure ◽  
Content Type ◽  
Fine Print

Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Methods. Thirty-seven patients (73%) presented with radiculopathy, eight (16%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10%). Based on CT and/or MR imaging findings, a closed reduction procedure was believed to be contraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) underwent closed reduction procedures. Two patients who underwent a closed reduction procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98%) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior—posterior decompressive procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18%). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.

Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system

2002 ◽  
Vol 97 (2) ◽  
pp. 213-217 ◽  
Author(s):  
Sylvain Palmer ◽  
Robert Turner ◽  
Rosemary Palmer
Keyword(s):  
Mr Imaging ◽  
Blood Loss ◽  
Spinal Stenosis ◽  
Outpatient Basis ◽  
Tubular Retractor ◽  
Content Type ◽  
Unilateral Approach ◽  
Flexion Extension ◽  
The Mean ◽  
Fine Print

Object. The authors studied a consecutive series of patients with spinal stenosis in whom surgery was performed by a single surgeon who used a microscopic tubular retractor system (METRx-MD); patients underwent prospective evaluation involving radiography and magnetic resonance (MR) imaging. The objective was to assess the feasibility and surgery-related efficacy of performing unilateral-approach bilateral decompression and utilization of METRx-MD instrumentation in patients with spinal stenosis. Methods. Seventeen consecutive patients with spinal stenosis underwent bilateral decompression; surgery was performed via a unilateral approach using METRx-MD instrumentation. The procedures were performed on an outpatient basis after induction of general anesthesia. Preoperative and 3-month follow-up plain radiographs with flexion—extension views were obtained. Preoperative and postoperative MR imaging was also performed. All studies were assessed by a single radiologist blinded to the clinical results. Twenty-two levels were surgically decompressed. The mean operative time was 90 minutes and the mean blood loss was 28 ml per level. Preoperatively stenosis was severe at 13 levels, moderate/severe at eight, and moderate at one. Postoperatively stenosis was absent at 13 levels, mild at seven, mild/moderate at one, and moderate at one. Preoperatively degenerative spondylolisthesis was documented in eight patients, with flexion—extension radiography revealing motion in three cases. On early (3-month) postoperative x-ray films there was no evidence of progression in any case. Grade I spondylolisthesis developed postoperatively in one patient, who remained asymptomatic. Conclusions. Minimally invasive bilateral decompression and instrumentation-assisted fusion can be successfully performed via a unilateral approach in patients with acquired spinal stenosis; the procedure can be undertaken on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity rates.

Ultra-early evaluation of intracerebral hemorrhage

1990 ◽  
Vol 72 (2) ◽  
pp. 195-199 ◽  
Author(s):  
Joseph P. Broderick ◽  
Thomas G. Brott ◽  
Thomas Tomsick ◽  
William Barsan ◽  
Judith Spilker
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Symptom Onset ◽  
Ct Scans ◽  
Content Type ◽  
Early Evaluation ◽  
Hemorrhage Volume ◽  
The Mean ◽  
Fine Print

✓ The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2½ hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours after onset for seven of the patients and 100 hours after onset for the eighth patient. In four patients, the second CT scan was obtained prospectively. The mean percentage of increase in the volume of hemorrhage between the first and second CT scans was 107% (range 1% to 338%). In each of the six patients with a greater than 40% increase in hemorrhage volume, neurological deterioration occurred soon after the first CT. A systolic blood pressure of 195 mm Hg or greater was recorded during the first 6 hours in five of the same six patients. The data from this study indicate that, in ICH, bleeding may continue after the 1st hour post-hemorrhage, particularly in patients with early clinical deterioration.

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