Clinical and radiological evaluation of the Codman semiconstrained load-sharing anterior cervical plate: prospective multicenter trial and independent blinded evaluation of outcome

2003 ◽  
Vol 99 (3) ◽  
pp. 264-270 ◽  
Author(s):  
Steven Casha ◽  
Michael G. Fehlings
Keyword(s):  
Load Sharing ◽  
Multicenter Trial ◽  
Plate Interface ◽  
Optimal Method ◽  
Content Type ◽  
Neurological Improvement ◽  
Clinical And Radiological Outcome ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. Semiconstrained load-sharing implants for spinal fixation accommodate change in the screw—plate interface as bone grafts shrink. The authors evaluated the clinical and radiological outcome in patients after placement of the Codman anterior cervical plate (ACP) system, which allows change in the screw—plate angle. Methods. The authors undertook a 10-center prospective study with independent blinded evaluation. All patients underwent cervical fusion and placement of ACPs. Clinical and radiological evaluations were performed at 1, 3, 6, 12, and 24 months. Radiographs were examined for screw angles, construct height, fusion, and screw fracture or displacement. One hundred ninety-five patients were enrolled. The mean follow-up period was 17 months. At 24 months neurological improvement was demonstrated in 68.7% and pain improvement in 76.6% of the patients. Fusion was successful in 93.8%. Varying degrees (most minor) of hardware-related failure occurred in 10.4% of cases; however, reoperation was required in only four (2.1%). A significant change in screw angles occurred over time (mean 6.4° in caudal screw angle [p < 0.001] and 2.4° in the rostral screw angle [p = 0.003]). These changes plateaued by 6 months. A change in construct height (mean 3.48 mm) occurred by 6 months (p < 0.05). Conclusions. Based on an independent blinded evaluation, the Codman ACP provides effective fixation with load sharing and is effective in achieving fusion with a 94% success rate. Direct comparison with rigidly locked devices is required to establish definitively the optimal method for anterior cervical fixation.

Biomechanical analysis of a newly designed bioabsorbable anterior cervical plate

2005 ◽  
Vol 3 (6) ◽  
pp. 465-470 ◽  
Author(s):  
Christopher P. Ames ◽  
Frank L. Acosta ◽  
Robert H. Chamberlain ◽  
Adolfo Espinoza Larios ◽  
Neil R. Crawford
Keyword(s):  
Axial Rotation ◽  
Metal Plate ◽  
Biomechanical Analysis ◽  
Fibular Graft ◽  
Disc Disease ◽  
Content Type ◽  
Flexion Extension ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. The authors present a biomechanical analysis of a newly designed bioabsorbable anterior cervical plate (ACP) for the treatment of one-level cervical degenerative disc disease. They studied anterior cervical discectomy and fusion (ACDF) in a human cadaveric model, comparing the stability of the cervical spine after placement of the bioabsorbable fusion plate, a bioabsorbable mesh, and a more traditional metallic ACP. Methods. Seven human cadaveric specimens underwent a C6–7 fibular graft—assisted ACDF placement. A one-level resorbable ACP was then placed and secured with bioabsorbable screws. Flexibility testing was performed on both intact and instrumented specimens using a servohydraulic system to create flexion—extension, lateral bending, and axial rotation motions. After data analysis, three parameters were calculated: angular range of motion, lax zone, and stiff zone. The results were compared with those obtained in a previous study of a resorbable fusion mesh and with those acquired using metallic fusion ACPs. For all parameters studied, the resorbable plate consistently conferred greater stability than the resorbable mesh. Moreover, it offered comparable stability with that of metallic fusion ACPs. Conclusions. Bioabsorbable plates provide better stability than resorbable mesh. Although the results of this study do not necessarily indicate that a resorbable plate confers equivalent stability to a metal plate, the resorbable ACP certainly yielded better results than the resorbable mesh. Bioabsorbable fusion ACPs should therefore be considered as alternatives to metal plates when a graft containment device is required.

Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption

2002 ◽  
Vol 97 (4) ◽  
pp. 473-480 ◽  
Author(s):  
Alexander R. Vaccaro ◽  
John A. Carrino ◽  
Benjamin H. Venger ◽  
Todd Albert ◽  
Peter M. Kelleher ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Reaction ◽  
Content Type ◽  
Single Level ◽  
Soft Tissue Reaction ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. Anterior cervical discectomy and fusion (ACDF) is a widely accepted treatment for anterior degenerative or traumatic instability of the cervical spine. To reduce or eliminate complications such as implant migration and failure, imaging degradation, and fusion stress shielding that are occasionally associated with spinal instrumentation, attention has been given to the use of bioresorbable anterior cervical plate (ACP) devices. This paper is a preliminary report of a retrospective series in which a resorbable mesh and screw system was used for graft containment in single-level ACDF. Methods. A review of patient charts and imaging studies was conducted to determine functional outcome, fusion success, and potential soft-tissue reaction to implant resorption. Nine patients with a cervical degenerative disc disease or traumatic disc disruption were treated between October 2001 and March 2002. Follow up averaged 206 days. Eight patients were found to have an excellent result, one patient had a good result, and no patients had a satisfactory or poor result. At the time of follow-up examination, 77% of patients were found to have a radiographically solid fusion. The two patients without a solid fusion were examined only an average 8 months postoperatively and manifested no symptoms related to fusion nonhealing. No significant soft-tissue reaction was noted clinically or radiographically in any of the patients. Conclusions. The results of this preliminary study indicate that bioresorbable ACP systems for single-level ACDF are both safe and effective.

Failure of a titanium anterior cervical plate implant: microstructural analysis of failure

1995 ◽  
Vol 83 (4) ◽  
pp. 741-743 ◽  
Author(s):  
Nevan G. Baldwin ◽  
Gregg P. Hartman ◽  
Martin W. Weiser ◽  
Edward C. Benzel
Keyword(s):  
Electron Microscopy ◽  
Cervical Spine ◽  
Microstructural Analysis ◽  
Content Type ◽  
Screw Hole ◽  
Plate Fracture ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

✓ The authors present the case of a failed titanium anterior cervical spine plate. The plate was contoured during implantation. Analysis of the failed implant with electron microscopy showed no metallurgical flaw to have caused the plate fracture. A crack was apparently initiated with the contouring of the plate. It was located at the weakest point in the plate (the position of the intermediate screw hole), and with subsequent stress, it propagated and led to fracture. Techniques for avoiding failure of this type are discussed.

Clinical experience with a new load-sharing anterior cervical plate

2002 ◽  
Vol 1247 ◽  
pp. 563-579 ◽  
Author(s):  
Ronald I Apfelbaum ◽  
Andrew T Dailey ◽  
Scott Soleau ◽  
Jose Barbera
Keyword(s):  
Clinical Experience ◽  
Load Sharing ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Tethered cord syndrome in children with anorectal malformations

2000 ◽  
Vol 92 (4) ◽  
pp. 626-630 ◽  
Author(s):  
Natarajan Muthukumar ◽  
Bhuvaneswari Subramaniam ◽  
Thangaraj Gnanaseelan ◽  
Ramesh Rathinam ◽  
Appaswamy Thiruthavadoss
Keyword(s):  
Tethered Cord ◽  
Anorectal Malformations ◽  
Neurological Deficits ◽  
Radiographic Evidence ◽  
Content Type ◽  
X Ray ◽  
Neurological Improvement ◽  
Intraspinal Anomalies ◽  
Bone Abnormalities ◽  
Fine Print

Object. Anorectal malformations are known to be associated with neurological deficits, which may contribute to the disability suffered by patients with these malformations. This study was undertaken to determine the incidence and pattern of sacral abnormalities in children with anorectal malformations, the incidence and nature of the neurological deficits, and the incidence and nature of operable intraspinal abnormalities in patients with this condition.Methods. Neurological evaluation was performed in 81 children with anorectal malformations. Plain x-ray films were obtained to identify the presence of sacral abnormalities. The patients with neurological deficits were evaluated for the presence of operable intraspinal anomalies, and when such anomalies were identified, correction of the same was undertaken. In 21% of these children radiographic evidence of sacral abnormalities was shown. Fifteen percent of patients harbored neurological deficits, and 10% harbored operable intraspinal anomalies. In addition, one patient had split notochord syndrome. Patients with operable intraspinal anomalies underwent surgical correction, with resultant neurological improvement.Conclusions. Bone abnormalities of the sacrum, neurological deficits, and operable intraspinal lesions are not uncommon in children with anorectal malformations. Because the neurological deficits can contribute to the disability suffered by these individuals, we recommend routine screening of patients with anorectal malformations and neurological deficits and/or sacral abnormalities for the early identification and treatment of potentially correctable intraspinal lesions.

Transcerebellomedullary fissure approach with special reference to the methods of dissecting the fissure

2001 ◽  
Vol 94 (2) ◽  
pp. 257-264 ◽  
Author(s):  
Toshio Matsushima ◽  
Tooru Inoue ◽  
Takanori Inamura ◽  
Yoshihiro Natori ◽  
Kiyonobu Ikezaki ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Posterior Margin ◽  
Lateral Wall ◽  
Microsurgical Anatomy ◽  
Optimal Method ◽  
Content Type ◽  
Lateral Recess ◽  
Tela Choroidea ◽  
Opening Method ◽  
Fine Print

Object. The purpose of the present study was to refine the transcerebellomedullary fissure approach to the fourth ventricle and to clarify the optimal method of dissecting the fissure to obtain an appropriate operative view without splitting the inferior vermis. Methods. The authors studied the microsurgical anatomy by using formalin-fixed specimens to determine the most appropriate method of dissecting the cerebellomedullary fissure. While dissecting the spaces around the tonsils and making incisions in the ventricle roof, the procedures used to expose each ventricle wall were studied. Based on their findings, the authors adopted the best approach for use in 19 cases of fourth ventricle tumor. The fissure was further separated into two slit spaces on each side: namely the uvulotonsillar and medullotonsillar spaces. The floor of the fissure was composed of the tela choroidea, inferior medullary velum, and lateral recess, which form the ventricle roof. In this approach, the authors first dissected the spaces around the tonsils and then incised the taenia with or without the posterior margin of the lateral recess. These precise dissections allowed for easy retraction of the tonsil(s) and uvula and provided a sufficient view of the ventricle wall such that the deep aqueductal region and the lateral region around the lateral recess could be seen without splitting the vermis. The dissecting method could be divided into three different types, including extensive (aqueduct), lateral wall, and lateral recess, depending on the location of the ventricle wall and the extent of surgical exposure required. Conclusions. When the fissure is appropriately and completely opened, the approach provides a sufficient operative view without splitting the vermis. Two key principles of this opening method are sufficient dissection of the spaces around the tonsil(s) and an incision of the appropriate portions of the ventricle roof. The taenia(e) with or without the posterior margin of the lateral recess(es) should be incised.

Pachymeningitis cervicalis hypertrophica

1987 ◽  
Vol 66 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Jeffrey V. Rosenfeld ◽  
Andrew H. Kaye ◽  
Stephen Davis ◽  
Michael Gonzales
Keyword(s):  
Cervical Radiculopathy ◽  
Decompressive Surgery ◽  
Content Type ◽  
Neurological Improvement ◽  
Fine Print

✓ The authors present the case of a 25-year-old man with idiopathic pachymeningitis hypertrophica that caused cervical radiculopathy. Decompressive surgery produced significant neurological improvement. The etiology and management of the condition are discussed and the literature is reviewed.

Surgical treatment of syringomyelia

1984 ◽  
Vol 61 (3) ◽  
pp. 531-538 ◽  
Author(s):  
Nicholas M. Barbaro ◽  
Charles B. Wilson ◽  
Philip H. Gutin ◽  
Michael S. B. Edwards
Keyword(s):  
Operative Therapy ◽  
Diagnostic Procedures ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Sensory Loss ◽  
Content Type ◽  
Neurological Improvement ◽  
Leg Stiffness ◽  
Fine Print

✓ The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1½ to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%. The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.

scholarly journals The Cervical Spine Study Group anterior cervical plate nomenclature

2002 ◽  
Vol 12 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Regis W. Haid ◽  
Kevin T. Foley ◽  
Gerald E. Rodts ◽  
Bryan Barnes
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Study Group ◽  
Review Of The Literature ◽  
New Classification ◽  
Plate Interface ◽  
Translational Movement ◽  
Laboratory Investigations ◽  
Cervical Plate ◽  
Anterior Cervical Plate

The authors review historical and biomechanical aspects of anterior cervical plate (ACP) systems. They propose a novel classification system for ACPs based on the biomechanical and graft-loading properties of these systems. A retrospective review of the literature comprising both clinical and laboratory investigations regarding the ACP system was undertaken. Comparison of each system is considered in the context of the biomechanical attributes and graft-loading properties of each type of plate. Salient characteristics reviewed include restriction of screw backout, screw-angle variability, and mobility at the screw–plate interface. A new classification system for ACPs is proposed that primarily considers the ability of the construct to restrict screw backout, as well as the properties of the plate–screw interface—that is, the capacity for rotational or translational movement. A new classification system is presented that provides unified, biomechanically descriptive nomenclature. Using this nomenclature, the ACP devices currently available and those developed in the future can be uniformly categorized.

Stereotactic craniotomy in the resection of small arteriovenous malformations

1991 ◽  
Vol 75 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Michael B. Sisti ◽  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
Complete Removal ◽  
Neurological Deficits ◽  
Content Type ◽  
Neurological Improvement ◽  
Stereotactic Frame ◽  
Microsurgical Resection ◽  
The Brain ◽  
Radiological Studies ◽  
Fine Print

✓ Surgical resection of 10 obscure arteriovenous malformations (AVM's) was accomplished with craniotomy guided by computerized tomography (CT) or angiography and the use of the Brown-Roberts-Wells stereotactic frame. Stereotactic craniotomy was invaluable for resection of the following types of AVM's: 1) AVM's with a nidus less than 2 cm in diameter, 2) AVM's located in an eloquent area of the brain, and 3) AVM's located deep in the brain. Stereotactic localization of these AVM's on preoperative radiological studies provides a precise route to the nidus, often avoiding important areas of the brain. This series included six male and four female patients with a mean age of 32 years. All patients presented with an intracerebral hemorrhage, from which eight made a complete neurological recovery prior to surgery. Two AVM's were located on the cortex, three were found subcortically, and five were situated near the ventricles or in the deep white matter. As a guide, angiography was used in six cases and CT in four cases. In each instance, the study providing the best image of the AVM nidus was employed. Postoperatively, no neurological deficits were found in eight patients and, in the two patients with preoperative deficits, neurological improvement was observed after recovery from surgery. Postoperative studies revealed complete removal of the AVM in all patients, and all lesions were confirmed histologically. The authors conclude that stereotactic craniotomy provides the optimum operative approach for the localization and microsurgical resection of AVM's that are either obscure or located deep in the brain.

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