scholarly journals A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine

2017 ◽  
Vol 11 (6) ◽  
pp. 935-942
Author(s):  
Osamu Kawano ◽  
Takeshi Maeda ◽  
Eiji Mori ◽  
Itaru Yugue ◽  
Takayoshi Ueta ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Surgical Procedure ◽  
Neurological Complications ◽  
Subaxial Cervical Spine ◽  
Anterior Discectomy ◽  
Stage 1 ◽  
Posterior Anterior ◽  
Anterior Posterior ◽  
Selection Of

<sec><title>Study Design</title><p>Retrospective review.</p></sec><sec><title>Purpose</title><p>To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine.</p></sec><sec><title>Overview of Literature</title><p>Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted.</p></sec><sec><title>Methods</title><p>To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries.</p></sec><sec><title>Results</title><p>No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder.</p></sec><sec><title>Conclusions</title><p>The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.</p></sec>

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.

scholarly journals Do experienced physiotherapists apply equal magnitude of force during a grade I central pa on the cervical spine?

2004 ◽  
Vol 60 (4) ◽  
Author(s):  
M. Conradie ◽  
E. Smit ◽  
M. Louw ◽  
M. Prinsloo ◽  
L. Loubser ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Disorders ◽  
Joint Mobilization ◽  
Treatment Techniques ◽  
Average Maximum ◽  
Manual Examination ◽  
The Mean ◽  
The Difference ◽  
Posterior Anterior ◽  
Selection Of

Background and purpose: Physiotherapists frequently use central posterior-anterior (PA) joint mobilization techniques for assessing and managing spinal disorders. Manual examination findings provide the basis for the selection of treatment techniques. From the literature it is evident that the level of reliability varies when physiotherapists perform different mobilization techniques. Repeatability of mobilization techniques is important for better physiotherapy management. The aim of the study was to determine whether experienced physiotherapists apply equal magnitude of force during a grade I central PA mobilisation technique on the cervical spine. Another aim was to determine the variation in the magnitude of forceapplied by each individual physiotherapist. Subjects: Sample of convenience, consisting of sixteen (n=16) selected qualified physiotherapists with experience inOrthopaedic Manual Therapy.Methods: A grade I central PA was performed on the Flexiforce TM sensors positioned on C6 of the same asymptomatic model to measure the applied magnitude of force. Two separate measurements, each lasting 30-seconds, were obtained.Results: The average maximum peak force applied by the majority of physiotherapists (87.5%) was between 10.95gand 72g. The difference in the forces applied for the two measurements ranged between 0.64g and 24.4g. The BlandAltman scatterplot determined the mean of the difference between measurement one and two, calculated for the group, was zero. When comparing the two measurements, little variation was noted in the forces applied, as well as the coefficient of variation for each physiotherapist.Conclusion and Discussion: Current results demonstrated good intra-therapist and moderate to good inter-therapist repeatability. Further research is required to generalize results.

scholarly journals Surgical treatment for irreducible pediatric subaxial cervical unilateral facet dislocation: case report

2016 ◽  
Vol 17 (5) ◽  
pp. 607-611 ◽  
Author(s):  
Wei Qu ◽  
Dingjun Hao ◽  
Qining Wu ◽  
Zongrang Song ◽  
Jijun Liu
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Complete Resolution ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Facet Dislocation ◽  
Unilateral Approach ◽  
Subaxial Cervical Spine

Unilateral facet dislocation at the subaxial cervical spine (C3–7) in children younger than 8 years of age is rare. The authors describe a surgical approach for irreducible subaxial cervical unilateral facet dislocation (SCUFD) at C3–4 in a 5-year-old boy and present a literature review. A dorsal unilateral approach was applied, and a biodegradable plate was used for postreduction fixation without fusion after failed conservative treatment. There was complete resolution of symptoms and restored cervical stability. Two years after surgery, the patient had recovered range of motion in C3–4. In selected cases of cervical spine injury in young children, a biodegradable plate can maintain reduction until healing occurs, obviate the need to remove an implant, and recover the motion of the injured segment.

Postoperative Outcomes of Subaxial Cervical Spine Metastasis: Comparison Among The Anterior, Posterior, and Combined Approaches

2021 ◽  
Author(s):  
Panya Luksanapruksa ◽  
Borriwat Santipas ◽  
Panupol Rajinda ◽  
Theera Chueaboonchai ◽  
Korpphong Chituaarikul ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Survival Time ◽  
Perioperative Complications ◽  
Postoperative Outcomes ◽  
Neurological Recovery ◽  
Surgical Approaches ◽  
Spine Metastasis ◽  
Combined Approach ◽  
Subaxial Cervical Spine ◽  
Anterior Posterior

Abstract Background: Incidence of subaxial spinal metastases is increasing due to longer life expectancy resulting from successful modern treatments of cancer. The three most utilized approaches for surgical treatment include the anterior, posterior, and combined approach. However, despite increasing surgical volume, data on the postoperative complication profiles of different operative approaches for this patient population is scarce.Methods: The institutional databases of two large referral centers in Thailand were retrospectively reviewed. Patients with subaxial cervical spine metastasis who underwent cervical surgery during 2005 to 2015 were identified and enrolled. Clinical presentations, baseline characteristics, operative approach, perioperative complications, and postoperative outcomes, including pain, neurological recovery, and survival, were compared among the three surgical approaches.Results: This study included 70 patients (44 anterior approach, 14 posterior approach, 12 combined approach). There were no statistically significant differences in preoperative characteristics, including Charlson Comorbidity Index(CCI), Tomita score, and revised Tokuhashi score, among the three groups. There were also no significant differences among groups for medical complications, surgical complications, neurological recovery, verbal pain score improvement, survival time, or ambulatory status improvement. However, the combined approach did show a significantly higher rate of overall perioperative complications (p=0.01), intraoperative blood loss, (p<0.001), and operative time (p<0.001) compared to the other two approaches. Conclusions: The results of this study do not reveal any clear superiority among the three main surgical approaches used to treat subaxial cervical spine metastasis. Patients in the combined approach group had the highest rates of perioperative complications. However, although the differences were not statistically significant, patients in the combined group tended to have better clinical outcomes after follow-up, and the longest survival time.

A Novel and Reproducible Classification of the Vertebral Artery in the Subaxial Cervical Spine

2019 ◽  
Vol 18 (6) ◽  
pp. 676-683
Author(s):  
Fabian Winter ◽  
Ichiro Okano ◽  
Stephan N Salzmann ◽  
Colleen Rentenberger ◽  
Jennifer Shue ◽  
...  
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
High Risk ◽  
Vertebral Artery ◽  
Intrarater Reliability ◽  
Cross Sectional ◽  
Cervical Spine Surgery ◽  
Subaxial Cervical Spine ◽  
Anterior Posterior

Abstract BACKGROUND An injury of the vertebral artery (VA) is one of the most catastrophic complications in the setting of cervical spine surgery. Anatomic variations of the VA can increase the risk of iatrogenic lacerations. OBJECTIVE To propose a novel and reproducible classification system that describes the position of the VA based on a 2-dimensional map on computed tomography angiographs (CTA). METHODS This cross-sectional retrospective study reviewed 248 consecutive CTAs of the cervical spine at a single academic institution between 2007 and 2018. The classification consists of a number that characterizes the location of the VA from the medio-lateral (ML) aspect of the vertebral body. In addition, a letter describes the VA location from the anterior-posterior (AP) aspect. The reliability and reproducibility were assessed by 2 independent raters on 200 VAs. RESULTS The inter- and intrarater reliability values showed the classification's reproducibility. The inter-rater reliability weighted κ-value for the ML aspect was 0.93 (95% CI: 0.93-0.93). The unweighted κ-value was 0.93 (95% CI: 0.86-1.00) for “at-risk” positions (ML grade ≥1), and 0.87 (95% CI: 0.75-1.00) for “high-risk” positions (ML grade ≥2). The weighted κ-value for the intrarater reliability was 0.94 (95% CI: 0.95-0.95). The unweighted κ-values for the intrarater reliability were 0.95 (95% CI: 0.91-0.99) for “at-risk” positions, and 0.87 (95% CI: 0.78-0.96) for “high-risk” positions. CONCLUSION The proposed classification is reliable, reproducible, and independent of individual anatomic size variations. The use of this novel grading system could improve the understanding and interdisciplinary communication about VA anomalies.

scholarly journals Burst Fracture of C5 with Traumatic Anterior Spondyloptosis of C6 and Posterior Spondylolisthesis of C4 Vertebra: A Case Report

2021 ◽  
Vol 59 (236) ◽  
Author(s):  
Poojan Kumar Rokaya ◽  
Nilam Kumar Khadka ◽  
Praveen Kumar Giri ◽  
Robin Khapung ◽  
Nirajan Mahaseth
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Burst Fracture ◽  
Preoperative Assessment ◽  
High Energy ◽  
Spine Injury ◽  
Subaxial Cervical Spine ◽  
Injury Treatment ◽  
Posterior Instrumented Fusion ◽  
Anterior Posterior

Burst fracture of C5 with traumatic anterior spondyloptosis of C6 and posterior spondylolisthesis of C4 vertebra is an exceedingly rare high energy injury. Treatment includes decompression, reduction, stabilization, and fusion via anterior or posterior or combined anterior-posterior approach with or without prior traction. We report this rare subaxial cervical spine injury associated with quadriplegia managed with combined anterior and posterior instrumented fusion. A multidisciplinary approach with preoperative assessment and planning is crucial in managing cervical spine injury. Immediate postoperative critical care support, rehabilitation, and dedicated nursing care are required for a favorable outcome in traumatic quadriplegia.

scholarly journals Occult Disco-Ligamentous Lesions of the Subaxial c-Spine—A Comparison of Preoperative Imaging Findings and Intraoperative Site Inspection

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 447
Author(s):  
Insa Janssen ◽  
Nico Sollmann ◽  
Melanie Barz ◽  
Thomas Baum ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Vertebral Fractures ◽  
Cervical Spondylosis ◽  
Diagnostic Yield ◽  
Preoperative Imaging ◽  
Imaging Findings ◽  
General Acceptance ◽  
Subaxial Cervical Spine ◽  
Cervical Surgery

Despite the general acceptance of magnetic resonance imaging (MRI) as the gold standard for diagnostics of traumatic disco-ligamentous injuries in the subaxial cervical spine, clinical experience shows cases where no lesion is detected in MRI exams but obtained during surgery. The aim of this study was to compare intraoperative site inspection to preoperative imaging findings and to identify radiological features of patients having a risk for under- or over-estimating disco-ligamentous lesions. We performed a retrospective analysis of our clinical database, considering all patients who underwent surgical treatment of the cervical spine via an anterior approach after trauma between June 2008 and April 2018. Only patients with availability of immediate preoperative computed tomography (CT), 3-Tesla MRI scans, and information about intraoperative findings were considered. Results of preoperative imaging were set in context to intraoperative findings, and receiver operator characteristics (ROC) were calculated. Out of 144 patients receiving anterior cervical surgery after trauma, 83 patients (mean age: 59.4 ± 20.5 years, age range: 12–94 years, 63.9% males) were included in this study. Included patients underwent surgical treatment via anterior cervical discectomy and fusion (ACDF; 79 patients) or anterior cervical corpectomy and fusion (4 patients) with ventral plating. Comparing preoperative imaging findings to intraoperative site inspection, a discrepancy between imaging and surgical findings was revealed in 14 patients, leading to an overall specificity/sensitivity of preoperative imaging to identify disco-ligamentous lesions of the cervical spine of 100%/77.4%. Yet, adding the existence of prevertebral hematoma and/or vertebral fractures according to preoperative imaging improved the sensitivity to 95.2%. Lack of sensitivity was most likely related to severe cervical spondylosis, rendering correct radiological reporting difficult. Thus, the risk of missing a traumatic disco-ligamentous injury of the cervical spine in imaging seems to be a particular threat in patients with preexisting degenerative cervical spondylosis. In conclusion, incorporating the existence of prevertebral hematoma and/or vertebral fractures can significantly improve diagnostic yield.

scholarly journals Comparative effectiveness of surgical versus nonoperative management of unilateral, nondisplaced, subaxial cervical spine facet fractures without evidence of spinal cord injury

2014 ◽  
Vol 20 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Bizhan Aarabi ◽  
Stuart Mirvis ◽  
Kathirkamanthan Shanmuganathan ◽  
Alexander R. Vaccaro ◽  
Cassandra J. Holmes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Nonoperative Management ◽  
Fracture Plane ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Cord Injury ◽  
The Mean ◽  
Stage 1

Object Facet joints are major stabilizers of cervical motion allowing for effortless and pain-free multidimensional cervical spine movements without significant linear or rotational translation, thus minimizing any chance for spinal cord or nerve root impingement. Unilateral, nondisplaced subaxial facet fractures do not meet the conventional criteria for spinal instability under physiological loads. Limited evidence indicates that even with no or minimal displacement, 20%–80% of these fractures fail nonoperative management. The risk factors for instability in isolated nondisplaced subaxial facet fractures remain uncertain. In this retrospective study of prospectively collected data, the authors attempted to identify the predictors of failure in the management of isolated, nondisplaced subaxial facet fractures admitted to their Level I trauma center over a 10-year period. Methods Demographic, clinical, imaging, and follow-up data for 25 patients with unilateral nondisplaced subaxial facet fractures who were managed surgically (n = 10) or nonoperatively (n = 15) were statistically analyzed. Results The mean age of the patients was 38 years, 19 were male, and 21 of the fractures were the result of either motor vehicle accidents or falls. The mean motor score on the American Spinal Injury Association scale was 99.2, and the mean Subaxial Injury Classification (SLIC) severity score was 3 (operated 3.5, nonoperated 2.3). Allen mechanistic classification included 22 compressive-extension Stage 1 and 2 distractive-extension Stage 1 fractures. Subaxial facet fractures involved C-7 in 17 patients (68%), C-6 in 7 (28%), and C-3 in 1 (4%). The anatomical plane of fracture through the lateral mass was sagittal in 12 patients, axial in 8, and coronal in 3 patients. Nondisplaced floating lateral mass injuries were noted in 2 patients. The mean instability score, considering 7 components of the discoligamentous complex on MRI, was 3.2 (operated 3.6, nonoperated 3.0). Ten (40%) of 25 patients in this investigation did not have successful management, 9 in the nonoperated and 1 in the operated group (p = 0.018). Unsuccessful management was significantly greater in younger patients (p = 0.0008), possibly indicating selection bias (p = 0.07, Wilcoxon ranksum test). Fracture plane, instability, and SLIC scores did not play a significant role in treatment failure in this study. Conclusions In this study, surgery was superior to nonoperative management of isolated, nondisplaced, or minimally displaced subaxial cervical spine facet fractures.

Sign in / Sign up

Export Citation Format

Share Document