A Modified Prone Position Using A Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Surgeries

Background A modified prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests. Methods Forty-seven patients undergoing posterior cervical spine surgery for cervical spine fracture were retrospectively classified into two groups, BSPST group (n = 24) and traditional group (n = 23) and underwent posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position. Results All the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group, with no significant difference. Intraoperative blood loss and total incidence of complications were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided greater comfort level for the operators and allowed convenient intraoperative radiography. Conclusions This is the first study to describe a combined body-shape plaster bed and skull traction as a modified cervical spine prone surgical position that is simple, safe and stable, adjustable during surgery, reproducible and economical for posterior cervical spine fracture surgery and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides surgeons a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.

Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation

Background: Atlantoaxial subluxation (AAS) is a not rare abnormality between the atlas (C1) and axis (C2). For AAS patients with persistent neck pain and neurologic symptoms, surgical intervention is a good choice. Nevertheless, there were still few reports about the use of intraoperative skull traction and different fixation methods in treatment of AAS.Methods: From January 2012 to December 2018, a total of 86 cases were admitted to our hospital and diagnosed as AAS. All the patients received atlantoaxial reduction with the help of intraoperative skull traction and C1-C2 fixation. Clinical and radiological parameters were collected through chart review.Results: There were 86 cases included in this study. The mean operative time was 153.9 ± 73.9 min, and the mean amount of intraoperative blood loss was 219.1 ± 195.6ml. 81 patients underwent posterior reduction, internal fixation and fusion. 5 patients underwent anterior release, followed by posterior internal fixation and fusion. All the patients got satisfactory postoperative outcomes. Significant neurologic improvement was observed in these patients. Bone fusion was achieved on the midline sagittal reconstructed CT images at the latest follow-up in all these patients except 1 case. All the patients were followed up for 34.84 ± 15.86 months at average (range 12-60 months). The mean ADI value was 7.55±1.67 mm at average preoperatively, and improved to 4.03±1.21 mm postoperatively, and to 4.21±0.99 mm at the latest follow-up. The mean A-A angle was 15.48±9.82 degrees at average preoperatively, and improved to 21.61±10.43 degrees postoperatively, and to 19.73±8.13 degrees at the latest follow-up. The mean A-A height was 35.61±7.66 mm at average preoperatively, and improved to 40.08±8.5 mm postoperatively, and to 38.83±6.97 mm at the latest follow-up. There were complications in 4 patients, including pedicle misplacement, pedicle fracture, infection and one death.Conclusion: Intraoperative skull traction can effectively facilitate the surgical procedures for ASS caused by different etiologies. Further research are needed to investigate the safety and effectiveness of this method.

Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation. Methods: Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4–C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D. Results: Surgical management was through posterior–anterior–posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs. Conclusion: A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Case Report of a Traumatic Atlantoaxial Rotatory Subluxation with Bilateral Locked Cervical Facets: Management, Treatment, and Outcome

The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Management consisted of analgesia, sedation, and application of a halo skull traction device. After removing halo skull traction, full reduction and recovery were achieved without instability.