Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review
|
|
- Chrystal Watkins
- 5 years ago
- Views:
Transcription
1 J Neurosurg 78: , 1993 Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review E. FRANCOIS ALDRICH, M.D., M.MEo., F.C.S., PE'rER B. WEnER, M.D., AND WAYNE N. CROW, M.D. Division of Neurosurgery and Department of Radiology, University of Texas Medical Branch, Galveston, Texas u- Fifty consecutive patients requiring posterior cervical fusion for various pathologies were treated with Halifax interlaminar clamps for internal spinal fixation. Fusion involved the CI-2 level in 17 cases, the C1-3 level in one, and the lower cervical area (C2-7) in 32. No patient was lost to follow-up review, which varied from 6 to 40 months (average 21 months). Fusion failed in five patients, three at the C1-2 level, one at the C1-3 level, and one at the C2-3 level. Screw loosening was the cause of failure in four patients, and in one the arch of C-I fractured. No other complications occurred. Because of the lack of complications, avoidance of the hazards of sublaminar instrumentation, and an excellent fusion rate, this technique is highly recommended for posterior cervical fusion in the lower cervical spine. Atlantoaxial arthrodesis was achieved in only 14 (82%) of 17 patients, however, which might be due to the higher mobility at this multiaxial level. Improved results in this region may be possible by using a new modified interlaminar clamp, by performing adequate bone fusions, and by postoperative external halo immobilization in high-risk patients. K~v WORDS ~ clamp 9 spinal fusion 9 cervical spine stabilization T HE Halifax interlaminar clamp system has become widely accepted instrumentation for posterior cervical fusion because of its ease of use, safety, magnetic resonance (MR) imaging compatibility, and especially because it avoids the hazards of sublaminar wire placement. In our previous experience with 21 patients undergoing posterior cervical fusion with Halifax interlaminar clamps, ~ we reported no complications or mechanical failures occurring after follow-up periods ranging from 1 to 18 months (average 9.2 months). However, with increasing experience and longer follow-up monitoring, it has become clear that the Halifax clamp has an inherent potential for screw loosening in the atlantoaxial region, and the results are therefore not as successful as in the lower cervical area. This report describes our surgical results in 50 consecutively managed patients (including the 21 previously reported cases) treated with Halifax interlaminar clamps for posterior internal fixation in combination with autogenous iliac bone grafting for posterior cervical spine stabilization. Clinical Material and Methods Patient Population This series included 50 consecutively treated patients undergoing posterior cervical spine stabilization proce- dures at the Neurosurgery Service of the University of Texas Medical Branch. This series covers all patients operated on for posterior cervical spine stabilization at this institution between December, 1989, and March, The causes and levels of instability are summarized in Table 1. Presenting symptoms and signs were typical for acute cervical spine disease, and included neck pain, radiculopathy, myelopathy, quadriparesis, quadriplegia, occipital neuralgia, Lhermitte's sign, and Brown-Srquard syndrome. Radiographic evidence of posterior instability was demonstrated preoperatively in all cases but one, in which instability followed bilevel facetectomies in a previously failed anterior cervical fusion. These studies included plain cervical spine x-ray films, cervical spine tomography, myelography with computerized tomography (CT) in flexion and extension, flexion-extension digital video fluoroscopy, and MR imaging. Surgical Technique Awake fiberoptic intubation and general anesthesia were used in all cases. Unless previously immobilized in a halo vest, all patients were placed in skeletal cervical traction using Gardner-Wells tongs. Lateral cervical spine x-ray or video fluoroscopy imaging was obtained throughout the procedure to assure adequate reduction and cervical alignment. A posterior midline approach 702 J. Neurosurg. / Volume 78/May, 1993
2 Long-term review of cervical fusion by Halifax clamp TABLE 1 Summary of procedures in 50 patients with posterior cervical spine fi~sion Level of Instability & Etiology No. of Cases CI-2 arthrodesis 17 trauma 10 rheumatoid arthritis 2 Down's syndrome 3 os odontoideum 1 infection 1 C1-3 arthrodesis 1 rheumatoid arthritis 1 C2-7 arthrodesis 32 trauma 30 tumor 1 degeneration 1 was used to gain access to the posterior elements of the unstable and adjacent levels. In the lower cervical area, the upper border of the superior lamina and the lower border of the inferior lamina were freed of ligamentum flavum attachments medially, and small rongeurs and curettes were used to prepare the clamp site to allow adequate clamp positioning. The laminae, spinous processes, and posterior surface of the facets in the region of the fusion were denuded of periosteum, and high-speed drills and curettes were used to roughen the bone until it bled freely. Bilateral clamps were placed in all cases except when the posterior ring was fractured unilaterally. Clamps designed for the lower cervical area were selected, with the correct screw length. It is of the utmost importance to tighten these screws adequately, alternating the tightening between the two clamps, until rigid internal fixation is obtained. Cancellous bone chips harvested from the iliac crest were wedged between the spinous processes and the clamp (below the free edge of the clamp) and placed bilaterally over the prepared fusion sites. Particular consideration was given in cases of atlantoaxial arthrodesis, where specially designed rounded clamps were used to hook around the arch of C-I and the lamina of C-2. Bilateral clamps were used and care was taken to achieve satisfactory positioning, avoiding rotation of the clamps (Fig. 1). During the first onethird of the series, only an onlay lateral bone graft was used, but in the latter part of the series a triangularshaped bone graft was wedged between the arch of C- 1 and the lamina of C-2 below the clamp before the screws were tightened, in addition to a lateral and interspinous onlay bone graft. The correct clamps and screws must be selected to achieve rigid internal fixation. All patients routinely wore a Philadelphia collar for 6 weeks after surgery. A perioperative antibiotic agent (nafcillin or vancomycin) was given: one dose preoperatively, then for 3 days postoperatively. Follow- Up Review No patients were lost to follow-up review. The followup period varied from 6 to 40 months, with an average of 21 months. All patients were followed clinically, and FIG. 1. Lateral cervical spine x-ray film obtained 6 months postoperatively in a 49-year-old patient with traumatic ligamentous instability at C1-2. Bilateral Halifax interlaminar clamps are shown in good position with solid bone fusion between the arch of C-1 and the laminae and spinous process of C-2. routine radiographs were obtained postoperatively at 6 weeks and at intervals thereafter to evaluate vertebral bone element alignment, clamp position, restoration of angulation, and the quality of the bone fusion. Flexionextension studies were obtained in all patients at 6 weeks. In cases where it was difficult or impossible to evaluate the integrity and quality of the bone fusion, additional studies were performed. These included conventional polytomography and axial CT in 15 cases. Magnetic resonance imaging was obtained in 12 cases at variable follow-up periods for evaluation of the spinal cord and adjacent structures, including the neural canal and intervertebral foramina. Results Intraoperative Course Clamps were placed bilaterally in 47 of the 50 patients. Two patients had unilateral laminar fractures, and a clamp was placed contralateral to these fractures. In the remaining patient a unilateral clamp was placed following hemifacetectomies for lateral cervical spine stenosis due to a failed anterior cervical fusion at the same level. Fusions were performed at the C 1-2 level in 17 cases, at the C1-3 level in one, between C-2 and C-7 at a single level in 28 cases, and between C-2 and C-7 at two levels in four cases. Iliac bone grafting was performed on all patients except one, where an anterior cervical fusion had previously been attempted. Rigid internal stabilization was achieved at the time of operation in all cases. This was demonstrated intraoperatively by axial rotation, with flexion-extension force applied by a Kocher clamp. Total reduction with realignment of the vertebral bone elements was achieved in all 32 cases of lower cervical spine fusion (C2-7) regardless of the amount of preoperative subluxation J. Neurosurg. / Volume 78/May,
3 E. F. Aldrich, P. B. Weber, and W. N. Crow FIG. 2. Lateral cervical spine x-ray film obtained at routine 6-week postoperative evaluation in a 55-year-old woman with rheumatoid arthritis. An asymptomatic C1-2 subluxation was identified with screw loosening and dislocation of one clamp. Anterior sabluxation of C-I with respect to C-2 is present, indicating instability without any evidence of bone fusion. or whether reduction was achieved by traction. In cases of perched or locked facets that did not realign with skeletal traction, open reduction followed by bilateral Halifax interlaminar clamp placement restored alignment. Initial satisfactory intraoperative reduction of the atlanto-dens interval was achieved in all 17 patients undergoing atlantoaxial arthrodesis and in the one patient undergoing C1-3 fusion with bilateral Halifax interlaminar clamp placement. Surgical Failure Surgical failure occurred in five patients in this series. In these cases either the patient became symptomatic or routine diagnostic studies revealed instability at the previously fused level. Atlantoaxial fusion failed in three of 17 cases. Failure occurred in two patients with atlantoaxial instability associated with Down's syndrome. Screw loosening was identified in one of these patients, causing residual atlantoaxial instability, as seen on the routine 6-week follow-up radiographic studies. The second patient became symptomatic (myelopathic) 5 months following the original fusion, and studies revealed a C-1 arch fracture to be the cause of the fusion failure. In both cases alternative fusion methods were employed to achieve atlantoaxial stability. Asymptomatic screw loosening with movement on flexion-extension views was noted in a 68-year-old woman with rheumatoid arthritis at a routine 6-week follow-up evaluation (Fig. 2). At reoperation, the screws were retightened and additional bone grafting was performed. The patient ultimately obtained a solid bone fusion and is currently asymptomatic. One patient with a failed CI-2 wire fusion was referred to our facility for reoperation. At the time of FIG. 3. X-ray films showing preoperative anterior subluxation with angulation of C4-5 (A) and bilateral Halifax interlaminar clamps in position (B) in a 51-year-old man who sustained traumatic C4-5 instability following a motor-vehicle accident. Note the satisfactory realignment of the vertebral bone elements and the restoration of the neural canal to normal. surgery, it was found that the C-2 laminae were eroded and fractured, and clamp placement was not possible. A C1-3 fusion with bone grafting was attempted but failed because of screw loosening 3 weeks following the procedure. An alternative fusion method was used; the patient is currently asymptomatic and doing well. Screw loosening was seen and movement occurred on flexion-extension views in a patient with posterior ligamentous instability at the C2-3 level 4 weeks postoperatively, at which time the Lhermitte's sign reappeared. At reoperation, the screws were tightened again and additional bone grafting was carried out; the patient continued to a solid bone fusion and is currently asymptomatic. There were no clamp failures or other complications in patients with fusion at the C3-7 levels. No other complications have thus far been encountered in this series. Radiographic Results Postoperative vertebral bone element alignment was maintained in all patients with pathology of the lower cervical spine (C2-7) until solid bone fusion was demonstrated. No vertebral body slippage or angulation developed at the level of fusion in any patient, and the neural canal was restored to its original diameter in all cases (Fig. 3). Slippage was noted on routine follow-up x-ray films at 6 weeks in the woman with rheumatoid arthritis mentioned above, resulting in an additional 4- mm atlanto-dens interval malalignment. No movement occurred on flexion-extension studies, and the patient was neurologically intact. She subsequently achieved a solid bone fusion and remains asymptomatic. In addition to the previously mentioned surgical failures, routine follow-up studies of a patient with a type II dens fracture revealed screw loosening. The patient was asymptomatic, and conventional polytomography and CT revealed solid bone fusion with no signs of instability on flexion-extension views. In cases where routine x-ray films did not clearly 704 J. Neurosurg. / Volume 78/May, 1993
4 Long-term review of cervical fusion by Halifax clamp FIG. 4. Computerized tomography scans in a 39-year-old man who underwent posterior cervical fusion with Halifax interlaminar clamps and iliac bone grafting for a traumatic C5-6 anterior subluxation. Six months postoperatively, solid bone fusion of the iliac graft to the laminae of C-5 (A and B) and the laminae of C-6 (C and D) is demonstrated, indicating solid bone fusion across the fused level. show solid bone fusion, polytomography as well as CT was performed to evaluate the integrity and quality of the bone fusion. All 32 patients with fusion in the lower cervical area (C2-7) demonstrated adequate solid bone fusion (Fig. 4). Following atlantoaxial arthrodesis in two patients, solid bone fusion could not be demonstrated by either method, but no movement occurred on flexion-extension views. In both cases the iliac bone graft had fused to the laminae of C-2, but not to the ring of C-1 (Fig. 5). These two patients have been followed for 13 and 21 months postoperatively, and continue to be asymptomatic. Of the 17 atlantoaxial fusions, 12 were well aligned with solid bone fusion, one was malaligned with solid bone fusion, and two fibrous well-aligned unions occurred; two cases were ultimately fused by alternative techniques. Conventional polytomography and CT showed similar results with regard to evaluation of bone fusion quality and integrity. Discussion Posterior Lower Cervical Fusion Various alternatives are available for posterior cervical fusion, and most of these methods use stainless steel as the internal fixation agent, with or without lilac bone grafting, z6"2z3~ Cervical sublaminar wire fusion can lead to intraoperative and postoperative complications, 14 therefore alternative techniques such as intraspinous or interlaminar wire internal fixation have been developed. Although these techniques avoid sublaminar wire placement, they do not avoid the potential danger of wire fatigue and breakage, or pulling through the bone. Halifax interlaminar clamps provide immediate rigid internal fixation, ~5 avoid the hazards of sublaminar wire, and potentially lessen the chance of metal fatigue. FIG. 5. Computerized tomography scans in a patient following bilateral Halifax interlaminar clamp atlantoaxial arthrodesis with iliac bone grafting. A and B: Incomplete bone fusion of the iliac bone graft to the arch of C-1 is illustrated. C and D: Solid bone fusion of the iliac bone graft to the laminae of C-2 can be seen. Because of MR imaging compatibility, l internal clamp fixation allows noninvasive lifelong follow-up monitoring of the cervical neural elements. Our current results provide further support that interlaminar clamp internal fixation is a very effective way of dealing with posterior cervical instability in the lower cervical area. The ease of the technique, lack of complications, and excellent results lead us to conclude that this might be the method of choice for performing posterior lower cervical fusions. Despite these favorable results, a few unresolved issues persist. Some authors advocate using only a unilateral interlaminar clamp in cases of posterior cervical spine instability.~6'28 In our current series we performed unilateral clamp placement in only three cases, two because of unilateral laminar and facet fractures. All three patients achieved a solid bone fusion without complication, but no meaningful conclusions can be made from these few patients. In general, we believe that, if the trauma was sufficient to cause unilateral facet dislocation, it is likely that anterior and posterior ligamentous injury, disc damage, and possible damage to the contralateral facet occurred. We fail to see the advantage of applying only one clamp when bilateral clamp placement surely adds to the immediate stability. Multilevel clamping was performed in three cases in the lower cervical area where two levels were spanned with the clamps. All three patients continued to a solid bone fusion without complication. Although these patients did well, some caution is warranted for multilevel fusion and care must be taken that anterior displacement of the intermediate segment does not occur. It is especially important to avoid cases in which there is potential posterior ring disruption or pedicle fractures. If more than one level is clamped, it might be effective to use one clamp to span two levels and the contralateral clamp to span only one level. A larger series would be necessary to evaluate multilevel fusion with Halifax interlaminar clamps. The method selected for treatment of cervical spine J. Neurosurg. / Volume 78/May,
5 E. F. Aldrich, P. B. Weber, and W. N. Crow instability must counteract the forces that produced the instability to ensure optimum results. Most instances of instability treated by posterior cervical fusion result from flexion forces, and this flexion force should therefore be counteracted by the fixation device. The design of the Halifax clamp negates the flexion-extension forces seen in this area, and is therefore well suited for posterior cervical fusion. Because of the clamp design, great reduction forces can be applied by slowly alternating tightening of the screws, thus leading to reduction and realignment of the subluxed vertebral bone elements at the unstable level, thereby restoring the vertebral canal to normal. Atlantoaxial Arthrodesis The atlantoaxial joint is a multiaxial joint with great mobility, accounting for one-half of the cervical rotation; 29 it therefore differs greatly from the lower cervical spine, where flexion-extension provides most of the movement. The atlantoaxial region is further complicated by a variety of pathological processes affecting this level, and therefore upper cervical fusion results are less than perfect. A variety of surgical options have been described to attain atlantoaxial arthrodesis. Wire internal fixation combined with autogenous bone grafts is now the most frequently used treatment, ~.-,5 with the methods described by Gallie ~2 and Brooks and Jenkins s being the most common. Many variations of this technique have also been described ~8'2~ as well as alternative methods, including screw fixation and instrumentation with rods. 4A~ The frequency of osseous union associated with a Brooks or Gallie technique without external halo fixation varies from 60% to 85%. 3~ ~.24.ze In a recent report, Dickman, etal., 9 reported a 97% union rate in 36 patients undergoing atlantoaxial arthrodesis for a variety of causes using a modified wire placement and iliac graft technique. Chan, etal., 7 reported fusion in 10 (91%) of 11 rheumatoid arthritic patients treated with a Gallie technique. In these two series the patients were immobilized postoperatively in a halo vest for 3 months. Cybulski, etal., 8 reported no failures in their series of eight patients undergoing atlantoaxial arthrodesis with Halifax interlaminar clamps in combination with methyl methacrylate and iliac bone grafting. We previously reported our experience with eight cases in which no fusion failures or mechanical difficulties were encountered. ~ However, with more experience and a longer follow-up period, it has become evident that fusion failures do occur at this level, mostly because of screw loosening and in patients at risk for nonunion. In our current series we obtained a fusion rate of 82% (14 of 17 cases). It is well known that instability resulting from trauma yields better results than that caused by rheumatoid arthritis, congenital abnormalities, or tumors. This was also the case in our series, where all the traumatic C 1-2 instabilities fused, but fusion failed in two of the three patients with Down's syndrome and in the one patient with rheumatoid arthritis. In two of these three cases, screw loosening was the cause of the fusion failure. Seex and Johnston 27 reported their ex- perience with interlaminar clamps for posterior cervical fusion; failure occurred in two of their four C1-2 fusions and in one case of attempted CI-3 fusion. Our only C 1-3 fusion failed because of screw loosening, and we recommend that alternative fusion methods be utilized should a CI-3 fusion be necessary. Recently Moskovich and Crockard 2~ reported their experience with Halifax interlaminar clamps for atlantoaxial anhrodesis for various causes and obtained an 80% fusion rate (20 of 25 cases). Screw loosening occurring between 3 and 6 weeks postoperatively led to fusion failure in four of our 50 cases. It would therefore seem, at least in our series, that longer periods of postoperative immobilization would not have prevented this complication. The only other failure occurred 5 months postoperatively when the arch of C-1 fractured in a patient with Down's syndrome. We believe that a good fusion technique is a prerequisite. It is important to use the specially designed clamp with a rounded, deeper curvature to hook around the arch of C-1 and the lamina of C-2. Use of the flatter clamp designed for the lower cervical area should be avoided, as this will lead to clamp dislocation. The clamp site should be adequately prepared so that clamp rotation is avoided. The correct screw length should be used, and the technique can only be successful if rigid internal stabilization is achieved at the time of surgery. Any movement at the level of internal fixation might lead to potential loosening of the screw, and solid bone fusion may not occur. Despite following a rigid surgical technique, there is still an inherent potential for screw loosening; a new Halifax interlaminar clamp is currently available that is designed to lessen or prevent this complication. A major difference among series describing atlantoaxial arthrodesis is the wide variation in the type and regimens of postoperative immobilization. It has been shown that a halo vest is the most effective way of immobilizing the upper cervical spine ~7 and that collars and braces are inadequate to control rotation. In our patients as well as those in other published Halifax interlaminar clamp series, the only postoperative immobilization used was a soft cervical collar or a Philadelphia collar for 6 weeks. When halo external fixation was not used, the routine wire autogenous bone fusion techniques achieved fusion rates ranging from 60% to 85%, with an average below 80%. It seems at this stage that superior results (90% to 97%) can be obtained by wire fusion with autogenous bone grafting combined with external halo immobilization for 3 months. We believe that higher atlantoaxial fusion rates can be achieved in the future using the redesigned Halifax interlaminar clamp for the C1-2 area to prevent screw loosening, with meticulous attention to the bone fusion, and with external halo immobilization for a 3-month period in the nontraumatic group of patients at risk for nonunion. Bone Graft Originally, Tucker 28 advocated the use of interlaminar clamps without bone grafting and reported fusion 706 J. Neurosurg. / Volume 78 /May, 1993
6 Long-term review of cervical fusion by Halifax clamp across the facet joints in most patients. Holness, et al., j6 reported radiographically documented anterior and/or posterior bone fusion in all patients followed longer than 4 years when only interlaminar clamps were used. Although it is difficult to argue with these authors' excellent results in their large series, not using a bone graft with internal fixation in the cervical spine remains controversial. The internal fixation devices provide only temporary fixation and cannot be depended upon for long-term stability. The success of the fusion, therefore, ultimately depends on the quality of the bone fusion. For that reason, it is our policy to perform bilateral onlay iliac bone grafts in all patients with fusion in the lower cervical spine, as we believe that this greatly enhances the chance of a solid bone fusion occurring and therefore providing long-term stability. Using this technique, we achieved good-quality solid bone fusion across the unstable level in all cases. Because of the anatomical configuration of the posterior elements of C-I and C-2, particular attention should be paid to the bone graft in this area. Most bone fusion failures in our series occurred because of inadequate fusion of the bone graft to the posterior ring of C-1. Onlay bone grafts in this area have a tendency to form a pseudoarthrosis and therefore in the latter twothirds of our series we adopted a technique in which a triangular-shaped piece of bone was wedged between the clamp and the posterior elements of C-I and C-2. In addition to this bilateral triangular bone graft, onlay bone was grafted lateral as well as medial to the clamps. Adequate decortication of the posterior elements of C-1 and C-2 is mandatory before clamp and bone graft placement to ensure fusion. Bone grafts should not be placed between the arches of C-1 and C-2 before the screws are tightened, as slippage would leave a gap resulting in clamp loosening. Using this technique, we obtained an 82% rate of solid bone fusion (14 of 17 patients). In recent reports, stable osseous fusions were reported in 76% :3 and 83% 9 of cases where atlantoaxial fusion was attempted using an interspinous method of posterior atlantoaxial arthrodesis. Radiographic Evaluation of Bone Fusion Flexion-extension studies, necessary to evaluate the stability of the fusion, are routinely carried out at 6 weeks postoperatively. Although the integrity of the bone fusion across the facets and lamina can be evaluated adequately on a routine x-ray film, this may sometimes be difficult. In these cases, conventional polytomography or axial CT yields excellent information regarding integrity of the fusion. In our series, both methods yielded the same information but, because of the ease of technique and interpretation, we prefer to obtain CT bone scans when in doubt. It is especially important when evaluating patients with atlantoaxial arthrodesis, where pseudoarthrosis is a more common occurrence. References 1. Aldrich EF, Crow WN, Weber PB, et al: Use of MR imaging-compatible Halifax interlaminar clamps for pos- terior cervical fusion. J Neurosurg 74: , Alexander E Jr: Posterior fusions of the cervical spine. Clin Neurosurg 28: , Anderson LD: Fractures of the odontoid process of the axis, in The Cervical Spine Research Society (eds): The Cervical Spine. Philadelphia: JB Lippincott, 1983, pp Barbour JR: Screw fixation in fracture of the odontoid process. South Austral Clin 5:20-24, Brooks AL, Jenkins EB: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg (Am) 60: , Cahill DW, Bellegarrigue R, Ducker TB: Bilateral facet to spinous process fusion: a new technique for posterior spinal fusion after trauma. Neurosurgery 13:1-4, Chan DPK, Ngian KS, Cohen L: Posterior upper cervical fusion in rheumatoid arthritis. Spine 17: , Cybulski GR, Stone JL, Crowell RM, et ai: Use of Halifax interlaminar clamps for posterior C 1-2 arthrodesis. Neurosurgery 22: , Dickman CA, Sonntag VKH, Papadopoulos SM, et al: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74: , DuToit G Jr: Lateral atlanto-axial arthrodesis. A screw fixation technique. S Aft J Surg 14:9-12, 1976 I I. Fielding JW: Current concepts review. The status of arthrodesis of the cervical spine. J Bone Joint Surg (Am) 70: , Gallie WE: Fractures and dislocations of the cervical spine. Am J Surg 46: , Geisler FH, Cheng C, Poka A, et ah Anterior screw fixation of posteriorly displaced type II odontoid fractures. Neurosurgery 25:30-38, Geremia GK, Kim KS, Cerullo L, et ah Complications of sublaminar wiring. Surg Neurol 23: , Grob D, Crisco JJ III, Panjabi MM, et al: Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17: , Holness RO, Huestis WS, Howes W J, et at: Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Nenrosurgery 14: , Johnson RM, Hart DL, Simmons EF, et al: Cervic,~d orthroses. A study comparing their effectiveness in restricting cervical motion in normal subjects. J Bone Joint Sorg (Am) 59: , Lipson S J, Hammerschlag SB: Atlantoaxial arthrodesis in the presence of posterior spondyloschisis (bifid arch) of the atlas. A report of three cases and an evaluation of alternative wiring techniques by computerized tomography. Spine 9:65-69, McCarron RF, Robertson WW: Brooks fusion for atlantoaxial instability in rheumatoid arthritis. South Med J 81: , Mitsui H: A new operation for atlanto-axial arthrodesis. J Bone Joint Surg (Br) 66: , I. Moskovich R, Crockard HA: Atlantoaxial arthrodesis using interlaminar clamps. An improved technique. Spine 17: , Murphy M J, Southwick WO: Posterior approaches and fusions, in The Cervical Spine Research Society (eds): The Cervical Spine. Philadelphia: JB Lippincott, 1983, pp Papadopoulos SM, Dickman CA, Sonntag VKH: Atlantoaxial stabilization in rheumatoid arthritis. J Neurosurg 74:1-7, Paradis GR, Janes JM: Posttraumatic atlantoaxial instability: the fate of the odontoid process fracture in 46 cases. J. Neurosurg. / Volume 78/May,
7 E. F. Aldrich, P. B. Weber, and W. N. Crow J Trauma 13: , Pierce DS, Barr JS Jr: Fractures and dislocations at the base of the skull and upper cervical spine, in The Cervical Spine Research Society (eds): The Cervical Spine. Philadelphia: JB Lippincott, 1983, pp Schatzker J, Rorabeck CH, Waddell JP: Fractures of the dens (odontoid process). An analysis of thirty-seven cases. J Bone Joint Surg (Br) 53: , Seex K, Johnston RA: lntedaminar clamp for posterior fusions. J Neurosurg 75:495, 1991 (Letter) 28. Tucker HH: Technical report: method of fixation of subluxed or dislocated cervical spine below CI-C2. Can J Neuroi Sci 2: , White AA III, Panjabi MM: Clinical Biomechanies of the Spine. Philadelphia: JB Lippincott, 1978, p Whitehill R, Schmidt R: The posterior interspinous fusion in the treatment of quadriplegia. Spine 8: , Yashon D: Surgical management of trauma to the spine, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques. Indications, Methods and Results, ed 2. Orlando, Ha: Grune & Stratton, 1988, Vol 1, pp Manuscript received June 26,! 992. Accepted in final form October 2, This paper was presented in part at the Annual Meeting of the American Association of Neurological Surgeons, San Francisco, California, April 11-16, Address reprint requests to: E. Francois Aldrich, M.D., Division of Neurosurgery, E-I 7, University of Texas Medical Branch, Galveston, Texas J. Neurosurg~ / Volume 78/May, 1993
Common fracture & dislocation of the cervical spine. Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University
Common fracture & dislocation of the cervical spine Theerachai Apivatthakakul Department of Orthopaedic Chiangmai University Objective Anatomy Mechanism and type of injury PE.and radiographic evaluation
More informationInvolvement of the spine is common in rheumatoid. Incidence been reported to be 85% radiologically but only 30% have neurological signs and symptoms.
RHEUMATOID SPINE Involvement of the spine is common in rheumatoid. Incidence been reported to be 85% radiologically but only 30% have neurological signs and symptoms. When neurology is present it may manifest
More informationSUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT
SUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT 1 Anatomy 3 columns- Anterior, middle and Posterior Anterior- ALL, Anterior 2/3 rd body & disc. Middle- Posterior 1/3 rd of body & disc, PLL Posterior-
More informationSpinal Cord Injuries: The Basics. Kadre Sneddon POS Rounds October 1, 2003
Spinal Cord Injuries: The Basics Kadre Sneddon POS Rounds October 1, 2003 Anatomy Dorsal columntouch, vibration Corticospinal tract- UMN Anterior horn-lmn Spinothalamic tractpain, temperature (contralateral)
More informationPediatric cervical spine injuries with neurological deficits, treatment options, and potential for recovery
SICOT J 2017, 3, 53 Ó The Authors, published by EDP Sciences, 2017 DOI: 10.1051/sicotj/2017035 Available online at: www.sicot-j.org CASE REPORT OPEN ACCESS Pediatric cervical spine injuries with neurological
More informationSubaxial Cervical Spine Trauma Dr Hesarikia BUMS
Subaxial Cervical Spine Trauma Dr. Hesarikia BUMS Subaxial Cervical Spine From C3-C7 ROM Majority of cervical flexion Lateral bending Approximately 50% rotation Ligamentous Anatomy Anterior ALL, PLL, intervertebral
More informationImaging of Cervical Spine Trauma Tudor H Hughes, M.D.
Imaging of Cervical Spine Trauma Tudor H Hughes, M.D. General Considerations Most spinal fractures are due to a single episode of major trauma. Fatigue fractures of the spine are unusual except in the
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of direct C1 lateral mass screw procedure for cervical spine stabilisation Introduction
More informationPosterior cervical fusion in children
Posterior cervical fusion in children JOE M. MCWHORTER, M.D., EBEN ALEXANDER, JR., M.D., COURTLAND H. DAVIS, JR., M.D., AND DAVID L. KELLY, JR., M.D. Section on Neurosurgery, Department of Surgery, Bowman
More informationSubaxial Cervical Spine Trauma
Subaxial Cervical Spine Trauma Pooria Salari, MD Assistant Professor Of Orthopaedics Department of Orthopaedic Surgery St. Louis University School of Medicine St. Louis, Missouri, USA Initial Evaluation
More informationComparative Study of Surgical Approaches for Distractive Flexion Injuries of Sub-Axial Cervical Spine
Open Journal of Modern Neurosurgery, 2018, 8, 342-351 http://www.scirp.org/journal/ojmn ISSN Online: 2163-0585 ISSN Print: 2163-0569 Comparative Study of Surgical Approaches for Distractive Flexion Injuries
More informationfactor for identifying unstable thoracolumbar fractures. There are clinical and radiological criteria
NMJ-Vol :2/ Issue:1/ Jan June 2013 Case Report Medical Sciences Progressive subluxation of thoracic wedge compression fracture with unidentified PLC injury Dr.Thalluri.Gopala krishnaiah* Dr.Voleti.Surya
More informationTechnique Guide. C1/C2 Access System. Percutaneous transarticular screw fixation.
Technique Guide C1/C2 Access System. Percutaneous transarticular screw fixation. C1/C2 Access System Table of Contents General introduction 2 Indications/Contraindications 2 Image intensifier-assisted
More information102 Posterior Cervical Arthrodesis
102 Posterior Cervical Arthrodesis Gabriel Widi, Mohammed Faraz Khan, and Glen Manzano Indications Posterior and posterolateral access to the cervical spine: Laminectomy for decompression Intradural tumor
More informationNewBridge. Laminoplasty Fixation INTERNATIONAL EDITION
NewBridge L A M I N O P L A S T Y F I X A T I O N S Y S T E M Laminoplasty Fixation INTERNATIONAL EDITION Table of Contents 1 INTRODUCTION 2 PRE-OPERATIVE 3 OPERATIVE 10 INSTRUCTIONS FOR USE 12 PART NUMBERS
More informationSubaxial Cervical Spine Trauma. Introduction. Anatomic Considerations 7/23/2018
Subaxial Cervical Spine Trauma Sheyan J. Armaghani, MD Florida Orthopedic Institute Assistant Professor USF Dept of Orthopedics Introduction Trauma to the cervical spine accounts for 5 of all spine injuries
More informationOdontoid process fracture in 2 year old child: a rare case report
Romanian Neurosurgery Volume XXXI Number 4 2017 October-December Article Odontoid process fracture in 2 year old child: a rare case report Prajapati Hanuman Prasad, Singh Deepak Kumar, Singh Rakesh Kumar,
More information2. The vertebral arch is composed of pedicles (projecting from the body) and laminae (uniting arch posteriorly).
VERTEBRAL COLUMN 2018zillmusom I. VERTEBRAL COLUMN - functions to support weight of body and protect spinal cord while permitting movements of trunk and providing for muscle attachments. A. Typical vertebra
More informationCase Report A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture
Case Reports in Orthopedics Volume 2013, Article ID 421087, 4 pages http://dx.doi.org/10.1155/2013/421087 Case Report A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture Ryo
More informationISPUB.COM. Fracture Through the Body of the Axis. B Johnson, N Jayasekera CASE REPORT
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 8 Number 1 B Johnson, N Jayasekera Citation B Johnson, N Jayasekera.. The Internet Journal of Orthopedic Surgery. 2007 Volume 8 Number 1. Abstract
More informationComparison of Anterior and Posterior Approaches in Cervical Spinal Cord Injuries
Journal of Spinal Disorders & Techniques Vol. 16, No. 3, pp. 229 235 2003 Lippincott Williams & Wilkins, Inc., Philadelphia Comparison of Anterior and Posterior Approaches in Cervical Spinal Cord Injuries
More informationPosterior Cervical Arthrodesis by Lateral Mass Screws Fixation A Long term Follow-up Study
Original Article Posterior Cervical Arthrodesis by Lateral Mass Screws Fixation A Long term Follow-up Study Bhaskar G 1, Sharath Kumar Maila 2, Lakshman Rao A 3, Mastan Reddy A 4 1 Professor I/C 2, 3 Assistant
More informationThe craniocervical junction
Anver Jameel, MD The craniocervical junction A biomechanical and anatomical unit that extends from the skull base to C2 Includes the clivus, foramen magnum and contiguous occipital bone, the occipital
More informationDIAGNOSTIC VIDEOFLUOROSCOPY IMPRESSIONS and BIOMECHANICS REPORT
P.O. Box 6743 New Albany, IN 47151-6743 (812) 945-5515 (812) 945-5632 Fax WWW.KMX.CC DIAGNOSTIC VIDEOFLUOROSCOPY IMPRESSIONS and BIOMECHANICS REPORT Patient Name: Lubna Ibriham Date of Digitization and
More informationTechnique Guide. ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty.
Technique Guide ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty. Table of Contents Introduction Overview 2 AO ASIF Principles 4 Indications and Contraindications 5 Product Information
More informationPosterior surgical procedures are those procedures
9 Cervical Posterior surgical procedures are those procedures that have been in use for a long time with established efficacy in the treatment of radiculopathy and myelopathy caused by pathologies including
More informationCERVICAL SPINE INJURIES IN THE ELDERLY
CERVICAL SPINE INJURIES IN THE ELDERLY ISADOR H. LIEBERMAN, JOHN K. WEBB From University Hospital, Queen s Medical Centre, Nottingham, England We reviewed 41 patients over the age of 65 years (mean 76.5)
More informationVertebral Artery Anomalies at the Craniovertebral Junction: A Case Report and Review of the Literature
Case Report 121 Vertebral Artery Anomalies at the Craniovertebral Junction: A Case Report and Review of the Literature Amir M. Abtahi 1 Darrel S. Brodke 1 Brandon D. Lawrence 1 1 Department of Orthopaedics,
More informationSurgical management of combined fracture of atlas associated with fracture of axis vertebrae (CAAF): Case Series
Romanian Neurosurgery (2015) XXIX 3: 335-341 335 Surgical management of combined fracture of atlas associated with fracture of axis vertebrae (CAAF): Case Series Guru Dutta Satyarthee, Gaurang Vaghani,
More informationFractures of the Thoracic and Lumbar Spine
A spinal fracture is a serious injury. Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological
More informationMDCT and MRI evaluation of cervical spine trauma
Insights Imaging (2014) 5:67 75 DOI 10.1007/s13244-013-0304-2 PICTORIAL REVIEW MDCT and MRI evaluation of cervical spine trauma Michael Utz & Shadab Khan & Daniel O Connor & Stephen Meyers Received: 10
More informationARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty.
ARCH Laminoplasty System. Dedicated System for Open-door Laminoplasty. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.
More informationA rare case of spinal injury: bilateral facet dislocation without fracture at the lumbosacral joint
J Orthop Sci (2012) 17:189 193 DOI 10.1007/s00776-011-0082-y CASE REPORT A rare case of spinal injury: bilateral facet dislocation without fracture at the lumbosacral joint Kei Shinohara Shigeru Soshi
More informationRheumatoid Arthritis and the Cervical Spine. Radiology Rounds November 21, 2006 Derek Haaland
Rheumatoid Arthritis and the Cervical Spine Radiology Rounds November 21, 2006 Derek Haaland Laiho et al. Semin Arthritis Rheum. 2004:34;267. Laiho et al. Semin Arthritis Rheum. 2004:34;267. *Shen et al.
More informationKey Primary CPT Codes: Refer to pages: 7-9 Last Review Date: October 2016 Medical Coverage Guideline Number:
National Imaging Associates, Inc. Clinical guidelines CERVICAL SPINE SURGERY: ANTERI CERVICAL DECOMPRESSION WITH FUSION CERVICAL POSTERI DECOMPRESSION WITH FUSION CERVICAL ARTIFICIAL DISC CERVICAL POSTERI
More informationVERTEBRAL COLUMN VERTEBRAL COLUMN
VERTEBRAL COLUMN FUNCTIONS: 1) Support weight - transmits weight to pelvis and lower limbs 2) Houses and protects spinal cord - spinal nerves leave cord between vertebrae 3) Permits movements - *clinical
More informationTraumatic spondylolisthesis of the axis has been
Bulletin Hospital for Joint Diseases Volume 60, Number 2 2001-2002 61 Traumatic Spondylolisthesis of the Axis 42 Cases Myung-Sang Moon MD Jeong-Lim Moon MD Young-Wan Moon MD Doo-Hoon Sun MD PhD and Won-Tai
More informationLigaments of the vertebral column:
In the last lecture we started talking about the joints in the vertebral column, and we said that there are two types of joints between adjacent vertebrae: 1. Between the bodies of the vertebrae; which
More informationSpineFAQs. Neck Pain Diagnosis and Treatment
SpineFAQs Neck Pain Diagnosis and Treatment Neck pain is a common reason people visit their doctor. Neck pain typically doesn't start from a single injury. Instead, the problem usually develops over time
More informationDegenerative spondylolisthesis at the L4 L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: A case report
Journal of Orthopaedic Surgery 2003: 11(2): 202 206 Degenerative spondylolisthesis at the L4 L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: A case report RB Winter Clinical Professor,
More informationDorsal Cervical Surgeries and Techniques
Dorsal Cervical Approaches Dorsal Cervical Surgeries and Techniques Gregory R. Trost, MD Professor and Vice Chair of Neurological Surgery University of Wisconsin-Madison Advantages Straightforward Easily
More informationSystematic review Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review (...)
Systematic review Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review (...) 59 59 66 Cervical artificial disc replacement versus fusion in the cervical spine:
More informationCervical Spine Anatomy and Biomechanics. Typical Cervical Vertebra C3 6. Typical Cervical Vertebra Anterior 10/5/2017
Cervical Spine Anatomy and Biomechanics Typical Cervical Vertebra C3 6 Small, relatively broad body Bifid SpinousProcess Long and narrow laminae Spinal Canal: large, triangular; remarkably consistent dimensions
More informationSubaxial (C3 7) cervical instability in children may
clinical article J Neurosurg Spine 24:892 896, 2016 Management of subaxial cervical instability in very young or small-for-age children using a static single-screw anterior cervical plate: indications,
More information102 Results RESULTS. Age Mean=S.D Range 42= years -84 years Number % <30 years years >50 years
102 Results RESULTS A total of 50 cases were studied 39 males and 11females.Their age ranged between 16 years and 84 years (mean 42years). T1 and T2WI were acquired for all cases in sagittal and axial
More informationManagement Of Posttraumatic Spinal Instability (Neurosurgical Topics, No 3) READ ONLINE
Management Of Posttraumatic Spinal Instability (Neurosurgical Topics, No 3) READ ONLINE If you are searching for a ebook Management of Posttraumatic Spinal Instability (Neurosurgical Topics, No 3) in pdf
More informationA study of indications and assessment of fusion rates for atlantoaxial subluxation
International Surgery Journal Reddy AM et al. Int Surg J. 2016 Feb;3(1):211-216 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20160228
More informationA Review of the Diagnosis and Treatment of Atlantoaxial Dislocations
Global Spine Journal Review Article 197 A Review of the Diagnosis and Treatment of Atlantoaxial Dislocations Sun Y. Yang 1 Anthony J. Boniello 1 Caroline E. Poorman 1 Andy L. Chang 1 Shenglin Wang 2 Peter
More informationTM TM Surgical Technique
TM TM Surgical Technique TABLE OF CONTENTS Reli SP Spinous Plating System Overview Device Description Implant Features Indications Instruments Access Instruments Preparation Instruments Insertion Instruments
More informationFractures of the thoracic and lumbar spine and thoracolumbar transition
Most spinal column injuries occur in the thoracolumbar transition, the area between the lower thoracic spine and the upper lumbar spine; over half of all vertebral fractures involve the 12 th thoracic
More informationTHE VERTEBRAL COLUMN. Average adult length: In male: about 70 cms. In female: about 65 cms.
THE VERTEBRAL COLUMN Average adult length: In male: about 70 cms. In female: about 65 cms. 1 Vertebral Column (Regions and Curvatures) Curvatures of the vertebral column: A. Primary curvature: C-shaped;
More informationPatient Information MIS LLIF. Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques
Patient Information MIS LLIF Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques Table of Contents Anatomy of Spine...2 General Conditions of the Spine....4 What is Spondylolisthesis....5
More informationOutline. Epidemiology Indications for C-spine imaging Modalities Interpretation Types of fractures
C-Spine Plain Films Outline Epidemiology Indications for C-spine imaging Modalities Interpretation Types of fractures Epidemiology 7000-10000 c-spine injuries treated each year Additional 5000 die at the
More informationChristopher I. Shaffrey, MD
CSRS 21st Instructional Course Wednesday, November 30, 2016 Laminoplasty/Foraminotomy: Why Fuse the Spine at all? Christopher I. Shaffrey, MD John A. Jane Distinguished Professor Departments of Neurosurgery
More informationBiomechanics of Interspinous Process Fixation and Lateral Modular Plate Fixation to Support Lateral Lumbar Interbody Fusion (LLIF)
Biomechanics of Interspinous Process Fixation and Lateral Modular Plate Fixation to Support Lateral Lumbar Interbody Fusion (LLIF) Calusa Ambulatory Spine Conference 2016 Jason Inzana, PhD 1 ; Anup Gandhi,
More informationsubluxation: a radiographic comparison
Annals of the Rheumatic Diseases, 1980, 39, 485-489 Cervical collars in rheumatoid atlanto-axial subluxation: a radiographic comparison BO ALTHOFF AND IAN F. GOLDIE From the Department of Orthopaedic Surgery
More informationSpinal Trauma. Dr T G Kruger
Spinal Trauma Dr T G Kruger Epidemiology Spine injury in 6% of trauma patients Multiple levels involved in 20% of cases 80% of spinal cord injury patients have concurrent other system injuries 41% have
More informationAnterior Cervical Subluxation: An Unstable Position
275 Anterior Cervical Subluxation: An Unstable Position, 1 A. T. Scher1 The radioiogic signs of cervical anterior subluxation are subtle. Even when recognized, the injury may not be considered significant.
More informationIncreased Fusion Rates With Cervical Plating for Two- Level Anterior Cervical Discectomy and Fusion
Increased Fusion Rates With Cervical Plating for Two- Level Anterior Cervical Discectomy and Fusion SPINE Volume 25, Number 1, pp 41 45 2000, Lippincott Williams & Wilkins, Inc. Jeffrey C. Wang, MD, Paul
More information5/19/2017. Interspinous Process Fixation with the Minuteman G3. What is the Minuteman G3. How Does it Work?
Interspinous Process Fixation with the Minuteman G3 LLOYDINE J. JACOBS, MD CASTELLVI SPINE MEETING MAY 13, 2017 What is the Minuteman G3 The world s first spinous process plating system that is: Minimally
More informationT.L.I.F. Surgical Technique. Featuring the T.L.I.F. SG Instruments, VG2 PLIF Allograft, and the MONARCH Spine System.
Surgical Technique T.L.I.F. Transforaminal Lumbar Interbody Fusion Featuring the T.L.I.F. SG Instruments, VG2 PLIF Allograft, and the MONARCH Spine System. CONSULTING SURGEON Todd Albert, M.D. Rothman
More informationCase report. Open Access. Abstract
Open Access Case report Orthotopic ossiculum terminale persistens and atlantoaxial instability in a child less than 12 years of age: a case report and review of the literature Ashwin Viswanathan 1, William
More informationProcedure Coding Made Simple Five principles will help you capture appropriate charges for spine surgeries.
Coding/Billing By Kim Pollock, MS, RN, MBA, CPC Procedure Coding Made Simple Five principles will help you capture appropriate charges for spine surgeries. It seems like coding spine cases is as complicated
More informationModule: #15 Lumbar Spine Fusion. Author(s): Jenni Buckley, PhD. Date Created: March 27 th, Last Updated:
Module: #15 Lumbar Spine Fusion Author(s): Jenni Buckley, PhD Date Created: March 27 th, 2011 Last Updated: Summary: Students will perform a single level lumbar spine fusion to treat lumbar spinal stenosis.
More informationThe indications of upper cervical fusion include. Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases
Chinese Journal of Traumatology 2008; 11(6):323-328.. Original articles Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases LI Lei *, ZHOU Feng-hua, WANG Huan, and
More informationInnovative Techniques in Minimally Invasive Cervical Spine Surgery. Bruce McCormack, MD San Francisco California
Innovative Techniques in Minimally Invasive Cervical Spine Surgery Bruce McCormack, MD San Francisco California PCF Posterior Cervical Fusion PCF not currently an ambulatory care procedure Pearl diver
More informationSURGICAL TECHNIQUE GUIDE TRESTLE. Anterior Cervical Plating System
SURGICAL TECHNIQUE GUIDE TRESTLE Anterior Cervical Plating System 2 SURGICAL TECHNIQUE GUIDE SURGICAL TECHNIQUE GUIDE System Features Large window enables visualization of graft site and end plates Screw
More informationPrognosis of neurological deficits associated with upper cervical spine injuries
Paraplegia (1995) 33, 195-202 1995 International Medical Society of Paraplegia All rights reserved 0031-1758/95 $9.00 Prognosis of neurological deficits associated with upper cervical spine injuries Y
More informationPOSTERIOR CERVICAL FUSION
AN INTRODUCTION TO PCF POSTERIOR CERVICAL FUSION This booklet provides general information on the Posterior Cervical Fusion (PCF) surgical procedure for you to discuss with your physician. It is not meant
More informationSPONTANEOUS dislocation of the atlas on the axis has been known
CLEVELAND CLINIC QUARTERLY Copyright 1970 by The Cleveland Clinic Foundation Volume 37,Jaunary 1970 Printed in U.S.A. Spontaneous subluxation of the first and second cervical vertebrae, in rheumatoid arthritis,
More informationSURGICAL TECHNIQUE MANUAL. InterFuse T
1 CONTENTS InterFuse T Product Description 3 Indications for Use 3 X-Ray Marker Locations 4 Product Specifications 4 Instrument Set 5 Step 1 Preoperative Planning 8 Patient Positioning 8 Step 2 Disc Removal
More informationSpondylolysis repair using a pedicle screw hook or claw-hook system. a comparison of bone fusion rates
ORIGINAL ARTICLE SPINE SURGERY AND RELATED RESEARCH Spondylolysis repair using a pedicle screw hook or claw-hook system. a comparison of bone fusion rates Ko Ishida 1), Yoichi Aota 2), Naoto Mitsugi 1),
More informationImaging of Orthopedic Spinal Devices: What Every Radiologist Should Know.
Imaging of Orthopedic Spinal Devices: What Every Radiologist Should Know. Poster No.: C-1656 Congress: ECR 2016 Type: Educational Exhibit Authors: E. Federici, C. Dell'atti, M. Bartocci, D. Beomonte Zobel,
More informationPatient Information. ADULT SCOLIOSIS Information About Adult Scoliosis, Symptoms, and Treatment Options
Patient Information ADULT SCOLIOSIS Information About Adult Scoliosis, Symptoms, and Treatment Options Table of Contents Anatomy of the Spine...2 What is Adult Scoliosis...4 What are the Causes of Adult
More informationC2 Body Fracture: Report of Cases Managed Conservatively by Philadelphia Collar
C2 Body Fracture: Report of Cases Managed Conservatively by Philadelphia Collar The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
More informationCongenital Anomaly of the Atlas Misdiagnosed as Posterior Arch Fracture of the Atlas and Atlantoaxial Subluxation
Case Report Clinics in Orthopedic Surgery 2014;6:96-100 http://dx.doi.org/10.4055/cios.2014.6.1.96 Congenital Anomaly of the Atlas Misdiagnosed as Posterior Arch Fracture of the Atlas and Atlantoaxial
More informationInterspinous Fusion Devices. Midterm results. ROME SPINE 2012, 7th International Meeting Rome, 6-7 December 2012
Interspinous Fusion Devices. Midterm results. ROME SPINE 2012, 7th International Meeting Rome, 6-7 December 2012 Posterior distraction and decompression Secure Fixation and Stabilization Integrated Bone
More informationARCH Laminoplasty System
Dedicated System for Open-door Laminoplasty ARCH Laminoplasty System Surgical Technique Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes
More informationRoyal Oak IBFD System Surgical Technique Posterior Lumbar Interbody Fusion (PLIF)
Royal Oak IBFD System Surgical Technique Posterior Lumbar Interbody Fusion (PLIF) Preoperative Planning Preoperative planning is necessary for the correct selection of lumbar interbody fusion devices.
More informationDelayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report
Shimada et al. Journal of Medical Case Reports 2013, 7:9 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using
More informationEvolution of posterior cervical and occipitocervical fusion and instrumentation
Neurosurg Focus 16 (1):Article 9, 2004, Click here to return to Table of Contents Evolution of posterior cervical and occipitocervical fusion and instrumentation JOHN R. VENDER, M.D., ANDY J. REKITO, M.S.,
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More informationINDEPENDENT LEARNING: DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE: ANATOMICAL FACTORS TO CONSIDER IN REVIEW
INDEPENDENT LEARNING: DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE: ANATOMICAL FACTORS TO CONSIDER IN REVIEW CDC REPORT - CAUSES OF DISABILITY, 2005 REVIEW QUESTIONS ABOUT DISC HERNIATION IN THE NATIONAL
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More information5/27/2016. Stand-Alone Lumbar Lateral Interbody Fusion (LLIF) vs. Supplemental Fixation. Disclosures. LLIF Approach
Stand-Alone Lumbar Lateral Interbody Fusion (LLIF) vs. Supplemental Fixation Joseph M. Zavatsky, M.D. Spine & Scoliosis Specialists Tampa, FL Disclosures Consultant - Zimmer / Biomet, DePuy Synthes Spine,
More informationRisk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty
CLINICAL ARTICLE Korean J Neurotrauma 18;14(2):118-122 pissn 2234-8999 / eissn 2288-2243 https://doi.org/1.134/kjnt.18.14.2.118 Risk Factors for Hinge Fracture Associated with Surgery Following Cervical
More informationTreatment of thoracolumbar burst fractures by vertebral shortening
Eur Spine J (2002) 11 :8 12 DOI 10.1007/s005860000214 TECHNICAL INNOVATION Alejandro Reyes-Sanchez Luis M. Rosales Victor P. Miramontes Dario E. Garin Treatment of thoracolumbar burst fractures by vertebral
More informationELY ASHKENAZI Israel Spine Center at Assuta Hospital Tel Aviv, Israel
nterior cervical decompression using the Hybrid Decompression Fixation technique, a combination of corpectomies and or discectomies, in the management of multilevel cervical myelopathy J ORTHOP TRUM SURG
More informationPatient Information MIS LLIF. Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques
Patient Information MIS LLIF Lateral Lumbar Interbody Fusion Using Minimally Invasive Surgical Techniques Table of Contents Anatomy of Spine....2 General Conditions of the Spine....4 What is Spondylolisthesis....5
More informationSynCage. Surgical Technique. This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.
SynCage Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Image intensifier control Warning This description alone
More informationFractures of the tibia shaft treated with locked intramedullary nail Retrospective clinical and radiographic assesment
ARS Medica Tomitana - 2013; 4(75): 197-201 DOI: 10.2478/arsm-2013-0035 Șerban Al., Botnaru V., Turcu R., Obadă B., Anderlik St. Fractures of the tibia shaft treated with locked intramedullary nail Retrospective
More informationTechnique Guide. VA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis.
Technique Guide VA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis. Table of Contents Introduction VA-Locking Intercarpal Fusion System 2 Indications
More informationClarification of Terms
Clarification of Terms The Spine, Spinal Column, and Vertebral Column are synonymous terms referring to the bony components housing the spinal cord Spinal Cord = made of nervous tissue Facet = a small,
More informationIncidence and Risk Factors for Late Neurologic Deterioration after C3-6 Laminoplasty in Patients with Cervical Spondylotic Myelopathy
Incidence and Risk Factors for Late Neurologic Deterioration after C3-6 Laminoplasty in Patients with Cervical Spondylotic Myelopathy Sakaura H, Miwa T, Kuroda Y, Ohwada T Dept. of Orthop. Surg., Kansai
More informationSCIWORA Rozlyn McTeer BSN, RN, CEN Pediatric Trauma Coordinator Trauma Services OBJECTIVES DEFINITION 11/8/2017. Identify SCIWORA.
SCIWORA Rozlyn McTeer BSN, RN, CEN Pediatric Trauma Coordinator Trauma Services Identify SCIWORA. OBJECTIVES Identify the population at risk. To identify anatomic and physiologic reasons for SCIWORA. To
More informationMatthew Colman, MD Assistant Professor, Spine Surgery and Musculoskeletal Oncology Rush University Medical Center ACDF
is the most reliable option for twolevel anterior cervical surgery Matthew Colman, MD Assistant Professor, Spine Surgery and Musculoskeletal Oncology Rush University Medical Center Disclosures Medicrea:
More informationDynamic anterior cervical plating for multi-level spondylosis: Does it help?
Original research Dynamic anterior cervical plating for multi-level spondylosis: Does it help? 41 41 46 Dynamic anterior cervical plating for multi-level spondylosis: Does it help? Authors Ashraf A Ragab,
More informationSpinal Trauma at the Pediatric Age
Spinal Trauma at the Pediatric Age Burçak B LG NER Nejat AKALAN ABSTRACT Spinal trauma is relatively rare in pediatric patients. The anatomy and biomechanics of the growing spine produce failure patterns
More information