Treatment of complex cervical spine disorders:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, PA
Saunders
2012
|
| Schriftenreihe: | Orthopedic clinics of North America
43,1 |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIII, 154 S. zahlr. Ill. |
| ISBN: | 9781455739042 |
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Datensatz im Suchindex
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| adam_text | Titel: Treatment of complex cervical spine disorders
Autor: Phillips, Frank M.
Jahr: 2012
Treatment of Complex Cervical Spine Disorders
Contents
Preface xiii
Frank M. Phillips and Safdar N. Khan
Occipitocervical Fusion 1
Ben J. Garrido and Rick C. Sasso
The evolution of occipitocervical fixation and new rigid universal screw-rod con-
struct technology has allowed secure anchorage at each level of the occipitocervical
junction with the elimination of rigid external orthoses. Rigid occipitocervical instru-
mentation constructs have achieved higher fusion rates and less postoperative
immobilization-associated complications. Outcomes have improved compared
with former nonrigid instrumentation techniques; however, with advances of rigid
occipitocervical stabilization capability have come new challenges, risks, and oper-
ative techniques. A thorough understanding of the relevant cervical bony and soft
tissue anatomy is essential for safe implantation and a successful outcome.
C1-C2 Posterior Fixation: Indications, Technique, and Results 11
Mark E. Jacobson, Safdar N. Khan, and Howard S. An
The atlantoaxial motion segment, which is responsible for half of the rotational
motion in the cervical spine, is a complex junction of the first (C1) and second
(C2) cervical vertebrae. Destabilization of this joint is multifactorial and can lead to
pathologic motion with neurologic sequelae. Posterior spinal fixation of the C1-C2
articulation in the presence of instability has been well described in the literature.
Early reports of interspinous/interlaminar wiring have evolved into modern-day ped-
icle screw/translaminar constructs, with excellent results. The success of a C1-C2
posterior fusion rests on appropriate indications and surgical techniques.
Subaxial Cervical and Cervicothoracic Fixation Techniques-Indications, Techniques,
and Outcomes 19
Miguel A. Pelton, Joseph Schwartz, and Kern Singh
The subaxial and cervicothoracic junction is a relatively difficult area for spine sur-
geons to navigate. Because of different transitional stressors at the junction of the
smaller cervical vertebrae and the larger thoracic segments, proximity to neurovas-
cular structures, and complex anatomy, extreme care and precision must be
assumed during fixation in these regions. Lateral mass screws, pedicle screws,
and translaminar screws are currently the standard of choice in the subaxial cervical
and upper thoracic spine. This article addresses the relevant surgical anatomy,
pitfalls, and pearls associated with each of these fixation techniques.
Posterior Surgery for Cervical Myelopathy: Indications, Techniques, and Outcomes 29
Brandon D. Lawrence and Darrel S. Brodke
This article details the controversies associated with the different treatment strate-
gies in patients with cervical spondylotic myelopathy. The natural history, incidence,
pathophysiology, physical examination, and imaging findings are discussed fol-
lowed by the indications, techniques, and outcomes of patients treated with
Contents
posterior cervical decompression via decompressive laminectomy, laminectomy
and instrumented fusion, and laminoplasty.
Anterior Approach for Complex Cervical Spondylotic Myelopathy 41
Krzysztof B. Siemionow and Sergey Neckrysh
Cervical spondylotic myelopathy (CSM) is a slowly progressive disease resulting
from age-related degenerative changes in the spine that can lead to spinal cord dys-
function and significant functional disability. The degenerative changes and abnor-
mal motion lead to vertebral body subluxation, osteophyte formation, ligamentum
flavum hypertrophy, and spinal canal narrowing. Repetitive movement during normal
cervical motion may result in microtrauma to the spinal cord. Disease extent and
location dictate the choice of surgical approach. Anterior spinal decompression
and instrumented fusion is successful in preventing CSM progression and has
been shown to result in functional improvement in most patients.
Management of Adjacent Segment Disease After Cervical Spinal Fusion 53
Christopher K. Kepler and Alan S. Hilibrand
Adjacent segment disease (ASD) was described after long-term follow-up of pa-
tients treated with cervical fusion. The term describes new-onset radiculopathy or
myelopathy referable to a motion segment adjacent to previous arthrodesis and of-
ten attributed to alterations in the biomechanical environment after fusion. Evidence
suggests that ASD affects between 2% and 3% of patients per year. Although pre-
vention of ASD was one major impetus behind the development of motion-sparing
surgery, the literature does not yet clearly distinguish a difference in the rate of
ASD between fusion and disk replacement. Surgical techniques during index sur-
gery may reduce the rate of ASD.
Esophageal and Vertebral Artery Injuries During Complex Cervical Spine
Surgery-Avoidance and Management 63
Gregory Grabowski, Chris A. Cornett, and James D. Kang
Vertebral artery and esophageal injuries are rare but feared complications of cervical
spine surgery. Appropriate understanding of treatment algorithms for prompt inter-
vention in the event of a vertebral artery injury minimizes the risk of exsanguination
and/or profound neurologic consequences. Esophageal injuries are often more sub-
tle, and although intraoperative injuries can sometimes be diagnosed at the time of
surgery, they frequently do not present until the week after surgery. They can addi-
tionally be seen as a late complication of instrumentation usage and/or failure.
Expedient diagnosis and management of these injuries minimize their impact and
allow for optimal treatment outcome.
Diagnosis and Management of Metastatic Cervical Spine Tumors 75
Camilo A. Molina, Ziya L. Gokaslan, and Daniel M. Sciubba
The bony spine is overall the third most common site for distant cancer metastasis,
with the cervical spine involved in approximately 8 to 20% of metastatic spine
disease cases. Diagnosis and management of metastatic spine disease requires
disease categorization into the compartment involved, pathology of the lesion,
and anatomic region involved. The diagnostic approach should commence with
careful physical examination, and the workup should include plain radiographs,
Contents
magnetic resonance imaging, computed tomography, and bone scintigraphy. Man-
agement ranges from palliative nonoperative to aggressive surgical treatment.
Optimal management requires proper patient selection to individualize the most
appropriate treatment modality.
Management of Cervical Spine Trauma: Can a Prognostic Classification of Injury
Determine Clinical Outcomes? 89
Melvin D. Helgeson, David Gendelberg, Gursukhman S. Sidhu, D. Greg Anderson, and
Alexander R. Vaccaro
Although the management of cervical spine trauma is relatively complex, multiple
classification systems have attempted to simplify it through the use of descriptive
terms. Most historical classification systems failed to yield sufficient prognostic
information to guide clinical treatment until the Subaxial Injury Classification system
was developed. This classification system takes into account the injury morphology,
discoligamentous complex, and the most important prognostic factor, neurologic
status. The early results of this classification system have been encouraging and it
is expected to improve spinal trauma care through enhancing more uniform nomen-
clature and communication for surgeons managing spinal trauma.
Cervical Total Disk Replacement: Complications and Avoidance 97
Behnam Salari and Paul C. McAfee
Anterior cervical diskectomy and fusion for neurologic deficits, radicular arm pain,
and neck pain refractory to conservative management are successful. The approach
and procedure were first described in 1955 and have become the anterior cervical
standard of care for orthopedic surgeons and neurosurgeons. Advancements and
innovations have addressed disease processes of the cervical spine with motion-
preserving technology. The possibility of obtaining anterior cervical decompression
while maintaining adjacent segment motion led to the advent of cervical total disk
replacement. The Food and Drug Administration has approved 3 cervical devices
with other investigational device exemption trials under way.
Surgical Management of Complex Spinal Deformity 109
Melissa M. Erickson and Bradford L. Currier
Surgical treatment of complex cervical spinal deformities can be challenging oper-
ations. Patients often present with debilitating conditions ranging from generalized
decreased quality of life to quadriplegia. Surgical treatment can be divided into
anterior, posterior, or combined procedures. A thorough understanding of anatomy,
pathology, and treatment options is necessary. This article focuses on the surgical
treatment of complex spinal deformity.
Revision Cervical Spine Surgery 123
Jeffrey A. Rihn, Chambliss Harrod, and Todd J. Albert
Principles of revision cervical spine surgery are based on adequate decompression
of neural elements and mechanical stability via appropriate selection of surgical
approach and constructs producing long-term stability with arthrodesis. When plan-
ning revision surgery, the surgeon must consider the cause of the underlying prob-
lem (eg, biological, mechanical), the potential for complications, and clinical
outcomes that can reasonably be expected. This information should be clearly
Contents
explained to the patient during the informed consent process. This article provides
the spine care provider with an understanding of how to appropriately evaluate and
manage the most common cervical conditions that require revision cervical spine
surgery.
Minimally Invasive Approaches to the Cervical Spine 137
Paul C. Celestre, Pablo R. Pazmiho, Mark M. Mikhael, Christopher F. Wolf, Lacey A. Feldman,
Carl Lauryssen, and Jeffrey C. Wang
Minimally invasive approaches and operative techniques are becoming increasingly
popular for the treatment of cervical spine disorders. Minimally invasive spine sur-
gery attempts to decrease iatrogenic muscle injury, decrease pain, and speed post-
operative recovery with the use of smaller incisions and specialized instruments.
This article explains in detail minimally invasive approaches to the posterior spine,
the techniques for posterior cervical foraminotomy and arthrodesis via lateral
mass screw placement, and anterior cervical foraminotomy. Complications are
also discussed. Additionally, illustrated cases are presented detailing the use of
minimally invasive surgical techniques.
Erratum 149
Index 151
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