摘要:

SummaryHistorically, injuries to the cervicothoracic junction have presented several challenges to the spine surgeon. Identification of injuries can be difficult given the limitations of plain radiographs in this region, contributing to delays in diagnosis. Attempts at closed reduction of fracture–dislocations are frequently unsuccessful. Nonoperative management of unstable cervicothoracic injuries is commonly afflicted with secondary loss of reduction. Anterior surgical exposures of the cervicothoracic junction are cumbersome and can be associated with notable morbidity resulting from anatomic constraints. Although simpler in approach, posterior instrumentation is limited by available bony fixation points and potential hardware prominence. The authors review the issues regarding cervicothoracic junction injuries and their management.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummarySurgical approaches to the cervicothoracic junction frequently involve complicated dissection because of the restricted accessibility during the procedure and the close proximity of the great vessels. Common indications for surgical intervention include infections, neoplasms, and fractures. Approaches described here are useful for pathologies of the difficult-to-access upper thoracic spine (T1–T4). The modified anterior approach has become the method of choice at the authors’ institution. Care must be taken when using this approach so as not to injure the recurrent laryngeal nerve or the brachiocephalic vessels. When using the sternal splitting approach, it is important to keep in mind that it adds marked morbidity risk with the potential for a sternal wound infection. The transthoracic approach uses a proximal thoracotomy with removal of the third or fourth rib. Exposure to the first four thoracic ribs is adequate with this technique, but access to the lower cervical vertebrae can be difficult. Other complications associated with this approach are the added morbidity related to lung manipulation and the potential for Horner’s syndrome resulting from damage to the sympathetic chain. In general, neurologic results depend largely on the patient’s preoperative status and their underlying disease process. Postoperative complications, such as shoulder dysfunction, hardly ever occur, and swallowing dysfunction is usually short lived. A positive outcome is that some patients can achieve as much as a 20° correction of kyphosis. In conclusion, the authors have found that most patients recover quite well from this procedure, with the vast majority experiencing notable pain relief and a timely return to independent ambulation.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryFrameless stereotactic imaging was introduced in 1992 as an adjunct to intracranial surgery. However, the clinical application of computer-assisted image-guided spine surgery has not been widely accepted because of the time consuming and arduous nature of maintaining accurate registration coordinates. Frameless spinal stereotaxis is an evolving adjunct to the surgeon’s anatomic knowledge and skill. A contemporary application of computer-assisted image guidance is the merging of intraoperative fluoroscopy with computer-assisted technology. Image-guided surgery can assist significantly in the technical application of implant placement and access for surgical decompression in a variety of cervical disorders. The following is an overview of computer-assisted cervical spine surgery with a more in depth technical discussion of the Fluoronav image guidance system (Medronics-Sofamor-Danek, Memphis, TN).

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe purpose of this article is to review the application of two techniques in the treatment of multilevel cervical spondylosis. Multiple level anterior cervical discectomy fusion (ACDF) and cervical corpectomies are effective for decompression and stabilization of the spondylitic spine. Each operation has advantages and drawbacks though, and appropriate patient selection is critical to successful outcome while minimizing complications. This review examines the perils of the anterior cervical approach and the indications and controversies of multiple ACDFs versus corpectomy. An overview of our most updated techniques for both operations is also presented.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID