ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryA variety of techniques exist for fixation of the upper cervical spine. Recently, several authors have published case series reporting the use of C1 lateral mass screws for posterior cervical fixation.8,9,11,19In this chapter, we describe our surgical technique for placement of C1 lateral mass screws. Additionally, we describe alternative techniques for achieving screw fixation at C2, an important adjunctive technique for achieving atlantoaxial stabilization.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryCervical spine clearance in the trauma patient remains a contentious topic. Conflicting priorities of minimizing unnecessary healthcare dollars while maximizing safety and efficacy of evaluation and treatment has led to the absence of a uniform approach. The patient populations that are most difficult to address are those that cannot provide reliable clinical feedback: the polytrauma patient with distracting injuries, the closed-head-injured patient, and the pediatric trauma patient. Prolonged immobilization in a cervical collar can lead to secondary problems of occipital and mental skin breakdown. Additional nursing efforts are required when patients are maintained on ventilatory support while in their collars. The common goal for these diverse populations is an effective and safe manner to remove the collar once the neck has been deemed free of an unstable occult injury. The authors provide rational guidelines and propose algorithms to address these difficult clinical scenarios.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryOccipitocervical stabilization for instability due to a variety of pathologies (congenital, posttraumatic, degenerative, infectious, or neoplastic origin) is a challenging procedure. Techniques have steadily been developed over several decades from simple onlay bone grafting requiring long period of immobilization to rigid internal fixation devices allowing early mobilization of the patient while solid arthrodesis occurs. Recently, several modular rod systems have been introduced allowing optimal adaptation to the patient’s anatomic situation and providing excellent stability. This paper describes the development of techniques for occipitocervical stabilization, its indications, the preoperative work-up, and the actual surgical technique of occipitocervical instrumentation using a modular rod system (CerviFix, Stratec, Oberdorf, Switzerland), which was developed and introduced in 1993 by the senior author (BJ). Our experience in 11 patients is reported.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryPosterior atlantoaxial arthrodesis is indicated in cases of instability arising from traumatic, degenerative, and congenital conditions. Posterior wiring has long been the fixation of choice; however, nonunion rates are high despite rigid postoperative external immobilization. Transarticular screw fixation is biomechanically superior to posterior wiring, decreasing the requirements for postoperative bracing and lowering nonunion rates. Placement of transarticular screws is technically demanding and requires comprehensive knowledge of the bony and neurovascular anatomy.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryOdontoid fractures represent a common spinal injury, accounting for nearly two thirds of all axis (C2) fractures. Despite their relative frequency, substantial controversy still exists regarding appropriate nonsurgical and surgical management of these injuries. Halo vest immobilization has evolved as the traditional treatment of odontoid fractures. However, more recently, anterior odontoid screw fixation with direct osteosynthesis has become used increasingly in the acute management of some odontoid fractures, even among elderly patients. Ideally, this technique achieves the goals of immediate stability, more rapid patient mobilization, improved union rates, and avoidance of prolonged rigid external immobilization. The authors review the relevant anatomy, surgical indications, biomechanics, operative techniques, and potential complications associated with anterior odontoid screw fixation.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryAnterior cervical plates are widely accepted as a form of internal fixation for discectomy and corpectomy reconstructions in the setting of trauma, deformity, degenerative disc disease, and tumor surgery in the cervical spine. The techniques for anterior cervical surgery with application of internal fixation have become a standard part of the spine surgeon’s armamentarium, but the types of plates available and the rationale behind their designs are quite varied. In the past 20 years, the complication rates associated with anterior cervical surgery have decreased, as compared with historical controls, but a 100% fusion rate remains elusive. Recent developments in cervical plate technology include the introduction of variable angle locking screws that mate securely with a cervical plate, monocortical screws that decrease the neurologic risks associated with penetration of the far cortex in the cervical spine, and dynamic cervical plates that are designed to permit a greater degree of load sharing between the interbody graft and the plate. In light of these advances, we review the history of anterior cervical plating, the surgical techniques, the design characteristics of several plates in common use, and the clinical results of surgical procedures performed with and without internal fixation.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryDefinitive treatment of cervical spinal stenosis for patients with substantial or progressive impairment of neurologic function without any sustained remission is operative. The source of spinal compression, the number of vertebral levels involved in the spondylosis, sagittal alignment, and surgeon preference are criteria that must be factored into whether an anterior or posterior cervical approach is used. Historically, laminectomy has been favored for posterior decompression, but the resultant instability, kyphosis, and late neurologic deterioration have decreased the enthusiasm for laminectomy alone. Even with the addition of a posterior fusion procedure, laminectomy and fusion have met with limited success because of the rate of complications, including kyphotic alignment, subjacent level degeneration, and progression of myelopathy. The advantages of laminoplasty include the preservation of motion, the reduction of adjacent segment degeneration, and the absence of fusion-related complications such as nonunion, autograft site discomfort, and instrumentation failure. However, laminoplasty is not without its difficulties because the creation of the “troughs” and “hinges” can be technically demanding.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryCervical facet dislocations continue to generate considerable controversy regarding the multitude of available treatment options. There is no agreement on the many aspects of diagnostic work-up, or on the variety of available conservative and surgical treatment options. This review discusses the diagnostic work-up, techniques of closed and open reduction, and methods of stabilization of these injuries, focusing on those techniques and methods that the authors have found most effective and reliable in avoiding complications and achieving satisfactory outcomes.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe human spinal column has evolved to a form that allows for efficient functioning in a highly technological society. According to the concept of sagittal spinal balance, the alternating curves of cervical and lumbar lordosis and thoracic and sacral kyphosis enable the head to be positioned over the trunk and pelvis. This form permitsHomo sapiensto assume a biped, upright position, with the upper limbs free for other tasks. Sagittal imbalance represents departure from this ideal form. Imbalance involving any of the constituent parts of the spinal column is problematic; despite mechanisms of spinal compensation, imbalance can affect form and function. Cervical kyphosis, a reversal of the normal lordosis, may represent the most disabling of these imbalances, for it can cause postural difficulties, pain, or neurologic deficit. The consequences of sagittal imbalance, especially “flatback deformity,” resulting from spinal instrumentation procedures, are well recognized. Similarly, structural deformities of the cervical spine cause pain related to increased energy expenditure of the posterior cervical musculature, can result in accelerated degenerative changes of adjacent segments of the spine, and impair the ability to maintain a horizontal line of view. A discussion regarding the etiology and treatment of this condition follows.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID