Distraction extension injuries of the cervical spine

Twenty-four consecutive patients with cervical distraction extension injuries were retrospectively reviewed to study the safety and efficacy of various treatment protocols in this type of cervical spine injury. Sixteen of 24 patients with cervical distraction extension injuries underwent surgical stabilization. All patients undergoing surgical stabilization were noted to have a stable fusion at their latest follow-up. There were three instances of surgically related neurologic deterioration as a result of over-distraction of the anterior column interspace at the time of graft placement. The overall mortality rate was 42% in this aged patient population. Anterior reconstruction of the cervical spine with an anterior cervical graft and plate acting as a tension band is the ideal treatment method for stabilization of acute distraction extension injuries involving primarily the soft tissue structures (anterior longitudinal ligament and intervertebral disc). Type 2 injuries, depending on the degree of displacement and the adequacy of closed reduction, may need to be approached initially posteriorly to obtain adequate alignment, followed by an anterior reconstructive procedure. Great care should be taken during anterior graft placement to avoid over-distraction of the spine. If nonsurgical intervention is selected, close regular radiographic follow-up is necessary to detect early vertebral malalignment, which may predispose to spinal cord dysfunction. Older patients sustaining this injury have a high mortality rate.

Uncemented total hip arthroplasty in Paget's disease of the hip: a report of 5 cases with 5-year follow-up

Five patients with Paget's disease localized to the acetabulum received cementless acetabular components during total hip replacement. Three were primary surgeries, and 2 were revisions of a failed cemented acetabular component. At an average of 5.8 years (range, 4.8-8.8 years) after the operation, all acetabular components were well fixed radiographically with no migration or loosening. No patients complained of clinical symptoms referable to the acetabular component. No revisions had been performed. The ability of this inherently abnormal bone to proceed through the reparative and remodeling phases of porous ingrowth adds support to the use of uncemented components for acetabular reconstruction in Paget's disease of the hip.

The efficacy of using an image-guided Kerrison punch in performing an anterior cervical foraminotomy. An anatomic analysis

STUDY DESIGN

This study comprised two parts: first, a feasibility study to determine the efficacy of using an image-guided Kerrison punch while performing a foraminotomy during an anterior cervical decompression and, second, an anatomic analysis using vector measurement to determine the distance from the entrance of the neuroforamen to the medial margin of the vertebral artery in the subaxial cervical spine.

OBJECTIVE

To assess the feasibility of using an image-guided Kerrison punch when performing an anterior foraminotomy and to obtain data regarding the distance from the vertebral artery to the entrance of the neuroforamen.

SUMMARY OF BACKGROUND DATA

The documented incidence of catastrophic iatrogenic vertebral artery injury in anterior cervical decompression is low. The use of a real-time image-guidance surgical system should reduce the risk of this complication.

METHODS

Twelve cadaveric cervical spines were harvested. Standard anterior cervical discectomies with bilateral foraminotomies were performed in the subaxial cervical spine using an image-guided Kerrison. Surgically significant morphometric data were measured using a computer-assisted image-guided surgical system.

RESULTS

Successful navigation into all neuroforamina in the subaxial cervical spine was attained using the image-guided Kerrison punch. The vector measurement from the neuroforamen to the vertebral artery averaged 5.8 +/- 1.2 mm at C3-C4, 6.5 +/- 1.6 mm at C4-C5, 7.9 +/- 1.4 mm at C5-C6, and 9.1 +/- 1.8 mm at C6-C7. Statistically significant differences (P < 0.05) were found between all cervical levels except C3-C4 and C4-C5.

CONCLUSION

An image-guided Kerrison punch may be used successfully when performing cervical foraminotomies during an anterior cervical discectomy, thus eliminating the risk of potential vertebral artery injury. These data confirm previous findings by other authors. Knowledge of these data may aid the spine surgeon in performing a foraminotomy during anterior cervical decompression.

Cervical degenerative disease: rationale for selecting the appropriate fusion technique (Anterior, posterior, and 360 degree)

Many options exist for those treating cervical disc herniation, spondylosis, and deformity. This article examines the options for cervical degenerative fusions, the appropriate choice of technique (anterior, posterior, or combined anterior/posterior techniques), as well as bone graft and instrumentation choices.

Bivector traction for unstable cervical spine fractures: a description of its application and preliminary results

The management of acute, displaced odontoid fractures requires the restoration of sagittal alignment and rigid external or internal immobilization to prevent late instability and achieve union. This report introduces a new traction technique for the reduction of posteriorly displaced type 2 odontoid fractures. Seven patients with traumatic injuries to the dens were placed in bivector traction for an awake closed reduction. Sagittal alignment was restored and maintained in all patients with no neurologic deterioration or traction-related complications during an average of 11 days (range, 2-28 days) in traction. The overall sagittal alignment corrected from an initial average of 12.2 mm (range, 5-22 mm) of posterior displacement to an average of 1.1 mm (range, 0-3 mm) at the completion of reduction. Only one patient had residual angulation, which measured 5 degrees. Three patients achieved an osseous union and the remaining four required a posterior C1-C2 fusion for nonunion. Although operative stabilization may be the preferred approach in this patient population and injury pattern, we conclude that bivector traction is a safe and effective technique for the initial management of posteriorly displaced odontoid fractures. In addition, its role can be expanded to the closed reduction of lower cervical spine fractures in patients with fixed flexion deformities secondary to ankylosing spondylitis or disseminated intraosseous segmental hyperostosis.