Anterior Reconstruction Techniques for Cervical Spine Deformity

Abstract

Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential-including global or focal realignment in the sagittal and coronal planes. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. A detailed understanding of the patient's local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.

Unilateral spacer distraction of the subaxial cervical facet joint for the treatment of fixed coronal malalignment of the craniovertebral junction

“…[ 17 ] In deformity correction, the risk of arterial injury during the surgical treatment by the anterior, posterior, or combined approaches is increased. [ 18 19 20 21 ] This is compounded by the challenges posed by the tortuous course the vertebral artery may take due to abnormalities or variants to the normal anatomy associated with diseases and disorders of the craniovertebral junction. [ 22 ] Therefore, a preoperative angiogram is essential to have a meticulous understanding of the vascular anatomy of each patient.…”