Instrumentation of the Cervicothoracic Junction After Destabilization

Bueff, H. Ulrich; Lotz, Jeffrey C.; Colliou, Olivier K.; Khapchik, Vladimir; Ashford, Francis; Hu, Serena S.; Bozic, Kevin J.; Bradford, David S.

doi:10.1097/00007632-199508150-00007

Cited by 60 publications

(44 citation statements)

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“…Anterior plates have been reported to offer a less rigid fixation than posterior constructs based on screws, wires and hooks [5,7,24,38,39]. In a human cadaver study, Bueff et al [5] showed that the pediatric CD system with sublaminar hooks and a crosslink provided a larger increase in stiffness of the cervicothoracic junction (C7-T1) than posterior lateral mass plates and an anterior plate. Particularly in patients with osteoporotic bone, as in RA and ankylosing spondylitis, which are common patient categories in cervical spine surgery, the use of hooks resting on intact cortical laminar bone seems advantageous to screw fixation.…”

Section: Discussionmentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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IntroductionSince Hadra first described the time-honored technique of cervical wiring, several alternative fixation techniques have been developed, all with inherent limitations and risks.In atlanto-axial surgical stabilization, the Gallie wiring technique is still the gold standard, but it has several limitations [15,26]. Its mechanical stabilizing potential is limited, it does not result in rotational or translational sagittal stability and additional external fixation is needed, which is a great disadvantage, particularly in rheumatoid arthritis (RA) and metastatic disease. Transarticular C2-1 screws with additional Gallie type wire fixation is biomechanically attractive, offering rotational and translational stability, but is technically demanding, with a risk of vertebral artery injury [8,29,40].Wiring is also a traditional method of subaxial spine fixation [33]. Techniques based on wires through the Abstract There are today several techniques available for cervical fixation -all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17-84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre-and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.

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Section: Discussionmentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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“…T2, 3 PS & R T2, 3 T2, 3 P C7-T5 2 2 4 19 57/M RCC T1 PS & R T1 T1, 2 P C7-T3 2 ior, posterior constructs prove superior to anterior plates for managing instabilities between C7 and T1. Bueff et al 5) compared three different fixation devices at the CTJ-an anterior plate, a posterior plate, and a posterior hook rod sytems. Anterior plates provided the least rigid construct in all tests and were significantly less stiff than posterior plates.…”

Section: Fig 4 Comparison Of Screw Violation Rate (%)mentioning

confidence: 99%

“…However, there have been serious complications related to visceral and vascular injury during anterior approach. Posterior stabilization is generally preferred for posterior and three column injuries because anterior plating is estimated to be biomechanically the least rigid construct in all tests and significantly less stiff than any type of posterior stabilization 5) . Several kinds of posterior fixation have been suggested, for example, sublaminar wiring with rod/plate fixation, laminar hook with rod fixation, and pedicle screw with rod fixation system 8,12,14,30) .…”

Section: Introductionmentioning

confidence: 99%

“…Lateral mass screw cannot provide strong fixation at C6, 7 levels of which lateral mass is smaller than other cervical levels 15) . Biomechanically, the transpedicular screw fixation system has the highest stability and is frequently considered, but it has a demerit of high possibility of pedicle violation 4,5,28) . CTJ is a surgically challenging area because vertebral artery, small spinal canal, and tenuous blood supply to spinal cord may cause frequent neurovascular complications.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Cho

Eid

Chang

2010

J Korean Neurosurg Soc

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Objective : In cervico-thoracic junction (CTJ), the use of strong fixation device such as pedicle screw-rod system is often required. Purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels. Methods : Nineteen patients underwent posterior CTJ fixation with C7 and/or T1 included in fixation levels. Seventeen patients had tumorous conditions and two with post-laminectomy kyphosis. The anatomical features were analyzed for C7 and T1 pedicles in 19 patients using computerized tomography (CT). Pedicle screw and rod fixation system was used in 16 patients. Pedicle violation by screws was evaluated with postoperative CT scan. Results :The mean values of the width, height, stable depth, safety angle, transverse angle, and sagittal angle of C7 pedicles were 6.9 ± 1.34 mm, 8.23 ± 1.18 mm, 30.93 ± 4.65 mm, 26.42 ± 7.91 degrees, 25.9 ± 4.83 degrees, and 10.6 ± 3.39 degrees. At T1 pedicles, anatomic parameters were similar to those of C7. The pedicle violation revealed that 64.1% showed grade I violation and 35.9% showed grade II violation, overall. As for C7 pedicle screw insertion, grade I was 61.5% and grade II 38.5%. At T1 level, grade I was 65.0% and grade II 35.0%. There was no significant difference in violation rate between the whole group, C7, and T1 group. Conclusion : C7 pedicles can withstand pedicle screw insertion. C7 pedicle and T1 pedicle are anatomically very similar. With the use of adequate fluoroscopic oblique view, pedicle screw can be safely inserted at C7 and T1 levels.

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“…При этом, в зависимости от конкретной кли-нической ситуации, ЗЦС выполня-ют на протяжении как одного позво-ночно-двигательного сегмента (ПДС) -моносегментарный спондилодез, так и нескольких -бисегментарный или мультисегментарный спондило-дез, а при необходимости стабили-зируют также краниовертебральный и/или шейно-грудной переход [1,3,4,6,16,17,25,27,2]. В 90-х гг.…”

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Posterior Fusion in Cervical Spine Surgery

Корж¹,

Barysh²

2010

Hir. pozvonoč.

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Instrumentation of the Cervicothoracic Junction After Destabilization

Cited by 60 publications

References 0 publications

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Posterior Fusion in Cervical Spine Surgery

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