Posterior Cervical Fusions Using Cerclage Wires, Methylmethacrylate Cement and Autogenous Bone Graft

Whitehill, Richard; Stowers, Stewart F.; Fechner, Robert E.; Ruch, Wolfgang W.; Drucker, S; Gibson, Lloyd R.; McKernan, Daniel; Widmeyer, Jeffrey H.

doi:10.1097/00007632-198701000-00003

Cited by 30 publications

(15 citation statements)

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“…However, the use of PMMA cement in spinal fixation has been debated because of theoretical objections based on experimental studies suggesting a possible decreasing stability with time and potential bone reorbing activity of the PMMA [10,36,37].…”

Section: Discussionmentioning

confidence: 99%

Occipito-cervical fixation in rheumatoid arthritis — an analysis of surgical risk factors in 163 patients

et al. 1995

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163 patients with rheumatoid arthritis (RA) and atlanto-axial subluxation treated by posterior occipito-cervical fixation (OCF) over a period of twenty-one years (November 1970-January 1991) were followed. Common complaints prior to surgery were occipital headache, neck pain, radicular pain and myelopathy. The mean age at time of surgery was 61 years. The mean follow-up time was 54 months. Clinical improvement was obtained in 88% of the patients, whereas 7% were unchanged and 5% had progressive symptoms in spite of surgery. There was no pre-operative or immediate postoperative mortality. In 79 patients, one or more potential surgical risk factors were identified. Twenty-four reoperations were performed in the neck. The most common cause for reoperation was mechanical failure due to wire-break or spinous process fracture. Wound infection in the neck was recorded in 16 patients. Five were deep and required removal of the fixation material. Following OCF, new or progressive subaxial subluxation (SAS) led to further surgery in 4%. The study offers support for the beneficial effect of OCF in rheumatoid AAS. We conclude that, in spite of a number of identified risk factors, OCF with the Brattström-Granholm technique remains a safe and effective method for stabilization of upper cervical subluxations in RA.

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Section: Discussionmentioning

confidence: 99%

Occipito-cervical fixation in rheumatoid arthritis — an analysis of surgical risk factors in 163 patients

et al. 1995

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“…Reviewing English literature, we can realize a tendency to preclude the use of PMMA because of its lower arthrodesis rates [15][16][17][18] and a high rate of complications [19][20][21] . However, Germany literature represents an opposite point of view: they affirm that PMMA is safe and efficient, sometimes safer than the autologous bone, with fewer rates of fracture and extrusion 5,22,23 .…”

Section: Surgical Techniquesmentioning

confidence: 99%

Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate

Mudo

Amantéa

Joaquim

et al. 2009

Arq. Neuro-Psiquiatr.

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-Background and objectives: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. Method: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD) submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA). Odom and Nürick scales were used to evaluation of functional status before and after surgery. Cervical spine X-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. Results: Excellent and good results (Odom I and II) were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. Using the chi square test of independence (1% of significance), there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical X-rays. The presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. Two patients died: one cervical hematoma and other from graft migration with cord compression. Conclusions: Cervical alignment was more important than fusion to achieve good surgical results in CDD.KEY WORDS: discectomy, polymethylmetacrilate (PMMA), arthrodesis, fusion, cervical alignment. avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato resumo -Tema e objetivo: O tratamento cirúrgico da radiculopatia cervical com ou sem mielopatia é um tema controverso, embora a discectomia por via anterior seja uma das formas mais comuns de tratamento. Método: Apresentamos a avaliação da artrodese cervical e do alinhamento pós operatório em 48 pacientes com doença degenerativa cervical (DDC) submetidos a discectomia por via anterior seguida da interposição de polimetilmetacrilato (PMMA). As escalas de Odom e de Nurick foram utilizadas para avaliar o status funcional dos pacientes antes e após a cirurgia. Radiografias da coluna cervical foram utilizadas para avaliar a artrodese e o alinhamento cervical, pelo menos 2 anos após o procedimento. Resultados: Excelentes e bons resultados (Odom I e II) foram obtidos em 91% dos casos com radiculopatia e em 69% dos pacientes com mielopatia. Usando o teste do qui-quadrado de independência (1% de significância), não houve associação entre os resultados excelentes e bons e a presença de artrodese. A presença de alinhamento cervical, ao contrário, correlacionou-se com bons resultados. Dois pacientes faleceram devido a hematoma cervical e migração do enxerto. Conclusão: O alinhamento cervical correlacionou-se com bons resultados cirúrgicos em nossos pacientes, enquanto que a taxa de artrodese não teve relação com o resultado clínico dos pacientes. PALAVRAS-CHAVE: discectomia, polimetilmetacrilato (PMMA), alinhamento cervical, artrodese.

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“…Getestet wurden ventral die winkelinstabile H-Platte [64,68], die Caspar-Platte [16,28,53,66], die CSLP [10,28,40,47,53,64], die ¹acro-med-plateª [40] und dorsal die sublaminäre Drahtcerclage nach Brooks [16,66,68], die Rogers-Cerclagetechnik durch die Basis der Dornfortsätze [16,25,47,66,74 ], die sog. ¹triple-wire-techniqueª nach Bohlmann [16,40,66], mono-und multisegmentale Plattenspondylodesen [25,40,53], die Halifax-Klammer [25], das Hakenplättchen [16,66,68], die Roy-Camille-Platte [16,63] und der Cervifix [36].…”

Section: Biomechanische Ergebnisseunclassified

“…Weit von einem international standardisierten Versuchsaufbau entfernt stimmen doch alle Ergebnisse, ob an Menschen- [10,16,25,47,63,64,68], Rinder- [40,66], Schweine- [28,53] oder Hundehalswirbelsäulen [74] erzielt, darin überein, daû die dorsalen schraubenfixierten Verfahren bei kompletter intersegmentaler Instabilität bzgl. der Steifigkeit den ventralen überlegen war.…”

Section: Biomechanische Ergebnisseunclassified

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Clinicial and biomechanical performance of lower cervical spine fixation procedures

Ulrich

Nothwang

1999

Orthopäde

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The break with the demand for maximum rigity of implant fixation of a traumatized unstable lower cervical spine is based on analyis and implementation of scientific and clinical data on the biomechanics of the native, the unstable and the implant-fixed spinal column. In view of these facts, recommendations for stabilization of the lower cervical spine can presently be formulated as follows:- The surgical procedure is to bring about decompression, restoration of form and stability.- The anterior approach should be the primary and preferred one. With regard to surgical and positioning technique, this access clearly involves less problems than the posterior approach; if required, unrestricted additional cord decompression can take place; implant fixation is technically simple: and the awareness of instability and type of implant permits functional therapy, also and above all for the paraplegic patient.- For traumatic conditions, posterior methods are reserved for exceptional indications, and being single procedures, they require the anterior column to be intact and a multisegmental procedure. They are therefore less recommendable for traumata but rather suitable for degenerative, rheumatoid or tumorous instabilities. The cerclage wire technique depends on intact, osseous posterior elements, while after laminectomy only screwed implants can secure safe stability. This disadvantage of the posterior access for the proprioception of the cervial muscles and the subjective well-being of the patient are known and to be taken into account.- Combined techniques are indicated for highly unstable or particularly complex injuries. On the cervicothoracic junction or in cases of Bechterew's disease, the decision is justifiably made in favor of the technique, which ca be performed as one-stage or two-stage operation.- Whenever possible, selection of the implant should take into account the foreseeable developments in diagnostic procedures; and therefore, with a view to follow-up examinations required later and to modern imaging techniques, the implant chosen should be made of titanium.

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Posterior Cervical Fusions Using Cerclage Wires, Methylmethacrylate Cement and Autogenous Bone Graft

Cited by 30 publications

References 0 publications

Occipito-cervical fixation in rheumatoid arthritis — an analysis of surgical risk factors in 163 patients

Occipito-cervical fixation in rheumatoid arthritis — an analysis of surgical risk factors in 163 patients

Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate

Clinicial and biomechanical performance of lower cervical spine fixation procedures

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