Posterior cervical interspinous compression wiring and fusion for mid to low cervical spinal injuries

Abstract

A technique of posterior cervical interspinous compression wiring and fusion, which offers significant immediate stability, is presented. Its efficacy in 50 consecutive cases illustrates its utility. The technique involves the passage of an interspinous cerclage wire. Rather than placement of onlay laminar and facet grafts, a split-thickness tricortical iliac-crest graft is compressed against the involved medial laminae and spinous processes bilaterally. These grafts are held in place by a compression wire, which encircles the grafts and thus sandwiches the spinous processes between them. This virtually ensures subsequent bone fusion and offers substantial acute stability. The compression wire offers an added advantage of encircling the cerclage wire, thus pulling it dorsally. This significantly diminishes translational mobility at the unstable segment. It also minimizes hyperextension at the unstable segment via medial compression of the grafts into the interspinous space. The fusion of a minimal number of spinal segments is emphasized. This substantially diminishes the chance of flexible kyphosis and degenerative changes, both above and below the fusion site. A three- or four-level fusion was performed in only 11 patients. The remaining 39 patients underwent two-level fusion. A solid bone fusion was achieved in all cases, with a follow-up period of at least 6 months. In one patient, the spinous process fractured, necessitating an anterior fusion procedure. The technique presented here appears to acutely offer a very stable construct and, in addition, is a simple and straightforward procedure for the treatment of the unstable cervical spine.

Clinical Experiences and Usefulness of Cervical Posterior Stabilization with Polyaxial Screw-Rod System

“…Traditionally 2,11) , posterior fixation of the cervical spine has involved some forms of wire fixation. Wire fixation is inexpensive, has a proven long-term track record, and requires no special expertise or X-ray guidance 1,3,4,7,16) .…”

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

“…However, because it has the potential to seriously injure the spinal cord, nerve roots or vertebral arteries, pedicle screw fixation has generally been considered a risky surgery [18]. For cases in which posterior wiring or lateral mass plating cannot be applied, transpedicular fixation may provide optimal stabilisation for an unstable motion segment [6,19,21]. Therefore, when the safety of the procedure is ensured, cervical pedicle screw fixation could become an effective procedure for reconstructing the cervical spine.…”

Surgical approach in treatment of translation/rotation injuries of the lower cervical spine in 21 patients

“…However, the failure to maintain anatomical reduction after surgery ranged from 1 to 18%. 3,8,[19][20][21][22] In our serie of 21 cases treated, only one case (5%), who was treated with an anterior approach, had a belated displacement requiring a second surgery. Another had a minimal displacement after surgery and did not require additional procedure.…”

“…7,19,25 Complications of anterior approach are dysphagia and dysphonia. Radiculopathy may occur up to 25% of cases of posterior approach.…”