Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

Abstract

The authors report on 32 consecutive patients with instability at the craniocervical, cervical and cervicothoracic regions suffering from various pathologies, who were treated with posterior instrumentation and fusion using the posterior hooks-rods-plate cervical compact Cotrel-Dubousset (CCD) instrumentation alone or, in three patients, in combination with anterior operation. The patients were observed postoperatively for an average of 31 months (range 25-44 months) and evaluated both clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, complications and status of arthrodesis. All patients but one (who died) achieved a solid arthrodesis based on plain and flexion/extension roentgenograms. Cervical lordosis (skull-C7) and cervicothoracic kyphosis (C7-T2) was improved by instrumentation towards a physiological lateral curve by an average of 33% (P<0.05) and 28% (P<0.05) respectively. Anterior vertebral olisthesis was reduced in the craniocervical and cervicothoracic region, by 73% and 90% respectively. At final follow-up there was an improvement of the neurologic Frankel status by an average of 1.2 grades and of myelopathy in 75% of the operated patients. Good to excellent functional results were seen in 77% of the operated patients, while acute and chronic pain was reduced by an average of 2.4 grades, on a scale of 0-3, in operated patients. No neurovascular or pulmonary complications arose from surgery. There was no significant change in lateral spine profile and olisthesis at the latest follow-up evaluation. There were no instrument-related failures. One patient requested hardware removal in the hope of reducing postoperative pain in the cervicothoracic region. The poor and fair results were related to the lack of improvement of neurologic impairment and myelopathy. The results of this study demonstrate that cervical CCD instrumentation applied in the region of the skull to the upper thoracic region for various disorders is a simple and safe instrumentation that restores lateral spine alignment, improves the potential for a solid fusion and offers sufficient functional results in the vast majority of the operated patients. However, the use of hooks in spinal stenosis is contraindicated.

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

“…The SHRSs, initially popularized by Cotrel and Dubousset, have been used for stabilization of the CTJ. 10 The disadvantage of using sublaminar hooks is predicated on the fact that it requires laminar integrity and cannot be utilized in a stenotic spine. Although our fixation failure rate was relatively low (15%) when using sublami-nar hooks, a patient who underwent reoperation for a spinal tumor treated at an outside institution experienced a significant spinal cord injury after hook placement, which was the impetus to change to a PSS as these systems became available.…”

34 Occipitocervical Fusion

“…58 Modular screw-and-rod systems were developed on the success of rigid plate fixation. [59][60][61] Abumi published a series using cervical pedicle screws in a screw-rod construct, with fusion obtained in 24 of 26 patients, significant malalignment correction, and no screw insertion complications. 62 Vale described a rigid posterior OCF system, improving the occipital fixation points towards the thicker skull midline under the external occipital protuberance.…”

Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy : a case report

“…The advantages of the hook-androd system, as compared to other techniques includes easy handling, a safe implantation, firm anchorage to the occipital bone, and an excellent postoperative stability. Several reports have described a high rate of successful osseous fusion [2,5,7,11,14]. On the other hand, one disadvantage of this system is the requirement of longer instrumentation because of the use of the claw configurations at two levels of fixation.…”