Reconstruction of the Cervical Spine Following Anterior Vertebral Body Resection: A Mechanical Analysis of a Canine Experimental Model

Whitehill, Richard; Reger, Steven I.; Kett, R L; Payne, Ray; Barry, John

doi:10.1097/00007632-198404000-00003

Cited by 7 publications

(3 citation statements)

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“…[26][27][28] The graft must be prepared carefully because anterior cervical instrumentation cannot substitute for a good fusion. 10,43,[48][49][50]53 Internal fixation by means of a plate has been reported to increase the incidence of fusion and to decrease the need for a rigid orthosis or posterior cervical fixation. 22,46 Autogenous iliac crest bone is the preferred graft material because vascularization and ossification occur more rapidly than when allograft is used.…”

Section: Graft Materialsmentioning

confidence: 99%

Cervical corpectomy: report of 185 cases and review of the literature

Eleraky¹,

Llanos²,

Sonntag³

1999

Journal of Neurosurgery: Spine

121

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Object. This study was conducted to determine the indications, safety, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions. Methods. Between 1987 and 1998, 185 patients underwent cervical corpectomy for the treatment of degenerative spondylitic disease (81 cases), ossification of posterior longitudinal ligament (16 cases), correction of postoperative kyphosis (31 cases), trauma (39 cases), tumor (10 cases), and infection (eight cases). Ninety-nine patients presented with myelopathy, 48 with radiculomyelopathy, 24 with radicular pain, and 14 with neck muscle pain. Eighty-seven patients underwent a one-level corpectomy; 45 of these patients underwent a discectomy at a different level. Seventy patients underwent a two-level corpectomy; 27 of these patients underwent a discectomy at a different level. Twenty-eight patients underwent a three-level corpectomy. Autograft (iliac crest) was used in 141 cases and allograft (fibula) in 44 cases. All but six patients underwent fixation with an anterior plate-screw system. There were no operative deaths. During the procedure the vertebral artery was injured in four patients and preserved in two of them. No neurological sequelae were encountered. Postoperative hoarseness, transient dysphagia, and pain at the graft site were transitory and successfully managed. The fusion rate was 98.8%. Six patients experienced transient deterioration after surgery but they improved. No patient experienced permanent neurological deterioration and 160 (86.5%) improved. Conclusions. Corpectomy has an important role in the management of various degenerative, traumatic, neoplastic, or infectious disorders of cervical spine. Following treatment in this series, radiculopathy always improved and myelopathy was reversed in most patients.

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Section: Graft Materialsmentioning

confidence: 99%

Cervical corpectomy: report of 185 cases and review of the literature

Eleraky¹,

Llanos²,

Sonntag³

1999

Journal of Neurosurgery: Spine

121

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“…3 Posterior ligamentous instability is not always appreciated when viewed on radiographic studies but is most important to consider when choosing an operative approach for stabilization. 14,25 In their study using a canine model, Whitehill and colleagues 29 have shown that in the face of posterior ligamentous instability anterior stabilization approaches do not result in a construct that can handle physiological flexion loads. Therefore, in instances in which anterior decompression of neurological structures is not necessary, posterior procedures are the technique of choice.…”

mentioning

confidence: 99%

Posterior cervical spine fusion with tension-band wiring

Lovely¹,

Carl²

1995

Journal of Neurosurgery

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In this study the authors detail their experience with posterior tension-band wiring for stabilization of the subaxial cervical spine. Fifty-five patients underwent fusion for trauma (41 patients), degenerative disease (13 patients), and tumor (one patient). The fusion rate was 96% (50 of 52 patients) and postoperative immobilization was accomplished by means of a Philadelphia collar in the majority of cases. Tension-band wiring provides a stable construct that is simple to perform, requires fusion of a minium number of motion segments, and allows early mobilization with only a hard collar needed for support. The details of the technique, which has been modified from preliminary descriptions, are discussed.

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“…Anterior fusions alone, in addition, do not offer acute stability and are associated with subsequent spinal deformities. 10,29,32,34 By forcing the bone graft medially into the interspinous space during the tightening of the compression wire, an acceptable interspinous distance is usually achieved with the technique described here. This "wedge" of bone prevents the spinous processes from "kissing" each other, thus minimizing the chance for hyperextension.…”

Section: Discussionmentioning

confidence: 99%

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

Benzel¹,

Kesterson²

1989

Journal of Neurosurgery

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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.

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Reconstruction of the Cervical Spine Following Anterior Vertebral Body Resection: A Mechanical Analysis of a Canine Experimental Model

Cited by 7 publications

References 0 publications

Cervical corpectomy: report of 185 cases and review of the literature

Cervical corpectomy: report of 185 cases and review of the literature

Posterior cervical spine fusion with tension-band wiring

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

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