Total subaxial reconstruction

Traynelis, Vincent C.

doi:10.3171/2010.4.spine09923

Cited by 12 publications

(8 citation statements)

References 62 publications

(71 reference statements)

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“…Significant multilevel cervical spinal deformities secondary to disease processes such as rheumatoid arthritis may require anterior, posterior, or combined approaches. 31 In these cases, the use of interfacet spacers may be useful to increase foraminal area, facilitate decompression of the cervical nerve root, and decrease the risk of iatrogenic foraminal stenosis. Interfacet allograft can be used in combination with laminectomy or laminoplasty for management of spinal cord compression.…”

Section: 23mentioning

confidence: 99%

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Tan

Gerard

Anderson

et al. 2014

SPI

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Object Iatrogenic foraminal stenosis is a well-known complication in cervical spine surgery. Machined interfacet allograft spacers can provide a large surface area, which ensures solid support, and could potentially increase foraminal space. The authors tested the hypothesis that machined interfacet allograft spacers increase cervical foraminal height and area. Methods The C4–5, C5–6, and C6–7 facets of 4 fresh adult cadavers were exposed, and the cartilage was removed from each facet using customized rasps. Machined allograft spacers were tamped into the joints. The spines were scanned with the O-arm surgical imaging system before and after placement of the spacers. Two individuals independently measured foraminal height and area on obliquely angled sagittal images. Results Foraminal height and area were significantly greater following placement of the machined interfacet spacers at all levels. The Pearson correlation between the 2 radiographic reviewers was very strong (r = 0.971, p = 0.0001), as was the intraclass correlation coefficient (ICC = 0.907, p = 0.0001). The average increase in foraminal height was 1.38 mm. The average increase in foraminal area was 18.4% (0.097 mm2). Conclusions Modest distraction of the facets using machined interfacet allograft spacers can increase foraminal height and area and therefore indirectly decompress the exiting nerve roots. This technique can be useful in treating primary foraminal stenosis and also for preventing iatrogenic foraminal stenosis that may occur when the initially nonlordotic spine is placed into lordosis either with repositioning after central canal decompression or with correction using instrumentation. These grafts may be a useful adjunct to the surgical treatment of cervical spine disease.

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Section: 23mentioning

confidence: 99%

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Tan

Gerard

Anderson

et al. 2014

SPI

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“…The contribution of facet resection to postlaminectomy instability has been well documented [2,14,15,17,29]. Thus, it is important that patients should not be considered for posterior procedures if their preoperative sagittal alignment is not lordotic, and they cannot be corrected with traction and reduction [29,38,44]. The principles of anterior column lengthening, posterior column shortening, and hinge correction around the posterior longitudinal ligament are recommended [3,10,11,29,33,35,36].…”

Section: Discussionmentioning

confidence: 99%

“…Present-day cervical spine instrumentation allows for anterior vertebral lengthening and fixation as well as dorsal rigid stabilization [38]. This manuscript provides an insight to results prior to the new instrumentation with long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Pediatric cervical kyphosis in the MRI era (1984–2008) with long-term follow up: literature review

Menezes

Traynelis

2021

Childs Nerv Syst

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Objective Cervical kyphosis is rare in the pediatric population. It may be syndromic or acquired secondary to laminectomy, neoplasia, or trauma. Regardless, this should be avoided to prevent progressive spinal deformity and neurological deficit. Long-term follow-up is needed to evaluate fusion status, spine growth, potential instability, and neurological function. Methods and materials A retrospective review of 27 children (6 months to 16 years) with cervical kyphotic deformity was performed and limited to the MRI era until 2008, to provide a long-term follow-up after which complex instrumentation was available. There were 27 patients, 19 syndromic (average age 5.36 years), and 8 non-syndromic (average age 14 years). Syndromes encountered were spondyloepiphyseal dysplasia (SED) 4, spondylometaphyseal dysplasia 1, unnamed collagen abnormality syndrome 1, osteogenesis imperfecta (OI) 2, Aarskog syndrome 1, Weaver syndrome 1, Larsen syndrome 1, multiple cervical level disconnection syndrome 1, Klippel-Feil 3, congenital absence of C2 pars 4. Non-syndromic cases; 2 with neurofibromatosis (NF1) and prevertebral tumors, fibromatosis 1, spontaneous kyphosis 1, and postlaminectomy 4. Factors considered were age, pathology, flexibility on cervical spine dynamic films, reduction with traction and spinal cord compression. Patients with flexible kyphosis underwent dorsal fixation. Children with non-flexible ventral compression/ kyphosis had crown halo traction. Irreducible kyphosis had ventral decompression and fusion as well as dorsal fusion. Eleven of 19 syndromic children with flexible and reducible kyphosis underwent dorsal fixation alone. Four of 8 non-syndromic (2 NF1) needed ventral and dorsal approaches. ResultsThe preoperative deformity (global and local Cobb angles) as well as neurological status improved. Growth during follow-up was not impaired, and we did not encounter instability or junctional kyphosis. The only complications were seen in syndromic patients. One patient with SED showed delayed cantilever bending of the ventral fusion mass requiring reoperation, and 1 other OI child had left C5 and C6 nerve root weakness after anterior C4 and C5 decompression which resolved over 1 year. One child with SED developed cervicothoracic junction scoliosis 18 years later after thoracic scoliosis surgery. Conclusions Syndromic pathology presented early with neurological dysfunction and 24% had rigid kyphosis. An attempt at traction/reduction was successful as in Tables 1 and 2. The majority exhibited long-term improvement in kyphosis and function. A treatment algorithm and literature review is presented.

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“…In such cases, the PAP approach with an initial posterior release, anterior correction and reconstruction, and posterior fixation with or without further correction was used. 1,24…”

Section: Methodsmentioning

confidence: 99%

“…In such cases, the PAP approach with an initial posterior release, anterior correction and reconstruction, and posterior fixation with or without further correction was used. 1,24 Case examples are provided in Figures 3 and 4. The choice of anterior approach (anterior cervical diskectomy and fusion, anterior osteotomy, anterior cervical corpectomy and fusion, or hybrid construct) was determined by the individual surgeon.…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of Perioperative Complications After Anterior–Posterior Versus Posterior–Anterior–Posterior Cervical Fusion: A Retrospective Review of 153 Consecutive Cases

et al. 2023

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BACKGROUND: Although published data support the utilization of circumferential fusion to treat select cervical spine pathologies, it is unclear whether the posterior–anterior–posterior (PAP) fusion has increased risks compared with the anterior–posterior fusion. OBJECTIVE: To evaluate the differences in perioperative complications between the 2 circumferential cervical fusion approaches. METHODS: One hundred fifty-three consecutive adult patients who underwent single-staged circumferential cervical fusion for degenerative pathologies from 2010 to 2021 were retrospectively reviewed. Patients were stratified into the anterior–posterior (n = 116) and PAP (n = 37) groups. The primary outcomes assessed were major complications, reoperation, and readmission. RESULTS: Although the PAP group was older (P = .024), predominantly female (P = .024), with higher baseline neck disability index (P = .026), cervical sagittal vertical axis (P = .001), and previous cervical operation rate (P < .00001), the major complication, reoperation, and readmission rates were not significantly different from the 360° group. Although the PAP group had higher urinary tract infection (P = .043) and transfusion (P = .007) rates, higher estimated blood loss (P = .034), and longer operative times (P < .00001), these differences were insignificant after the multivariable analysis. Overall, operative time was associated with older age (odds ratio [OR] 17.72, P = .042), atrial fibrillation (OR 158.30, P = .045), previous cervical operation (OR 5.05, P = .051), and lower baseline C1-7 lordosis (OR 0.93, P = .007). Higher estimated blood loss was associated with older age (OR 1.13, P = .005), male gender (OR 323.31, P = .047), and higher baseline cervical sagittal vertical axis (OR 9.65, P = .022). CONCLUSION: Despite some differences in preoperative and intraoperative variables, this study suggests both circumferential approaches have comparable reoperation, readmission, and complication profiles, all of which are high.

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Total subaxial reconstruction

Cited by 12 publications

References 62 publications

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Effect of machined interfacet allograft spacers on cervical foraminal height and area

Pediatric cervical kyphosis in the MRI era (1984–2008) with long-term follow up: literature review

Comparison of Perioperative Complications After Anterior–Posterior Versus Posterior–Anterior–Posterior Cervical Fusion: A Retrospective Review of 153 Consecutive Cases

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