Treatment of Lower Cervical Spinal Injuries—C3 to C7

Roy-Camille, R; Saillant, G; Laville, Christian; Benazet, J. P.

doi:10.1097/00007632-199210001-00017

Cited by 144 publications

(85 citation statements)

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“…In regard to the trauma literature, conclusions that might be drawn from several previous studies suffer on heterogeneous samples [3,7,33,40,44,55,57,59,62,67,77,82,83,89,95], and direct comparisons of results after different treatments remain difficult [29,81]. But the accurate collection of qualitative outcome data is essential because it reflects what is relevant to the patient and society [33].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, posterior approaches may be injurious to adjacent levels; this has been postulated to cause late deformity [68,81]. Additionally there have also been concerns regarding the rate of wound infection, the inability to address a disrupted disc prior to reduction, and the ability of stand-alone posterior stabilization to prevent segmental kyphosis despite including more segments into the fusion mass [29,42,54,60,64,75,83]. However, there have been also both theoretical and practical concerns regarding the use of anterior plating alone in severe instabilities [32].…”

Section: Introductionmentioning

confidence: 99%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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“…Muffoletto et al [14] reported that the longer unicortical insertion of a lateral mass screw leads to equal pullout strength compared with bicortical insertion, and recommended longer unicortical screw purchase to reduce the risk of neural or arterial involvement. However, many investigators in clinical studies [2,9,10,16] have recommended the use of bicortical screw purchase in the lateral mass, because it is biomechanically superior to unicortical purchase. Moreover, it is very difficult to control the screw length within a few millimeters.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of subaxial cervical foramens: the safety zone for lateral mass screwing

Nishinome

Iizuka

et al. 2011

Eur Spine J

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AbstractsIntroduction The purpose of this study was to measure the structures of the ventral of lateral masses using cadaver specimens and to quantitatively compare the safety zone for the two major techniques used on each vertebral level from C3 to C6. Methods This study is based on 52 cervical vertebrae of 13 cadavers. The anatomical measurements focused on the anterior surface of the lateral mass. We investigated the safety width, heights, and the height of nerve roots. Results The mean values of the safety width of the Magerl technique from C3 to C6 were 6.1, 7.3, 6.4 and 4.3 mm, respectively. The mean values of the safety width of the Roy-Camille technique were 6.7, 6.6, 5.8 and 5.4 mm, respectively. The mean values of the safety height of the Magerl technique were 5.0, 5.4, 5.8 and 5.2 mm, respectively. The mean values of the safety height of the Roy-Camille technique were 4.9, 4.0, 1.0 and -1.2 mm, respectively. The mean values of the nerve root height were 3.9, 4.9, 5.9 and 6.9 mm, respectively. Conclusion The safety width of the Magerl technique was shorter at C6 because the vertebral artery runs more laterally at C6. The height for the Magerl technique was not significantly different from C3 to C6, however, the safety height for the Roy-Camille technique was significantly shorter at C5 and C6. Our findings suggest that it is important to ensure that the screw(s) penetrate through the cranial side of the ventral aspect of a lateral mass when performing the Magerl technique at all vertebral levels, and to carefully select the screw length when using the RoyCamille technique, especially at C5 and C6, in order to avoid nerve root injury.

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“…Although lateral mass screw fixation in the cervical spine has been shown to provide excellent stability and high rates of fusion in adult patients, 8,14,16 little has been published about the use of subaxial lateral mass screws in the pediatric age group. In this age group, unlike the adult age group, there have been limited cadaveric biomechanical analyses of these types of constructs.…”

Section: Discussionmentioning

confidence: 99%

Translaminar screw fixation in the subaxial pediatric cervical spine

Jea¹,

Johnson²,

Whitehead³

et al. 2008

PED

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The use of spinal instrumentation to stabilize the occipitocervical junction in pediatric patients has increased and evolved in recent years. Wiring techniques have now given way to screw-rod or screw-plate techniques with or without postoperative external immobilization. Although C-2 translaminar screws have been used in these constructs, subaxial translaminar screws have not, to date, been described in either the pediatric or adult patient populations. The authors describe the feasibility of translaminar screw placement in the C-3 lamina. Rigid fixation with translaminar screws offers an alternative to subaxial fixation with lateral mass screws, allowing for formation of biomechanically sound spinal constructs and minimizing potential neurovascular morbidity. Their use requires careful analysis of preoperative imaging studies, intact posterior elements, and avoidance of violation of the inner laminar wall.

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Treatment of Lower Cervical Spinal Injuries—C3 to C7

Cited by 144 publications

References 0 publications

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Anatomy of subaxial cervical foramens: the safety zone for lateral mass screwing

Translaminar screw fixation in the subaxial pediatric cervical spine

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