Anatomic considerations of the anterior upper cervical spine during decompression and instrumentation: a cadaveric based study

Fard, Salman Abbasi; Patel, Apar S.; Avila, Mauricio J.; Sattarov, Kamran; Walter, C.; Skoch, Jesse; Baaj, Ali A.

doi:10.1016/j.jocn.2015.05.012

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…Besides, cervical osteoporotic fractures rarely occur in C2 (37), which indirectly corroborates our finding. Moreover, the vBMD values of the cervical vertebrae were not uniform and exhibited greater fluctuations than those of lumbar vertebrae, especially in C6 and C7, which were significantly different from those of C2–5, possibly due to the unique characteristics of cervical vertebral anatomy, phylogenetic factors and complex motions from the surrounding muscles (1838). Miller et al (39) reported that fractures at C7 level were more common than those at other cervical levels, which could be attributed to lowest BMD values among the cervical vertebrae.…”

Section: Discussionmentioning

confidence: 98%

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

Zhang

Zhou

et al. 2016

Korean J Radiol

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ObjectiveTo investigate the bone mineral density (BMD) of cervical vertebrae in a population-stratified manner and correlate with that of the lumbar vertebrae.Materials and MethodsFive hundred and ninety-eight healthy volunteers (254 males, 344 females), ranging from 20 to 64 years of age, were recruited for volumetric BMD (vBMD) measurements by quantitative computed tomography. Basic information (age, height, weight, waistline, and hipline), and vBMD of the cervical and lumbar vertebrae (C2–7 and L2–4) were recorded. Comparisons among sex, age groups and different levels of vertebrae were analyzed using analysis of variance. Linear regression was performed for relevance of different vertebral levels.ResultsThe vBMD of cervical and lumbar vertebrae was higher in females than males in each age group. The vBMD of the cervical and lumbar vertebrae in males and the vBMD of lumbar vertebrae in females decreased with aging. In each age group, the vBMD of the cervical vertebrae was higher than that of the lumbar vertebrae with gradual decreases from C2 to C7 except for C3; moreover, the vBMD of C6 and C7 was significantly different from that of C2–5. Correlations of vBMD among different cervical vertebrae (females: r = 0.62–0.94; males: r = 0.63–0.94) and lumbar vertebrae (males: r = 0.93–0.98; females: r = 0.82–0.97) were statistically significant at each age group.ConclusionThe present study provided normative data of cervical vertebrae in an age- and sex-stratified manner. Sex differences in vBMD prominently vary with age, which can be helpful to design a more comprehensive pre-operative surgical plan.

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Section: Discussionmentioning

confidence: 98%

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

Zhang

Zhou

et al. 2016

Korean J Radiol

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“…In their cadaveric study, Fard and his colleagues indicated that some anatomical structures blocking the surgical corridor can be divided, such as ascending pharyngeal artery and vein, lingual artery and vein, facial artery vein, retromandibular vein (temporo-maxillary vein, posterior facial vein) and digastric tendinous junction [16]. In our study, we had to ligate the facial vein in two patients with no complications.…”

Section: Discussionmentioning

confidence: 86%

Retropharyngeal approach in cervical disc hernias

Oral¹

2020

Journal of Surgery and Medicine

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Aim: High-level disc hernias are rare pathologies encountered in clinical practice. Treatment is more difficult than other cervical disc hernias. In this study, we aimed to convey our clinical experience in C2-3 and C3-4 disc herniations, also presenting the complications we encountered during surgical treatment. Methods: In this retrospective cohort study, we reviewed the clinical and radiological records of 42 patients we operated between 2010-2019. Magnetic resonance imaging, computed tomography and direct radiographs were utilized as imaging modalities. Anterior retropharyngeal approach was the preferred surgical method. The modified Japanese Orthopedic Association (mJOA) score and Nurick Scale were used in clinical follow-up and physical examination of these patients. Results: Among all patients, the most common symptom was severe pain radiating from the neck to the occipital region. The mean age was 54.14 years. The average mJOA scores were 15.1 in the preoperative period and 17 in the postoperative sixth month. We observed that 83.3% of our patients had an mJOA recovery rate of fifty percent and above. All but seven patients' complaints improved well after treatment. There was a negative correlation between symptom duration and recovery rate (P=0.003, Correlation Coefficient r=-0.449). The rate of recovery was lower in patients with a longer duration of symptoms. Three of our patients developed difficulty in swallowing after the operation and recovered within four weeks with diet and exercise. Conclusion: We determined that retropharyngeal approach is a safe option for disc hernias at the upper cervical level. However, long operation time and excessive retraction during surgery may lead to complications such as difficulty in swallowing due to the stretching of the neural structures.

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“…Nowadays, however, with the abundance and high availability of assisted technologies and navigation, spine surgeons should still master the basic structure of spine instrument, as to familiarize them selves with the freehand technique and diminish the patient's exposure to prolonged radiation and its adverse effects. [6][7][8][9][10][11][12][13][14] A review by parker et al 15 reported high accuracy from thoracic pedicle screw placement with up to 98.3% accuracy. The other 1.7% comprises ofbreaches found in 9% of the different cohort of patients in the study.…”

Section: Discussionmentioning

confidence: 99%

Handsfree techniques onthoracic pedicle screws insertion in congenital scoliosis patients with a history of previous surgery

Saputra¹

2019

MOJCR

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Thoracic pedicle screws deliver various advantages compared to other approaches of spinal fixation. 1.Stronger pull-out strength, 2. Better control in the sagittal, coronal, and rotational planes as a result of increased stability to axial, bending and rotational forces by threecolumn fixation, 3. Lesser arthrodesed vertebral motion segments 4. Negates the need of postoperative bracing and securing fixation after laminectomy or incompetent posterior elements. In spite of having potential benefits, many surgeons avoid using thoracic pedicle screws because much concern for neurologic, vascular and visceral complications has been observed. [1][2][3][4][5] Nowadays, surgeons often prefer the freehand technique when it comes to pedicle screw placement in the thoracic segment of the spine. Present techniques, however, mostly depend on surgeon's selection and tendencies, as these techniquesare not reproducible and is different per case. Moreover, the majority of these techniques involves many point of entries and directions depending on the level and region of thoracic spine. Due to the fact that there are many various sizes of thoracic pedicles, as well as various adjacent structures, positioning freehand screw requires a high level of precision and expertise.

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Anatomic considerations of the anterior upper cervical spine during decompression and instrumentation: a cadaveric based study

Cited by 16 publications

References 21 publications

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

Retropharyngeal approach in cervical disc hernias

Handsfree techniques onthoracic pedicle screws insertion in congenital scoliosis patients with a history of previous surgery

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