Circumferential Reconstruction of Subaxial Cervical and Cervicothoracic Spine by Simultaneously Combined Anterior–posterior Approaches in the Sitting Position

Han, Yue; Ma, Xinlong; Hu, Yongcheng; Zhang, Jidong; Bai, Jian-qiang; Xiang, Qun

doi:10.1111/os.12341

Cited by 2 publications

(3 citation statements)

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“…1 Reports have also indicated that sitting procedures allow for the maintenance of a more normal anatomical alignment of the cervical spine and used the 360° of access afforded by the sitting position in order to perform frontback procedures. 14,19 We also noted reduced episodes of hypoventilation postoperatively in sitting cases, which logically follows compared to the challenges with ventilation in the prone position and may merit consideration in patients in whom adequate ventilation is a particular concern.…”

Section: Discussionmentioning

confidence: 62%

“…Much of the research on the sitting position in neurosurgery has focused on posterior fossa cranial surgeries or deep brain stimulation, though we have also recently reported on a large cohort that included cervical procedures performed in patients in the sitting position. 19 However, few reports are specifically dedicated to posterior cervical procedures or provided a direct comparison of sitting and prone procedures. Several recent publications have discussed minimally invasive approaches to the posterior cervical spine with patients in the sitting position, and one recent series even made use of instrumented procedures, demonstrating ongoing interest in its use.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes in single-level posterior cervical spine surgeries performed in the sitting and prone positions

Himes¹,

Abcejo

Kerezoudis³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe sitting or semisitting position in neurosurgery allows for several technical advantages, including improved visualization of the surgical field. However, it has also been associated with an increased risk of venous air embolisms and positioning-related complications that limit its commonplace adoption. The authors report a large, single-center series of cervical spine procedures performed with patients in the sitting or prone position in order to assess the perceived risk of intraoperative and postoperative complications associated with the sitting position.METHODSNoninstrumented, single-level posterior cervical spine procedures performed with patients in the sitting/semisitting or prone position from 2000 to 2016 at a single institution were reviewed. Institutional abstraction tools (DataMart and Chart Plus) were used to collect data from the medical records. The two positions were compared with regard to preoperative factors, intraoperative variables, and postoperative outcomes. Multivariable logistic regression models were fitted for 30-day readmission, 30-day return to the operating room, and complication rates.RESULTSA total of 750 patients (sitting, n = 480; prone, n = 270) were analyzed. The median age was 53 years for those who underwent surgery in the prone position and 50 years for those who underwent surgery in the sitting position (IQRs 45–62 years and 43–60 years, respectively), and 35% of the patients were female. Sitting cases were associated with significantly longer anesthetic times (221 minutes [range 199–252 minutes] vs 205 minutes [range 179–254 minutes]) and operative times (126 minutes [range 101–163 minutes] vs 149 minutes [120–181 minutes]). Cardiorespiratory events in the postanesthesia care unit (PACU) were comparable between the two groups, with the exception of episodes of apnea (2.6% vs 0.6%, p = 0.041) and hypoventilation (4.4% vs 0.8%, p < 0.003), which were more frequent in the prone-position cohort. On multivariable analysis, the effect of the sitting versus the prone position was not significant for 30-day readmission (OR 0.77, 95% CI 0.34–1.71, p = 0.52) or reoperation (OR 0.71, 95% CI 0.31–1.60, p = 0.40). The sitting position was associated with lower odds of developing any complication (OR 0.31, 95% CI 0.16–0.62, p < 0.001).CONCLUSIONSBased on the intraoperative and postoperative complications chosen in this study, the sitting position confers a similar safety profile to the prone position. This can be explained by a more anatomic positioning accounting for reduced temporary neurological deficits and reduced PACU-associated hypoventilation noted in this series. Nevertheless, the findings may also reflect institutional familiarity, experience, and mastery of this position type, and outcomes may not reflect practices in general.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Outcomes in single-level posterior cervical spine surgeries performed in the sitting and prone positions

Himes¹,

Abcejo

Kerezoudis³

et al. 2020

Journal of Neurosurgery: Spine

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“…Комбіновані хірургічні підходи представлені передньо-задніми, задньо-передніми, у деяких випадках -задньо-передньо-задніми або передньо-задньо-пере дніми. Основною перевагою комбінованої 360°-стабілізації є надійна фіксація прооперованого ХРС, що дає змогу значно обмежити залишковий обсяг рухів [77,78]. Відзначено, що комбінована стабілізація при вивихах/переломо-вивихах ШВХ на субаксіальном рівні збільшує швидкість консолідації, однак не має значущих переваг щодо регресу неврологічних порушень [79].…”

Section: комбіновані доступиunclassified

The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions

Nekhlopochyn¹,

Слынько²,

Verbov³

2021

Ukr Neurosurg J

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Traumatic injury to the cervical spine accompanied by a wide range of possible changes in its osteo-ligamentous apparatus. One of the basic criteria to determine the treatment strategy is the assessment of injury stability which depends on the condition of the spine supporting columns. Most of the modern and widely used classifications of subaxial cervical spine traumatic injuries quite sufficiently characterize the state of the anterior support column. At the same time, much less attention is paid to the assessment of the degree and nature of traumatic changes in lateral masses, facet joints, as well as possible dislocations. Literature analysis reveals the absence of a generally accepted scheme that would allow one to unambiguously and comprehensively characterize the damage to the facets / lateral masses and choose the optimal surgical or conservative treatment method. This review provides well known assessment schemes: classification of traumatic changes of facet joints by Marcel F. Dvorak et al., variants of traumatic displacement of the cervical vertebrae by V.P. Selivanov, variants of lateral mass traumatic injury by Y. Kotani et al. and Posterior Ligament-Bone Injury Classification and Severity Score. The advantages and disadvantages of anterior, posterior or combined approach for the treatment of traumatic injuries of posterior support complex are considered that is of critical importance for obtaining better clinical results. It is noted that the choice of the optimal treatment method is currently a controversial issue. Although good surgical results can be obtained using a variety of methods, there are certain situations in which one technique may be better than others. The accumulated clinical experience and current research on the injured spine biomechanics demonstrate the advantage of surgical treatment in most patients, since such injuries are usually unstable or potentially unstable.

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Circumferential Reconstruction of Subaxial Cervical and Cervicothoracic Spine by Simultaneously Combined Anterior–posterior Approaches in the Sitting Position

Abstract: The "sitting position" simultaneously combined anterior-posterior approach is safe and is superior to the traditional prone position and supine position, and the surgical results are satisfactory.

Cited by 2 publications

References 36 publications

Outcomes in single-level posterior cervical spine surgeries performed in the sitting and prone positions

Outcomes in single-level posterior cervical spine surgeries performed in the sitting and prone positions

The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions

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