Correction of Cervical Kyphosis Using Pedicle Screw Fixation Systems

Abumi, Kuniyoshi; Shono, Yasuhiro; Taneichi, Hiroshi; Ito, Manabu; Kaneda, Kiyoshi

doi:10.1097/00007632-199911150-00017

Cited by 173 publications

(137 citation statements)

References 27 publications

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“…Accordingly, reconstructions of most cervical disorders do not require CPS. But, of the current techniques, transpedicular anchorage provides highest stability [2,3,22,31,38,44,62], and in selected patients with advanced instability, CPS fixation is a sound treatment [12,21,28,62] with high accuracy rates in the hands of trained surgeons, particularly at C2 and C7 [1,9,25,29,62]. Our study offers new biomechanical data for the selective usage of CPS.…”

Section: Discussionmentioning

confidence: 86%

“…Therefore, the purposes of the current study were (1) to analyze primary construct stability of different instrumentations currently in use for the reconstruction of a 2-level corpectomy, (2) to test an ATPS plate prototype system and its performance compared to common anterior and posterior instrumentations, and (3) to assess the general impact of end-level unilateral transpedicular screw anchorage within anterior, posterior, and combined instrumentations compared to bilateral-pedicle screw anchorage at the endlevels. We performed a biomechanical comparative study of different instrumentations for the reconstruction of a 2-level corpectomy model with special interest on ATPS as a new anchorage principle for the reconstruction of advanced cervical spine instabilities.…”

Section: Introductionmentioning

confidence: 99%

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The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

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Clinical studies reported frequent failure with anterior instrumented multilevel cervical corpectomies. Hence, posterior augmentation was recommended but necessitates a second approach. Thus, an author group evaluated the feasibility, pull-out characteristics, and accuracy of anterior transpedicular screw (ATPS) fixation. Although first success with clinical application of ATPS has already been reported, no data exist on biomechanical characteristics of an ATPS-plate system enabling transpedicular end-level fixation in advanced instabilities. Therefore, we evaluated biomechanical qualities of an ATPS prototype C4-C7 for reduction of range of motion (ROM) and primary stability in a non-destructive setup among five constructs: anterior plate, posterior all-lateral mass screw construct, posterior construct with lateral mass screws C5 ? C6 and end-level fixation using pedicle screws unilaterally or bilaterally, and a 360°construct. 12 human spines C3-T1 were divided into two groups. Four constructs were tested in group 1 and three in group 2; the ATPS prototypes were tested in both groups. Specimens were subjected to flexibility test in a spine motion tester at intact state and after 2-level corpectomy C5-C6 with subsequent reconstruction using a distractable cage and one of the osteosynthesis mentioned above. ROM in flexionextension, axial rotation, and lateral bending was reported as normalized values. All instrumentations but the anterior plate showed significant reduction of ROM for all directions compared to the intact state. The 360°construct outperformed all others in terms of reducing ROM. While there were no significant differences between the 360°a nd posterior constructs in flexion-extension and lateral bending, the 360°constructs were significantly more stable in axial rotation. Concerning primary stability of ATPS prototypes, there were no significant differences compared to posterior-only constructs in flexion-extension and axial rotation. The 360°construct showed significant differences to the ATPS prototypes in flexionextension, while no significant differences existed in axial rotation. But in lateral bending, the ATPS prototype and the anterior plate performed significantly worse than the posterior constructs. ATPS was shown to confer increased primary stability compared to the anterior plate in flexion-extension and axial rotation with the latter yielding significance. We showed that primary stability after 2-level corpectomy reconstruction using ATPS prototypes compared favorably to posterior systems and superior to anterior plates. From the biomechanical point, the 360°i nstrumentation was shown the most efficient for reconstruction of 2-level corpectomies. Further studies will elucidate whether fatigue testing will enhance the benefit of transpedicular anchorage with posterior constructs and ATPS.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

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“…For kyphosis correction of the cervical spine, some surgeons select the anterior procedure [13,14], whereas other surgeons choose the posterior [15,16] or a combination of anterior and posterior approaches [17,18]. In posterior cervical reconstruction surgery, postoperative neurological deficits unrelated to instrument malpositioning or hematoma formation have been reported by some authors [8,[19][20][21] Heller et al [8] reported 2 (2.7%) cases with this complication after posterior cervical reconstruction surgery using lateral mass screws and plates.…”

Section: Discussionmentioning

confidence: 99%

A late neurological complication following posterior correction surgery of severe cervical kyphosis

et al. 2010

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Though a possible cause of late neurological deficits after posterior cervical reconstruction surgery was reported to be an iatrogenic foraminal stenosis caused not by implant malposition but probably by posterior shift of the lateral mass induced by tightening screws and plates, its clinical features and pathomechanisms remain unclear. The aim of this retrospective clinical review was to investigate the clinical features of these neurological complications and to analyze the pathomechanisms by reviewing pre-and post-operative imaging studies. Among 227 patients who underwent cervical stabilization using cervical pedicle screws (CPSs), six patients who underwent correction of cervical kyphosis showed postoperative late neurological complications without any malposition of CPS (ND group). The clinical courses of the patients with deficits were reviewed from the medical records. Radiographic assessment of the sagittal alignment was conducted using lateral radiographs. The diameter of the neural foramen was measured on preoperative CT images. These results were compared with the other 14 patients who underwent correction of cervical kyphosis without late postoperative neurological complications (non-ND group). The six patients in the ND group showed no deficits in the immediate postoperative periods, but unilateral muscle weakness of the deltoid and biceps brachii occurred at 2.8 days postoperatively on average. Preoperative sagittal alignment of fusion area showed significant kyphosis in the ND group. The average of kyphosis correction in the ND was 17.6°per fused segment (range 9.7°-35.0°), and 4.5°( range 1.3°-10.0°) in the non-ND group. A statistically significant difference was observed in the degree of preoperative kyphosis and the correction angles at C4-5 between the two groups. The diameter of the C4-5 foramen on the side of deficits was significantly smaller than that of the opposite side in the ND group. Late postoperative neurological complications after correction of cervical kyphosis were highly associated with a large amount of kyphosis correction, which may lead foraminal stenosis and enhance posterior drift of the spinal cord. These factors may lead to both compression and traction of the nerves, which eventually cause late neurological deficits. To avoid such complications, excessive kyphosis correction should not be performed during posterior surgery to avoid significant posterior shift of the spinal cord and prophylactic foraminotomies are recommended if narrow neuroforamina were evident on preoperative CT images. Regardless of revision decompression or observation, the majority of this late neurological complication showed complete recovery over time.

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“…It has also been reported after other posterior-based techniques. The incidence varies from 0-50% depending on the technique used, how the condition is defined and which patient group is being analysed [3,[4][5][6][7][8]9,10]. Takemitsu et al [11] reported a higher incidence among patients undergoing instrumentation than those treated by laminoplasty alone.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of C5 Palsy Resulting from Posterior Spinal Decompression for the Treatment of Cervical Spondylotic Myelopathy

Saoud¹

2013

J Spine

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Objective: To assess the feasibility of anterior cervical procedures in the treatment of C5 palsy occurring after posterior cervical decompression procedures done for the treatment of cervical spondylotic myelopathy. Introduction:In this study we hypothesized that anterior cervical decompression would benefit these patients through widening the cervical foramen, directly by rongeurs and drills and indirectly by placing an intervertebral spacer (cervical cage). The aim of the study is to assess whether a more proactive approach would benefit these patients.

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Correction of Cervical Kyphosis Using Pedicle Screw Fixation Systems

Cited by 173 publications

References 27 publications

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

A late neurological complication following posterior correction surgery of severe cervical kyphosis

Surgical Management of C5 Palsy Resulting from Posterior Spinal Decompression for the Treatment of Cervical Spondylotic Myelopathy

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