Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Abstract

IntroductionSince Hadra first described the time-honored technique of cervical wiring, several alternative fixation techniques have been developed, all with inherent limitations and risks.In atlanto-axial surgical stabilization, the Gallie wiring technique is still the gold standard, but it has several limitations [15,26]. Its mechanical stabilizing potential is limited, it does not result in rotational or translational sagittal stability and additional external fixation is needed, which is a great disadvantage, particularly in rheumatoid arthritis (RA) and metastatic disease. Transarticular C2-1 screws with additional Gallie type wire fixation is biomechanically attractive, offering rotational and translational stability, but is technically demanding, with a risk of vertebral artery injury [8,29,40].Wiring is also a traditional method of subaxial spine fixation [33]. Techniques based on wires through the Abstract There are today several techniques available for cervical fixation -all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17-84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre-and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.

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

“…To avoid late postoperative neurological complications in posterior reconstruction surgery for correcting cervical kyphosis, the present study recommends the following: (1) prophylactic foraminotomies at C4-5 [10] should be performed during surgery if there are findings of foraminal stenosis on preoperative CT images, (2) it is preferable to avoid excessive correction of cervical kyphosis exceeding 9.7°per segment, and (3) it is better to avoid conducting kyphosis correction mainly at C4-5, which may cause both foraminal stenosis at C4/5 foramen and the most dramatic posterior shift of the spinal cord at C4/5 segment. Despite using all the measures listed above, it may be said that such late neurological complications cannot be avoided perfectly.…”

Two asymmetric contoured plate-rods for occipito-cervical fusion

“…The presently available implants are usually in the form of an inverted U or a inverted tuning fork, frequently with only minimal midline fixation to the skull [2,12,13,14,16,19,24,28,29,32,36,39,40]. These systems are fixed to the occiput either by screws, hooks or wires.…”

“…The procedure has been changed several times, and now a variety of techniques exist [1,2,12,15,16,19,22,33,39], none of which has gained widespread popularity. Bone-graft alone [8,11,30,34] is no longer used because of the high failure rate.…”

Occipitocervicothoracic fixation using a hook and rod system for patients with rheumatoid cervical spine

“…Although decompression and fusion via the anterior approach has been performed, 20 currently posterior spinal instrumentation is usually applied via the posterior approach. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Several posterior spinal instrumentations are available, such as the hook and rod method, 3,4 the sublaminar wiring method, 6,[8][9][10][11]13 the lateral mass screw method, 2,21 and the pedicle screw method. 1,7 The sublaminar wiring method is not indicated after laminectomy or laminoplasty because the wires cannot be anchored at the laminae.…”

“…Recently, several types of spinal fixation procedures using specially developed spinal instrumentation have been performed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, some problems relating to the surgical method and fixation area remain unresolved. We have performed occipitocervicothoracic fixation using a hook and rod system 3,4 combined with laminoplasty, which simultaneously allows decompression of the spinal cord and spinal fusion at multiple levels.…”