Indication, Surgical Technique, and Results of 100 Surgically-treated Fractures and Fracture-dislocations of the Cervical Spine

Aebi, Max; Mohler, John R.; Ga, Zäch; Morscher, E

doi:10.1097/00003086-198602000-00031

Cited by 148 publications

(89 citation statements)

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“…The frequency of implant penetration into the esophagus is given as 1 in 500 (0.2%) by Tew and Mayfield [9] and 0 in 100 (0%) by Aebi et al [1]. The frequency of abscess formation following an operative revision of a cervical spine injury was given as 4 in 400 (1%) by Kelly et al [4].…”

Section: Discussionmentioning

confidence: 99%

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—Report of six cases

et al. 2006

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A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5-12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1-5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus.

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Section: Discussionmentioning

confidence: 99%

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—Report of six cases

et al. 2006

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“…Early treatment ranged between 6 h and more than a week in the reviewed literature. 39,51,53,55,56 Even when performed within 24 h, which we selected as time window for early surgery, the operation might be too late to reverse some of the secondary injury mechanisms that follow acute SCI. The only therapeutic window established in humans, actually, is the 8-h trauma-to-treatment window reported in the NASCIS-2 in which methyl-prednisolone was used.…”

Section: Literature Reviewmentioning

confidence: 99%

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

et al. 2004

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Study design: Definitive and unequivocal evidence to support the practice of early or late surgery is still lacking in clinical studies. Accordingly, meta-analysis is one of the few methods that offer a rational, statistical approach to management decision. A review of the clinical literature on spinal cord injury with emphasis on the role of early surgical decompression and a meta-analysis of results was performed. Objectives: To determine whether neurological outcome is improved in traumatic spinal cordinjured patients who had surgery within 24 h as compared with those who had late surgery or conservative treatment. Methods: A Medline search covering the period 1966-2000, supplemented with manual search, was used to locate studies containing information on indication, rationale and timing of surgical decompression after spinal cord injuries. The analysis included a total of 1687 eligible patients. Results: Statistically, early decompression resulted in better outcome compared with both conservative (Po0.001) and late management (Po0.001). Nevertheless, analysis of homogeneity showed that only data regarding patients with incomplete neurological deficits who had early surgery were reliable. Conclusions: Although statistically the percentage of patients with incomplete neurological deficits improving after early decompression appear 89.7% (95% confidence interval: 83.9, 95.5%), to be better than with the other modes of treatment when taking into consideration the material available for analysis and the various other factors including clinical limitations; early surgical decompression can only be considered as practice option for all groups of patients.

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“…At the early phase, the complication rate of the unlocked plate was relatively high, especially loosening of the screws and the plates [1,3,5,6,12,15]. Locking plates are now being used to stabilise cervical spinal trauma, or used in combination with cages or meshes after discectemy or corpectemy in cervical degenerative diseases or tumours [4,9,14,17,18,20,21].…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical locking plate-related complications; prevention and treatment recommendations

Xie

Yuan

et al. 2007

International Orthopaedics (SICO

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A retrospective study evaluating complications in 2,233 consecutive patients of subaxial cervical disorders treated with an anterior cervical locking plate was performed, and recommendations for prevention and treatment were made. The average length of follow-up was 1.3 years. Any loosening or breaking of the plates and screws or malpositions that threatened tracheoesophageal or neurovascular structures were defined as the complications. There were 239 cases (10.7%) with different kinds of complications. The complications included oblique plating in 56 cases in which the screw could irritate the nerve root. Screws were driven into the disc space in four cases, which ultimately led to plate loosening. Screws penetrated the endplate or passed excessively close to it producing a triangle fracture in 19 cases. Loosening or breaking of the plate and the screw was found in 115 cases. These phenomena were always associated with non-union. Three oesophageal perforations occurred and conservative treatments proved effective. Finally, overlong plates impinged on the adjacent level in 14 cases and promoted disc degeneration ultimately leading to revision surgery. Good training and careful operation may help to decrease the complication rate. Most hardware complications are not symptomatic and can be treated conservatively. Only a few of them need immediate reoperation.Résumé Nous avons réalisé une étude rétrospective de 2,233 patients consécutifs, traités par plaques cervicales verrouillées pour divers problèmes cervicaux. Le suivi moyen a été de 1.3 ans. Nous n'avons observé aucun démontage ni aucune fracture de matériel. Les malpositions de la plaque avec des lésions trachéo oesophagiennes ou neurovasculaires ont été répertoriées comme complications. Celles-ci ont été au nombre de 239 (10.7%), notamment une malposition de plaque implantée obliquement avec une irritation des racines nerveuses. Les vis étaient dans l'espace inter discal dans 4 cas avec un démontage dans les suites. Les anomalies au niveau de la plaque ont été retrouvées dans 115 cas. Celles-ci sont toujours associées à une pseudarthrose. Nous avons observé trois perforations de l'oesophage qui ont été traitées de façon conservatoire. Un conflit avec la plaque ou une dégénération discale du disque adjacent est survenu 14 fois. Avec la courbe d'apprentissage, les résultats devraient s'améliorer et le taux de complication diminuer. La plupart des complications dues au matériel n'ont pas entraîné de symptômes et n'ont pas été traitées.

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Indication, Surgical Technique, and Results of 100 Surgically-treated Fractures and Fracture-dislocations of the Cervical Spine

Cited by 148 publications

References 0 publications

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—Report of six cases

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach—Report of six cases

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

Anterior cervical locking plate-related complications; prevention and treatment recommendations

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