Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord

Fagerström, T.; Hedlund, Rune; Bancel, Philippe; Robert, René; Dupas, B.

doi:10.1007/s005860100251

Cited by 13 publications

(12 citation statements)

References 11 publications

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“…Perioperative blood transfusion was not needed. The number of segments fused averaged 5±3 (range [2][3][4][5][6][7][8][9][10][11][12][13][14]. For fusion within the region from skull to C7, an average of 4±2 segments were fused, whereas the average number for the cervicothoracic junction was 8±3 segments.…”

Section: Resultsmentioning

confidence: 99%

“…However, a recent clinical-neurophysiological study [4] in cadavers (without spinal stenosis) showed that cervical CCD hooks can be used with safety and reliability without neurologic complications during and after surgery. One cadaveric study [14] showed a close anatomical relationship with the dura and spinal cord, with a mean cervical CCD hook intrusion into the spinal canal of 27% of the diameter; however, they found no evidence of deformation of the spinal cord.…”

Section: Discussionmentioning

confidence: 95%

“…Impaired single or multiple vertebrae were variously distributed across the occipitocervical region to the cervicothoracic junction. Single-or multisegmental instability was mostly caused by the cervical lesions themselves, and instability was obvious, so that functional roentgenograms were either not necessary (vertebral bone deficiency due to metastasis or primary tumor: cases 1,2,3,14) or theoretically dangerous for iatrogenic neurologic lesion (facet subluxation, dislocation, vertebral body fracture: cases 4, 6, 15-32). Alternatively, the instability was caused by extensive laminectomy for spinal cord decompression (cases 7-12) ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

et al. 2001

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The authors report on 32 consecutive patients with instability at the craniocervical, cervical and cervicothoracic regions suffering from various pathologies, who were treated with posterior instrumentation and fusion using the posterior hooks-rods-plate cervical compact Cotrel-Dubousset (CCD) instrumentation alone or, in three patients, in combination with anterior operation. The patients were observed postoperatively for an average of 31 months (range 25-44 months) and evaluated both clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, complications and status of arthrodesis. All patients but one (who died) achieved a solid arthrodesis based on plain and flexion/extension roentgenograms. Cervical lordosis (skull-C7) and cervicothoracic kyphosis (C7-T2) was improved by instrumentation towards a physiological lateral curve by an average of 33% (P<0.05) and 28% (P<0.05) respectively. Anterior vertebral olisthesis was reduced in the craniocervical and cervicothoracic region, by 73% and 90% respectively. At final follow-up there was an improvement of the neurologic Frankel status by an average of 1.2 grades and of myelopathy in 75% of the operated patients. Good to excellent functional results were seen in 77% of the operated patients, while acute and chronic pain was reduced by an average of 2.4 grades, on a scale of 0-3, in operated patients. No neurovascular or pulmonary complications arose from surgery. There was no significant change in lateral spine profile and olisthesis at the latest follow-up evaluation. There were no instrument-related failures. One patient requested hardware removal in the hope of reducing postoperative pain in the cervicothoracic region. The poor and fair results were related to the lack of improvement of neurologic impairment and myelopathy. The results of this study demonstrate that cervical CCD instrumentation applied in the region of the skull to the upper thoracic region for various disorders is a simple and safe instrumentation that restores lateral spine alignment, improves the potential for a solid fusion and offers sufficient functional results in the vast majority of the operated patients. However, the use of hooks in spinal stenosis is contraindicated.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

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Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

et al. 2001

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“…In a recent experimental study with Cotrel Dubousset Instrumentation, Fagerström et al [3] found no evidence of deformation of the spinal cord in a study of 80 hook sites. Deformation of the dura was observed at four hook sites, and at two of them the hooks were in contact with the spinal cord, but without deformation of the cord.…”

Section: Discussionmentioning

confidence: 95%

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system

Hildingsson

Jonsson

2001

European Spine Journal

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“…In an experimental study of the cervical spine, Fagerström et al [12] reported on the relation between sublaminar hooks and the neuraxis, and found no evidence of spinal cord deformation exerted by sublaminar hooks, although the safety margin was limited. Pham et al [30] reported good results of cervical CDI in a series of 30 patients with RA.…”

Section: Introductionmentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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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.

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Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord

Cited by 13 publications

References 11 publications

Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

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