Operative spondylodesis in injuries of the lower cervical spine

Kalff, Rolf; Kocks, W; Grote, W; Schmit-Neuerburg, K. P.

doi:10.1007/bf00304331

Cited by 8 publications

(8 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In regard to the trauma literature, conclusions that might be drawn from several previous studies suffer on heterogeneous samples [3,7,33,40,44,55,57,59,62,67,77,82,83,89,95], and direct comparisons of results after different treatments remain difficult [29,81]. But the accurate collection of qualitative outcome data is essential because it reflects what is relevant to the patient and society [33].…”

Section: Discussionmentioning

confidence: 99%

“…This fact deserves attention as the literature serves evidence that reconstruction and maintenance of a sagittal balance and a lordotic cervical spine has impact on the patients' outcomes [5,33,60,76,88,95]. Given the potential risks that can go with a cervical kyphotic deformity (CKD) [60,88] as well as the young age of the patients with subaxial trauma [3,11,21,40,55,82,85] the goal of maintaining a lordotic posture across the injury segments may not be trivial. Maintaining sagittal balance avoids an escalating cycle of abnormal forces that may lead to progressive CKD, compromise of the adjacent motion segments and potential neurologic symptoms.…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

“…Nevertheless, although ACDFP was suggested to confer excellent immediate stability making any posterior element instability clinically insignificant [85], early changes in construct geometry and mechanical failures occur and promote a debate regarding the use of anterior, posterior or combined stabilization for patients with marked instability [29]. Using ACDFP, the incidence of loss of alignment has been reported as 13-19% [47, 54], the need for supplemental posterior stabilization as 10-21% [20,92] and revision rates average of 6.5% [10,11,20,40,41,47,51,55,59,77,82,85,95]. Early plate designs relying on NC-plate-screw interfaces were suggested to be plagued by increased mechanical failure, screw loosening and pseudoarthrosis [10,11,30,40,69,77,82,85] most notably in multilevel constructs [60].…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

“…Mirroring the reported failures, the average rate of combined anterior-posterior surgeries as the index procedure for subaxial injuries is 11% [3,21,51,52,55,57,59,89,95] and the evidence of redo surgeries after ACDFP warrants concerns that distinct injury patterns are not amenable for anterior-only surgery. Those injury patterns demanding combined surgery are not stratified yet [29].…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

“…The undoubted increase in construct stability with 360°f usions [4,18,58] has to be weighed against higher potential for surgical morbidity and prolonged surgical time. Several authors recommend 360°surgery in the presence of injuries to both anterior and posterior columns, in 'severe' fracture-dislocations or in cases with 'gross' instability, poor bone quality and increased rigidity of the spine, such as in ankylosing spondylitis and DISH [7,21,31,44,47,48,55,81,95]. In Johnson's series [54] radiographic failure rate with 1-level ACDFP was strongly correlated with facet fractures combined with superior endplate compression fractures of the lower vertebra suggesting a 360°procedure.…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

See 4 more Smart Citations

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

View full text Add to dashboard Cite

The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

show abstract