Posterior instrumentation of the unstable cervicothoracic spine

Chapman, Jens R.; Anderson, Paul A.; Pepin, C; Toomey, Sean D.; Newell, David W.; Grady, M. Sean

doi:10.3171/jns.1996.84.4.0552

Cited by 79 publications

(37 citation statements)

References 32 publications

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“…4,5,8) The compression fracture combined with the lateral mass fracture of the C-7 vertebra due to flexion force and associated tensile force were considered unstable and required surgical stabilization to avoid delayed kyphosis expected to result in further neurological compromise in this patient.…”

Section: Discussionmentioning

confidence: 99%

Traumatic C6-7 Subluxation Associated With C-7 Fracture Treated With a Pedicle Screw System Under Navigation Guidance-Case Report-

Mahadewa

Mizuno

Inoue

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 51-year-old female presented with traumatic C6-7 subluxation associated with C-7 fracture due to an automobile accident. She underwent pedicle screw fixation at C-6, C-7, and T-1 for stabilization of the spinal column. A neuronavigation system was used to obtain accurate placement of the pedicle screws. The patient recovered well without further neurological compromise. Postoperative cervical radiography showed reasonable restoration of the vertebral column without delayed kyphotic deformity.

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Section: Discussionmentioning

confidence: 99%

Traumatic C6-7 Subluxation Associated With C-7 Fracture Treated With a Pedicle Screw System Under Navigation Guidance-Case Report-

Mahadewa

Mizuno

Inoue

et al. 2005

Neurol. Med. Chir.(Tokyo)

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“…The CTJ, as a unique area, is the crossing transitional area of lordotic cervical spine and kyphotic thoracic spine 3) . Because laminectomy for neural decompression in CTJ usually aggravates spinal instability, stabilization process should be accompanied 2,7,13,23) . Various internal fixation techniques have been used for the stabilization of CTJ.…”

Section: Introductionmentioning

confidence: 99%

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Cho

Eid

Chang

2010

J Korean Neurosurg Soc

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Objective : In cervico-thoracic junction (CTJ), the use of strong fixation device such as pedicle screw-rod system is often required. Purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels. Methods : Nineteen patients underwent posterior CTJ fixation with C7 and/or T1 included in fixation levels. Seventeen patients had tumorous conditions and two with post-laminectomy kyphosis. The anatomical features were analyzed for C7 and T1 pedicles in 19 patients using computerized tomography (CT). Pedicle screw and rod fixation system was used in 16 patients. Pedicle violation by screws was evaluated with postoperative CT scan. Results :The mean values of the width, height, stable depth, safety angle, transverse angle, and sagittal angle of C7 pedicles were 6.9 ± 1.34 mm, 8.23 ± 1.18 mm, 30.93 ± 4.65 mm, 26.42 ± 7.91 degrees, 25.9 ± 4.83 degrees, and 10.6 ± 3.39 degrees. At T1 pedicles, anatomic parameters were similar to those of C7. The pedicle violation revealed that 64.1% showed grade I violation and 35.9% showed grade II violation, overall. As for C7 pedicle screw insertion, grade I was 61.5% and grade II 38.5%. At T1 level, grade I was 65.0% and grade II 35.0%. There was no significant difference in violation rate between the whole group, C7, and T1 group. Conclusion : C7 pedicles can withstand pedicle screw insertion. C7 pedicle and T1 pedicle are anatomically very similar. With the use of adequate fluoroscopic oblique view, pedicle screw can be safely inserted at C7 and T1 levels.

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“…Based on comparative biomechanical studies of cervical fixation procedures, however, there is not much difference in stability between lateral mass screw-plate fixation and conventional non-screw fixation methods [1,10,22,29,37,38].…”

Section: Introductionmentioning

confidence: 99%

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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Posterior instrumentation of the unstable cervicothoracic spine

Cited by 79 publications

References 32 publications

Traumatic C6-7 Subluxation Associated With C-7 Fracture Treated With a Pedicle Screw System Under Navigation Guidance-Case Report-

Traumatic C6-7 Subluxation Associated With C-7 Fracture Treated With a Pedicle Screw System Under Navigation Guidance-Case Report-

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

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

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