Posterior Plating of the Cervical Spine

Gill, Kevin; Paschal, Scott O.; Corin, J. D.; Ashman, Richard; Bucholz, Robert W.

doi:10.1097/00007632-198807000-00018

Cited by 98 publications

(3 citation statements)

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“…Lateral mass screw fixation is considered the mainstay of fixation in the cervical spine and offers superior stability when compared with other types of cervical screw fixation. 33 The 2 most commonly reported techniques are the Magerl and Roy-Camille techniques. 34 Other cervical screw options include laminar screws at C2 and pedicle screws.…”

Section: Constructsmentioning

confidence: 99%

Crossing the Cervicothoracic Junction

Vickery¹,

Varas²,

Abtahi

2022

Clinical Spine Surgery: A Spine Publication

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: The cervicothoracic junction (CTJ) is the site of transition in biomechanical, osseous, and alignment properties of the spine. The interface between the highly mobile, lordotic cervical spine and the rigid, kyphotic thoracic spine results increased the biomechanical stress experienced at this junction. The concentration of stress at this level has led to high rates of failure when instrumenting near or across the CTJ. The changes in osseous anatomy from the cervical spine to the thoracic spine present additional challenges in construct planning. For these reasons, a thorough understanding of the complexity of the cervicothoracic junction is necessary when operating near or across the CTJ. There are multiple options for cervical fixation, including lateral mass screws, pedicle screws, and laminar screws, each with its own advantages and risks. Instrumentation at C7 is controversial, and there is data supporting both its inclusion in constructs and no risk when this level is skipped. Thoracic pedicle screws are the preferred method of fixation in this region of the spine; however, the connection between cervical and thoracic screws can be challenging due to differences in alignment. Transitional rods and rod connectors mitigate some of the difficulties with this transition and have shown to be effective options. Recently, more investigation has looked into the failure of posterior cervical constructs which end at or near the CTJ. The trend in data has favored fixation to T1 or T2 rather than ending a construct at C7 due to the decreased rates of distal junction kyphosis. Although data on patient-reported outcomes with a length of constructs and the lowest instrumented vertebra is scarce, preliminary reports show no difference at this time. As posterior cervical instrumentation continues to increase in frequency, the CTJ will continue to be an area of difficulty in navigation and instrumentation. A thorough understanding of this region is necessary and continued research is needed to improve outcomes. Level of Evidence: Level V.

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Section: Constructsmentioning

confidence: 99%

Crossing the Cervicothoracic Junction

Vickery¹,

Varas²,

Abtahi

2022

Clinical Spine Surgery: A Spine Publication

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“…The bone stock here is large and allows strong posterior fixation in patients with instability of the subaxial cervical spine, which leads to highly successful fusion rates. Lateral mass screws have proven to have superior stability, as compared with translaminar screws and wiring [5, 13, 17]. Lateral mass screws may be used in cases of traumatic instability, infection, malignancy, degenerative instability, and failed anterior fusions.…”

Section: Posterior Cervical Lateral Mass Screwsmentioning

confidence: 99%

Posterior Fusion for the Subaxial Cervical Spine: A Review of the Major Techniques

2019

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Posterior fusion is a powerful tool to address pathology of the cervical spine, but the decision to fuse at any level should be made with great care. Various methods and constructs for posterior cervical fusion exist, all of which aim to restore the posterior tension band's ability to resist flexion forces. We identified articles regarding posterior fusion of the subaxial cervical spine in MEDLINE, Google Scholar, and PubMed. This article is a narrative review of earlier and current concepts regarding the posterior fusion of the subaxial cervical spine, including wiring, translaminar screws, lateral mass screws, and pedicle screws, weighing the strengths and weakness of the different modalities that the surgeon should bear in mind in creating operative plans individualized to patient pathology.

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“…Since the first occipitocervical fusion in 1927 by Foerster [17], a number of posterior techniques for fusing the cervical spine using wire, metal, or methacrylate, with or without the addition of bone have been described [1,2,6,8,9,12,13,16,18,19,20,21,24,25,26,27,28,30,31,38].…”

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 Plating of the Cervical Spine

Cited by 98 publications

References 0 publications

Crossing the Cervicothoracic Junction

Crossing the Cervicothoracic Junction

Posterior Fusion for the Subaxial Cervical Spine: A Review of the Major Techniques

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

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