Biomedical subjects

Rick C Sasso

Publications and source records attributed to Rick C Sasso.

At least 19 recordsLinked to original sources

PubMed2006

The evolution of spinal instrumentation for the management of occipital cervical and cervicothoracic junctional injuries.

STUDY DESIGN/SETTING: Independent computer-based literature review of articles pertaining to instrumentation and fusion of junctional injuries of the cervical spine. OBJECTIVE: To review and discuss the evolution of instrumentation techniques and systems used in the treatment of cervical spine junctional injuries. SUMMARY OF BACKGROUND DATA: Instrumentation of junctional injuries of the cervical spine has been limited historically by failure to achieve rigid internal fixation in multiple planes. The evolution of these techniques has required increased insight into the morphology and unique biomechanics of the structures to be instrumented. METHODS: Computer-based literature search of Ovid and PubMed databases. RESULTS: Extensive literature search yielded insights into the evolution of systems initially based on onlay bone graft combined with wiring techniques. Such techniques have come to include systems incorporating rigid, longitudinal struts that accommodate multiplanar screws placed in the lateral masses, pedicles, transarticular regions, and occipital bone. CONCLUSIONS: Despite a rapid evolution of techniques and instrumentation technologies, it remains incumbent on the physician to provide the patient with a surgical procedure that balances the likelihood of a favorable outcome with the risk inherent in the implementation of the procedure.

Cervical Vertebrae↗

PubMed2006

Resorptive response of rhBMP2 simulating infection in an anterior lumbar interbody fusion with a femoral ring.

RhBMP-2 has been available for general use since July of 2002. No literature regarding its use with femoral ring allografts exists. This case demonstrates how a resorptive effect of rhBMP-2 with a femoral ring allograft on host bone at the interbody fusion site can easily be confused with infection. Spine surgeons should be aware of this effect to avoid unnecessary antibiotic use or additional surgery.

Bone Morphogenetic Protein 2↗

PubMed2006

Efficacy of translaminar facet screw fixation in circumferential interbody fusions as compared to pedicle screw fixation.

OBJECTIVES: Posterior lumbar fixation with translaminar facet screws is a minimally invasive technique with good success rates. Long-term follow-ups show reduced reoperation rates, a decrease in pain scores, and few complications compared with pedicle screw fixation devices. The purpose of this study was to compare the reoperation rate of translaminar facet screw fixation with that of pedicle screw fixation in 360 degrees anterior and posterior fusions for incapacitating low back pain due to lumbar disc degeneration unresponsive to at least 6 months of aggressive nonoperative treatment. METHODS: One hundred five patients underwent a combined circumferential lumbar fusion with posterior fixation for discogenic pain by one surgeon between August 1993 and February 2003. Seventeen patients were excluded from the study owing to their preoperative etiology for fusion or a prior instrumented posterior fusion. A retrospective chart review was done on all 88 remaining patients. Patients were followed in the office, by phone, or by mail to obtain functional outcome measures. Any subsequent operations by this surgeon or another were recorded. The comparison focused on the rate of reoperation on the region of posterior lumbar fixation. RESULTS: Sixty-seven patients have had at least a 2-year follow-up. Twenty-four patients had a posterior fusion with pedicle screws, and 43 had translaminar facet screw fixation. Nine patients of the pedicle screw population (37.5%) had a reoperation to remove their instrumentation. Two patients of the translaminar facet screw population (4.7%) had reoperations on their lumbar spine. There was a significant association between posterior instrumentation type and reoperation (P = 0.001). CONCLUSION: The success of translaminar facet screws in circumferential fusions is justified.

Adult↗

PubMed2006

Success and safety in outpatient microlumbar discectomy.

Currently, many spine surgeons perform microlumbar discectomies on an outpatient basis. Yet, it is often customary for patients to have a 1-night stay in the hospital. Many studies have shown the efficacy of microlumbar discectomy (MLD) and its preference among surgeons for the treatment of lumbar disc herniation. It has also been shown to be safe, successful, and cost-effective. However, a large comprehensive study of this magnitude, gauging safety, success, and patient satisfaction for these procedures on an outpatient basis has not yet been done. One thousand three hundred seventy-seven MLD procedures have been done from 1992 to 2001 by 1 surgeon. A retrospective chart review was done on all procedures. Patients were then contacted by either telephone or mail to complete an outcome questionnaire. Seven hundred thirteen patients (53.9%) completed the questionnaire. Follow-up questionnaires were not completed due to deaths, incorrect contact information, and refused responses. Out of all MLD procedures, 55 (4.0%) were done with a hospital stay-only 24 of these (1.7%) were originally intended outpatient procedures. Of those that were done on an outpatient basis, 8.6% had a complication, including 6.4% who had a recurrent disc herniation. When asked, 81.6% said they would undergo the procedure again as an outpatient. In 82.1% the surgery's outcome was good, very good, or excellent. MLD is a routine procedure that can be performed on an outpatient basis safely, successfully, and with high patient satisfaction.

Adult↗

PubMed2006

Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation.

Operative management of a thoracolumbar burst fracture varies according to many factors. Fracture morphology, neurologic status, and surgeon preference play major roles in deciding upon anterior, posterior, or combined approaches. Optimizing neural decompression while providing stable internal fixation over the least number of spinal segments is the goal. Short-segment constructs via a single-stage approach (anterior versus posterior) have become viable options with advances in instrumentation and techniques. This study compares anterior-only fixation utilizing a corpectomy strut graft and a modern thoracolumbar plating system with a posterior-only construct using pedicle screws and load sharing hooks for the treatment of unstable burst fractures. Functional outcome and sagittal plane restoration and maintenance of sagittal plane alignment were evaluated. Fifty-three patients with unstable burst fractures were assessed with 40 undergoing an anterior-only construct and 13 having a short-segment posterior-only construct. The posterior-only group had no hardware failures; however, the loss of sagittal plane correction averaged 8.1 degrees, whereas the anterior-only group averaged only a 1.8-degree increase in sagittal plane kyphosis. Both techniques resulted in statistically significant initial improvement in sagittal alignment; however, the posterior short-segment group lost this statistical significance at follow-up whereas the anterior-only group continued to demonstrate statistically significant improvement in sagittal alignment at follow-up compared to preoperative measurements.

Adolescent↗

PubMed2005

Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures.

STUDY DESIGN: This retrospective review compares the intraoperative and perioperative complications associated with the placement of threaded devices and nonthreaded devices used in anterior lumbar interbody fusions. OBJECTIVE: Anterior lumbar interbody fusion is a common procedure performed with either a nonthreaded device, such as a femoral ring, or a threaded device, such as with a cage or a bone dowel. SUMMARY OF BACKGROUND DATA: Many studies have been done detailing the fusion rates and biomechanical properties of both devices. However, few studies have been performed evaluating acute complications between the two device types. METHODS: A retrospective chart review was performed of 471 consecutive patients who underwent anterior lumbar interbody fusion: 243 with a nonthreaded interbody device and 228 with a threaded interbody device. Operative notes, anesthesia reports, discharge summaries, and follow-up notes were reviewed from 1992 to June 2002. The patients' demographics, diagnosis, number of levels fused, type of device used, length of hospital stay, and acute complications, either intraoperative or perioperative, were collected and analyzed. RESULTS: Approximately 4.8% of patients with a threaded type interbody device had an intraoperative complication whereas only 0.4% of patients with a nonthreaded type device had an intraoperative complication. There was a significant association between interbody device type (threaded vs. nonthreaded) and occurrence of an intraoperative complication (P = 0.0024). CONCLUSIONS: Placement of threaded devices, such as cages or bone dowels, was associated with a higher acute complication rate than was the placement of nonthreaded devices during anterior lumbar interbody fusion.

Adolescent↗

PubMed2005

Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: a prospective patient satisfaction outcome assessment.

BACKGROUND: Autogenous iliac crest bone is the gold-standard graft for spinal fusion surgery. Unfortunately, there is a frequent incidence of graft site pain that persists well into the postoperative period with complication rates reported in 2.8-39% of patients. Persistent pain lasting at least 2 years is reported in 15-39% of patients. OBJECTIVE: The objective of this work was to determine the incidence of acute and persistent pain as well as patient assessment of graft site appearance following iliac crest bone graft harvest for anterior lumbar interbody fusion (ALIF). The control arms of four randomized prospective multicenter clinical trials evaluating recombinant human bone morphogenetic protein-2 (rhBMP-2) versus autogenous iliac crest bone graft were combined. Two hundred eight patients underwent iliac crest bone graft harvest for ALIF in threaded cylindrical cages or threaded bone dowels. Patients were assessed at each postoperative visit with questionnaires evaluating graft site pain intensity, duration, and appearance. METHODS: Two hundred eight patients underwent iliac crest bone graft harvest for ALIF as the control group of four randomized prospective multicenter clinical trials evaluating rhBMP-2 versus autogenous iliac crest bone graft in threaded cylindrical cages or threaded bone dowels. Most patients in the control group had anterior iliac crest graft harvest, equally from the right and left side. Three grafts (1.4%) were taken from the posterior crest and six (2.9%) were tricortical. Follow-up was obtained at hospital discharge, 6 weeks, 3, 6, 12, and 24 months. A pain evaluation score was made up of two Visual Analog Scales: one scale measuring intensity, the other frequency of pain. For the intensity scale, a rating of "0" meant no pain and "10" was "as bad as it could be." For the frequency scale, a rating of "0" meant pain was present "none of the time" and "10" meant it was present "all the time." Combining these scales, a total score of 20 indicated the worst pain was present all the time. Patients were also questioned about the graft site appearance. RESULTS: Two hundred eight patients underwent iliac crest harvest, and prospective data were available on 202 patients. At hospital discharge, 2 patients (1%) had no pain; this increased to 34 of 199 (17%) at 6 weeks postoperatively and to 85 of 199 patients (43%) at 3 months. However, 41% of patients reported pain at 6 months postoperatively (79/192), and 33% of 168 reported pain at 1 year. One hundred forty-one of 208 patients completed a survey at 24 months, with 31% reporting some level of pain. At hospital discharge, the graft site pain score ranged from 0 to 20 with a mean of 12.8, decreasing to 7.3 at 6 weeks, to 3.8 at 3 months, and to 2.9, 2.4, and 1.8 at 6, 12, and 24 months, respectively. At all time intervals, P values from t tests comparing the mean with 0 were <0.001. Graft site appearance at discharge was good in 49% of patients, fair in 40%, and poor in 11%. At 6 weeks, appearance was good in 69%, fair in 27%, and poor in 5%; at 3 months, it was good in 75%, fair in 24%, and poor in 2%; at 6 months, it was good in 82%, fair in 15%, and poor in 3%; at 12 months, it was good in 82% and fair or poor in 19%; and at 24 months, it was good in 84% and fair or poor in 16%. There was no significant difference between posterior and anterior harvest sites or bicortical grafts, and all were included in the analysis. Right or left side demonstrated no differences. DISCUSSION: This is the first study known to the authors presenting results of prospective data collected in a multicenter study evaluating iliac crest harvest site pain, both intensity and frequency, as well as graft site appearance. The results demonstrate that 31% of patients had persistent pain at 24 months postoperatively and 16% reported fair or poor appearance of their graft site. CONCLUSIONS: Persistent donor site pain remains a problem with harvest of autogenous iliac crest bone graft for spinal fusion. This prospective study, the first such study reported for ALIF, confirms that donor site pain remains a significant postoperative management problem.

Adult↗

PubMed2005

Anterior-only stabilization of three-column thoracolumbar injuries.

OBJECTIVE: The optimal treatment of "unstable" thoracolumbar injuries remains controversial. Studies have shown the advantages of direct anterior decompression of thoracolumbar injuries along with supplemental posterior instrumentation as a combined or staged procedure. Others have also shown success in decompression as a single-stage anterior procedure, largely limited to two-column (anterior and middle) injuries. A retrospective review of all available clinical and radiographic data was used to classify unstable three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) classification system. This was conducted to evaluate the efficacy of stand-alone anterior decompression and reconstruction of unstable three-column thoracolumbar injuries, utilizing current-generation anterior spinal instrumentation. METHODS: Between 1992 and 1998, 40 patients underwent anterior decompression and two-segment anteriorly instrumented reconstruction for three-column thoracolumbar fractures. Retrospective review of all available clinical and radiographic data was used to classify these unstable injuries according to the AO classification system, evaluating for neurologic changes, spinal canal compromise, preoperative and postoperative segmental angulation, and arthrodesis rate. RESULTS: According to the AO classification system, there were 24 (60%) type B1.2, 10 (25%) type B2.3, 5 (12.5%) type C1.3, and 1 (2.5%) type C2.1 three-column injuries. Preoperative canal compromise averaged 68.5% and vertebral height loss averaged 44.5%. There were no cases of neurologic deterioration, and 30 (91%) patients with incomplete neurologic deficits improved by at least one modified Frankel grade. Mean preoperative segmental kyphosis of 22.7 degrees was improved to an early mean of 7.4 degrees (P < 0.0001). At latest follow-up, angulation had increased by an average 2.1 degrees but maintained significant improvement from preoperative measurements (P < 0.0001). There was one early construct failure due to technical error. Thirty-seven of the remaining patients (95%) went on to apparently stable arthrodesis. CONCLUSIONS: Current types of anterior spinal instrumentation and reconstruction techniques can allow some types of unstable three-column thoracolumbar injuries to be treated in an anterior stand-alone fashion. This allows direct anterior decompression of neural elements, improvement in segmental angulation, and acceptable rates of arthrodesis without the need for supplemental posterior instrumentation.

Adolescent↗

PubMed2005

Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging.

OBJECTIVE: Diagnostic selective nerve root injection (SNI) results were analyzed in 101 patients who underwent lumbar or cervical decompression for radiculopathy and compared to surgical outcome 1 year postoperatively. A comparison of surgical outcomes was also examined between magnetic resonance imaging (MRI) and SNI results. RESULTS: Of the 101 patients, 91 (90%) had positive and 10 had negative SNI results at the level operated. Ninety-one percent of the patients with a positive SNI had good surgical outcomes, whereas 60% of the patients with a negative SNI had good outcomes. Of the patients with a positive MRI result, 87% had good surgical outcomes, whereas a similar percentage of the patients with a negative MRI (85%) had good surgical outcomes. When findings between SNI and MRI differed (n = 20), surgery at a level consistent with the SNI was more strongly associated with a good surgical outcome. Of the patients with a poor surgical outcome, surgery was most often performed at a level inconsistent with the SNI finding. CONCLUSIONS: Our study found that a diagnostic SNI can safely and accurately discern the presence or absence of cervical or lumbar radiculopathy. The diagnostic SNI can persuade surgeons from operating on an initially suspicious, but incorrect, level of radiculopathy. In cases where MRI findings are equivocal, multilevel, and/or do not agree with the patient's symptoms, the result of a negative diagnostic SNI (ie, lack of presence of radiculopathy) becomes superior in predicting the absence of an offending lesion.

Anesthetics, Local↗

PubMed2005

Minimally invasive, endoscopic, internal thoracoplasty for the treatment of scoliotic rib hump deformity: technical note.

OBJECTIVE: Patients with idiopathic scoliosis often have a noticeable rib deformity that frequently persists after corrective surgery. Open thoracoplasty has been the traditional method of reducing rib deformity. Recently, however, video-assisted thoracoscopy (VATS) has been used to perform thoracoplasty. There have been no long-term follow-up studies on VATS thoracoplasty, nor have there been outcome scores to assess the results of thoracoplasty procedures. We present our experience using VATS thoracoplasty with long-term follow-up and propose an outcome grading system for thoracoplasty. METHODS: Between 1998 and 2000, four patients (age range, 14-53 yr) underwent VATS thoracoplasty for significant rib hump deformity (mean height, 5 cm; range, 4-6 cm) associated with idiopathic scoliosis. All patients had four rib segments resected during the VATS thoracoplasty procedure. Three of the four patients also underwent anterior thoracic release and discectomy during the procedure. RESULTS: Patients were followed for a mean of 40 months after surgery (range, 33-50 mo). There were no intraoperative or postoperative complications. Outcomes were assessed using a patient questionnaire with our new thoracoplasty grading system. All patients were pleased that they had chosen to have VATS internal thoracoplasty. Based on our new grading system, two patients had an excellent outcome and two had a good outcome. CONCLUSION: VATS provides an alternative, minimally invasive route to perform thoracoplasty. VATS incisions are much smaller and more cosmetically appealing than open thoracoplasty incisions. Long-term follow-up indicates good to excellent patient outcomes.

Adolescent↗

PubMed2004

A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device.

STUDY DESIGN: A prospective, randomized, controlled clinical trial comparing a cylindrical threaded titanium cage to a femoral ring allograft control for anterior lumbar interbody fusion. OBJECTIVE: To compare these two implants with regard to arthrodesis. Secondary outcome measures included pain relief, neurological status, and general health status. SUMMARY OF BACKGROUND DATA: Anterior lumbar interbody fusion is a well-accepted procedure using trapezoidal femoral ring allografts or cylindrical titanium cages. Clinical and biomechanical studies evaluating these two distinct constructs are numerous; however, no prospective, randomized study comparing them has been done. METHODS: A multicenter trial of 140 patients: 78 were randomized to the cylindrical threaded titanium cage device treatment arm and 62 patients randomized into the control group. All had autogenous iliac crest bone graft packed into the device. All patients had a single-level stand-alone anterior lumbar interbody fusion at either the L4-L5 or L5-S1 interspace for symptomatic degenerative disc disease. Radiographic fusion data were collected as well as multiple types of outcome data, including pain/disability scores, neurologic status, and overall health. RESULTS: At 12 months, 97% of the cylindrical threaded titanium cage device group and 40% of the control group demonstrated radiographic fusion. At 24 months, 97% of the cylindrical threaded titanium cage group and 52% of the control group showed radiographic fusion. These fusion rate differences are statistically significant (P < 0.001). The Oswestry and neurologic scores were not significantly different between groups. DISCUSSION: This is the first prospective, randomized, multicenter clinical trial that compares fusion cage results to control data. CONCLUSION: Cylindrical threaded titanium cages have a higher fusion rate, comparable improvements in clinical outcome (Oswestry, Low Back Pain Questionnaire, SF-36), and fewer secondary supplemental fixation procedures compared to the femoral ring allograft control.

Adolescent↗

PubMed2004

Diagnosis and management of thoracolumbar spine fractures.

The lack of robust clinical studies has contributed to controversy regarding optimal treatment for patients with injuries to the thoracolumbar spine. The transitional anatomy of the thoracolumbar spine makes it vulnerable to injury resulting from high-energy motor vehicle collisions and falls; osteoporosis is an underlying factor in most of the compression fractures identified in elderly patients. The formulation of a treatment plan for patients with injuries to the thoracolumbar spine depends on the presence and extent of neurologic injury and deformity and an estimate concerning spinal stability. Both nonsurgical and surgical treatment options are available to achieve the goals of preservation of neurologic function and restoration of spinal stability.

Decompression, Surgical↗

PubMed2004

Diagnosis and management of sacral spine fractures.

The sacrum is the mechanical hub of the axial skeleton, serving as the base for the spinal column and keystone for the pelvic ring. Both surgical and nonsurgical options are available to treat sacral spine fractures; however, because these fractures are relatively rare and heterogeneous in nature and because there is little evidence-based literature, choosing the optimal treatment is challenging. The timing of intervention and the choice of surgical technique need to be determined on an individual basis, with the goal of producing the best outcome for the patient.

Decompression, Surgical↗

PubMed2003

Retrograde ejaculation after anterior lumbar interbody fusion: transperitoneal versus retroperitoneal exposure.

STUDY DESIGN: In this multicenter, prospective, 2-year study, 146 male patients underwent a single-level anterior lumbar interbody fusion with a tapered threaded titanium fusion device. All the patients were advised before surgery of the risk for retrograde ejaculation. After surgery, any case of retrograde ejaculation was recorded as an adverse event, and the patient was observed up for the remainder of the study. OBJECTIVE: To determine the incidence of retrograde ejaculation in male patients treated for single-level degenerative lumbar disc disease at L4-L5 or L5-S1 with a stand-alone anterior interbody fusion using tapered, threaded titanium fusion cages. SUMMARY OF BACKGROUND DATA: The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%. Various risk factors that increase the chance of retrograde ejaculation have been proposed. METHODS: In this prospective study, 146 male patients underwent an open surgical exposure of the lumbosacral junction and a single-level interbody fusion at either L4-L5 or L5-S1. Assessment of a patient's clinical outcome was based on written questionnaires at 6 weeks and then 3, 6, 12, and 24 months after surgery. Patients were questioned about adverse events at each of these assessments, and any case of retrograde ejaculation was recorded and followed. RESULTS: Retrograde ejaculation developed in 6 of the 146 men after open anterior lumbar interbody fusion surgery. Two cases (1.7%; 2/116) involved patients who underwent a retroperitoneal surgical exposure. Four cases (13.3%; 4/30) involved patients who had a transperitoneal surgical exposure. This difference is statistically significant according to Fisher's exact test (P = 0.017). At 12 months after surgery, 2 patients had resolution of their symptoms: 1 in the retroperitoneal approach group and 1 in the transperitoneal group. At the final 2-year follow-up, no changes in symptoms were reported. One patient in the retroperitoneal approach group (0.86%) and three patients in the transperitoneal group (10%) reported permanent retrograde ejaculation (P = 0.027). CONCLUSIONS: A transperitoneal approach to the lumbar spine at L4-L5 and L5-S1 has a 10 times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach.

Ejaculation↗

PubMed2003

Early reconstruction failures after multilevel cervical corpectomy.

STUDY DESIGN: A retrospective analysis of graft and plate complications after multilevel anterior cervical corpectomy and fusion (ACF) attributed to spondylosis, stenosis, and ossification of posterior longitudinal ligament was conducted. OBJECTIVE: To identify factors contributing to graft and plate complications in this population. SUMMARY OF BACKGROUND DATA: Biomechanical factors contributing to the increased morbidity associated with plated multilevel ACF were evaluated. METHODS: Graft- and/or plate-related complications were retrospectively reviewed in 33 patients undergoing two-level ACF reconstructions and in seven patients having three-level ACF reconstructions performed with iliac crest grafting and instrumentation with a fixed-plated design (cervical spine locking plate). Neurologic status was assessed before surgery and after surgery using both the Nurick Grading Scale and modified JOA (Japanese Orthopaedic Association) Score. The patients were observed an average of 31.4 months after surgery. The follow-up included lateral flexion and extension radiographs and a neurologic examination. RESULTS: Two of the 33 patients undergoing two-level fusions available for long-term follow-up after surgery developed reconstruction failures. All of the remaining fusions were successful, demonstrated by lateral flexion and extension radiographs. Seven patients had plated three-level corpectomy reconstructions. Five of the seven who had anterior-only reconstruction failed. DISCUSSION: A two-level ACF reconstruction is reliable with an anterior strut graft and fixed screw plate construct. A three-level ACF reconstruction is not reliably achieved with an anterior-only construct. The construct failures may be attributed in part to the fixed-plated design being used, as well as the long lever arm of the construct. CONCLUSION: There is a 6% failure rate after fixed-plated (cervical spine locking plate) two-level ACF reconstruction but a 71% failure rate after three-level fixed-plated ACF reconstruction. Future consideration should be given to simultaneous posterior fusion.

Bone Plates↗

PubMed2003

Cervical osteotomy for the correction of chin-on-chest deformity in ankylosing spondylitis. Technical note.

The correction of chin-on-chest deformity is challenging and requires combined anterior and posterior approaches to the cervical spine. The authors describe a cervical osteotomy technique for the correction of chin-on-chest deformity in patients with ankylosing spondylitis (AS). This procedure can be accomplished using a posterior screw rod construct combined with an anterior hybrid plate system. In patients with AS, a "front-back-front" approach may be necessary because of the deformity's rigidity. The authors describe the complicated intubation and anesthetic requirements for this approach. They performed an anterior discectomy, cervical osteotomy, and unilateral pediculectomy but did not place anterior instrumentation. Via a posterior approach, laminectomies, facetectomies, and the contralateral pediculectomy were then undertaken. A posterior cervical screw/rod system was placed and loosely connected to titanium rods. Intraoperatively the deformity was corrected by placing the neck in extension combined with compression of the posterior screws on the rods. The posterior construct is then tightened. Finally, an anterior cervical approach is performed to place a structural interbody graft and a hybrid anterior cervical plate construct. The authors have successfully used this approach to correct a chin-on-chest deformity in a patient with ankylosing spondylitis. At 1-year follow-up examination, excellent resolution of the deformity and solid fusion had been achieved. They prefer to perform this procedure by using state-of-the-art anterior and posterior instrumentation systems.

Bone Plates↗

PubMed2003

Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation.

Symptomatic atlantoaxial instability requires atlantoaxial stabilization. In this study the authors compared clinical, radiographic, and cervical outcome questionnaire results in 67 such patients who underwent 71 separate procedures. Thirty-eight patients had traditional posterior C1-C2 cervical wiring and halo-vest immobilization (group 1), whereas 33 were alternatively managed with transarticular screw fixation without rigid external immobilization (group 2). Mean follow-up in group 1 was 53.2 months and mean follow-up in group 2 was 41.0 months. Radiographic evaluation demonstrated seven pseudoarthroses and four fibrous unions in group 1, with six patients subsequently undergoing reoperation. There were no pseudoarthroses and two fibrous unions in the transarticular screw group (p = 0.015). In those that fused, >2-mm displacement occurred in six of the group 1 patients (p = 0.027). There was a trend toward fewer complications in group 2 patients (p = 0.085) with four complications, as compared with 12 complications in group 1, including a 21% incidence of halo-vest-related complications. These results demonstrate the significant benefits of transarticular screw fixation over posterior cervical wiring techniques in the management of atlantoaxial instability.

Atlanto-Axial Joint↗

PubMed2002

Posterior cervical fixation using a new polyaxial screw and rod system: technique and surgical results.

OBJECT: Standard lateral mass plate and screw systems are of limited use in patients with abnormal cervical anatomy and do not easily allow for extension to either the occipit or the thoracic spine. The objective of this study was to demonstrate the safety, surgical efficacy, and advantages of a new cervical polyaxial screw and rod system for posterior occipitocervicothoracic arthrodesis. METHODS: The authors reviewed a multicenter series of patients who underwent surgery in which they used a new posterior cervical polyaxial screw and rod system. The system was implanted in 32 (20 women and 12 men) adult patients (mean age 56.9 years, range 23-84 years). Twenty-three of the patients were treated for spondylostenosis; four for cervical fracture/dislocations; four for kyphosis; and one patient was treated for pseudarthrosis that developed after prior surgery. The system was successfully implanted in all patients despite the presence of anatomical lateral mass anomalies in the majority of cases. The mean number of levels fused was 3.9 (range one-eight levels). This dynamic system allowed for screw placement into the occiput, C-1 lateral masses, C-2 pars, C3-7 lateral masses, and low cervical as well as upper thoracic pedicles. Selective application of compressive or distractive forces was possible in adjacent segments. Surgery-related complications included one dural tear and one malpositioned screw. There were two cases of wound infection. CONCLUSIONS: Unlike standard lateral mass plate and screw systems, the new cervical polyaxial screw and rod system easily accommodates severe degenerative cervical spondylosis and curvatures. This instrumentation system allows for polyaxial screw placement with subsequent multiplanar rod contouring and offset attachment. The authors have used this system successfully, and without significant complications, to achieve posterior cervical arthrodesis.

Adult↗