PubMed · 7231972
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V I Chaplygin. 1981. [Hinged wrench].. https://pubmed.ncbi.nlm.nih.gov/7231972/
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STUDY DESIGN: Investigation of the mean safe lateral-mass screw lengths in the Roy-Camille and Magerl screw techniques in cadaveric cervical specimens. OBJECTIVES: To report the mean screw path length and to evaluate the relation of the screw trajectory to the nerve root in the Roy-Camille and Magerl screw techniques. SUMMARY OF BACKGROUND DATA: Potential injury to the cervical nerve root caused by too long a screw remains a major concern. Few studies regarding proper screw length and its relation to the adjacent nerve root are available. METHODS: Fourteen cervical spines were used for this study. Each lateral mass from C3 to C7 was drilled according to the techniques described by Roy-Camille (right side) and Magerl (left side). The cervical spines were harvested from the cadavers, and the anterior aspect of the lateral mass and spinal nerve were exposed. The screw path length between the dorsal and ventral cortices of the lateral mass were measured. An additional measurement was taken from the ventral aspect of the lateral mass to the nerve root along the screw path. RESULTS: The mean screw path length in the Roy-Camille technique decreased consistently from C3 (15.7 +/- 1.7 mm) to C7 (11.3 +/- 0.8 mm). The mean distance from the ventral cortex to the nerve root ranged from 1.2 to 2.3 mm, and the smallest value was at C7. The mean screw path length in the Magerl technique also decreased from cephelad to caudal, with a range of 15-16 mm at C3-C6 and a mean value of 13.8 mm at C7. CONCLUSIONS: A safe screw length is 14-15 mm in the Roy-Camille technique and 15-16 mm in the Magerl technique at C3-C6. A short screw may be used at C7 if desired.
STUDY DESIGN: A case of a 9-year-old girl with von Recklinghausen's disease who has acute tetraparesis caused by a complete dislocation of C6-C7 after a cervical laminectomy performed at another hospital. OBJECTIVES: To demonstrate the treatment difficulties of cervical spine abnormality associated with neurofibromatosis. SUMMARY OF BACKGROUND DATA: Craig and Govender have reported cases of neurofibromatosis of the cervical spine (1992). METHODS: The patient underwent emergency surgery starting with a posterior release of the articular facets and with the positioning of two Roy-Camille plates. The dislocation of C6-C7 was reduced by an anterior approach. Finally the Roy-Camille plates were removed, a plate was implanted posteriorly at the C6 and C7 joints, and a posterior cable was positioned around the C2-C3 posterior arches. RESULTS: More than 4.5 years after surgery, the patient's neurologic condition remains satisfactory. She can walk and run and has no sphincter disorders. CONCLUSIONS: The results underline the importance of simultaneous anterior and posterior surgical approaches in this disease.
The reduction and plate osteosynthesis of condylar fractures often require a wide extraoral approach with the risk of facial nerve palsy. The endoscopic technique is an alternative. Seven condylar fractures were operated on under endoscopic control. In three patients a newly developed device for endoscopically controlled plate application was clinically tested for osteosynthesis. In two cases fracture healing was achieved. In the third case the plate had to be removed early due to insufficient screw fixation. The new device and the application technique are described in detail. This technique may be helpful in further minimizing trauma surgery.