New developments in surgery of the injured spine

Abstract

There are many new options, and those procedures that are interesting from the aspect of traumatology have been selected: (1) A special positioning aid for the treatment of injuries to the cervical spine. The appliance has proved extremely useful for reduction and immobilization of fractures and dislocations and also allows reliable positioning of the head in all desired surgical positions when ventral and/or dorsal approaches are used. (2) A new titanium H-plate, which can be fixed either with the usual 3.5-mm-thick screws or with unconventional 4.5-mm-thick screws in the case of lesions to the lower cervical spine. (3) A new technique for less invasive atlanto-axial screw fixation, with a cannula system extending to the axis from small incisions at the level of the upper thoracic spine, by way of which the C-1 joint block can be drilled, milled and screwed. (4) Jeanneret's CerviFix rod system. This system has progressed beyond the drawbacks of plating as performed so far for internal fixation of the dorsal cervical spine, in which screws could be inserted only at predetermined intervals and angles. Movable grips, lateral stabilizers and extension pieces mean that the system is very well able to fulfil the demands of a variable and stable implant. (5) Transthoracic endoscopic spinal surgery, which is excellently suited to fusion of a traumatized segment to supplement reduction and instrumentation from a dorsal approach. (6) A reduced-invasion method at the thoracolumbar transition, with no insertion of implants from a ventral approach and blocking through a small left lateral thoracotomy with autogeneic shavings from the iliac crest.