The role of stabilization in the treatment of cervical spine injuries.

Abstract

This presentation started with the assumption that our patient needs a cervical spine operation. Attention has been focused on the questions of which operation is needed and why. Most operations substitute one abnormal situation for another. The second abnormal situation must be beneficial to the patient. It was suggested that we think about the concept of immediate postoperative stability and the methods of achieving it when needed. When decompressions are indicated, we should determine as precisely as possible where the pressure is and what surgical procedure is the best to relieve it. We have suggested that allographs may be as good or in some ways better than autographs. The validity of the statement that bone grafts under tension will be absorbed has been questioned. We have suggested that the maturation of a bone graft can be staged and the patient managed accordingly. The discussion included an analysis of the advantages and disadvantages of some of the surgical constructions that are employed into the occipital-atalantoaxial complex. The importance of preserving motion in this joint as much as is compatible with a solution of the clinical problem was indicated. We suggested the use of the halo applied preoperatively and maintained through surgery in order to have safe, thorough control for the highly unstable situations in the upper cervical spine. In the lower cervical spine the selection of procedures that do not add to already existing instability was emphasized. Opinion was submitted about the relative immediate postoperative stability of the various anterior and posterior procedures in the lower cervical spine. We submitted some ideas about the principles of the use of methylmethacrylate in cervical spine surgery. Specific details of the surgical procedures were discussed when needed and illustrative case reports were included, when they were thought to be helpful.