Anterior Cervical Spine Fusion Research Articles

頚椎脱臼における前方固定術後の局所アライメントの変化について ＯＲＩＯＮ ａｎｔｅｒｉｏｒ ｃｅｒｖｉｃａｌ ｐｌａｔｅ併用の有用性の検討

頚椎脱臼における前方固定術後の局所アライメントの変化について ＯＲＩＯＮ ａｎｔｅｒｉｏｒ ｃｅｒｖｉｃａｌ ｐｌａｔｅ併用の有用性の検討

Anterior and Posterior Cervical Spine Fusions

Anterior and Posterior Cervical Spine Fusions

Anterior cervical fusion with the Orion locking plate system.

This study was conducted to evaluate an anterior cervical fusion plate system, the Orion locking plate, regarding its surgical handling, hardware-related failures, and short-term and long-term results. A comprehensive evaluation of the implant in a broad range of patients with cervical spine diseases. Locking plates are the most recent devices for achieving anterior cervical spinal fusion and offer considerable advantages such as faster and easier implantation and fewer implant-related failures than older plate systems. Ninety-six patients were investigated. All underwent anterior cervical plate fusion as a component of the surgical treatment for symptomatic degenerative cervical spinal disease or for vertebral destruction caused by trauma, tumor, or inflammation. Besides plate fixation, 6 of the 96 patients had a combined ventrodorsal fusion. In 28 cases, one or more vertebral bodies were removed and replaced with titanium place-holders. The remaining 62 patients were first treated by intervertebral inlay placement, and the fused segments were subsequently plated. Neurologic signs and symptoms were evaluated before and after surgery and during a follow-up period of at least 1 year. The rate of neurologic improvement was highest in radiculopathy patients and lowest in patients with severe myelopathy. In all cases, control radiographs demonstrated a solid bony fusion. Clinical deterioration after surgery was seen in four cases of severe myelopathy in which considerable neurologic deficits existed before surgery, possible because of rapid decompression of the cord and associated microvascular alterations. In two of these cases, there was long-term improvement. Additional general complications caused by surgical retraction included temporary swallowing disturbance in seven patients and a large wound hematoma in one. Hardware failures were encountered in three cases, all of them caused by improper implantation technique and not material failure, per se. In the study group, the Orion locking plate was easy to use, failure-free if properly implanted, safe for the patient and supported solid bony fusion in every case.

A technique for prevention of donor site pain associated with harvesting iliac bone grafts

Patients who have undergone anterior cervical spine fusion with an iliac bone graft frequently experience donor site pain after surgery. We found that an effective technique to avoid donor site pain is to round off the corners of the iliac crest with an air drill after harvesting the graft.

Low-Dose Chemonucleolysis Combined with Percutaneous Nucleotomy in Herniated Cervical Disks

The combination of low-dose chemonucleolysis with 500 IU chymopapain followed by an automated percutaneous nucleotomy of the cervical spine is a new procedure. A follow-up of at least 1 year of the first 22 patients showed in 19 patients good or excellent results. In one patient a fair result was obtained, and in two patients the symptoms were unchanged; one of these patients subsequently underwent diskectomy and anterior cervical spine fusion. Preoperatively, all patients showed a clear cervical disk herniation with predominantly radicular pain. The procedure has been performed so far in approximately 100 patients. No intra- or postoperative complications have been noted.

破壊性脊椎関節症の治療経験

Patients receiving long-term hemodialysis frequently develop orthopaedic complications such as renal osteodystrophy and carpal tunnel syndrome. Kuntz and colleagues reported a new syndrome named destructive spondylarthropathy (DSA). We experienced four cases of DSA who required surgical treatment. Patients included one male and three females with an average age of 60 years (range 54-72 years). The mean duration of follow-up was eleven months (range 7-16 months) and the length of hemodialysis ranged from 8 to 17 years (mean 12 years). All patients had myelopathy along with radiculopathy. We performed anterior cervical spinal fusion (ASF) in three cases and posterior cervical spinal fusion using a rectangular rod in one case. Mean recovery rate using Hirabayashi's method was 59% (range 0-100). Histological examination of the disc was carried out in three cases with ASF and amyloid deposits were found in two. In two case of ASF group, bone union was insufficient.

A simple method to ensure proper screw position and plate size selection using the Morscher cervical spine locking plate. Technical note.

The use of bone plate instrumentation with screw fixation has proved to be a useful adjunctive measure in anterior cervical spine fusion surgery. Proper fitting, positioning, and attachment of this instrumentation have been shown to be frequently suboptimal if done without radiographic guidance. The most commonly used method of radiographic assistance for placement of this instrumentation is fluoroscopy. While this gives satisfactory technical results, it is expensive and time-consuming, and exposes the patient and the operating room personnel to ionizing radiation. The authors present a simple technique to ensure screw placement and plate fitting using Kirschner wires and a single lateral radiograph. This technique saves time, reduces exposure to radiation, and has led to satisfactory results in over 20 operative cases.

Severe retroperitoneal hemorrhage complicating anterior iliac bone graft acquisition

The anterior iliac crest is a frequent donor site for procuring autologous bone grafts for reconstructive surgical procedures. 1 Complications following this procedure are rare and usually minor. Pain, infection, and self-limited hematoma are most commonly reported. 2 More significant complications include stress fracture of the iliac bone, 1–3 herniation of abdominal viscera through the donor site bone defect, 4,5 ilioinguinal or femoral neuropathy, 6 ureteral injury, arteriovenous fistula, 7 and meralgia paresthetica (anesthesia and dyesthesia in the region supplied by the lateral femoral cutaneous nerve). 8 Recently, a patient at our institution developed massive, subacute retroperitoneal hemorrhage following acquisition of an anterior iliac crest bone graft for anterior cervical spine fusion. Further complications related to the hemorrhage ultimately led to the patient's death. To our knowledge, no similar case has been reported in the literature. Awareness of this rare, but potentially catastrophic, complication of iliac bone graft acquisition is important for proper postoperative management, especially when unexplained postoperative hypotension or decreasing hematocrit are encountered.

Pseudarthrosis and delayed union after anterior cervical fusion

Anterior cervical spine fusion was carried out on 443 cases between 1965 and 1988 with pseudarthrosis or delayed union in 15 (3.4%). The causes of these complications were malalignment and faulty postoperative care. Symptoms resulted from abnormal mobility, cord compression due to posterior slip or rotation of the upper vertebral body, kyphotic deformity or a problem at the adjacent level. Four out 5 cases with symptoms recovered successfully after a second operation.

Anterior cervical spine fusion: struts, plugs, and plates.

Bone grafting in the cervical spine is an expanding and rapidly changing area. Its success depends on the presence of bone formation, bone incorporation, and ongoing adaptive remodeling to mechanical loads. The evaluation of anterior cervical spine grafts requires a basic understanding of bone graft physiology, its clinical applications, and its postoperative appearances. The roles of routine radiography, polydirectional tomography, computed tomography, and magnetic resonance imaging in the assessment and follow-up of the postoperatively grafted cervical spine will be discussed. The main focus of this paper is to review current surgical procedures utilized for stabilizing the cervical spine as well as to discuss the radiologist's role in the imaging of this region.

ｖｏｎ Ｒｅｃｋｌｉｎｇｈａｕｓｅｎ病の頚椎後わんに対する前方固定術後に環軸椎脱臼をきたした１例

We report a case of atlantoaxial dislocation associated with von Recklinghausen's disease which developed after anterior cervical spinal fusion.Anterior spinal fusion was performed from C3 to C7 to prevent the progression of marked kyphosis (125 degrees) found in a 22-year-old man with von Recklinghausen's disease. Spondylosis was well established, and no further increase in kyphosis was seen. However three years after the operation, he complained of lower extremity tingling and had a spastic gait. Radiological instability of C1-C2 was then confirmed.The earlier anterior cervical spinal fusion was considered to be potentially involved in the pathogenesis of this patient's atlantoaxial dislocation.

Excessive atlanto-occipital flexion as a cause of complete airway obstruction following anterior cervical spine fusion

This report describes complete airway obstruction following anterior cervical fusion caused by extreme, fixed f exion of the neck in a halo device. The causes and treatment of such an airway complication are reviewed.

Cervical Spine and Shoulder Pain

The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.

頚椎症性脊髄症に対する前方除圧術の検討 成績不良例について

頚椎症性脊髄症に対する前方除圧術の検討 成績不良例について

Reversible Loss of Somatosensory Evoked Potentials during Anterior Cervical Spinal Fusion

Reversible Loss of Somatosensory Evoked Potentials during Anterior Cervical Spinal Fusion

The Anatomy of the Distal Ulnar Tunnel

Two hundred twenty-two cervical spine stabilization procedures in 212 patients are reviewed. In 114 posterior cervical fusions, 88 anterior fusions, and ten combined procedures, no deaths occurred. Surgical complication rates were similar, but more severe complications were noted with anterior cervical fusions, including tracheoesophageal problems and transient neurologic loss. Six cases of graft dislodgement requiring reoperation also occurred. In long-term follow-up evaluations, 36 anterior fusion patients developed progressive kyphotic deformity averaging 22 degrees between surgery and the time solid fusion was obtained. Degenerative changes above and below the fusion mass were detected in 36 of 59 patients treated by anterior surgery. Posterior cervical fusion patients were noted to have no significant late change in alignment, and degenerative changes were infrequent. However, 73 of 98 patients had significant extension of fusion mass beyond the originally intended levels of stabilization. Because anterior cervical spine fusion was associated with significant complications of graft dislodgement and tracheoesophageal trauma, as well as postsurgical progressive deformity, the authors recommend posterior wiring and fusion as the procedure of choice to treat cervical spine instability and permit halo-free postsurgical rehabilitation. When anterior neural decompression and fusion is necessary, concomitant posterior wiring and fusion or halo vest immobilization may be necessary to maintain reduction and prevent kyphotic angulation, because posterior ligamentous disruption is not always grossly evident on radiographic examination.

当科におけるけいつい前方除圧固定術の予後調査

A follow-up study of 41 cases with anterior decompressive interbody fusion of cervical spine was done. We analysed relationships of results to many factors. (term of illness, age, Hattori's classification, developmental Canal stenosis, Pseudoarthrosis and so on.) We found significant relationships of results to term of illness and Hattori's classification.

Acquired nonmalignant tracheoesophageal fistula

Acquired tracheoesophageal fistula (TEF) caused by cuffed tracheal tubes, surgical trauma, and blunt injuries is an unusual and serious problem. Several differing approaches to management have been proposed. We have repaired such fistulas in 20 patients; 14 of them were related to tracheal intubation, three to blunt trauma, two followed anterior cervical spine fusions, and one resulted from a foreign body. Fistula closure on ventilator-dependent patients was usually delayed until they were weaned from respiratory support. Four patients had esophageal diversion before repair of their fistulas. There was sufficient tracheal damage to require resection and end-to-end anastomosis in 13 patients. The esophageal defect was closed directly in 16 patients, and end-to-end reconstruction of the esophagus was accomplished in four. There were two deaths, and one fistula recurrence required reoperation. These results support our recommendations to delay fistula closure in most ventilator patients, to use esophageal diversion selectively, to employ tracheal resection when there is evidence of extensive damage, and to directly repair the esophagus.

Cervical Discography in Traumatic Myelopthy

Cervical Discography has been performed on 5 cases of traumatic myelopathy. These cases have no fracture, dislocation and disc degeneration in X-P. All of them have negative myelogram.In discography contrast medium leaked into the spinal canal and all patients complained of nape pain, arm pain, when disc was injected.In two patients the pain spread downward into abdomen and extremities.All of them were performed anterior body fusion of cervical spine, neurological recovery were excellent.

The Effects of Hyperoxia Upon Bone in Organ Culture

Hyperoxia has been reported to stimulate both resorption and synthesis of bone in vitro. The effects of increased oxygen tension were re-investigated using calvaria from infant mice maintained in a stationary grid culture system for 48 48 hours with an unsupplemented chemically defined medium. Resting resorption due to osteoclastic activity was demonstrated in the explants in air by Von Kossa staining, histology, and 45 Ca release. Resorption was inhibited by exposure to 95 per cent oxygen or hyperbaric oxygenation at 2 atmospheres pressure. Hyperoxia also depressed new bone formatin by osteoblasts although the production of a new collagen, as measured by the incorporation of 3H-proline, was greater in calvaria cultured in hyperbaric oxygen than in paired explants in 95 per cent oxygen. Thus hyperoxia was toxic for both synthetic and resorptive activity of bone cells; these effects may stem from the loss of vital factors present in natural MEDIA supplements.