Cervical Spine Problems Research Articles

Treatment problems in unilateral locked facet syndrome of the cervical spine

In a retrospective study of 22 patients with unilateral locked facet syndrome of the cervical spine, diagnostic and treatment problems were analysed. Diagnosis was delayed in ten patients; in two-thirds of the patients minor or major therapeutic problems were encountered. The treatment protocol advised manipulative reduction and--before 1986--posterior fusion by bone blocks and interspinous wiring; after 1986 ventral intercorporeal fusion by plates was recommended. Closed reduction manoeuvres risk dislocation of intervertebral discs, overdistraction of the spinal cord or injury to the vertebral artery. Unreduced and unfused dislocations are likely to develop chronic instability. Dorsal wiring is an inadequate form of stabilization and ventral plates or dorsal hooks are preferred. To prevent treatment problems a treatment protocol is proposed according to which open reduction following anterior discectomy, operative decompression of endangered nerve roots and stable one-level fusion is done. In non-acute injuries neural structures are decompressed; posterior fusion is done without attempts at reduction.

Operative management of cervical spine problems in athletes

Injuries to the cervical spine that require operative treatment are infrequent in athletes; however, when operative treatment is required, the surgeon should be familiar with anterior, posterior, and combined techniques to determine the best approach for a particular patient. Improvements in internal fixation have decreased the need for combined procedures and lengthy postoperative immobilization, but the use of these devices requires experience and careful patient selection.

BRIEFLY NOTED

We have presented a case of death from AAS in a rheumatoid patient. We believe her cardiac arrest was caused by an acute myocardial infarction (MI) or dysrhythmia. We cannot determine whether the MI/dysrhythmia was itself a lethal event. The damage to her lower medulla and upper cervical cord, which most likely occurred at the time of her intubation, was a lethal injury. The presence of spinal cord ischemic changes and acute inflammatory cells within the cord indicate that the cervical spine injury occurred premortem. This patient had no neck pain, no neurologic symptoms or signs, and had AAS of 8 mm. Weissman suggests that 9 mm of AAS is the critical amount. The 1-mm subluxation difference here is probably not significant, because there is inherent error when measuring radiographs. We took into account her clinical and radiographic data, and decided to manage her C1-C2 articulation nonoperatively. Nevertheless, her atlanto-axial joint consisted of abnormal soft and hard tissue. This joint was satisfactory for her usual activities of daily living. The anteroposterior forces generated during ACLS intubation, which are unlikely to disrupt a normal atlanto-axial joint, were sufficient to subluxate her joint. This case demonstrates that it behooves us to maintain a high level of awareness for potential cervical spine problems in all rheumatoid arthritis patients.