The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Jan 2012
ReviewEsophageal and vertebral artery injuries during complex cervical spine surgery--avoidance and management.
Vertebral artery and esophageal injuries are rare but feared complications of cervical spine surgery. Appropriate understanding of treatment algorithms for prompt intervention in the event of a vertebral artery injury minimizes the risk of exsanguination and/or profound neurologic consequences. ⋯ They can additionally be seen as a late complication of instrumentation usage and/or failure. Expedient diagnosis and management of these injuries minimize their impact and allow for optimal treatment outcome.
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Orthop. Clin. North Am. · Jan 2012
Review Comparative StudyPosterior surgery for cervical myelopathy: indications, techniques, and outcomes.
This article details the controversies associated with the different treatment strategies in patients with cervical spondylotic myelopathy. The natural history, incidence, pathophysiology, physical examination, and imaging findings are discussed followed by the indications, techniques, and outcomes of patients treated with posterior cervical decompression via decompressive laminectomy, laminectomy and instrumented fusion, and laminoplasty.
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Principles of revision cervical spine surgery are based on adequate decompression of neural elements and mechanical stability via appropriate selection of surgical approach and constructs producing long-term stability with arthrodesis. When planning revision surgery, the surgeon must consider the cause of the underlying problem (eg, biological, mechanical), the potential for complications, and clinical outcomes that can reasonably be expected. This information should be clearly explained to the patient during the informed consent process. This article provides the spine care provider with an understanding of how to appropriately evaluate and manage the most common cervical conditions that require revision cervical spine surgery.
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Orthop. Clin. North Am. · Jan 2012
ReviewSubaxial cervical and cervicothoracic fixation techniques--indications, techniques, and outcomes.
The subaxial and cervicothoracic junction is a relatively difficult area for spine surgeons to navigate. Because of different transitional stressors at the junction of the smaller cervical vertebrae and the larger thoracic segments, proximity to neurovascular structures, and complex anatomy, extreme care and precision must be assumed during fixation in these regions. Lateral mass screws, pedicle screws, and translaminar screws are currently the standard of choice in the subaxial cervical and upper thoracic spine. This article addresses the relevant surgical anatomy, pitfalls, and pearls associated with each of these fixation techniques.
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Orthop. Clin. North Am. · Jan 2012
ReviewCervical total disk replacement: complications and avoidance.
Anterior cervical diskectomy and fusion for neurologic deficits, radicular arm pain, and neck pain refractory to conservative management are successful. The approach and procedure were first described in 1955 and have become the anterior cervical standard of care for orthopedic surgeons and neurosurgeons. ⋯ The possibility of obtaining anterior cervical decompression while maintaining adjacent segment motion led to the advent of cervical total disk replacement. The Food and Drug Administration has approved 3 cervical devices with other investigational device exemption trials under way.