Spine
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Clinical Trial
Anatomic considerations for the pedicle screw placement in the first cervical vertebra.
Anatomic bony measurements were manually performed on 50 dry atlantoaxial vertebral complexes with an electronic digital caliper, and a reliable landmark for insertion of a pedicle screw in C1 vertebra was described and evaluated. ⋯ The heights of the C1 pedicle, the posterior arch under the groove and the posterior lamina at the screw entry point are the major determinants for the possibility of placing pedicle screws in C1 of a given patient. This study indicates that it is feasible to place a 3.5-mm pedicle screw safely in C1 in most patients, and the lateral mass of C2 is a reliable anatomic landmark that can be easily identified to help the surgeon determine the optimal screw entry portal conveniently during surgery.
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Retrospective clinical and radiographic review. ⋯ Traditional anterior/posterior fusion technique provides no additional improvement in radiographic outcome compared to posterior-only surgery for adolescent hyperkyphosis. Preliminary anterior release and fusion is no longer performed when correcting this deformity with a posterior column shortening procedure and threaded rod compression instrumentation.
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An in vitro biomechanical study of C1-C2 posterior fusion techniques using a cadaveric model. ⋯ The results clearly indicate the potential of the intralaminar screw technique to provide stability that is equivalent to methods currently used. Given the serious complications that can follow vertebral artery injury and the decreased likelihood of injury by avoiding placement of C2 pedicle screw(s) and C1-C2 transarticular screw(s), strong consideration should be given to using a construct that incorporates C2 intralaminar screw(s).
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This study retrospectively reviewed 12 years of consecutive patients with cervical spine injuries. ⋯ The realistic expectation for short-term postoperative survival in the elderly patient with a cervical spine injury is 87.8%. With a complete neurologic injury, 80.0% short-term survival was observed. Incomplete neurologic injury yielded 83.3% short-term survival. Close to 100.0% survival can be expected with no neurologic injury.