Der Orthopäde
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The posterior approach to the cervical spine was the only method of access to the spinal canal until the anterior approach was developed by Robinson and Smith, and Cloward. With the accumulation of experience in posterior decompression for cervical spondylotic myelopathy (CSM), successful laminectomy was guaranteed only when lordotic alignment of the cervical spine, wide and extensive laminectomy for adequate posterior shift of the spinal cord, and stability of the spine were ensured after surgery. The thick scar formation occasionally seen subsequent to postlaminectomy hematoma could lead to an unfavorable outcome. ⋯ Preservation of the posterior spinal structures permits reinsertion of the nuchal muscles and the spinal ligaments after they have been totally or partially detached. This prevents kyphosis or listhesis of the cervical spine, which often develops after laminectomy, particularly in subjects below 50 years of age. Reconstructive procedures for reattaching muscles and/or ligaments to the spinous processes are added to the laminoplasty, improving the dynamic or ligamentous stability of the spine.
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Injection therapy is highly significant in the treatment of cervical syndromes. Following the differential diagnosis and analysis of the symptoms, injection treatment leads to a worthwhile degree of pain relief as a result of the anaesthetic effect on the nerve. This paper describes the general criteria for such treatment and also the various injection techniques in use.