European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. ⋯ Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.
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Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures. However, refracture of cemented vertebrae occurs occasionally after vertebroplasty. It is unclear whether such fractures are procedure-related or part of the natural course of osteoporosis. ⋯ Only restoration of anterior vertebral height was positively associated with refracture during the follow-ups (P < 0.01). In conclusion, refractures of cemented vertebrae after vertebroplasty occurred in 63% of osteoporotic patients. Significant anterior vertebral height restoration increases the risk of subsequent fracture in cemented vertebrae.
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Multilevel cervical spine procedures can challenge the stability of current anterior cervical screw-and-plate systems, particularly in cases of severe three-column subaxial cervical spine injuries and multilevel plated reconstructions in osteoporotic bone. Supplemental posterior instrumentation is therefore recommended to increase primary construct rigidity and diminish early failure rates. The increasing number of successfully performed posterior cervical pedicle screw fixations have enabled more stable fixations, however most cervical pathologies are located anteriorly and preferably addressed by an anterior approach. ⋯ On the basis of these results, standard spine models were reconstructed and used for the conceptual development of a preclinical release prototype of an anterior transpedicular screw-and-plate system. The morphological feasibility of the new technique is demonstrated, and its indications, biomechanical considerations, as well as surgical prerequisites are thoroughly discussed. In the future, the technique of cervical anterior transpedicular screw fixation might diminish the number of failures in the reconstruction of multilevel and three-column cervical spine instabilities, and avoid the need for supplemental posterior instrumentation.
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Reconstruction after multilevel decompression of the cervical spine, especially in the weakened osteoporotic, neoplastic or infectious spine often requires circumferential stabilization and fusion. To avoid the additional posterior surgery in these cases while increasing rigidity of anterior-only screw-plate constructs, the authors introduce the concept of anterior transpedicular screw (ATPS) fixation. We demonstrated its morphological feasibility as well as its indications in a previous study in Part I of our project. ⋯ The study demonstrated that the use of ATPS might be a new technique worthy of further investigation. The use of ATPS shows the potential to increase construct rigidity in terms of screw-plate pull-out resistance. It might diminish construct failures during anterior-only reconstructions of the highly unstable decompressed cervical spine.
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The use of C2 laminar screws in posterior cervical fusion is a relatively new technique that provides rigid fixation of the axis with minimal risk to the vertebral artery. The techniques of C2 laminar screw placement described in the literature rely solely on anatomical landmarks to guide screw insertion. The authors report on their experience with placement of C2 laminar screws using three-dimensional (3D) fluoroscopy-based image-guidance in eight patients undergoing posterior cervical fusion. ⋯ Postoperative computed tomographic (CT) scanning was available for seven patients allowing evaluation of placement of thirteen C2 laminar screws, all of which were in good position with no spinal canal violation. The intraoperative planning function of the image-guided system allowed for 4-mm diameter screws to be placed in all cases. Using modified Odom's criteria, excellent or good relief of preoperative symptoms was noted in all patients at final follow-up.