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Joaquim AF, Lee NJ, Riew KD. Circumferential Operations of the Cervical Spine. Neurospine 2021; 18:55-66. [PMID: 33819936 PMCID: PMC8021816 DOI: 10.14245/ns.2040528.264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Generally, a combined anterior and posterior cervical approach is associated with significant morbidity since it requires an extended operative time, greater intraoperative blood loss, and both anterior- and posterior-related surgical complications. However, there are some instances where a circumferential cervical fusion can be advantageous. Our objective is to discuss the indications for circumferential cervical spine procedures. A narrative review of the literature was performed. We include the indications for circumferential cervical approaches of the senior author (KDR). Indications for circumferential approaches include: (1) high-risk patients for pseudoarthrosis, (2) cervical deformity (e.g., degenerative, posttraumatic, cervicothoracic kyphosis), (3) cervical spine metastases (especially those with multilevel involvement), (4) cervical spine infection, (5) unstable cervical trauma, (6) movement disorders and cerebral palsy, (7) Multiply operated patient (especially postlaminectomy kyphosis and patients with massive ossification of the posterior longitudinal ligament), and when (8) early fusion is desirable. Circumferential procedures may be useful in many different cervical spine conditions requiring surgery. Despite its advantages, particularly with reducing the risk for pseudarthrosis, the benefits of a combined approach must be weighed against the risks associated with a dual approach. With appropriate preoperative planning, intraoperative decision-making, and surgical techniques, excellent clinical outcomes can be achieved.
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Affiliation(s)
| | - Nathan J Lee
- Department of Orthopedics, Columbia University, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopedics, Columbia University, New York, NY, USA
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Janka M, Handschu R, Merkel A, Schuh A. [Spinal stenosis]. MMW Fortschr Med 2020; 162:58-65. [PMID: 33140362 DOI: 10.1007/s15006-020-1459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Janka
- Klinikum Neumarkt\/Muskuloskelettales Zentrum, Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany.
| | - René Handschu
- Klinikum Neumarkt i.d. Oberpfalz, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
| | - Andreas Merkel
- , Nürnberger Straße 12, 92318, Neumarkt i.d. OPf., Germany
| | - Alexander Schuh
- Friedrich-Alexander-Univ. Erlangen-Nürnberg, Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Germany
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O'Connor KP, Smitherman AD, Palejwala AH, Krempl GA, Martin MD. Anterior cervical discectomy and fusion requiring resection of the superior horn of thyroid cartilage: case report. J Neurosurg Spine 2020; 32:559-561. [PMID: 31812135 DOI: 10.3171/2019.9.spine19158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/23/2019] [Indexed: 11/06/2022]
Abstract
Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure utilized for degenerative diseases of the cervical spine. The authors present the case of a 64-year-old man who underwent an ACDF for degenerative changes causing cervical stenosis with myelopathy. The patient's symptoms consisted of pain and weakness of the bilateral upper extremities that slowly progressed over 1.5 years. During the procedure, the superior horn of the thyroid cartilage impeded proper retraction, preventing adequate visualization due to its prominent size. At this point, otorhinolaryngology was consulted, which allowed for safe resection of this portion of the thyroid cartilage while preserving nearby critical structures. With the frequent usage of this surgical approach for various etiologies, the importance of proper recognition and consultation is paramount. Encountering prominent thyroid cartilage resulting in surgical obstruction has not been described in the literature and this report represents a paradigm for the proper course of action.
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Affiliation(s)
| | | | | | - Greg A Krempl
- 2Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Bajamal AH, Kim SH, Arifianto MR, Faris M, Subagio EA, Roitberg B, Udo-Inyang I, Belding J, Zileli M, Parthiban JKBC. Posterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019; 16:421-434. [PMID: 31607074 PMCID: PMC6790723 DOI: 10.14245/ns.1938274.137] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022] Open
Abstract
Objective This study was conducted to determine and recommend the most up-to-date information on the indications, complications, and outcomes of posterior surgical treatments for cervical spondylotic myelopathy (CSM) on the basis of a literature review.
Methods A comprehensive literature search was performed, using the MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and Web of Science databases, for peer-reviewed articles published in English during the last 10 years.
Results Posterior techniques, which include laminectomy alone, laminectomy with fusion, and laminoplasty, are often used in patients with involvement of 3 or more levels. Posterior decompression for CSM is effective for improving patients’ neurological function. Complications resulting from posterior cervical spine surgery include injury to the spinal cord and nerve roots, complications related to posterior screw fixation or instrumentation, C5 palsy, spring-back closure of lamina, and postlaminectomy kyphosis.
Conclusion It is necessary to consider multiple factors when deciding on the appropriate operation for a particular patient. Surgeons need to tailor preoperative discussions to ensure that patients are aware of these facts. Further research is needed on the cost-to-benefit analysis of various surgical approaches, the comparative efficacy of surgical approaches using various techniques, and long-term outcomes, as current knowledge is deficient in this regard.
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Affiliation(s)
- Abdul Hafid Bajamal
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Mohammad Reza Arifianto
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia
| | - Ben Roitberg
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Inyang Udo-Inyang
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan Belding
- Department of Neurosurgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
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Joaquim AF, Baum G, Tan LA, Riew KD. C1 Stenosis - An Easily Missed Cause for Cervical Myelopathy. Neurospine 2019; 16:456-461. [PMID: 31607078 PMCID: PMC6790717 DOI: 10.14245/ns.1938200.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/17/2019] [Indexed: 01/09/2023] Open
Abstract
C1 stenosis is often an easily missed cause for cervical myelopathy. The vast majority of cervical myelopathy occurs in the subaxial cervical spine. The cervical canal is generally largest at C1/2, explaining the relatively rare incidence of neurological deficits in patients with odontoid fractures. However, some subjects have anatomical anomalies of the atlas, which may cause stenosis and result in clinical symptoms similar to subaxial cord compression. Isolated pure atlas hypoplasia leading to stenosis is quite rare and may be associated with other anomalies, such as atlas clefts or transverse ligament calcification. It may also be more commonly associated with syndromic conditions such as Down or Turner syndrome. Although the diagnosis can be easily made with a cervical magnetic resonance imaging, the C3/2 spinolaminar test using a lateral cervical plain radiograph is a useful and sensitive tool for screening. Surgical treatment with a C1 laminectomy is generally necessary and any atlantoaxial or occipito-atlanto instability must be treated with spinal stabilization and fusion.
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Affiliation(s)
- Andrei Fernandes Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Griffin Baum
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Lee A Tan
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
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Joaquim AF, Baum GR, Tan LA, Riew KD. Dynamic Cord Compression Causing Cervical Myelopathy. Neurospine 2019; 16:448-453. [PMID: 31607076 PMCID: PMC6790743 DOI: 10.14245/ns.1938020.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022] Open
Abstract
Due to the highly mobile nature of the cervical spine, and the fact that most magnetic resonance imagings (MRIs) and computed tomography scans are obtained only in one single position, dynamic cord compression can be an elusive diagnosis that is often missed and not well-understood. In this context, dynamic MRI (dMRI) has been utilized to improve the diagnostic accuracy of cervical stenosis. We performed a literature review on dynamic cord compression in the context of cervical spondylotic myelopathy (CSM), with particular emphasis on the role of dMRI. Cadaveric studies report that the spinal cord lengthens in flexion and the spinal canal dimension increases, whereas the spinal cord relaxes and shortens in extension and the spinal canal decreases. These changes may lead to biomechanical stress in the spinal cord with movement, especially in patients with critical cervical stenosis. The majority of the studies using dMRI in CSM reported that this imaging modality is more sensitive at detecting cervical cord compression compared to routine MRIs done in a neutral position, especially with the neck in extension. Dynamic MRI was also useful to diagnose dynamic cervical cord compression after laminectomies in patients with clinical deterioration without evident cord compression on neutral static MRI. Finally, dMRI is more sensitive in detecting stenosis in patients with CSM than in those with ossification of the posterior longitudinal ligament (OPLL), likely because OPLL patients often have a more limited range of motion than CSM patients. Thus, dMRI is a promising new tool that can help spine surgeons in diagnosing and treating CSM.
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Affiliation(s)
- Andrei Fernandes Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Griffin R Baum
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Lee A Tan
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
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Joaquim AF, Figueiredo EG. Commentary: Posterior Cervical Keyhole Laminoforaminotomy: A Cadaveric Comparative Study to Evaluate Limits of Bony Resection. Oper Neurosurg (Hagerstown) 2019; 16:E136-E137. [PMID: 30690587 DOI: 10.1093/ons/opy284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/24/2018] [Indexed: 11/12/2022] Open
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Yamaguchi S, Mitsuhara T, Abiko M, Takeda M, Kurisu K. Epidemiology and Overview of the Clinical Spectrum of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:1-12. [DOI: 10.1016/j.nec.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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