Management of Complex Cervical Instability

 

 Buy Article Permissions and Reprints

Abstract

Purpose Illustrative cases are presented to demonstrate the surgical management of complex instability of the cervical spine.

Methods Six patients with different underlying pathologies are presented along with their clinical and radiologic findings, surgical procedures, complications, and outcomes.

Results Five patients underwent anteroposterior (AP) decompression and stabilization, of which two required secondary posterior stabilization because of dislocation or subsidence of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy, a stable situation was achieved with an anterior approach only. The outcomes, measured according to Odom's criteria, were excellent in one patient, good in three patients, and fair in two patients.

Conclusions In cases of complex cervical instability, combined AP decompression and stabilization minimizes the risk of anterior plate failure or dislocation of the vertebral body prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore, a combined procedure should be considered in selected patients. Not all patients with cervical instability require circumferential surgery. In two-level corpectomy cases, the decision between the less invasive anterior-only approach and the more stable combined approach can be difficult. However, in patients with proof of poor bone quality or with metabolic disorders, a more stable combined approach should be considered.

• References

• 1 Kim PK, Alexander JT. Indications for circumferential surgery for cervical spondylotic myelopathy. Spine J 2006; 6 (6, Suppl): 299S-307S
  CrossrefPubMedGoogle Scholar
• 2 Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion. Spine J 2006; 6 (6, Suppl): 252S-267S
  CrossrefPubMedGoogle Scholar
• 3 König SA. To the editor: cervical stability. J Neurosurg Spine 2012; 16 (1) 102
  PubMedGoogle Scholar
• 4 Medow JE, Trost G, Sandin J. Surgical management of cervical myelopathy: indications and techniques for surgical corpectomy. Spine J 2006; 6 (6, Suppl): 233S-241S
  CrossrefPubMedGoogle Scholar
• 5 Japanese Orthopaedic Association. Japanese Orthopaedic Association scoring system for cervical spondylotic myelopathy. Nippon Seikeigeka Gakkai Zasshi 1976; 50: 18-19
  PubMedGoogle Scholar
• 6 Odom GL, Finney W, Woodhall B. Cervical disc lesions. JAMA 1958; 166: 23-28
  CrossrefPubMedGoogle Scholar
• 7 Hussain M, Nassr A, Natarajan RN, An HS, Andersson GB. Biomechanical effects of anterior, posterior, and combined anterior-posterior instrumentation techniques on the stability of a multilevel cervical corpectomy construct: a finite element model analysis. Spine J 2011; 11 (4) 324-330
  CrossrefPubMedGoogle Scholar
• 8 Arts MP, Peul WC. Vertebral body replacement systems with expandable cages in the treatment of various spinal pathologies: a prospectively followed case series of 60 patients. Neurosurgery 2008; 63 (3) 537-544 , discussion 544–545
  CrossrefPubMedGoogle Scholar
• 9 Auguste KI, Chin C, Acosta FL, Ames CP. Expandable cylindrical cages in the cervical spine: a review of 22 cases. J Neurosurg Spine 2006; 4 (4) 285-291
  CrossrefPubMedGoogle Scholar
• 10 Burkett CJ, Baaj AA, Dakwar E, Uribe JS. Use of titanium expandable vertebral cages in cervical corpectomy. J Clin Neurosci 2012; 19 (3) 402-405
  CrossrefPubMedGoogle Scholar
• 11 Castellvi AE, Castellvi A, Clabeaux DH. Corpectomy with titanium cage reconstruction in the cervical spine. J Clin Neurosci 2012; 19 (4) 517-521
  CrossrefPubMedGoogle Scholar
• 12 Das K, Couldwell WT, Sava G, Taddonio RF. Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg 2001; 94 (1, Suppl): 174-178
  PubMedGoogle Scholar
• 13 Dorai Z, Morgan H, Coimbra C. Titanium cage reconstruction after cervical corpectomy. J Neurosurg 2003; 99 (1, Suppl): 3-7
  CrossrefPubMedGoogle Scholar
• 14 Kandziora F, Pflugmacher R, Schaefer J , et al. Biomechanical comparison of expandable cages for vertebral body replacement in the cervical spine. J Neurosurg 2003; 99 (1, Suppl): 91-97
  PubMedGoogle Scholar
• 15 Narotam PK, Pauley SM, McGinn GJ. Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 2003; 99 (2, Suppl): 172-180
  PubMedGoogle Scholar
• 16 Schulz C, Koschel S, Kunz U , et al. PEEK implant or autologous iliac crest graft as vertebral body substitute after anterior cervical corporectomy?. Eur Spine J 2011; 20 (Suppl. 04) S421-S464
  CrossrefPubMedGoogle Scholar
• 17 Cabraja M, Abbushi A, Kroppenstedt S, Woiciechowsky C. Cages with fixation wings versus cages plus plating for cervical reconstruction after corpectomy: is there any difference?. Cent Eur Neurosurg 2010; 71 (2) 59-63
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Yan D, Wang Z, Deng S, Li J, Soo C. Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients. Arch Orthop Trauma Surg 2011; 131 (10) 1369-1374
  CrossrefPubMedGoogle Scholar
• 19 McAfee PC, Bohlman HH, Ducker TB, Zeidman SM, Goldstein JA. One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up. J Bone Joint Surg Am 1995; 77 (12) 1791-1800
  CrossrefPubMedGoogle Scholar
• 20 Schultz Jr KD, McLaughlin MR, Haid Jr RW , et al. Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg Spine 2000; 93 (2, Suppl): 214-221
  CrossrefPubMedGoogle Scholar
• 21 Swank ML, Sutterlin III CE, Bossons CR, Dials BE. Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine. Spine 1997; 22 (3) 274-282
  CrossrefPubMedGoogle Scholar
• 22 Lund T, Oxland TR. Adjacent level disk disease—is it really a fusion disease?. Orthop Clin North Am 2011; 42 (4) 529-541 , viii
  CrossrefPubMedGoogle Scholar