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C2 Translaminar Screw Fixation

Chapter Preview Chapter Synopsis C2 translaminar screws are an effective method for fixation of the C2 vertebra. Compared with other techniques, this procedure is technically less demanding and has potentially fewer risks. A thorough history and examination, as well as a careful assessment of the anatomy of the C2 lamina, are still required preoperatively to minimize complications. The goal of this chapter is to review preoperative…

C1-C2 Transarticular Screws

Chapter Preview Chapter Synopsis Placement of the C1-C2 transarticular screw (Magerl technique) remains a viable alternative for the surgical management of a variety of atlantoaxial disorders. Although the operation is technically demanding, a careful understanding of the procedure and its limitations, as well as a thorough understanding of each patient’s individualized bony and vascular anatomy, can help reduce the risk of complications. Proper preoperative radiographic evaluation…

C1 Lateral Mass and C2 Pedicle Screw Fixation

Chapter Preview Chapter Synopsis Although many different fixation techniques have been developed to manage atlantoaxial instability, C1 lateral mass–C2 pedicle screw fixation has emerged as a preferred treatment, based on its comparative biomechanical strength and modest risk of neurologic or vascular injury, as well as the ability to perform intraoperative reduction. Important Points Surgical indications include atlantoaxial instability caused by trauma, tumors, infection or inflammatory disease,…

Occipitocervical Fixation

Chapter Preview Chapter Synopsis Occipitocervical fixation techniques have evolved significantly from early occipitocervical wiring techniques to the current rod-screw-occipital plate constructs. Indications for occipitocervical fixation include traumatic injuries, congenital malformations, rheumatoid arthritis, and oncologic processes involving the craniovertebral junction. Judicious clinical decision making and meticulous surgical technique are necessary to manage patients requiring occipitocervical fixation. Important Points Surgical indications Imaging findings Surgical techniques Clinical and Surgical…

Osteotomies of the Cervical Spine

Chapter Preview Chapter Synopsis Cervical deformity correction commonly includes kyphosis correction, regional sagittal balance restoration, and correction of the chin-brow vertical angle to restore horizontal gaze, decrease cantilever forces at the cervical thoracic junction, and decrease spinal cord tension-induced myelopathy. Rigid deformity requires osteotomy and release to achieve adequate correction. This chapter reviews commonly used and advanced techniques to correct semirigid and rigid deformities. Important Points…

Posterior Cervical Endoscopic Laminoforaminotomy

Chapter Preview Chapter Synopsis The surgical treatment of unilateral cervical radiculopathy with a minimally invasive, microendoscopic technique is reviewed. Important surgical techniques, as well as indications and contraindications, are discussed. Important Points Indications: Unilateral one- or two-level refractory cervical radiculopathy Concordant symptoms and physical examination findings Radiographic imaging confirmation of nerve root compression Contraindications: Bilateral radiculopathy Cervical myelopathy Alignment abnormalities or instability Clinical and Surgical Pearls…

Cervical Laminoplasty

Chapter Preview Chapter Synopsis Many techniques have been developed for the surgical management of compressive cervical myelopathy. Laminoplasty is a posterior canal expanding procedure that in selected patients allows for spinal cord decompression, avoids the loss of cervical range of motion, maintains spinal stability without the need for spinal fusion, and potentially avoids the complications associated with scar membrane formation. Various laminoplasty techniques have been developed;…

Laminectomy and Fusion

Chapter Preview Chapter Synopsis Symptomatic cervical myelopathy from multilevel spinal cord compression in older patients is an increasing clinical problem. Multilevel anterior cervical surgical procedures carry significant morbidity. The posterior cervical approach reduces surgical morbidity. Although laminoplasty is often the surgical procedure of choice, laminectomy with spinal fusion and instrumentation is indicated in older patients who have significant neck pain and a K-line–negative or kyphotic cervical…

Anterior Cervical Foraminotomy

Chapter Preview Chapter Synopsis This chapter describes in detail the surgical techniques and merits of transcorporeal anterior cervical microforaminotomy for cervical radiculopathy. This procedure involves a modification of the previous anterior microforaminotomy in terms of its medial starting point and tunneling on the upper vertebral body. Important Points Transcorporeal anterior cervical microforaminotomy allows for direct decompression of the cervical nerve root while preserving the uncovertebral joint…

Cervical Disk Arthroplasty

Chapter Preview Chapter Synopsis The ability for cervical total disk arthroplasty (TDA) to treat specific cervical spine disorders while maintaining cervical motion is now feasible. Although unclear, it appears that cervical TDA may be an effective alternative to anterior cervical diskectomy and fusion (ACDF) for the management of cervical myelopathy or radiculopathy, or both, in selective cases. Careful patient selection and surgical technique are vital to…

Anterior Cervical Corpectomy and Fusion and Hybrid Techniques

Chapter Preview Chapter Synopsis Surgical decompression of the neural elements is of paramount importance in all spinal procedures, especially those of cervical myelopathy. Neural compression at the level of the disk space can be addressed by performing anterior cervical diskectomy and fusion. When the compression occurs posterior to the disk spaces, corpectomy is typically necessary. Multilevel corpectomies can result in mechanical instability, and therefore posterior stabilization…

Anterior Cervical Diskectomy and Fusion

Chapter Preview Chapter Synopsis Anterior cervical diskectomy and fusion (ACDF) comprises a common procedure used to treat cervical radiculopathy and cervical myelopathy. Excellent results can be achieved through careful patient selection and operative technique, which allows for reliable decompressiosn of the neuroforamen and the spinal canal for anterior cervical disease. Important Points The ACDF procedure is indicated for treatment of degenerative changes of the cervical spine…

Syringomyelia

Chapter Preview Chapter Synopsis Partial obstruction of the subarachnoid space can be identified as the underlying cause of syringomyelia in almost all patients: tonsillar descent causes this in Chiari malformation–related syringomyelia, and arachnoid webs or scars are the most common causes in patients with primary spinal syringomyelia. Relief of obstruction forms the basis of the preferred surgical treatment and is generally possible for Chiari malformation–related syringomyelia…

Ankylosing Spondylitis of the Cervical Spine

Chapter Preview Chapter Synopsis Ankylosing spondylitis (AS) is a disease of unknown origin that is characterized by inflammation of the axial skeleton. It affects the cervical spine in many patients in the late stages of the disease. Cervical spine involvement invariably leads to kyphotic deformity, which can cause severe functional impairment and can also predispose patients to cervical spine fractures. Several diagnostic and treatment strategies are…

Rheumatoid Arthritis of the Cervical Spine

Chapter Preview Chapter Synopsis Rheumatoid arthritis is a chronic autoimmune inflammatory polyarthritis that often involves the joints of the upper and subaxial cervical spine. The common spinal manifestations include atlantoaxial subluxation, rheumatoid basilar invagination, and subaxial subluxation. Important Points Selection of the appropriate approach, technique, and construct depends on the severity of symptoms and preoperative reducibility of the subluxation or basilar invagination, or both. Clinical and…

Tuberculosis of the Cervical Spine

Chapter Preview Chapter Synopsis Tuberculosis (TB) continues to be a global health care challenge. The increased susceptibility to coinfection in the presence of human immunodeficiency virus infection and the emergence of drug-resistant strains have led to a higher burden of the disease worldwide. Although cervical spine involvement is relatively uncommon, it can be an important cause of instability of the craniovertebral junction and atlantoaxial and subaxial…

Infections of the Cervical Spine

Chapter Preview Chapter Synopsis Infections of the cervical spine account for less than 10% of all spine infections, but they are the source of 27% of all neurologic deficits associated with an infectious process. The classification of cervical infections includes diskitis and osteomyelitis. This chapter discusses pyogenic, granulomatous, and postoperative infections of the cervical spine Important Points Vertebral osteomyelitis and diskitis comprise a spectrum of disease,…

Metastatic Disease of the Cervical Spine

Chapter Preview Chapter Synopsis The spine is the most common site of metastatic disease involving bone. The cervical spine is less often affected by metastatic disease, yet metastasis still occurs with a greater frequency per year than do primary bone sarcomas. Metastatic cervical spine disease presents unique challenges, and optimal care requires a multidisciplinary team approach. The purpose of this chapter is to discuss the pathophysiology,…

Primary Bony Tumors of the Cervical Spine

Chapter Preview Chapter Synopsis Most lesions in the cervical spine are metastatic; primary bone tumors are rare. The goals of treatment vary from palliation to cure. It is vital to recognize primary tumors before an operation, to achieve the best possible outcome. Surgical treatment of these lesions is complex because of the unique anatomy of the neck and cervical spine. Benign and malignant tumors often require…

Primary Tumors of the Spinal Cord

Chapter Preview Chapter Synopsis Primary tumors of the spinal cord comprise 5% to 15% of all central nervous system (CNS) tumors. They can be divided into two main categories based on anatomic origin: intradural extramedullary or intramedullary spinal cord tumors. Different tumors can result in different findings on clinical examination and imaging. Definitive diagnosis, however, typically involves examination of histologic features of the tumor. Careful assessment…