• MULTI-LEVEL ANTERIOR CERVICAL RECONSTRUCTION: COMPARISON OF SURGICAL TECHNIQUES AND RESULTS

    INTRODUCTION: Due to the relative infrequency of cervical corpectomies involving two or more vertebrae, little comparative information exists regarding different reconstruction techniques. An independent retrospective investigation was undertaken to compare union rates and other com METHODS: The medical records and radiographs of 49 patients who underwent multi-level cervical corpectomies ( two vertebrae, or three motion segments) by a single surgeon were retrospectively reviewed by an independent
  • DYNAMIC MRI STUDY IN POSTOPERATIVE PATIENTS WITH CERVICAL MYELOPATHY

    INTRODUCTION: There has been no previous studies which evaluated morphological changes of the spinal cord in flexion and extension after posterior decompression of the cervical spine (laminoplasty). To clarify the relationship between clinical recovery and dynamic cord compression after surgery, cervical magnetic resonance imaging (MRI) was obtained in flexion and extension in patients who underwent posterior decompression. METHODS: The subjects were 25 patients (19 men, 6 women) who had posterior decompression from C3 to C7 due to cervical myelopathy. The ages at the examination ranged from 41 to 75 years (average, 61 years). Their diagnoses were cervical spondylotic myelopathy (CSM) in 14 patients and ossification of the posterior longitudinal ligament (OPLL) in 11 patients.
  • INTRAOPERATIVE MUSCLE MOTOR EVOKED POTENTIAL MONITORING; TRANSCRANIAL ELECTRIC VS MAGNETIC STIMULATION

    INTRODUCTION: Muscle motor evoked potential (muscle MEP) monitoring after transcranial motor cortex stimulation is reliable neurophysiological assessment of the integrity of motor pathway in spine surgery, and indispensable technique in spinal cord tumors. Two method of transcranial stimulation was compared with its clinical significance and reliability. METHODS: Seventy-five patients between 12-78 years of age undergoing spine surgery were monitored by muscle MEP. Two anesthetic protocol, ketamine based anesthesia (group 1: 34 patients) and propofol based anesthesia (group 2: 41 patients), were examined. In group 1, paired magnetic stimulation was performed. In group 2, repetitive electrical stimulation (Digitimer D185) and paired magnetic stimulation (7 out of 41 patients) were performed. Neuromuscular blockade level was controlled using the microinfusion pump and the relaxograph.
  • CORRECTION OF ANKYLOSING SPONDYLYTIS CERVICAL FLEXION DEFORMITY USING A HYBRID ILIZAROV-HALO APPARATUS

    PURPOSE: A series of five patients with ankylosing spondylitis and severe, fixed flexion deformity of the cervical spine were treated by cervical laminectomy and osteoclasis in conjunction with a hybrid llizarov-halo apparatus for perioperative control of the osteoclasis axis of rotation and translation. BACKGROUND: Historically, fixed flexion deformities of the cervical spine in patients with ankylosing spondylitis have been treated by laminectomy and osteoclasis. Hazards of the procedure include uncontrolled rotation and translation about the osteoclasis level. A novel hybrid llizarov-halo device was employed in our series of patients to reduce operative complications.
  • POSTERIOR DECOMPRESSION AND RECONSTRUCTION OF THE CERVICAL SPINE USING PEDICLE SCREW FIXATION SYSTEMS

    PURPOSE: There have been a number of internal fixation procedures for one-stage posterior decompression and stabilization of the cervical spine. The purpose of this study was to analyze the results of 68 patients who underwent one-stage cervical reconstruction using pedicle screw fixation and posterior decompression for primary or salvage surgery. MATERIALS AND METHODS: Between 1991 and 1996, a total of 68 patients who required cervical reconstructed procedure with pedicle screw fixation systems were identified. In all patients, the lamina was removed or laminoplasty was performed for posterior decompression of the spinal cord, or the lamina had been removed by previous decompression surgery. There were 40 females and 28 males, and their average age at the time of surgery was 56.7 years.
  • THE EFFECT OF DISTRACTION – FLEXION INJURIES TO THE LOWER CERVICAL SPINE ON THE VERTEBRAL ARTERIES. AN EXPERIMENTAL STUDY

    INTRODUCTION: The fact that injuries to the vertebral arteries can result in occlusion in closed lower cervical spine trauma is not unknown. On reviewing the literature, injuries of the distraction - flexion type are seen to have a special significance concerning lesions to the vertebral arteries, but a study of the mechanisms which lead to vertebral artery traumatization was not found. AIM OF THE STUDY: An attempt was made to clarify the significance of the various stages of injuries to the lower cervical spine as classified by Allen et al. as to the possibility of traumatization of the vertebral arteries.
  • BIOMECHANICAL EVALUATION OF FIVE DIFFERENT OCCIPITO-ATLANTO-AXIAL FIXATION TECHNIQUES

    INTRODUCTION: Many stabilizing procedures have been reported for craniocervical reconstruction. Recently, new instrumentation using C1-C2 transarticular screw (Magerl) or C2 pedicle screw as a fixation anchor have been developed to provide greater stability. However, few studies have biomechanically evaluated occipitocervical reconstruction methods. Moreover, although stability against anterior shear force is required to prevent anterior translation of C1 in occipitocervical reconstruction, no studies have investigated the stability under anterior translation loading. The purpose of this study was to evaluate the stability provided by five types of occipito-atlanto-axial fixation techniques.
  • EN BLOC LAMINOPLASTY FOR CERVICAL MYELOPATHY AND ACUTE DIFFUSE SPINAL CORD EDEMA – RAPID DECOMPRESSION INDUCES SPINAL CORD EDEMA?

    INTRODUCTION: En bloc laminoplasty is widely preferred to laminectomy for treatment of cervical myelopathy. Nevertheless, there are some complications: we have had five cases of incomplete paralysis with acute diffuse spinal cord edema. This study reviews 204 patients to assess the advantages and examine the complications. MATERIALS & METHODS: Subjects included 145 men and 59 women with a mean age of 57.2 years (range: 23 - 83). There were cervical spondylotic myelopathy (CSM) 155 with underlying conditions: hemodialysis 8; cerebral palsy (CP) 4; rheumatoid arthritis (RA) 4; and disc herniation (HNP) 6 and ossification of posterior longitudinal ligament (OPLL) 43. Operating time was 146.9 ± 52.8 minutes; blood loss was 356.7 ± 290.0 g. Postoperative follow-up ranged from 1 year to 6.1 years ( average: 2.3).