• RETURN TO PLAY AFTER CERVICAL SPINE INJURY

    INTRODUCTION: The criteria to determine if and when an athlete can safely return to his or her sport after cervical spine injury are in the early stages of development. Published guidelines are admittedly based on anecdotal evidence and often the science behind the decision is nothing more than the good judgement and personal experiences of the treating physician. Because the consequences of cervical spine injury are potentially catastrophic, these decisions can be agonizing, especially if an athlete places high value on his or her sport and is reluctant to modify his or her activity. The present study attempted to elucidate the current thinking amongst orthopedists in making these decisions.
  • CERVICAL CORD NEURAPRAXIA IN PROFESSIONAL ATHLETES: A REVIEW OF TWENTY-SIX CASES

    INTRODUCTION: Recent accounts indicate that decisions to return the professional athlete to his activity following an episode of cervical cord neurapraxia has been based on fear of potential litigation rather than clinical science. This study reports on long-term follow of 26 professional athletes with documented CCN. METHODS: Study group consisted of 26 professional athletes that presented or were referred to the senior author. All participated in collision sports. There were 24 football players, 1 hockey player and 1 professional wrestler. Average age was 25.8 years, average follow-up is 32 months. The athletes were evaluated by history, physical examination, plane roentgenograms, and MRI of the cervical spine. Follow-up evaluation was by physical exam, questionnaire or telephone interview. Three case examples will be presented.
  • OCCIPITOCERVICAL FUSION BY COMBINATION OF CERVICAL PEDICLE SCREWS AND OCCIPITOCERVICAL ROD SYSTEMS

    INTRODUCTION AND PURPOSE: Many fixation procedures have been developed for stabilization of the occipitocervical junction. Although variable results of those procedures have been reported in the literature. Some techniques require long fusion and rigid postoperative external support due to mechanical weakness of the fixation systems. The purposes of this report were to show our surgical technique of occipitocervical fusion by combination of cervical pedicle screws and occipitocervical plate systems, and review the clinical outcome of our first 28 patients treated by this technique.
  • BIOMECHANICAL STABILITY OF A MOVABLE ARTIFICIAL CERVICAL JOINT

    INTRODUCTION: Anterior cervical discectomy with or without fusion is an acceptable surgical method for the treatment of cervical spondylosis or other spinal disc diseases. A spinal device may be used to immobilize the operated/injured region to promote bony fusion. Clinical studies have shown that motion at spinal segments adjacent to a fused region increases over time and may cause adjacent segment problems. An alternative approach to fusion surgery of the cervical spine is to restore the motion to the diseased joint using an implanted movable artificial joint. The biomechanical stability of the harvested and instrumented cervical spine was determined for physiologic flexion/extension and lateral bending loading mechanics. The instrumented spine consisted of a single level discectomy with subsequent disc replacement using a prototype movable intervertebral implant by Sofamor Danek Group, Memphis, TN.
  • A COMPARISON OF THE CLINICAL BEHAVIOR AND THE HISTOPATHOLOGY OF PLATE VERSUS CAGE-PLATE SYSTEMS FOR CERVICAL FUSION: AN IN VIVO STUDY

    INTRODUCTION: A recent advance in the technology for cervical fusions is the “The Telescopic Anterior Plate Spacer (TAPS)” (Interpore Cross, Inc.). This device is a combination of the anterior plate system and the fusion cage, and has several of the advantages of both. Further, failure modes such as piston effect and subsidence of the construct are believed to be minimized with the new device. The goal of this study was to compare the clinical performance of this device with a more commonly used and well-accepted device, “The CODMAN® Anterior Cervical Plate System” (Johnson and Johnson, Medical Inc.).
  • THREE AND FOUR LEVEL ANTERIOR CERVICAL DISKECTOMY AND FUSION WITH PLATE FIXATION: A PROSPECTIVE STUDY

    PURPOSE: The success of arthrodesis for anterior cervical fusion depends on several factors, including the number of surgical levels. The arthrodesis rate and outcome for patients having specifically three or four level diskectomy and fusion procedures is disappointing [1]. Internal fixation putatively improves these parameters. We prospectively studied fifteen patients who underwent modified Smith-Robinson anterior cervical diskectomy and fusion at three or four operative levels to determine the effect that unicortical anterior plate fixation has on the results. METHODS: Fifteen patients (7 female, 5 male), with an average age of 51 years (range 35 to 77), were followed for an average of 40 months (range 25 to 73). All had an anterior diskectomy, burring of the endplates, placement of an autogenous tricortical iliac crest graft at three (12 patients) or four (3 female patients) levels, and application of a Synthes Cervical Spine Locking Plate.
  • BIOMECHANICAL RATIONALE FOR THE PATHOLOGY OF RHEUMATOID ARTHRITIS IN THE CRANIOVERTEBRAL JUNCTION

    INTRODUCTION: Rheumatoid arthritis (RA) involvement of the occipito-atlanto-axial (C0-C1-C2) complex is commonly seen, however the biomechanical role during disease progression is not well understood. Investigation of progressive disease states does not lend itself to traditional in vitro methods such as cadaver experimentation. Thus, the authors implemented the finite element (FE) method to study the biomechanical factors, if any, that contribute to the development and advancement of RA and its associated clinically-observed lesions.
  • SPINAL CORD SIZE AND SHAPE FOLLOWING CERVICAL LAMINOPLASTY

    PURPOSE: To determine the effect of cervical laminoplasty on the cross-sectional morphology of the spinal cord. METHODS: Cervical laminoplasty with neolamina reconstruction was performed in 40 patients with cervical spondylotic myelopathy from 1992 to 1995. The average age at the time of surgery was 61 years. The average follow-up was 36 months. Spinal cord cross-sectional area and sagittal and coronal cord sizes were measured using an image analysis program pre-operatively, three months and one year postoperatively on axial MRI scans. Interobserver variability was assessed. The data were analyzed using nonparametric statistical tests.