• SINGLE-LEVEL ANTERIOR CERVICAL DISCECTOMY: PLATE VS NO PLATE

    INTRODUCTION: Cervical plate fixation for single-level anterior cervical discectomy and fusion (ACDF) has generated a large amount of controversy. Proponents of plate fixation argue that there is increased stability, higher fusion rates, and less collapse and resulting deformity. Others argue that the plate can prevent settling of the graft and lead to lower fusion rates and more complications. The purpose of this study was to compare a large group of patients undergoing single-level anterior cervical discectomy and fusion with and without plate fixation and determine the pseudarthrosis rates, amount of collapse, and the complication rates.
  • WAS JEFFERSON WRONG? A BIOMECHANICAL STUDY OF FRACTURES OF THE ATLAS

    Jefferson fracture, one of the most frequently encountered fractures of the cervical spine, is commonly believed to result from the creation of tensile forces across the C1 ring generated by axial loading of the wedge-shaped lateral masses. This fracture mechanism, originally proposed by Jefferson, assumes that the C1 and C2 vertebrae are aligned in neutral rotation. If there is significant rotation of the atlas on the axis, axial load results in considerable asymmetry in the forces seen by the inferior facets of C1 and create acute torsional forces. With right rotation, for example, only the posterior portion of the right C1 inferior facet and the anterior portion of the left inferior facet can bear load; the remainder of each of the facet surfaces overhangs the articular surface of the C2 superior facets.
  • MULTILEVEL CERVICAL CORPECTOMY AND FUSION USING AUTOGENOUS FIBULA STRUT GRAFT WITHOUT INSTRUMENTATION: HEALING PATTERNS OF THE GRAFT IN SMOKERS VS NON-SMOKERS

    INTRODUCTION: Multilevel cervical corpectomy provides excellent decompression of the spinal cord and nerve roots for numerous pathologic conditions of the cervical spine. Previous reports of fusion rates in cervical corpectomy surgery are sparse and few have included a strict criteria to determine radiographic fusion for autogenous fibula graft without instrumentation. The purpose of this study was to determine radiographic healing patterns of the fibula strut graft and the effects on fusion rates with smoking. METHODS: A retrospective chart and radiographic review was performed for 45 consecutive patients who underwent multilevel cervical corpectomy with autogenous fibula strut graft without instrumentation utilizing the technique by Bohlman (1). Office charts were reviewed for history of smoking, complications, revisions, and length of follow-up.
  • ANTERIOR CERVICAL INSTRUMENTATION FOR RADICULOPATHY: AN ECONOMIC ANALYSIS

    INTRODUCTION: Minimal data exist in the literature evaluating the efficacy of instrumentation when performing an anterior cervical diskectomy and fusion (ACDF) for one or two level cervical spondylotic radiculopathy patients. Many would argue plating less than three levels provides no added benefit to the patient and needlessly increases the cost and operative time. The purpose of this study is to determine the economic impact of plating one and two level ACDF's by examining both direct and indirect costs. METHODS: The hospital charts of 40 patients who underwent 1 and 2 level ACDF's with and without plating by the senior author were retrospectively reviewed. The patients were separated into two groups, 18 patients in Group 1 were plated and 16 patients in Group 2 were not plated.
  • DIFFERENTIAL IMMUNOREACTIVITY TO GALECTIN-3 IN HERNIATED AND NON-HERNIATED INTERVERTEBRAL DISC

    INTRODUCTION: Galectin-3, galactose binding lectin (formerly named Mac-2) is involved in numerous cellular processes (regulation of cell growth and differentiation, apoptosis, neoplastic transformation, metastatic penetration, and cell adhesion to matrix and to surrounding cells). Galectin-3 is also involved in the mechanism of inflammation. Recent studies have shown that intervertebral disc (IVD) cells do not present Galectin-3 in the intact IVD but do become immunoreactive to Galectin-3 in cell culture and cell smear. This phenomenon may be a cellular reaction to environmental changes. Changes in the cellular environment occur also in disc herniation. Knowledge of the pattern of Galectin-3 expression in herniated and non-herniated intervertebral disc is important for understanding the mechanism of inflammation in intervertebral disc herniation.
  • HIGHER BONE GRAFT FORCE HELPS IN STABILIZING ANTERIOR CERVICAL MULTI-LEVEL PLATE SYSTEM

    INTRODUCTION: The anterior cervical plate system is widely used in stabilizing the cervical corpectomy. Many factors such as the applied screw torque, screw pullout force, plate strength, plate geometry and type of graft have been studied. However, the role of graft force in stabilizing the anterior plate system has not been explored. In this study, we first find the graft force variation during physiologic loading, and then determine the stability of low and high graft force provided by an anterior cervical plate for both one-level and three-level corpectomy models. METHOD: Six fresh human cadaveric cervical spines (C2-Th1) were dissected preserving the osteoligamentous structure. Following radiographic screening, C2 and Th1 were mounted to place C5 vertebra horizontally. One-level (C5) and three-level (C4, C5 and C6) corpectomy with plate stabilization (Cervical Spine Locking Plate: Synthes) were prepared.
  • 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.