• COMPLICATIONS OF BUTTRESS PLATE STABILIZATION OF CERVICAL CORPECTOMIES.

    INTRODUCTION: Graft extrusion is a well-recognized complication of multi-level cervical corpectomies and strut grafting. In an attempt to decrease this complication, a number of authors have employed anterior cervical plates. One recently reported technique involves the use of short buttress plates which are fixed to the inferior most vertebrae only. In the present study, we report our experience with these types of buttress plates with a focus on their complications. METHODS: The records and radiographs of all patients who had undergone cervical buttress plate fixation following anterior cervical corpectomy from August 1995 to the present, by the lead author, were independently evaluated by two residents uninvolved in the patients’ clinical management. A total of 14 patients were identified: ten female, four males; age range 29 to 82.
  • NECK AND SHOULDER PAIN AFTER MUSCLE-PEDICLED SPINOUS PROCESS RECONSTRUCTIVE OPEN DOOR LAMINOPLASTY: RELATION TO POSTOPERATIVE IMMOBILIZATION PERIOD

    INTRODUCTION: Postoperative nape pain is not an unusual or major complication of surgery, but many surgeons report that patients suffer from it. In 1994, the authors presented that the postoperative ROM of the cervical spine correlated to postoperative nape pain. The authors hypothesized that shortening the postoperative immobilization period would increase the postoperative cervical ROM and decrease postoperative nape pain. Since 1994, we have shortened the postoperative immobilization period from 12 weeks to 6 weeks. The purpose of this study was to compare postoperative nape pain, ROM, and clinical results in a 12 weeks-postoperative group and a 6 weeks-postoperative group, thereby to examine our hypothesis.
  • 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.