scholarly journals The Application of Endoscopic Technique in High Cervical Anterior Approach to the Craniovertebral Junction

2020 ◽  
Author(s):  
Jiangtao Liu ◽  
Hongming Ji ◽  
Gangli Zhang ◽  
Shengli Chen ◽  
Shiyuan Zhang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Anterior Approach ◽  
Craniovertebral Junction ◽  
Close Proximity ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Surgical Corridor ◽  
High Cervical ◽  
Neurovascular Structures

Abstract Objectives: Surgery on the craniovertebral junction (CVJ) presents particular challenges owing to the close proximity of critical neurovascular structures and the brainstem. It is difficult for classic approaches to obtain the extra exposure of neurovascular structures of the CVJ in practice.The surgical approach to the craniovertebral junction (CVJ) offers specific challenges. We explored the feasibility of an endoscope-assisted high anterior cervical approach to the CVJ. Methods: We quantitatively assessed the surgical corridor to, and extent of exposure of, the CVJ in six cadaveric specimens, using 0° and 30° endoscopes. Results: The endoscope provided sufficient exposure of neurovascular structures and the brainstem in the CVJ. Resection of the anterior arch of C1 was avoided in minimal anterior clivectomy. After removing the odontoid, greater exposure of the CVJ was obtained. Conclusion: An endoscope-assisted high anterior cervical approach to the CVJ preserves cervical spine stability while minimizing the risk of neurovascular injury within the surgical corridor.

scholarly journals Surgical treatment of degenerative cervical spine diseases: Analyses of 90 patients clinical study

2012 ◽  
Vol 59 (3) ◽  
pp. 61-68
Author(s):  
M. Markovic ◽  
N. Zivkovic ◽  
D. Stojanovic ◽  
M. Samardzic
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Iliac Crest ◽  
Cervical Disc ◽  
Cervical Spine Surgery ◽  
Clinical Series ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Cervical Plating ◽  
Degenerative Cervical Spine

The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation.

ANTERIOR CERVICAL APPROACH FOR THE TREATMENT OF CERVICAL MYELOPATHY

Neurosurgery ◽  
2007 ◽  
Vol 60 (suppl_1) ◽  
pp. S1-64-S1-70 ◽  
Author(s):  
Paul G. Matz ◽  
Patrick R. Pritchard ◽  
Mark N. Hadley
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Surgical Technique ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Clinical Symptoms ◽  
Recovery Of Function ◽  
Surgical Decompression ◽  
Cervical Approach ◽  
Anterior Cervical Approach

Abstract COMPRESSION OF THE spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

2011 ◽  
Vol 15 (5) ◽  
pp. 467-471 ◽  
Author(s):  
Fred C. Lam ◽  
Michael W. Groff
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Surgical Pathology ◽  
Anterior Decompression ◽  
Upper Thoracic Spine ◽  
Perioperative Morbidity ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Upper Thoracic

Surgical pathology in the region of the upper thoracic spine (T1–4) is uncommon compared with other regions of the spine. Often times posterior and posterolateral approaches can be used, but formal anterior decompression often requires a low anterior cervical approach combined with a sternotomy, which yields significant perioperative morbidity. The authors describe a modified low anterior cervical dissection combined with a partial manubriotomy that they have used to successfully access and decompress anterior pathology of the upper thoracic spine. Their modified approach spares the sternoclavicular joints and leaves the sternum intact, decreasing the morbidity associated with these added procedures.

scholarly journals Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

2013 ◽  
Vol 22 (12) ◽  
pp. 2850-2856 ◽  
Author(s):  
Hiroyuki Tanahashi ◽  
Kei Miyamoto ◽  
Akira Hioki ◽  
Nobuki Iinuma ◽  
Takatoshi Ohno ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Axial Curvature

Anatomic and Biomechanical Considerations of the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A2-A6 ◽  
Author(s):  
Michael D. Martin ◽  
Harlan J. Bruner ◽  
Dennis J. Maiman
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Anatomic Variations ◽  
Basic Principles ◽  
Regional Anatomy ◽  
Atlas And Axis

Abstract AN UNDERSTANDING OF the regional anatomy and specific biomechanics of the craniovertebral junction is relevant to the specific diseases that affect the region as well as instrumentation of the occiput, atlas, and axis. This article reviews the bony, ligamentous, and vascular anatomy of the region, in relation to the posterior surgical approach to this anatomically unique segment of the cervical spine. Anatomic variations of the area are also discussed. Basic principles of instrumentation of the region are also reviewed. The kinematics of the region as they pertain to the anatomic discussion are reviewed and discussed.

Results and risk factors for anterior cervicothoracic junction surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 12-17 ◽  
Author(s):  
John A. Boockvar ◽  
Matthew F. Philips ◽  
Albert E. Telfeian ◽  
Donald M. O'Rourke ◽  
Paul J. Marcotte
Keyword(s):  
Risk Factors ◽  
Anterior Approach ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Significant Risk ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Four Levels ◽  
Fine Print

Object. Stabilization of the cervicothoracic junction (CTJ) requires special attention to the operative approach and biomechanical requirements of the fixation construct. In this study the authors assess the morbidity associated with the anterior approach to the CTJ and define risks that may lead to construct failure after anterior CTJ surgery. Methods. Data obtained for 14 patients (six men and eight women, mean age 50.1 years) who underwent surgical stabilization of the CTJ via an anterior cervical approach were retrospectively reviewed to assess the anterior approach—related morbidity and the risks of construct failure. The mean follow-up period was 21.1 months. Four patients (29%) had previously undergone CTJ surgery; in 11 patients (64%) more than one motion segment was involved (two levels, six patients; three levels, four patients; four levels, one patient); allograft was placed in three (21%) of 14 graft sites; and anterior plates were used for reconstruction augmentation in eight patients (57%). Postoperatively all patients improved, although four patients had residual deficits or pain. Graft/plate failure, requiring surgical revision and/or halo placement, occurred in five patients (36%). One patient experienced transient recurrent laryngeal nerve palsy. Postoperatively, the authors classified patients into one of two groups: those in whom surgery was successful (nine cases) and those in whom it had failed (five cases). Analysis of the characteristics of these two groups revealed that male sex (p < 0.0365), multiple levels of involvement (p < 0.0378), and the use of allograft as compared with autograft (p < 0.0088) were significant risk factors for construct failure. Prior CTJ surgery (p < 0.053) tended to be associated with graft failure. Conclusions: Findings of this study, in the setting of these factors, indicate that anterior reconstruction alone may not meet the biomechanical needs of this spinal region and that supplementary fixation may be considered to augment stabilization for fusion success.

Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

scholarly journals Management of C2-C3 fracture subluxation by anterior cervical approach and C2-C3 trans-cortical screw placement

2018 ◽  
Vol 32 (1) ◽  
pp. 170-173
Author(s):  
Amit Agrawal
Keyword(s):  
Cervical Spine ◽  
Morbidity And Mortality ◽  
Screw Placement ◽  
Upper Cervical Spine ◽  
Cervical Spine Injuries ◽  
Cortical Screw ◽  
Spine Injuries ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach

AbstractCervical spine injuries are the major cause of morbidity and mortality in trauma victims. Upper cervical spine injuries account for about 24% of acute fractures and dislocations and one third of fractures occur at the level of C2, while one half of injuries occur at the C6 or C7 levels. In contrast to this approach we used the transverse cervical, platysma splitting incision at a lower (C3-C4 disc) to expose the upper cervical spine particularly lower border of C3 (entry point for the screw).

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