[Operative treatment of the degenerative cervical spine]. / Operative Versorgung der degenerativen Halswirbelsäule.

BACKGROUND: Degenerative alterations of the cervical spine often entail disc herniations and stenoses of the spinal canal and/or neural foramen. Mediolateral or lateral compression of nerve roots causes cervical radiculopathy, which is an indication for surgery in cases of significant motor deficits or refractory pain. Median canal encroachment may result in compression of the spinal cord and cervical myelopathy. Its natural history is typically characterized by episodic deterioration, so that surgical decompression is indicated in cases of clear myelopathic signs. OBJECTIVE: The aim of the present article is to outline the operative options for patients with cervical radiculopathy and myelopathy. Furthermore, we describe the operative complications and the outcome in these patients. MATERIAL AND METHODS: For this manuscript a systematic PubMed search was carried out, the papers were systematically analyzed for the best evidence and this was combined with the authors' experience. RESULTS AND CONCLUSION: Depending on the cervical pathology, the most prevalent surgical options for radiculopathy include anterior cervical discectomy and fusion (ACDF), cervical arthroplasty or posterior cervical foraminotomy. Cervical myelopathy may be decompressed by ACDF, corpectomy or posterior approaches like laminectomy plus instrumented fusion or laminoplasty. The outcome depends on the cervical pathology and the type of operation. Overall, in long-term follow-up studies the results of all surgical techniques on the cervical spine are generally considered to be very good, although specific patient characteristics are more suited for a particular approach.

Retrospective analysis of cervical corpectomies: implant-related complications of one- and two-level corpectomies in 45 patients.

Cervical corpectomies are increasingly used to treat degenerative, metastatic, inflammatory and traumatic multisegmental diseases. The postoperative results are thought to correlate mainly with the number of resected vertebral bodies. Thus, the aim of the study was to analyse complications and early outcome of these procedures to document the implant-related complications in order to set up a prospective clinical trial. Forty-five patients, who were treated in our department from 2011 to 2014 and who were available for a minimum follow-up of 1 year, were consecutively included in this retrospective evaluation. The median age was 61 (±11) years with a female to male sex ratio of 19 to 26, respectively. In these patients, cervical corpectomies (one-, two- and three-level procedures) were performed. The average number of resected levels was 1.2 levels. The intraoperative loss of blood (LOB), the red cell transfusions (rcT), the length of operation (LOO) and the usage of drains were investigated and correlated with intra- and postoperative complications. The mean LOO was 244 min (±68) with a mean LOB of 511 ml (±531). The overall complication rate was 22.9% (10 patients). Six patients (13.3%) had implant-related complications due to loosening and toggling of the screws and/or cage subsidence. Two patients (4.4%) had a postoperative haematoma and another two patients (4.4%) suffered from neurological deterioration due to an ongoing and severe myelopathic syndrome. All these patients received revision surgery. The average time from the first to revision surgery was 90 days. Cervical corpectomies still remain procedures with a high complication rate mainly represented by implant-related failures. These implant-related complications range from screw/plate loosening or toggling to graft dislocation with subsidence and might be associated with constructs extended to the C7 vertebral body. In our study population, the rate of implant failure was comparable to the literature, but not obviously correlated with the number of vertebral bodies resected. This may be attributed to the different disease entities. Thus, our results support the use of circumferential approaches for selected instability scenarios (metastatic or inflammatory diseases, kyphosis, osteoporosis, etc.) of one- and two-level corpectomies.

Transoral vertebroplasty of the lateral mass of C1 using image guidance.

BACKGROUND: Osteolytic lesions of the anterior aspects of C1 (lateral mass) are difficult to address in a minimally invasive fashion and are often treated by craniocervical instrumentation. METHODS: We report the feasibility and technical method of transoral vertebroplasty of the lateral mass of the atlas using image guidance and describe the workflow of the procedure. To our knowledge, there has not yet been a technical description of a transoral vertebroplasty using image guidance. RESULTS: Adequate positioning of the pedicle access needle using image guidance for addressing the lateral mass of C1 through a transoral, permuceous access can be achieved. CONCLUSIONS: With the assistance of image guidance, it is safe and feasible to access the lateral mass of the atlas. This constitutes a minimally invasive and fast alternative for introducing the bone needle to C1 rather than using a fluoroscopic device alone.