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Background Anterior cervical disk fusion (ACDF) is a common surgical approach for the treatment of cervical spine pathology. Esophageal perforations, though uncommon, are a devastating complication of this surgery. The objective of this paper is to assess the success of different treatment approaches for the management of esophageal/pharyngeal injury after ACDF. Methods Given the absence of prospective trials, the review includes institutional case reports and case series from 1985–2020 in the English language literature. Only cases of esophageal/pharyngeal injury in the setting of anterior cervical hardware were considered for study inclusion. For purposes of this study, treatment success is defined as resumption of oral intake. Results The database review identified 76 distinct series that meet criteria for study inclusion, with 173 patients available for analysis. A heterogeneous array of treatments was used for the management of pharyngoesophageal injuries after ACDF ranging from observation to complex free tissue reconstruction, with varying degrees of treatment success reported. We identified a number of factors, specifically duration of injury from initial ACDF procedure, which may impact the complexity of treatment required to maximize likelihood of treatment success. Conclusions Pharyngoesophageal injuries, albeit rare, are a serious and often complex complication after ACDF procedures. We propose a detailed algorithmic approach to guide decision making if faced with this clinical challenge. The huge variability in how these patients are treated emphasizes the potential utility of future multiinstitutional studies.

Objective The superiority of neurosurgical over orthopaedic spinal procedures is a point of contention. While there is the perception that neurosurgeons are more specifically trained to deal with spinal pathology, no study has directly compared outcomes of spinal surgeries performed by both groups. Methods We sought to evaluate the differences in length of surgery, hospital stay, complications, mortality, and readmission for anterior cervical decompression and fusion (ACDF) performed by neurosurgeons versus orthopaedic surgeons. Results 17,967 ACDF procedures were analyzed. Neurosurgeons performed 74.3% of the fusions with a trend towards longer operative times and significantly more patients that were discharged to extended care facilities. There was no significant difference in the length of stay, overall complications, mortality, readmission, or reoperation when comparing the two specialties. Conclusion Despite a significantly higher volume of ACDF performed by neurosurgeons, outcomes are comparable following orthopaedic and neurosurgical procedures.

Dysphagia, dysphonia and injuries of the recurrent laryngeal nerve still remain the most frequent complications of anterior cervical spinal fusion despite rich world experience, high technological level of anterior supporting complex surgeries. These complications very seldom lead to life-threatening situations, but they reduce patients’ quality of life during the early post-surgical period and patients’ satisfaction with the results of the surgery. The main reasons of intraoperative damage of esophagus, larynx and recurrent laryngeal nerve, methods of dysphagia and dysphonia prevention are described in this work.

To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed‐effect model or random‐effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta‐analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD = 1.61 days, 95% CI: 0.51, 2.71; P = 0.004), longer surgical time (WMD = 4.55, 95% CI: 1.04, 8.07; P = 0.011), higher mortality rate (RR = 3.01, 95% CI: 2.75, 3.29; P

Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with non-cervical spine involvement.The objective of this study was to compare patient characteristics, comorbidities, and complications in patients with and without RA undergoing primary non-cervical spinal fusions.This is a retrospective national database review.A total of 52,818 patients with adult spinal deformity undergoing non-cervical spinal fusions (1,814 patients with RA and 51,004 patients without RA).The outcome measures in the study include patient characteristics, as well as complication and mortality rates.Using the Nationwide Inpatient Sample from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients aged ≥18 years old with and without RA undergoing primary non-cervical spinal fusions. Univariate analysis was used to determine patient characteristics, comorbidities, and complication values for each group. Bivariate analysis was used to compare the two groups. Significance was set at p.05.Patients with RA were older (p.001), were more likely to be women (p.001), had increased rates of osteoporosis (p.001), had a greater percentage of their surgeries reimbursed by Medicare (p.001), and more often had weekend admissions (p=.014). There was no difference in all the other characteristics. Patients with RA had higher rates of iron deficiency anemia, congestive heart failure, chronic pulmonary disease, depression, and fluid and electrolyte disorders (all, p.001). Patients without RA had higher rates of alcohol abuse (p=.027). There was no difference in all the other complications. There was no difference in mortality rate (p=.99). Total complications were greater in patients with RA (p.001). Patients with RA had higher rates of infection (p=.032), implant-related complications (p=.010), incidental durotomies (p=.001), and urinary tract infections (p.001). No difference existed among the other complications.Patients with RA have an increased number of comorbidities and complication rates compared with patients without RA. Such knowledge can help surgeons and patients with RA have beneficial preoperative discussions regarding outcomes.

Background: Cervical spinal fusion is a surgical procedure that joins selected bones in the cervical spine.The anterior approach to the cervical spine was developed for treatment of cervical disc, it involves removing the symp-tomatic disc from an anterior approach without placement of a bone graft. Early studies demonstrated fusion rates with Anterior Cervical Discectomy (ACD) were similar to those of procedures of anterior cervical discectomy and fusion (ACDF) using bone graft. The anterior cervical discectomy and fusion with instru-mentation (ACDFI) technique involves the additional stabili-zation of the cervical spine & graft with instrumentation.Cages were introduced to be used with either autologous or synthetic bone grafts, promoting stability and encouraging fusion. Comparing to graft alternatives, cage interbody implants have better biomechanical properties, designed to maximise biocompatibility and reduced graft dislodgements, increased fusion rates, and decreased foraminal stenosis. However, placement of implants introduces hardware-related complica-tions.Aim of the Study: This prospective study aims to compare the results of ACDFI using cages with & without synthetic bone granules evaluating the outcomes, fusion and associated morbidities.Patients and Methods: Prospective study of 42 patients operated upon between 2012 and 2014 in Cairo University Hospitals & Beni Sueif University Hospital with ACDFI using cervical cages. Patients were divided into two groups: - Group (A) 22 patients operated by ACDFI with placement of cages only - Group (B) 20 patients operated by ACDFI with placement of cages and synthetic bone granules. Both groups underwent postoperative clinical follow-up for an average of 12 months, and results were evaluated according to radiographic evidence of fusion and Fisher exact probability test was used to compare fusion of both groups. We made considerations for patient's age, sex, osteoporosis, and smoking habits. We recorded fusion rates, cervical alignment, postoperative complications & patient satisfaction using Visual Analogue Score (VAS). Results: 42 patients were included in the study. The mean age was 46, 18 of them were females and 24 were males. 29 patients had single level discs and 13 patients had two levels.One year follow-up fusion rates that were achieved in group (A) were 81.8% while group (B) reached 95%. One year follow up on achievement of alignment of cervical spine was 90.9% of patient's in group (A) and in group (B) was 95% of cases.There were no problems regarding surgical technique or dislodgment in both techniques. Only in one patient in group(A)CSF leak developed and resolved. One patient in group(B)developed a keloid at incision site.Conclusion: Fusion rate is one of several factors that guide surgical decision making for cases requiring ACDFI. Fusion rate is significantly higher in group (B) using cages filled with synthetic bone granules than in group (A) with cages only. Age, sex, osteoporosis and smoking status have not given significantly different results between both groups studied.

The rate of cervical spinal fusion has been increasing significantly. However, there is a paucity of literature describing trends based on surgical approach using complete population databases. We investigated the approach-based trends in epidemiology, indications, and in-hospital outcomes of cervical spinal fusion.New York's Statewide Planning and Research Cooperative System database was queried to identify patients who underwent primary subaxial cervical fusion from 1997 to 2012. Demographic and clinical information was obtained. Subgroup analyses were performed based on surgical approach: anterior (A), posterior (P), and circumferential (C).A total of 87,045 cervical fusions were included. Over the study period, the population-adjusted annual fusion rate increased from 23.7 to 50.6 per 100,000 population (P0.001). A fusion was most common (85.2%), followed by P (12.3%), and C (2.5%). Mean ages were 49.8 ± 11.9, 59.9 ± 15.2, and 55.1 ± 14.5 years (P0.001), respectively. Although rates remained steady among younger patients, they increased for older patients. Overall, degenerative conditions were the predominant indications for surgery and increased in rate over time. The mean length of stay was: A, 3.1 ± 10.5; P, 9.1 ± 14.1; and C, 14.1 ± 22.5 days (P0.001). Rates of in-hospital complications were A, 3.0%; P, 10.5%; and C, 18.9% (P0.001), and mortality was A, 0.3%, P, 1.8%, and C, 2.5% (P0.001).The rate of subaxial spinal fusions increased 114% from 1997 to 2012 in New York State. Rates remained stable in younger patients but increased in the older population. Preoperative indications and postoperative courses differed significantly among the various approaches, with patients undergoing anterior fusion having better short-term outcomes.

Purpose To report indications, outcomes and complications of instrumented cervical spinal fusion in a consecutive series of children at major university hospitals. Methods A retrospective, single surgeon series identified 35 consecutive children with a mean follow-up (FU) of 2.5 years undergoing instrumented cervical spinal fusion between 2005 and 2015. Results The main indications were skeletal dysplasia and trauma associated cervical instability. Surgical complications were observed in 12 (34%) patients with multiple complications in four (11%). Four (11%) children required at least one revision surgery, three for nonunion and one for graft dislodgement. All were fused at FU. Surgical complications were more common in children undergoing occipitocervical (OC) fusion than in those avoiding fusion of the OC junction (60% versus 24%) (p = 0.043). Complications were found significantly more in children operated on under the age of ten years than above (50% versus 18%) (p = 0.004). The risk of complications was not dependent on the indications for surgery (skeletal dysplasia versus trauma) (p = 0.177), Conclusion Skeletal dysplasia associated cervical instability and cervical spine injuries represented the most common indications for instrumented cervical spinal fusion in children. Complications were observed in one-third of these children and 11% required revision surgery for complications. OC spinal fusion and spinal fusion before the age of ten years are associated with higher risk of surgical complications and increased mortality than non-OC fusions and cervical spinal fusions at an older age. We urge surgeons to employ caution to the patient, timing and procedure selection when treating paediatric cervical spine.

STUDY DESIGN A retrospective study. OBJECTIVE To report the incremental hospital resources consumed with treating adverse events experienced by Medicare beneficiaries undergoing a two or three vertebrae level cervical spinal fusion. SUMMARY OF BACKGROUND DATA Hospitals are increasingly at financial risk for patients experiencing adverse events due "pay for performance." Little is known about incremental resources consumed when treating patients who experienced an adverse event after cervical spinal fusions. METHODS Fiscal years 2013 and 2014 Medicare Provider Analysis and Review file was used to identify 86,265 beneficiaries who underwent 2 or 3 vertebrae level cervical spinal fusion. International Classification of Diseases 9th Clinical Modification diagnostic and procedure codes were used to identify 10 adverse events. This study estimated both the observed and risk-adjusted incremental hospital resources consumed (cost [2014 US $] and length-of-stay) in treating beneficiaries experiencing each adverse event. RESULTS Overall, 6.2% of beneficiaries undergoing cervical spinal fusion experienced at least one of the study's adverse events. Beneficiaries experiencing any complication consumed significantly more hospital resources (incremental cost of $28,638) and had longer length-of-stay (incremental stays of 9.1 days). After adjusting for patient demographics and comorbid conditions, incremental cost of treating adverse events ranged from $42,358 (infection) to $10,100 (dural tear). CONCLUSION Adverse events frequently occur and add substantially to the hospital costs of patients undergoing cervical spinal fusion. Shared decision-making instruments should clearly provide these risk estimates to the patient before surgical consideration. Investment in activities that have been shown to reduce specific adverse events is warranted, and this study may allow health systems to prioritize performance improvement areas. LEVEL OF EVIDENCE 3.

Objectives A common question posed by patients undergoing cervical fusion pertains to the likelihood of perceiving a postoperative limitation in neck mobility. The aim of this study was to assess the change in neck mobility after subaxial cervical fusion using an objective range of motion (ROM) measure and patient reported assessment. Patients and methods Patients older than 18 years of age, undergoing first-time anterior or posterior subaxial cervical arthrodesis for a symptomatic spondylotic process (radiculopathy, cervical spondylotic myelopathy or primary neck pain) at a single center were eligible. Assessment included: 1) neck pain on a numeric rating scale; 2) four-directional objective neck mobility using the validated cervical ROM goniometer; and 3) a novel Mobility Assessment Scale (MAS) for patient perceived neck mobility. Subjects were dichotomized by number of levels fused (1-2 levels and ≥3 levels). Results There were 25 patients with a mean of 2.7±1.5 levels fused. Neck pain was improved in both groups with mean change of -3.4 [95% CI -4.7,-2.1], p=0.004 for 1-2 levels and -3.5 [95% CI -5.4,-1.5], p=0.009 for ≥3 levels. MAS score improved significantly in group undergoing 1-2 level fusion (-1.8 [95% CI: -3.1,-0.4], p=0.016) but not in those with ≥3 levels fused. There was a significant positive correlation between MAS and neck pain in the 1-2 level fusion group (rs=0.667, p=0.012) but not in the ≥3 level group. Objective neck mobility did not changed significantly in either group. Conclusions Patient reported neck mobility was significantly improved following 1-2 level cervical fusion. This change correlated significantly with patient reported improvement in neck pain. No significant difference in reported neck mobility was found in those undergoing fusion of ≥3 levels.

Background and objective: In the current clinical scenario, a wide variety of fusion techniques are being used along with polyetheretherketone (PEEK) cages in anterior cervical discectomy and fusion surgeries. Some of these techniques involve use of autografts, allografts, biomaterials or only PEEK cages. In this study, the existing literatures for anterior cervical discectomy fusion surgeries using PEEK cages and their outcomes have been reviewed to evaluate the results for the best possible alternative. Materials and methods: A PubMed search for all papers stating “PEEK cages used in cervical spinal fusion,” “PEEK materials used in cervical spinal fusion,” and “artificial materials used in cervical fusion surgery with PEEK cages” was done for all studies before January 2018. A total of 197 studies were found, of which 15 were shortlisted as per the inclusion criteria. The existing literatures on PEEK cages used in spinal surgeries were reviewed and analyzed. Statistical analysis was done using SPSS software version 25.0 and Student’s t-test was used to compare the results. Results: The total number of patients involved in the existing study was 767 with a mean age of 51.67 ± 9.01 years. 191 patients (24.9%) had cervical radiculopathy or myelopathy; 35 patients (4.5%) had cervical degenerative diseases; 29 patients (3.78%) had cervical spine injury with monosegmental instability; and the rest of the patients suffered from other disorders. The level of surgery for patients was single in 429 patients (55.93%) and multiple in 338 patients (44.06%). PEEK plus bone grafts had a significantly better fusion rate compared with PEEK plus artificial materials (95% confidence interval: 91.075 ± 2.09%; P = 0.0035) for multiple-level anterior cervical discectomy and fusion surgery. Conclusion: PEEK plus bone grafts showed a significant fusion rate compared with PEEK plus artificial materials. PEEK plus bone grafts is a better filler material as compared to PEEK plus artificial materials in anterior cervical discectomy and fusion surgeries for multiple levels involved.

Dexmedetomidine is an α2-adrenergic sedative-hypnotic medication used as an adjunct to general anesthesia. While experimental studies in animals have demonstrated a mild diuretic effect of dexmedetomidine, only recently have case reports described dexmedetomidine-induced diuresis in humans. Interestingly, the majority of such cases have involved patients undergoing spinal fusion surgery. Here, we report a case of a 30-year-old woman undergoing cervical spinal fusion surgery who experienced a massive diuresis starting 30 minutes after receiving dexmedetomidine intravenous infusion. We discuss the differential diagnosis and synthesize the current literature on this rare effect.

Background We aimed to determine the incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault. Methods The ACS National Trauma Data Bank (NTDB) 2012 Research Data Set was used to identify victims of blunt assault using the ICD-9 E-codes 960.0, 968.2, 973. ICD-9 codes 805.00, 839.00, 806.00, 952.00 identified cervical vertebral fractures/dislocations and CSCI. Multivariable analyses were performed to identify independent predictors of CSCI. Results 14,835 (2%) out of 833,311 NTDB cases were blunt assault victims and thus included. 217 (1%) had cervical vertebral fracture/dislocation without CSCI; 57 (0.4%) had CSCI. Age ≥55 years was independently predictive of CSCI; assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI. 25 (0.02%) patients with CSCI underwent cervical spinal fusion. Conclusions CSCI is rare after blunt assault. While the odds of CSCI increase with age, facial fracture or intracranial injury predicts the absence of CSCI. Summary The incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault was investigated. 14,835 blunt assault victims were identified; 217 had cervical vertebral fracture/dislocation without CSCI; 57 had CSCI. Age ≥55 years was found to independently predict CSCI, while assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI.

In our previous study, we focused on the motion of cervical spines in video-fluorography (VF), and we revealed that the physiological lordosises were reduced during normal swallowing. In the study, cervical spines were required to be manually extracted in all the frames of VF. Therefore the study had a difficulty in performing the statistical analysis based on a large amount of patient data. The present study proposes an automatic tracking method of cervical spines in VF by use of the two-dimensional template matching technique. In the method, cervical spines can be extracted automatically, though templates should be set manually only in the first frame of VF. The automatic tracking method was applied to cervical spines, from C1 to C6, in actual VF of ten cases who were planned to undergo posterior cervical spinal fusion. The cervical spines were able to be tracked at the accuracy of more than 77% in the Jaccard index. The experimental results demonstrated that the proposed method was able to analyze the motion of cervical spines in VF during swallowing.

Retrospective study of prospectively collected data.To investigate the applicability of the modified frailty index (mFI) as a predictor of adverse postoperative events in patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF).Prior studies have investigated the mFI and shown it as an independent predictor of adverse postoperative outcomes across multiple surgical specialties. However, this topic has not still been studied in patients undergoing cervical fusion or in spinal surgery.The National Surgical Quality Improvement Program is a multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent elective ACDF and PCF between 2005 and 2012. The mFI was calculated for each patient. Univariate analysis and multivariate logistic regression were used to analyze the mFI as a predictor for postoperative complications.For ACDF group, Clavien-Dindo grade IV complications rate increased from 0.8% to 9.0% as mFI increased from 0 to ≥0.27, and mFI = 0.27 was found to be an independent predictor of Clavien-Dindo grade IV complications (odds ratio, OR, = 4.67, 95% confidence interval, CI, = 2.27-9.62, P 0.001). For PCF groups, Clavien-Dindo grade IV complications rate increased from 0.7% to 20.0% as mFI increased from 0 to ≥0.36, and mFI ≥ 0.36 was identified as an independent predictor of Clavien-Dindo grade IV complications (OR = 41.26, 95% CI = 6.62-257.15, P 0.001).The mFI was shown to be an independent predictor of Clavien-Dindo grade IV complications in patients undergoing ACDF or PCF. The mFI itself may be used to stratify risks in patients undergoing cervical fusion, or, the mFI scheme could be used as a platform upon which more efficient risk stratification could be done with addition of other variables.4.

BACKGROUND CONTEXT Cervical spinal fusion (CF) is employed for treating degenerative spine diseases, which are age-related conditions. Despite the age-dependent nature of these conditions, there is little evidence comparing the outcomes of elderly adults to active adults. It is possible that patient age has a significant effect on postoperative outcomes following cervical spinal fusion. PURPOSE This study evaluated the: (1) demographics, (2) complications, (3) length of stay, (4) hospital charges, (5) reoperations and (6) readmissions following cervical spinal fusion. We hypothesized that elderly patients will experience poorer outcomes compared to younger adults after cervical spinal fusion. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients 45-64years and ≥80years of age who underwent elective cervical spinal fusion between 2009 and 2011 and were eligible for at least two year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 14,578 patients were included, 3.4% of which were ≥80years old and 96.6% of which were 45-64years old. OUTCOME MEASURES Demographic information, complications, length of stay, hospital charges, reoperations and readmissions METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was utilized to identify all elective cervical spinal fusions performed from 2009 to 2011 by ICD-9-CM code. Demographics including age, sex and race as well as perioperative factors, and two year postoperative complication, reoperation and readmission rates were collected for all patients. This cohort was then placed in two groups based on age: 45-64years and ≥80years. Patients outside of these ages were excluded. These two groups were then compared with univariate analysis. Regression models were developed and attempted to identify potential predictive factors for two-year postoperative outcomes. RESULTS A total of 14,578 patients were included, with 96.6% 45-64years (Younger) and 3.4% ≥ 80years (Older) old at time of surgery. Older patients were more commonly male (54.0vs. 50.1%, p CONCLUSIONS This study compared outcomes between patients ≥80years old and patients 45-64years old following cervical spinal fusion. The older patient group had higher two-year complication and reoperation rates. Patient age was a significant predictor for higher complication and revision rates. This study should assist spine surgeons preoperatively in risk-stratifying and counseling patients for postoperative outcomes after cervical spinal fusion.

Autogenous iliac crest bone is the gold standard for graft material in cervical spinal fusion, but a high incidence of donor site morbidity has been reported. Therefore, to achieve a better fusion rate and decrease the rate of donor site morbidity, we used a novel method whereby hollow bone cement filled with impacted cancellous bone is used as a substitute for bone graft in cervical interbody fusion. From 2003 to 2004, 21 patients with cervical spinal disorders who were treated using this method were included in this study. Fourteen patients underwent single-level grafts and seven underwent two-level grafts. Evaluation included a monthly clinical and X-ray examination for the first 3 months, and then follow-up every 3 months thereafter. Multiple-slice computed tomography (CT) scan with reconstruction to evaluate the viability of the bone graft was performed when evidence of bone fusion was found on X-ray. The mean age of the patients was 59 years (range 27-79). The mean follow-up period was 19 months (13-24 months). Evidence of impacted cancellous bone bridging the adjacent vertebral body was observed in all patients at the 6-month follow-up based on X-rays and reconstructive CT scans. No severe donor site morbidity occurred. One patient experienced hardware failure due to screw fracture, but a reconstructive CT scan revealed well-bridged cancellous bone between the vertebral bodies. Hollow bone cement filled with impacted cancellous bone could be an alternative material for cervical spine interbody fusion. Using this method, we found not only satisfactory growth of cancellous bone in the holes of the bone cement, but also low morbidity in the donor site. However, for this method, the long-term stability, potential complications, and the necessity of instrumentation all require further investigation.

The implantation of a spacer is common practice after ventral discectomy in the cervical spine. Besides bone or bone cement (Palacos, Sulfix, and Allofix), the surgeon has the choice of a variety of factory-made implants (cages). We report on our experience with the Intromed ZWE [Zwischenwirbel-Ersatzsystem (Intervertebral Replacement System)] implant. The ZWE implant (Intromed Medizintechnik GmbH, 15754, Senzig, Germany), made from titanium 6AL 4V, consists of a flat quadrangular body with a large supporting surface on the bottom and top and a central hole. We report the first 100 cases treated with their 1- or 2-year follow-up completed (mean follow-up, 1.7 years). The mean age was 47+/-9 years (range: 27-73 years). The implantation was performed without filling the central hole. In addition to the clinical investigation of neurological alterations and the range of movement, X-rays were taken, and the clinical result was determined by an independent investigator according to the Odom Scale. After the minimum follow-up of 1 year, 32 patients scored excellent on the Odom scale, 38 patients good, 25 patients satisfactory, and 5 patients bad. In 74 cases, fusion occurred radiologically as bony bridging around the implant. In 21 cases, the cage showed no change and no radiolucency. In five cases, radiolucency around the implant occurred without instability at flexion-extension X-ray views. In CT scans done in two patients with complaints, we confirmed bony bridging inside the centre hole implanted empty. The Intromed-ZWE-System performs well in routine clinical use. Compared to bone or bone cement, the operating time is reduced. The Intromed System offers an easy fusion method for a competitive price.

60歳, 男性. 頚椎椎弓形成・前方固定術後の頚部違和感のためプレート抜去術を行った際, 麻酔導入時に挿管困難をきたした. 頚椎前方にプレートと一塊になった硬い膿瘍が存在し, 気管を前方に偏移させたことが原因と思われた. 術前の頚部Ｘ線写真で気管の前後径は第6頚椎の高さで22mm, 横径20mmと太さは十分であったが気管の前方偏移が強かった. このような症例では挿管困難を念頭におき十分な準備を整えておくべきである.

Study Design. This study analyzed the use of the one piece cervical device (OPCD) surgically inserted to treat atlanto-axial or subaxial subluxation. Operative results, techniques, and the enhanced correction mechanism were studied. Objectives. The results were correlated to provide a rationale for posterior cervical spinal fusion. Summary of Background Data. Wiring techniques were generally performed for posterior fusion. Recently, the Luque rod has been used on the cervical spine. Methods. One hundred eighty-seven patients were analyzed clinically and radiologically. The operative techniques were detailed and the corrective mechanism explained through biomechanical considerations. Results. The patients were followed from 2 to 13 years. The results were 94% satisfactory. No poor or worsening cases were encountered. Conclusions. Satisfactory operative results showed that the OPCD is safe, convenient, and reliable. It can be used in all areas of the cervical spine. The primary reason for these benefits is the enhanced correction mechanism of the OPCD.

Patients receiving long-term hemodialysis frequently develop orthopaedic complications such as renal osteodystrophy and carpal tunnel syndrome. Kuntz and colleagues reported a new syndrome named destructive spondylarthropathy (DSA). We experienced four cases of DSA who required surgical treatment. Patients included one male and three females with an average age of 60 years (range 54-72 years). The mean duration of follow-up was eleven months (range 7-16 months) and the length of hemodialysis ranged from 8 to 17 years (mean 12 years). All patients had myelopathy along with radiculopathy. We performed anterior cervical spinal fusion (ASF) in three cases and posterior cervical spinal fusion using a rectangular rod in one case. Mean recovery rate using Hirabayashi's method was 59% (range 0-100). Histological examination of the disc was carried out in three cases with ASF and amyloid deposits were found in two. In two case of ASF group, bone union was insufficient.

We report a case of atlantoaxial dislocation associated with von Recklinghausen's disease which developed after anterior cervical spinal fusion.Anterior spinal fusion was performed from C3 to C7 to prevent the progression of marked kyphosis (125 degrees) found in a 22-year-old man with von Recklinghausen's disease. Spondylosis was well established, and no further increase in kyphosis was seen. However three years after the operation, he complained of lower extremity tingling and had a spastic gait. Radiological instability of C1-C2 was then confirmed.The earlier anterior cervical spinal fusion was considered to be potentially involved in the pathogenesis of this patient's atlantoaxial dislocation.

Study Design Retrospective cross-sectional study of spinal procedures from 2002 to 2010 using the Nationwide Inpatient Sample database. Objective To determine the patterns of bone morphogenetic protein (BMP) usage in fusion surgery before and after the U.S. Food and Drug Administration (FDA) 2008 advisory for the anterior cervical spine to understand how advisories affect U.S. physician practices. Methods Procedures were identified through International Classification of Diseases, Ninth Revision procedure codes and were plotted over time based on fusion procedure type, site, and area of fusion. U.S. national trends were approximated by polynomial regression analysis. Results The majority of the data trends of BMP usage reflect a second-order polynomial model. BMP usage in anterior cervical spine fusion procedures plateaued during the fourth quarter of 2007. The most apparent change in trend was noted in BMP usage pre- and postadvisory in the analysis of anterior cervical spine fusions. BMP percentage of use decreased in this area by 5% from the time of the FDA advisory to the fourth quarter of 2010. Conclusions The decrease in BMP usage in anterior cervical spinal fusion procedures coincided with the timing of the FDA advisory. The fact that BMP continued to be used in cervical spine fusion procedures, even at lower rates, despite the advisory, may reflect the availability of new clinical information that could lessen complications (i.e., lower BMP dose, perioperative steroids, BMP containment). Furthermore, factors like the natural ceiling effect of use or demand for new technology, complications, prohibitive institutional costs, access to information, and insurance compensation may have all contributed to the BMP usage trends observed.

Cervical vertebral interbody fusion was performed on 30 horses affected with cervical vertebral malformation (CVM) or “wobbles” to assess the efficacy of the surgery in either preventing progression of or reversing the neurologic deficit induced by the syndrome. Evaluation of each horse prior to surgery included clinical, radiographic, neurologic, and laboratory examination. Subjects ranged from 3 months to 8 years of age, and included 22 males and 8 females of various breeds. Three normal horses were included as controls. The Cloward method of cervical fusion was used to achieve stabilization at the affected vertebral articulation. Horses were reexamined 3 months after surgery. Clinical improvement was seen in 90% (27 of 30) of the cases. Four horses were returned to training, which had been interrupted by onset of symptoms. Seven were returned to owners as breeding animals. Twelve horses were kept for long-term studies. Seven horses were sacrificed to examine the surgical site. In 6 of the 7 horses on which necropsy was performed, the most severe histologic lesion in the spinal cord could be predicted from lesions seen radiographically. The spinal cords of control animals were normal. Osseous fusion was dependent on the completeness of removal of disc fibrocartilage during surgery. We conclude that clinical improvement in some horses affected with CVM can be achieved by cervical fusion.

Cervical spondylitic spurs can cause impairment of vertebral artery blood flow, thus producing the clinical picture of vertebral artery insufficiency. The fifty-four year old man described herein had severe recurrent headaches, and angiography demonstrated impairment of left vertebral artery blood flow by a large cervical osteophyte. Cervical spinal fusion resulted in clinical remission for four years. The anatomic relationships of the vertebral arteries which predispose them to compression and trauma are discussed. The resulting neurologic symptoms and signs are similar to those occurring with basilar artery insufficiency. They are frequently episodic and are associated with certain postures of the head and neck. Angiographic study should include visualization of all four cervical arteries, with the neck held in flexion and hyperextension, and with the head turned to both sides. Surgical intervention is indicated when symptoms are frequent and severe, and consists of decompression of the vertebral artery and/or cervical spinal fusion.

A patient with Klippel-Feil syndrome, which was associated with Pierre Robin sequence, bilateral mandibular duplication, and occipital clefts, is described. The management, surgery, and possible etiology are discussed in relation to the relevant literature.