Cervical spine fusion have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications and acceptable results. The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect, if any on complication rates. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion surgery from 2010 to 2013. Univariate and multivariate regression analysis was used to determine post-operative complications associated with transfusion and cervical fusion. We identified 11,588 patients who had cervical spine fusion between 2010 and 2013. The overall rate of transfusion was found to be 1.47%. All transfused patients were found to have increased risk of: venous thromboembolism (TBE) (OR 3.19, CI: 1.16–8.77), myocardial infarction (MI) (OR 9.12, CI: 2.53–32.8), increased length of stay (LOS) (OR 28.03, CI: 14.28–55.01) and mortality (OR 4.14, CI: 1.44–11.93). Single level fusion had increased risk of: TBE (OR 3.37, CI: 1.01–11.33), MI (OR 10.5, CI: 1.88–59.89), and LOS (OR 14.79, CI: 8.2–26.67). Multilevel fusion had increased risk of: TBE (OR 5.64, CI: 1.15–27.6), surgical site infection (OR 16.29, CI: 3.34–79.49), MI (OR 10.84, CI: 2.01–58.55), LOS (OR 26.56, CI: 11.8–59.78) and mortality (OR 10.24, CI: 2.45–42.71). ACDF surgery had an increased risk of: TBE (OR 4.87, CI: 1.04–22.82), surgical site infection (OR 9.73, CI: 2.14–44.1), MI (OR 9.88, CI: 1.87–52.2), LOS (OR 28.34, CI: 13.79–58.21) and mortality (OR 6.3, CI: 1.76–22.48). Posterior fusion surgery had increased risk of: MI (OR 10.45, CI: 1.42–77.12) and LOS (OR 4.42, CI: 2.68–7.29). Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion surgery. These patients are demonstrated to have higher rate of MI, DVT, wound infection and mortality when compared to those who do not receive transfusion

In multilevel posterior cervical instrumented fusions, extending the fusion across the cervico-thoracic junction at T1 or T2 (CTJ) has been associated with decreased rate of re-operation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient reported outcomes (PROs) remains unclear. The primary objective was to determine whether extending the fusion through the CTJ influenced PROs at 3 and 12 months after surgery. Secondary objectives were to compare the number of patients reaching the minimally clinically important difference (MCID) for the PROs and mJOA, operative time duration, intra-operative blood loss (IOBL), length of stay (LOS), discharge disposition, adverse events (AEs), re-operation within 12 months of the surgery, and patient satisfaction. This is a retrospective analysis of prospectively collected data from a multicenter observational cohort study of patients with degenerative cervical myelopathy. Patients who underwent a posterior instrumented fusion of 4 levels of greater (between C2-T2) between January 2015 and October 2020 with 12 months follow-up were included. PROS (NDI, EQ5D, SF-12 PCS and MCS, NRS arm and neck pain) and mJOA were compared using ANCOVA, adjusted for baseline differences. Patient demographics, comorbidities and surgical details were abstracted. Percentafe of patient reaching MCID for these outcomes was compared using chi-square test. Operative duration, IOBL, AEs, re-operation, discharge disposittion, LOS and satisfaction were compared using chi-square test for categorical variables and independent samples t-tests for continuous variables. A total of 206 patients were included in this study (105 patients not crossing the CTJ and 101 crossing the CTJ). Patients who underwent a construct extending through the CTJ were more likely to be female and had worse baseline EQ5D and NDI scores (p> 0.05). When adjusted for baseline difference, there was no statistically significant difference between the two groups for the PROs and mJOA at 3 and 12 months. Surgical duration was longer (p 0.05). Satisfaction with the surgery was high in both groups but significantly different at 12 months (80% versus 72%, p= 0.042 for the group not crossing the CTJ and the group crossing the CTJ, respectively). The percentage of patients reaching MCID for the NDI score was 55% in the non-crossing group versus 69% in the group extending through the CTJ (p= 0.06). Up to 12 months after the surgery, there was no statistically significant differences in PROs between posterior construct extended to or not extended to the upper thoracic spine. The adverse event profile did not differ significantly, but longer surgical time and blood loss were associated with construct extending across the CTJ

Thirty-three patients who had undergone anterior cervical fusion for degenerative disc disease were reviewed to determine the efficacy of the procedure. Only patients who were available for examination and who had undergone operation at least one year previously were included in the review. Nearly all had had arm pain and three-quarters neck pain. Diminished neck movement and neurological abnormalities in the arms had been frequent findings. Diagnosis from the clinical features and plain radiographs is described. Myelography was not used routinely and discography was not used at all. Indications for operation and surgical technique are described. Results show that pain in the neck and arm was relieved in a high proportion of cases and that the neurological abnormalities often recovered. It is concluded that this operation is safe and has a definite place in the relief of pain from cervical disc degeneration resistant to conservative treatment

Introduction Locking plates are the most used devices for achieving anterior cervical spinal fusion and offer considerable advantages such as faster and easier implantation and fewer implant-related failures than older plate systems. Recently polyaxial locking screws were introduced to make the implantation of these plates even easier by facilitating the implantation of the screw in all directions. However polyaxial screws may have the disadvantage of losing the angular stability with subsequent failure of the plate. The aim of this study was the radiological follow up of the patients with polyaxial screw and to compare them with the conventional looking plates. Methods Patients underwent anterior cervical discectomy and fusion in which either ventral cervical locking plates or a polyaxial locking screw were used for indications including cervical spondylotic radiculopathy, disc herniation, trauma, and myelopathy. Patients underwent anterior cervical discectomy and interbody fusion and / or corpectomy. Preoperative and postoperative radiographic data included sagittal angle, translation, and settling of the graft. Results One hundred and forty patients were investigated (mean age of 49 years) with an average follow up period of 21.5 months (range from 4 to 50 months). All underwent anterior cervical plate fusion as a component of the surgical treatment for symptomatic degenerative cervical spinal disease (55%) or for vertebral destruction caused by trauma (45%).100 (71%) of patients were treated with a conventional locking plate and 29 % with a plate with polyaxial screw fixation. Besides plate fixation, 4 of the 140 patients had a combined ventrodorsal fusion. In 46 cases (25%), one or more vertebral bodies were removed and replaced with either iliac bone graft (two levels, 21% of all cases) or fibula strutgraft (4%). In the group with conventional locking plates no patient had to be revised, 3 showed a subluxation (up to 1/3 of the vertebral body diameter) and 2 screw back out posteriorly without clinical relevance. In the group with the plate with polyaxial screw fixation two patient had to be revised (posterior stabilisation) because of subluxation due to loss of angular stability of the screws and one patient developed subluxation of 1/3 of the vertebral body also due to loss of angular stability. Discussion The complication rate and the revision rate for anterior cervical discectomy and fusion with plates with and without polyaxial screw fixation were similarly low. Polyaxial screw may have the theoretical disadvantage of loosening with loss of the angular stability and subsequent failure necessitating revision

Aim: To determine the incidence of adjacent level osteophytes in patients who have had anterior cervical fusion using an anterior cervical plate as compared to those who are fused without an anterior cervical plate. Design: We retrospectively reviewed the lateral radiograms of sixty two patients who have had an anterior cervical fusion with a minimum follow up of twelve months. Materials and methods: We looked for the development of adjacent level osteophytes in these patients at their final follow up, which was generally at the time radiological fusion. There were 27 patients in the first group who had an anterior cervical plate used to fix the vertebrae in addition to the Cervios cage, while the 35 patients in the second group in whom only a Rabea cage was used for the fusion. The mean follow-up was 20.6 months (range 12–48). Results: 64.3% of the patients who had an anterior cervical plate developed adjacent level osteophytes while none of the patients who have had the fusion without the cage developed the osteophytes. Conclusion: We found the patients who had an anterior cervical interbody fusion using a plate had a significant risk of developing adjacent level osteophytes while this is not seen in patients who do not have the plate for the fixation

Objective: To determine if a porous, coralline-derived hydroxyapatite block (ProOsteon 500. TM. , Interpore, Irvine, CA) is a suitable substitute for tricortical iliac crest autograft in cervical interbody fusion. Design: A prospective randomised trial with two-year follow-up comparing clinical and radiographic outcomes in patients receiving either iliac crest or hydroxyapatite grafts in cervical interbody fusion. Subjects: Twenty-nine patients undergoing cervical fusion and anterior plating were randomised to receive either iliac crest (Group I) or hydroxyapatite (Group II) interbody grafts. Fourteen patients (19 grafts) in Group I and twelve patients (18 grafts) in Group II were available for final analysis. Both groups were similar with respect to age, sex, diagnosis and levels fused. Outcome Measures: The SF-36 and Oswestry Disability Index were used to measure clinical outcome. Post-op and final follow-up radiographs were analysed for graft fragmentation, loss of height, loss of angular alignment and hardware failure to assess structural integrity of the graft. Computed or plain tomography was used to evaluate fusion. Results: Groups I and II demonstrated improvement in preoperative scores for bodily pain (p=. 016 and. 016 respectively) and physical functioning (p=. 050 and. 016 respectively) at final follow-up. There was no significant difference in SF-36 and Oswestry scores between the two groups. Successful radiographic fusion was similar in both groups (79% in Group I and 76% in Group II). Graft fragmentation occurred in 89% of the hydroxyapatite grafts and 11% of the autografts (p=. 001). Greater than 2mm of graft height and 3° of segmental lordosis were lost in 55% of hydroxyapatite grafts vs. 11% of autografts (p=. 009). One patient in Group II and none in Group I required revision surgery for graft failure. The high rate of early radiographic failure in the hydroxyapatite grafts prompted suspension of further enrolment in the clinical trial. Conclusions: ProOsteon 500 coralline hydroxyapatite blocks do not possess adequate structural integrity to resist axial loading and maintain disc height or segmental lordosis during cervical interbody fusion

Using the United States Nationwide Inpatient Sample, we identified national trends in revision spinal fusion along with a comprehensive comparison of comorbidities, inpatient complications and surgical factors of revision spinal fusion compared to primary spinal fusion.

In 2009, there were 410 158 primary spinal fusion discharges and 22 128 revision spinal fusion discharges. Between 2002 and 2009, primary fusion increased at a higher rate compared with revision fusion (56.4% vs 51.0%; p < 0.001). In 2009, the mean length of stay and hospital charges were higher for revision fusion discharges than for primary fusion discharges (4.2 days vs 3.8 days, p < 0.001; USD $91 909 vs. $87 161, p < 0.001). In 2009, recombinant human bone morphogenetic protein (BMP) was used more in revision fusion than in primary fusion (39.6% vs 27.6%, p < 0.001), whereas interbody devices were used less in revision fusion (41.8% vs 56.6%, p < 0.001).

In the multivariable logistic regression model for all spinal fusions, depression (odds ratio (OR) 1.53, p < 0.001), psychotic disorders (OR 1.49, p < 0.001), deficiency anaemias (OR 1.35, p < 0.001) and smoking (OR 1.10, p = 0.006) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges, adjusting for other variables. In terms of complications, after adjusting for all significant comorbidities, this study found that dural tears (OR 1.41; p < 0.001) and surgical site infections (OR 3.40; p < 0.001) had a greater chance of occurrence in revision spinal fusion discharges than in primary fusion discharges (p < 0.001). A p-value < 0.01 was considered significant in all final analyses.

Cite this article: Bone Joint J 2014;96-B:807–16.

Background: Smaller versions of threaded lumbar cages were developed for cervical spine to obviate the need for allograft, iliac autograft use and to provide initial stability before fusion. Clinical trials of threaded cervical fusion cages have shown higher fusion rates and lower rates of graft-donor site complications. Study design/Aims: Prospective. Radiological and clinical outcomes of an age, sex and diagnosis matched patient population who underwent cervical fusion with (A) BAK/C cages filled with autograft reamings (Center-pulse Spine-tech Inc., Minneapolis, MN) (N=50) were compared with (B) Anterior cervical decompression and fusion (ACDF, N=50). Methods: Patients with symptomatic cervical discogenic radiculopathy were treated with either anterior cervical discectomy with uninstrumented bone-only fusion (ACDF) or BAK/C fusion cage(s). Independent radiographic assessment of fusion was made and patient-based outcome was assessed by a Short Form (SF)-36 Health Status Questionnaire. All patients had minimum follow up of at least 2 years. Results: Similar outcomes were noted for duration of surgery, hospital stay, improvements in neck pain and radicular pain in the affected limb, improvements in the SF-36 Physical Component subscale and Mental Component subscale, and the patients’ perception of overall surgical outcome. Symptom improvements were maintained at 2 years. Iliac crest harvesting was carried out as a standard procedure in all cases of ACDF whereas only 2 cases in BAK/C group required the same. Average operative time of 115 minutes and 145 minutes, blood loss of 110ml and 175ml and hospital stay of 1.5 and 3.5 days were noted for BAK/C and ACDF groups respectively. Successful fusion was achieved in 49 cases in BAK/C and 46 patients in ACDF group. None of the patients in the BAK/C group had reappearance of symptoms while 3 patients in ACDF group had developed symptomatic adjacent level disc disease. The complication rate for the ACDF group was 9% compared with an overall complication rate of 3% with BAK/C. Complications that necessitated a second operative procedure included. Graft dislodgement (N=3) and. Cage subsidence, both requiring re-operation in the form of ACDF with plate supplementation. Conclusions: These results demonstrate that outcomes after a cervical fusion procedure with a threaded cage are the same as those of a conventional uninstrumented bone-only anterior discectomy and fusion with a low risk of complications, less operative time and rare need for autogenous bone graft harvest

We conducted a prospective, randomised study of 42 cervical interbody fusions undertaken with either an autologous tricortical graft or a cage. The factors assessed in the two groups were: (1) time taken to achieve fusion; (2) neck disability index; (3) pain score; (4) interbody height ratio; (5) interbody angle and (6) the influence of smoking on fusion. No statistical difference was seen in the time taken to achieve fusion, neck disability index, interbody height ratio, or interbody angles. Smoking did not have any effect on the fusion process. The pain score was significantly lower in the tricortical graft group at six months. We conclude that both methods of fusion give similar results, although tricortical graft fusion is cheaper than cage fusion, and is more effective in reducing the pain score

Introduction: Many different techniques exist for cervical interbody fusion after discectomy for soft and hard disc prolapses. The six years clinical and radiological results and the complications with a hydroxy-apatite ceramic (hac)-titanium implant are presented. Methods: Between 1/1995 and 12/2000 a titanium implant coated with hydroxy-apatite ceramic (hac) has been used for ventral cervical interbody fusion after discectomy in 596 patients with soft and hard disc prolapses who were operated in 670 levels. There were 333 male and 263 female patients. The mean age was 48.2 years. Clinical and radiological follow-up studies were performed direct after operation and 6 weeks, 6 months and 1 year later with an average follow-up of 14 months. The functional outcome was assessed according to Odom’s score, and the neurological outcome according to Kadoya’s score. Results: 93.2 % of the patients had a good to excellent result according to Odom’s score at follow-up whereas the neurological findings showed improvement in 71.2 % and no change in 27.9 %. After 6 months a good bony fusion could be seen around 91.2 % of the implants, and after 12 months around 95.7 %. 1,7 % of the operated patients developed a recurrent laryngeal nerve injury. Three implants broke into the adjacent vertebral endplate. Six patients had a second operation because of a dislocated cage. An adjacent segment pathology occured in 25 patients (4.2 %), of whom 15 patients had a second operation. Conclusions: With the use of this hydroxy-apatite ceramic (hac)-titanium implant we get an immediate postoperative stability of the cervical spine without the need of any orthosis. Harvesting of bone grafts is unnecessary which reduces operation time and eliminates donor site complications. The clinical and radiological are good and comparable to other fusion techniques in the cervical spine and the complication rate is low. If the number of adjacent segment pathology can be reduced with total disc arthroplasty has to be clarified in further comparable studies

Objective: To compare fusion time, Neck Disability scores, Pain scores, interbody height ratio and angulation, in cervical interbody fusion performed using tricortical graft or Ostapek cage, and a comparison between smokers and non smokers in fusion times. Design: A prospective randomised study. Subjects: Forty-two patients aged between 30 and 71years. Eighteen tricortical graft fusions, and 24 Ostapek cage fusions. Outcome measures: Grading of fusion from plain radiographs, Neck Disability Scores, Pain scores, interbody height ratio, and interbody angulation. Results: Mean time to good quality fusion was 4.66 months in the cage group and 5.97 months in the tri-cortical graft group with p< 0.5 and 5.00 months in the smoking population and 5.6 months in the non-smoking population with p< 0.5. At six months: mean percent NDI was 66.75 in the cage group and 50.67 in the tri-cortical graft group 0.1< p< 0.5;mean percent pain scores were 70.33 in the cage group and 34.50 in the tricortical graft group 0.02< p< 0.05; mean percent interbody height ratio was 98.68 in the cage group and 95.22 in the tricortical graft group 0.1< p< 0.5; mean change in interbody angle was 1.36° kyphosis in the cage group and 3.8° of kyphosis in the tricortical graft group 0.05< p< 0.1. Conclusions: Tricortical graft fusion gives equal results to cage fusion and is much cheaper

Study Design: Retrospective review of patients treated with mineralized collagen matrix hydrated with bone marrow in Anterior Cervical Decompression and Fusion (ACDF).

Background: Autologous iliac crest bone is regarded as the gold standard graft material for ACDF. Postoperative donor site pain and morbidity made us seek for an alternative while still providing a high rate of fusion as attained with autologous bone.

Methods: All patients who underwent ACDF between August 2005 and May 2007 by the senior author for cervical myelopathy or radiculopathy secondary to degenerative changes or trauma were included. Patients with an additional posterior fusion were excluded. A total of 80 patients were observed for 16 months (range, 6–27 months). In all patient we used a mineralized collagen matrix hydrated with bone marrow aspirate from the left iliac crest as our cage graft material. All patients had PEEK interbody cages and anterior cervical plating. Clinical and radiographic follow-up data were obtained. X-rays were reviewed by both the senior author and an independent radiologist. Clinical outcomes were measured as described by Robinson and with the Nurick scale.

Results: 31 single-level fusions, 35 two-level, 13 three-level and 1 four-level fusion were performed. No revision surgery was needed. One patient had a subsequent laminectomy for residual cord compression. All patients achieved a solid fusion. No symptomatic pseudoarthrosis was noted. No donor site morbidities were noted.

With a successful clinical result defined as an excellent or good outcome accompanied by significant pain relief, 73 patients had a successful clinical result.

Conclusion: The use of a mineralized collagen matrix in combination with bone marrow aspirate in ACDF eliminates iliac crest donor site morbidities while still providing high rates of fusion.

Anterior decompression and adequate spine fixation in patients with cervical radiculopathy and myelopathy are essential for functional restoration of cervical spine. In this study, we performed evaluation and comparative radiological assessment of several types of spinal implants in terms of bone block formation, sagittal alignment and effectiveness as a structural support.

Materials and Methods: From 1993 to 2003, 165 patients with radiculopathy and myelopathy due to degenerative disease of cervical spine were operated on. The age of patients was 32–74 years (mean age 57, 8). The interbody fusion was performed by several methods.

Group1. Autograft – 91 patients

Group 2. TiNi alloy cages – 74 patients.

Group 3. Varilift expandable cages without plate fixation – 22 patients

Group 4. Verilift cages with plate fixation – 8 patients

Group 5. Bone substitute spacer and plate fixation – 3 patients.

Results: In groups 1 and 2, the bone and bone-metal block was formed during the first 3–4 months after surgery in all patients. There were no cases of bone resorbtion around the TiNi cages or loosening of the device. In patients with one-level (15 patients) interbody fusion by Varilift cages (group 3); formation of the bone block during the same time period was observed in 14 out of 15 patients. In cases with two-level fusion (7 patients), the bone block at the second level was not formed for longer than 6 months. There were 7 cases of subsiding and segmental kyphosis. In group 4, we did not detect any cases of loosening, subsiding or segmental kyphosis. In group 5, no bone block formation was observed after 6 months despite plate fixation.

Conclusions: A high fusion rate was achieved after a single or multi-level discectomy and interbody fusion by autograft and TiNi cages, which did not subside due to their design and superelasticity and can therefore be used without plate fixation. Varilift cages were also very effective, but if used without plate fixation may be associated with subsiding effect. The use of the bone substitute spacer is questionable in cervical spine surgery. Cervical plate fixation is effective as a prophylactic measure against segmental kyphosis in all types of interbody fusion.

Objectives. Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion. Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1

In a retrospective cohort study we compared the clinical outcome and complications, including dysphagia, following anterior cervical fusion for the treatment of cervical spondylosis using either a zero-profile (Zero-P; Synthes) implant or an anterior cervical plate and cage. A total of 83 patients underwent fusion using a Zero-P and 107 patients underwent fusion using a plate and cage. The mean follow-up was 18.6 months (. sd. 4.2) in the Zero-P group and 19.3 months (. sd. 4.1) in the plate and cage group. All patients in both groups had significant symptomatic and neurological improvement. There were no significant differences between the groups in the Neck Disability Index (NDI) and visual analogue scores at final follow-up. The cervical alignment improved in both groups. There was a higher incidence of dysphagia in the plate and cage group on the day after surgery and at two months post-operatively. All patients achieved fusion and no graft migration or nonunion was observed. When compared with the traditional anterior cervical plate and cage, the Zero-P implant is a safe and convenient procedure giving good results in patients with symptomatic cervical spondylosis with a reduced incidence of dysphagia post-operatively. Cite this article: Bone Joint J 2013;95-B:543–7

The aim of most new implants for cervical disc replacement is to maintain or restore function. The Dynamic Cervical Implant (DCI(tm), Paradigm Spine) aims at combining the advantages of the gold standard fusion technique with the motion preservation philosophy. DCI has a limited motion: it works like a shock absorbing spring and may help to slow down adjacent segment degeneration. Between 2007 and 2009 we selected 79 patients aged 32 to 73 years for treatment with DCI at either one or two levels (10 patients). Indications were radiculopathies (n=45), axial pain (n=4) or spondylotic spinal stenosis (n=30) with out chronic myelopathy. Patients are followed up at 3, 6, and 12 months after surgery. Disc surgery was performed at C3/C4 (n=2), C4/5 (n=6), at C5/6 (n=43), C6/7 (n=37) and at C7/T1 (n=1). In flexion/extension radiographs motion rapidly increased after surgery. However, 5 of 19 treated levels were fused (seen at 6 or 12 months). After implant footprint was changed and larger sizes were provided only 2 of 67 segments fused. Still 96% of the patients rated their clinical result as excellent or good. There were no implant related complications or revision surgery. Disc replacement with DCI is a new strategy that is positioned in between anterior cervical fusion and disc prosthesis. Clinical results are as good as in anterior cervical fusion. Adjacent segment protection must be judged in future follow-ups. We were able to show that the change of implant footprint has significantly reduced fusion rate

Atlanto-axial rotatory fixation is one of a spectrum of rotatory abnormalities of the atlanto-axial joint. Rotatory fixation without anterior displacement of the atlas (Type I) has been reported in only a few cases in which there has been a prolonged interval between injury and diagnosis. The majority of these cases eventually required cervical fusion for persistent deformity or instability. Two cases are presented in which this diagnosis was made early with the aid of rotated odontoid radiographs, tomography and computerised axial tomography. Treatment by a short period of halter traction achieved reduction and early return of function. The authors conclude that early recognition and treatment of this rare condition may prevent the subsequent deformity and instability for which cervical fusion has been required

A series of 75 patients who had undergone anterior cervical fusion between 1965 and 1977 were reviewed. The patients were divided into two groups: those in Group A had had the level of fusion indicated by cine radiography, whereas in Group B the level had been determined by plain radiographs and clinical symptoms and signs. Results showed that cine radiography was the more accurate diagnostic technique. Accurate diagnosis of the level to be fused, the careful clinical selection of patients and sound bony union were found to be vital to the success of anterior cervical fusion. The incidence of pseudarthrosis was significant in single-level fusions and was even greater in double-level fusions and in patients with a history of trauma, especially whiplash injuries. It was rare to develop recurrence of symptoms in adjacent levels after fusion of a level localised by cine radiography

To provide short- term follow-up data on the surgical success and patient outcome following early anterior cervical fusion in this particular type of injury. A prospective study of 10 consecutive patients. Stage I compressive extension injury of the cervical spine, as described by Allen and Ferguson, is not always a stable injury. The combined unilateral failure of the posterior structures under compression together with failure of the anterior structure under tension will lead to a rotationally unstable segment. Various treatment options are available including halo vest immobilization, posterior stabilization with plating and anterior fusion and plating. 10 consecutive patients diagnosed with stage I compressive extension injury (fracture subluxation of the cervical spine). All subjects presented with a neurological deficit and vertebral subluxation. All patients were investigated with CT scan of the involved segment; in addition 2 patients had MRI scans. The surgical protocol consisted of early reduction followed by anterior cervical fusion using a tricortical iliac graft, and stabilization, using locking plate fixation. Follow-up was by radiographs and clinical examination. Intraoperative assessment revealed disc injury in all patients. Anatomical realignment was achieved together with a solid fusion in all of the patients. All patients showed improvement in the neurological deficit. One patient remains with some residual weakness in his triceps and another patient required removal of a prominent screw. Early anterior fusion and plating for this type of injury is a safe procedure

Purpose: To study the pattern of neurological lesions and the frequency they occur in patients with cervical injuries. The relationship of these lesions with certain types of injuries and the cause of omjury. Patients and methods: Between 1970–2001, 665 patients suffering a cervical injury were studied in our Department. There were 192 male and 73 female patients aged 42,3 years on average. Two hundred sixty-five of these cases (38,5%) were presented with neurological symptoms.The mean time of hospitalization was 43,45 days. The patients were classified according to the type and the level of injury. ASIA‘s functional classification was used (35,1% were ASIA A, 13,96% ASIA B, 10,57% ASIA C and 40,37% ASIA D). 194 were followed up for a mean period of 7 years. Conservative treatment was applied to 183 (69%) patients while 82 patients (31%) were treated operatively with anterior cervical fusion, posterior cervical fusion, or combined anterior and posterior fusion. Postoperatively, most of the patients with incomplete neurological lesion, were improved. Conclusions: An analysis of our cases showed the following: a) There is a relationship between the type of neurological signs and the type of osseous or ligamentous injuries. b) There is relationship between type of osseous or ligamentous injury and severity of neurological lesion.. c) Burst fractures are the most severe fractures, followed by bilateral dislocations and tear-drop fractures. d) There is a relationship between mechanism of injury and severity of neurological lesion