F-4-06-02
POSTOPERATIVE CERVICAL MALALIGNMENT FOLLOWING OCCIPITO-CERVICO-THORACIC FIXATION WITH LUQUE SSI
Hitoshi Hase, Taku Ogura, Youichiro Hatta, Kenichi Chatani, Yasuhiro Iwasaku, Yasusuke Hirasawa (Department of Rehabilitation, Kyoto Prefectural University of Medicine, Kyoto, Japan)
[Purpose] Occipito-cervico-thoracic fixation with Luque SSI is applicable to a wide range of cervical disorders involving the occipito-cervical area. However, jaw opening and swallowing disturbance may appear as a complication. Regarding this issue, we retrospectively investigated alignment of fixation on X-ray films.
[Method] Between 1988 and 1996, this method was applied to sixteen cases, ranging in age from 47 to 73 (average 61.5). The follow-up period ranged from 6 months to 8 years and 6 months (average 3 years and 4 months). Thirteen cases were diagnosed with RA and 2 with spinal bone tumor. Regarding the range of fixation, 5 cases were fixed from the occipital bone to C5, 6 cases to C6, 2 cases to TH1 and 1 case to TH3.
[Result] All cases showed postoperative improvement. There was no myelopathy nor radiculopathy as a complication. However, 3 cases developed jaw opening and swallowing disturbance. One of the 3 cases showed improvement after further surgery. Two cases remain under observation.
To determine the proper fixing alignment, we focus on the angle between the occipital bone and the lower margin of the C2 vertebra (O-C2 angle). Dynamic X-ray showing the lateral view of normal cervical vertebrae (n=10) and maximal jaw opening with the head pushed forward or pulled backward were investigated. The O-C2 angles in all positions with jaw opening were always in extension (lordosis). In 3 cases with jaw opening and swallowing disturbance, the O-C2 angle demonstrated flexion (kyphosis).
[Conclusion] The O-C2 angle has a close relation to jaw opening and swallowing disturbance. Therefore, occipito-cervico-thomcic fixation ought to be employed snuff position (O-C2 angle is at the light extension and C2-7 is located at the mid position) always with the check of lateral view of X-ray. In a case showing remarkable malalignment, it is necessary to obtain the minimal O-C2 angle during maximal jaw opening at the middle position of cervical vertebra preoperatively.
F-4-06-03
THORACOLUMBAR FRACTURES RECONSTRUCTION OF ANTERIOR COULUMN WITH TITANIUM MESH
Ashok R. Bajracharya; Richard T. Holt.
(Bir Hospital, Nepal and Spine Surgery, U.S.A.)
Abstract Purpose: To find out the results of this operation, any gradual collapse of the column after the reconstruction and any unique complication associated with this procedure and the new implant.
Method: After anterior vertebral corpectomy decompression, instead of a strut bone graft a titanium mesh cylinder filled with cancellous graft obtained from the excised vertebral body and rib, was used to reconstruct the anterior vertebral column, stabilised either anteriorly or posteriorly as the situation demanded.
Result: Seven male 10 female aged between 20 to 76 yrs with 10 burst & 7 compression fractures had this operation. Of them 12 had anterior stabilization with a staple plate, 5 had posterior instrumentation for stabilization. Average follow up was 20 months (32 to 2 months). Symptomatically all were relieved except one. Radiologically all except 2 showed various amount of Kyphotic correction. Only those two, one severely osteoporotic, other with plasmocytoma under radiotherapy, showed progressive collapse. Complicationwise, inferior prong of the staple cut out in one patient. Otherwise no other complication inherent with this procedure was seen. Post operative scar pain for various length of time was present in 4 patients. One had osteoporotic collapse cephlad to the reconstruction.
Conclusion: This is a preliminary report. Yet this procedure overcame the disadvantages of traditional strut bone graft for reconstruction of the anterior vertebral column.
