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Complications of Cervical Spine Surgery

June 25, 2010 By 18 Comments

Cervical spine surgery is a major surgical procedure and like every other surgical procedure has potential for complications. Te complications can be related to injury or type of surgery performed.

Postoperative Complications

Neurologic Deficit

Neurological deficit is most devastating complication of spine surgery.   The cause could be an intraoperative event such as a direct spinal cord injury, posterior strut or graft displacement. Otherwise failure of the construct could be responsible.

A detailed examination is the key  to identification of the problem and it should follow with plain radiographs. [Read more...]

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Dislocation of C6-C7 Vertebra – Xray

June 15, 2010 By 6 Comments

38 years old man suffered trauma to neck when a pole fell on him while he was working on his tube well. He developed sudden onset weakness in all the four limbs.

He reported to casualty about 2 hours after the injury and found to have quadriparesis [weakness in all four limbs] with grade 2 power in all the limbs along with numbness below sternum.

Xray revealed unifacetal dislocation of sixth cervical vertebra over seventh cervical vertebra.

MRI revealed C6-c7 disc impinging upon the cord. The patient was given injection solumedrol for 24 hours and was taken for anterior decompression, cervical plating and bone grafting.

This xray is one month postoperative and the patient has shown good recovery. He has 3+ power in all the limbs and is free of catheter.

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What Is Basilar Impression?

June 4, 2010 By Leave a Comment

Basilar impression is an abnormality where the skull floor is indented by the upper cervical spine. The tip of the dens is more cephalad [towards head] and sometimes protrudes into the opening of the foramen magnum. This may cause brainstem encroachment and then risk neurologic damage from direct injury, vascular compromise, or cerebrospinal fluid flow alteration.

There are two types of basilar impression

  • Primary
  • Secondary

Primary basilar impression is a congenital abnormality often associated with other vertebral defects  like Klippel-Feil syndrome, odontoid abnormalities, atlanto-occipital fusion, and atlas hypoplasia. Primary basilar impression is found in 1% of the general population. [Read more...]

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What Is Os Odontoideum

June 3, 2010 By Leave a Comment

Os odontoideum is an anomaly where the tip of the odontoid process is divided by a wide transverse gap. This leaves the apical segment without its basilar support.

This anomaly is very rare and the exact incidence is unknown. While the exact etiology is not understood, it most likely represents an unrecognized fracture at the base of the odontoid or damage to the epiphyseal plate during the first few years of life.

Either of these can compromise the blood supply to the developing odontoid, resulting in the os odontoideum.

However another school of thought considers it a congenital anomaly.

Presentation

These children usually present with local neck pain, and occasionally transitory episodes of paresis [weakness of limbs], myelopathy, or cerebral-brainstem ischemia due to vertebral artery compression from the upper cervical instability.

Sudden death can occur, but is rare.

The neurologic symptoms are due to cord compression from posterior translation of the os into the cord in extension, or the odontoid into the cord in flexion. Increased motion at the C-1 to C-2 level can lead to vertebral artery occlusion ischemia of the

brainstem and posterior fossa structures, resulting in seizures, syncope, vertigo, and visual disturbances.

The long-term natural history is unknown.

Radiology

On radiographs, an os odontoideum is seen as an oval or round ossicle with a smooth sclerotic border located in the position of the normal odontoid tip. the size is variable.

There are three radiographic types of os odontoideum

  • round
  • Cone
  • Blunt tooth

The base of the dens is usually hypoplastic. It is often difficult to differentiate an os odontoideum from nonunion following a fracture.

CT scans are useful to further delineate the bony anatomy. Fllexion-extension lateral radiographs are useful to assess instability.

Treatment

Non Operative Management

Observatio is sufficient in non symptomatic patients. Medical management of symptomatic patients consists of cervical traction, physical therapy, cervical collar use, and anti-inflammatory medications.

Opertive Management

Operative management is indicated in follwing settings

  • Spinal instability
  • Neurologic involvement
  • Intractable pain

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Transverse Foramen Fractures And Vertebral Artery Injury

May 11, 2010 By Leave a Comment

Transverse foramen fractures in cervical spine can cause injury to vertebral artery. It can occur as a result of  occlusion, laceration, or distractive avulsion of the artery.

The incidence of vertebral artery injury following lower cervical spine trauma has been reported to be as high as 46%.

Transverse  foramen fractures have been associated with facet dislocations, facet fractures with translation, and transverse foramen fractures .

Majority of injuries are unilateral.

Diagnosis

Detection of the injury can has  important influences on overall decision making.

An xray would raise the suspicion of transverse foramen fracture. MR arteriograms are an effective means of noninvasive diagnosis of vertebral artery occlusion or narrowing following cervical trauma.

Arteriography is another option.

Bilateral vertebral artery injuries can be devastating, leading to cerebellar infarction.

Treatment

The vast majority of injuries are unilateral, which have a very low rate of clinical sequelae. In most cases, no specific treatment is necessary.

However, the presence of arterial injury does affect the treatment decision of the fracture.

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C7 Spinous Process Avulsion Fracture Or Clay Shoveler’s Fractures

May 10, 2010 By 8 Comments

Fractures of the  spinous process fractures are usually benign injuries. Clay shoveler’s fracture is thought to occur from powerful contraction of the muscles that insert onto the spinous process.

Otherwise also the  spinous process fractures can be present with lamina fractures, facet dislocations, and various other injuries to the cervical spine.

Clay shoveler’s fracture is  type of hyperflexion avulsion injury  that causes fractures of spinous process at base. Most commonly they occur at C7 level followed by C6 and T1.

[Read more...]

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Severe Cervical Spondylosis With Large Multiple Anterior Osteophytes – Lateral View Cervical Spine Xray

May 3, 2010 By Leave a Comment

This xray is of 48 years old male who is a shopkeeper by profession and presented with neck pain. The xray revealed cervical spondylosis with large multiple osteophytes.

The patient was put on analgesics, intermittent cervical traction and isometric neck exercises. He has shown good improvements of symptoms.

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Facet Subluxation And Dislocations of Lower Cervical Spine

May 2, 2010 By 1 Comment

Subluxations and dislocations of facet joints are part of facet joint injury spectrum that ranges from facet capsule disruption to complete, bilateral locked facets.

Anterior subluxation is also known as hyperflexion sprain. The posterior ligamentous structures fail because of the hyperflexion of the cervical spine.

A pure subluxation injury has no associated fractures.  A subluxation would be like following diagram.

Radiographic findings can include a fanning or widening of the spinous processes at the level of injury. The disc space may be widened posteriorly and narrowed anteriorly. [Read more...]

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Tear Drop Fractures of Lower Cervical Spine

May 1, 2010 By 12 Comments

Tear-drop fractures are recognized by their characteristic fracture pattern. These fractures involve anteroinferior portion of vertebral body and the fracture line is at an oblique angle to the body. It can be either extension tear drop or flexion teardrop depending on the mechanism of injury. [See images below]

An extension teardrop fracture occurs when there is hyperextension of the cervical spine. Hyperextension may cause the anterior longitudinal ligament to avulse the inferior portion of the anterior vertebral body at its insertion. The most common location is at C2.

In this case the height of the fragment usually exceeds its width. This fracture is more common in older patients with osteoporosis. The extension teardrop fracture is unstable in extension.

Similarly an extreme flexion can cause the flexion teardrop fracture. This may lead to impingement of the spinal cord due to extreme kyphosis caused by fracture. There is complete disruption of all ligamentous structures at the level of the injury. [Read more...]

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Facet Fractures Without Dislocation In Lower Cervical Spine Injury

April 28, 2010 By Leave a Comment

Facet joints are articulations between two adjacent vertebrae. Two superior articular facets of lower vertebra and two inferior articular facets of higher vertebra form two facet joints. Thus each vertebrae participates in two superior and two inferior joints thus creating a chain of facet joints.

Majority of the fractures of facet joints are minimally displaced fractures which can be treated with non operative methods.

However, in some cases there may be present associated ligamentous disruption. These fractures are considered unstable. [Read more...]

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