A Case of Laterally Extended High-Positioned Chordoma Treated Using the High Cervical Retropharyngeal Approach
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Chordoma
Lateral mass
Background: Lateral mass screw fixation with plates or rods has become the standard method of posterior cervical spine fixation and stabilization for a variety of surgical indications. Despite ubiquitous usage, the safety and efficacy of this technique have not yet been established sufficiently to permit ‘‘on-label’’ U.S. Food and Drug Administration approval for lateral mass screw fixation systems. The purpose of this study was to describe the safety profile and effectiveness of such systems when used in stabilizing the posterior cervical spine.
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Radl, Roman MD; Leithner, Andreas MD; Kastner, Norbert MD; Bodo, Koppany MD; Nader, Alexander MD; Windhager, Reinhard MD Author Information
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Abstract
This is the first of a three part series describing the clinical issues surrounding the radiographic assessment of the cervical spine. Defined in this literature review is the working definition of cervical stability. Described are the “normal” anatomical relationships between the cervical vertebrae for both the adult and the child, as portrayed by lateral radiographs. Also presented is a review of available documentation regarding the normal segmental function of the vertebrae in the upper and in the lower cervical spine. The next two parts in this series will deal with the definitions and radiographic evaluation of cervical hypermobility and instability respectively.
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Chordoma of the mobile segments of the spine are infrequent lesions and especially rare are those located in the lower part of the cervical spine. We present the case of a cervical chordoma located in the C6 vertebral body diagnosed by means of magnetic resonance imaging and operated on by an anterior approach. The authors discuss the clinical and neuroradiological features of this disease also analysing some controversial therapeutic aspects.
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Cervical fracture
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The aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.
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A Comparison of Three Screw Types for Unicortical Fixation in the Lateral Mass of the Cervical Spine
Study Design. In vitro comparison of three different screws for unicortical fixation in lateral masses of the cervical spine. Objectives. To compare the axial load-to-failure of cervical lateral mass screws and their revision screws in a cadaveric model. Summary of Background Data. Lateral mass screws are used for posterior fixation of the cervical spine. Risks to neurovascular structures have led many surgeons to advocate unicortical application of these screws, although fixation strength may vary with screw design. Methods. Screws from three posterior cervical fixation systems were used: Axis, Starlock/Cervifix, and Summit. Tested were 3.5-mm cancellous screws, along with revision screws for each system. The C3–C6 vertebrae from three cadaveric specimens were fixed with screws inserted into the lateral masses at a depth of 10 mm with 30° cephalad and 20° lateral angulation. Coaxial pullout force was recorded for each primary and revision screw. Results. Axial load-to-failure (mean ± SD) of the screws was 459 ± 60 N for Axis screws, 423 ± 78 N for Starlock screws, and 319 ± 97 N for Summit screws. The Axis and Starlock screws were significantly stronger than Summit screws (P = 0.017 and P = 0.067, respectively). The load-to-failure of revision screws was much lower than that of primary screws (Axis 54%, Starlock 56%, Summit 63% of the primary screw), without significant difference between screw types. Conclusions. The Axis and Starlock screws resisted significantly greater axial load-to-failure than did the Summit screws. For all three systems, the revision screws could not restore the load-to-failure of the primary screw in this model. The tested unicortical screws had a consistently higher load-to-failure than those previously tested under similar conditions, suggesting that currently available screws may be superior to those previously tested.
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