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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 88

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 88. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 868 Section Fractures Figure 21. Technique of corpectomy and instrumented fusion The cervical spine is exposed by an anteromedial approach. a The intervertebral discs are excised adjacent to the fractured vertebral level. b The medial three-fifths of the fractured vertebral body is resected. The lateral wall is preserved to protect the vertebral arteries. c A high-speed diamond burr is used to remove the median part of the vertebral body. Care must betaken not to push the vertebral wall against the spinal cord during this preparation. d The remaining part of the posterior vertebral wall is elevated away from the spinal cord and resected with a Kerrison rongeur. e Kerrison rongeur and curettes are used to remove posterior osteophytesand decompress spinal cord and exiting nerve roots. f The spine is reconstructed by insertion of a tricortical iliac bone block and anterior plating. fusion techniques using lateral mass plates or screw-rod fixation systems Fig. 20 . Combined anterior posterior approaches are necessary in cases with irreducible facet joint dislocations remote fracture dislocations with evidence of osseous fibrous fusion very unstable fractures e.g. bilateral facet joint dislocations Although patients with persistent or recurrent cervical spinal malalignment often achieve spinal stability with either external immobilization or surgical fusion many of these malaligned patients have residual cervical pain when compared to similarly treated patients for whom anatomical spinal alignment could be achieved and maintained. Cervical Spine Injuries Chapter 30 869 Management Recommendations In a systematic review of subaxial spinal injuries published in 2002 11 42 articles were identified that include sufficient information on the treatment of patients with subaxial injuries with or without facet joint dislocation. Standards of care or widely accepted guidelines could not be derived from the literature 11 . In view of the lack of scientific evidence the authors .