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Journal of Neurosurgical Sciences 1998 June;42(2):101-9

lingua: Inglese

A ­new instru­men­tation ­for pos­te­ri­or sta­bil­iza­tion of cer­vi­cal trau­mat­ic instabil­ity

Cigliano A., De Falco R., Scarano E., Profeta G.

Neurosurgical Division of Emergency Department, Cardarelli Hospital, Naples, Italy


Background. Twenty-­six ­patients under­went appli­ca­tion of a ­new pos­te­ri­or plat­ing ­system (­CIDEF ­SYSTEM) ­for ­the align­ment ­and ­the sta­bil­iza­tion of C3-C7 cer­vi­cal ­unstable frac­tures ­from January 1992 to December 1993.
Methods. The oste­o­syn­the­sis appa­ra­tus ­employs pos­te­ri­or artic­u­lar ­screw fix­a­tion ­and ­plate appli­ca­tion. Indications ­for sur­gery ­were the pres­ence of neu­ro­log­i­cal dam­age ­and cer­vi­cal col­umn instabil­ity. Operative tech­niques includ­ed decom­pres­sive ­and explor­a­to­ry lam­i­nec­to­my in 20 cas­es ­and an artic­u­lar resec­tion in ­six cas­es of pos­te­ri­or super­i­or artic­u­lar frac­tures. A ­one-­stage oper­a­tion ­with an ante­ri­or ­approach, ­designed to ­remove ante­ri­or com­pres­sion ­from her­ni­at­ed ­discs, or ­bone frag­ments, ­was ­also per­formed in ­four cas­es. Three cer­vi­cal ­motion seg­ments ­were immo­bi­lized in 15 of ­the treat­ed cas­es; ­four in ­nine; ­and ­five in ­two. All ­patients ­were stud­ied ­pre- ­and post­op­er­a­tive­ly ­with ­plain radio­graphs ­and com­put­ed tomog­ra­phy. Pre- ­and post­op­er­a­tive exam­ina­tions dem­os­trat­ed no alter­a­tion in neu­ro­log­i­cal stat­us.
Results. At a ­mean fol­low-up peri­od of 47 ­months, no evi­dence ­was ­found of infec­tion, rejec­tion of ­the mate­ri­als ­used, or mechan­i­cal fail­ure of ­the ­plates ­and ­screws; ­all ­patients ­with incom­plete ­lesion ­showed improve­ment in neu­ro­log­i­cal func­tion. Four ­patients tet­ra­pleg­ic at admis­sion ­expired ­from system­ic com­pli­ca­tions (­one ­from pul­mo­nary embo­lism; ­one ­from Disseminated Intravascular Coagulopathy; ­one ­for sep­sis; ­and ­one ­from myo­car­dial infarc­tion). All ­patients ­were immo­bi­lized ­for at ­least 4 ­months ­with a Philadelphia col­lar. No inju­ry to ­the neu­ral or vas­cu­lar struc­tures con­tig­u­ous to ­the cer­vi­cal ­spine ­has ­occurred.
Conclusions. The ­authors’ expe­ri­ence sug­gests ­that ­the ­new ­system ­offers ­ease ­and ver­sa­til­ity of appli­ca­tion, res­to­ra­tion of ver­te­bral align­ment, ­enhanced spi­nal stabil­ity ­and is use­ful in ­the treat­ment of ­urgent ­and rath­er com­plex trau­mat­ic ­lesions of ­the low­er cer­vi­cal ­spine.

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