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Cervical and Thoracic Spinal Disorders: New Surgical Technique

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Cervical and thoracic spine disorders can affect more than one vertebral level of the spine. Degenerative disc disease, spinal stenosis, excessive kyphosis, vertebral fracture, and other disorders can cause pain, numbness, weakness, and tingling in the upper back, shoulders, and arms. In some cases, surgery is necessary.

Sometimes these disorders involve the junction between the cervical and the upper thoracic spine. Characteristically, the cervical spine is quite flexible and the thoracic spine is rigid. Disorders involving these vertebral levels can present a specific challenge to the spine specialist.

Now these difficult cases can be instrumented using a different device that is modular by design. This device allows the spine surgeon to stabilize the cervical and upper thoracic spine using anchors (screws and hooks) attached to a rod in a variety of positions.

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Patient Cases
To illustrate how patients have been effectively treated, read the three patient cases summarized below.

Degeneration of the Cervical Spine
The images below represent the case of a 60-year-old man with progressive degeneration of the cervical spine. He suffered neck pain and showed signs of spinal cord compression (called myelopathy). The pre-operative x-ray (Figure 1) shows many degenerative changes such as bone spurs (osteophytes). The MRI (Figure 2) shows spinal cord compression caused by the bone spurs.

Figure 1: Pre-Operative X-Ray
Figure 2: Pre-Operative MRI
Figure 1: Pre-Operative X-ray
Figure 2: Pre-Operative MRI

The x-rays taken following the surgery show spinal cord decompression. The pressure has been removed from the spinal cord with a surgical procedure called laminectomy. The spine has been stabilized.

Figure 3: Post-Operative X-Ray Posterior View
Figure 4: Post-Operative X-Ray Lateral View
Figure 3: Post-Operative X-ray, Posterior View
Figure 4: Post-Operative X-ray, Lateral View

Kyphotic Deformity
In this complicated case, the patient, a 60-year-old woman suffered progressive kyphotic deformity and spinal stenosis. The deformity prevented the patient from looking forward (Figure 5). She required posterior decompression from C1-C5 (first 5 cervical vertebrae) due to her kyphosis. However, the spine also needed to be stabilized from C1 through T4 (fourth thoracic vertebra). Without the flexibility this new modular device offers, it would have been impossible to anchor screws into every vertebral segment (vertebral body). Instead, using this new modular reconstruction system, it was very simple and safe (Figures 6 and 7).

Figure 5: Pre-Operative X-ray, Lateral View, Kyphotic Deformity
Figure 6: Post-Operative X-Ray, Lateral View
Figure 5: Pre-Operative X-ray, Lateral View, Kyphotic Deformity
Figure 6: Post Operative X-ray, Lateral View

 

Figure 7: Post-Operative X-Ray, Posterior View
Figure 7: Post Operative X-ray, Posterior View

Cervical Instability
This is a case of a 30-year-old woman with spinal instability at C1-C2 (first two cervical vertebrae) (Figure 8). This disorder caused the patient severe neck pain and created the potential for spinal cord injury. Figures 9 and 10 illustrate how VERTEX? stabilized this patient?s spine.

Figure 8: Pre-Operative X-Ray, Lateral View, C1-C2 Instability
Figure 9: Post-Operative X-Ray, Lateral View, C1-C2 Stabilized
Figure 8: Pre-Operative X-ray, Lateral View, C1-C2 Instability
Figure 9: Post-Operative X-ray, Lateral View, C1-C2 Stabilized

 

Figure 10: Post-Operative X-Ray, through mouth to C1-C2, Stabilized
Figure 10: Post-Operative X-ray, Through Mouth to C1-C2, Stabilized

 

Advantages
In the past, spine surgeons had a difficult time placing the screws into the proper positions in the vertebrae and still attaching the plate or rod. This new device (VERTEX? Reconstruction System) allows the screws to be placed exactly where they need to go safely. Then the rod is simply attached to the screw heads either directly or via connectors.

Patients benefit by a shorter operative time and safer surgery because the anchors (screws) can be implanted exactly where they need to be placed. When screws have to be placed through holes in a plate, the position and angulation of the screws through the plate holes is limited.

Conclusion
This new modular system is another step forward for surgeons and their patients who require posterior cervical and thoracic spinal instrumentation. These technical advancements evidence the interest spine specialists have in finding better solutions for spinal instability.

Updated on: 09/07/12
Thomas G. Lowe, MD
: This article illustrates how another of the new modular posterior instrumentation systems has allowed excellent stabilization of complex problems involving the cervical and upper thoracic spine. Because of these newer systems postoperative pain is greatly reduced and patients can be returned to normal activities much quicker.
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