Page 1
Spectrum of pathology
• Prolapsed discs and osteophytic compression; ‘wear and repair’
• Inflammatory: rheumatoid, ankylosing spondylitis
• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,
metastatic cord compression• Congenital Klippel Feil, fused, Down’s,
enterogenous cysts
Page 2
43 yr male, brachalgia C5 right
Page 6
Spectrum of pathology
• Prolapsed discs, osteophytic compression: ‘wear and repair’
• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,
metastatic cord compression• Congenital Klippel Feil, fused, Down’s,
enterogenous cysts• Infection: discitis, osteomyelitis, epidural
abscess
Page 7
•S.R. - Male, Age 77•Severe Rheumatoid Arthritis•Past multiple joint replacements and episodes of steroid Px•Progressive upper and lower limb long tract symp/signs•Neck Pain and Stiffness
Page 10
Occipitocervical fixation
Page 11
Halo support post-op
Page 13
Sub axial rheumatoid deformity
Page 14
Seronegative arthritis
Page 15
Ankylosing spondylitis
Page 16
Spectrum of pathology
• Prolapsed discs, osteophytic compression: ‘wear and repair’
• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,
metastatic cord compression• Congenital Klippel Feil, fused, Down’s,
enterogenous cysts• Infection: discitis, osteomyelitis, epidural
abscess
Page 17
Odontoid fracture
Page 18
Odontoid screw fixation
Page 19
Hangman’s fracture
Page 20
C6 Crush fracture, posterior ligamentous injury
Page 21
Interspinous ligamentous disruption
Page 22
Hyperextension injury, ALL disrupted
Page 23
Rotatory subluxation
Page 36
Interspinous ligamentous disruption
Page 37
Posterior reduction and fixation techniques
• Currette or hook• Drilling/ nibbling the superior aspect of the inferior facet• Wires • Hooks or clamps• Screws/ Plates• Screws/ Rod combinations
Page 39
Spectrum of pathology
• Prolapsed discs, osteophytic compression: ‘wear and repair’
• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,
metastatic cord compression• Congenital Klippel Feil, fused, Down’s,
enterogenous cysts• Infection: discitis, osteomyelitis, epidural
abscess
Page 44
51 years neck , arm pain
Page 45
NHL cervical cord compression
Page 46
CT pelvis: right inguinal lymphadenopathy
Page 48
Patchell, Lancet 2005
Page 49
Complications
General (DVT, MI, Infection, haematoma)
Specific: Recurrent and sup laryngeal n
Dysphasia
Retropharyngeal haematoma
Nerve root injury
Spinal cord injury
Vertebral artery injury
Page 50
The future
• Better analysis of results
• Better constructs• Clearer indications• More work
• Ceramic vs plastics vs metal
• Interface with bone • Bone growth
stimulants• Genetically
engineered solutions