12/25/2023 0 Comments Cervical spine alignment deviceWhen considering goals of surgery for CSD, the primary aim must be to treat and prevent neurologic deterioration. Additional considerations include the patient’s bone quality, functional status, and comorbidities. Patterns may be appreciated by understanding the interplay of primary drivers of the cervical deformity including compensatory mechanisms, associated symptoms, and outcomes based on management. Here, we review anterior reconstruction techniques for CSD including the preoperative planning necessary, complication care and avoidance, and postoperative management.ĬSD surgeries are technically demanding and require significant preoperative planning based on presence of radiculopathy or myelopathy with anterior or posterior compression, driver of deformity including the apical level, rigidity or flexibility of the deformity, and patient’s local anatomy. In the setting of CSD, anterior reconstruction techniques represent a range of options with potential for powerful global or focal correction in the sagittal and coronal plane. Now, it is one of the most familiar and popular procedures with spine surgeons utilizing an anterior approach for more than 80% of cervical fusions. Īnterior approaches to the cervical spine have been promoted since introduction of the technique by Smith-Robinson and Cloward beginning in 1958. Despite classification schemes and proposed treatment algorithms, the ultimate decisions will be dependent on patient and surgeon preference. combined approaches, grades of osteotomy, and number of levels addressed. As such, management and treatments demonstrate significant variation amongst treating surgeons with anterior vs. It is further characterized by marked heterogeneity related to the various etiologies, distinct drivers of deformity, clinical manifestations, and dynamic state being the most mobile region of the spine. A detailed understanding of the patient’s local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.Ĭervical spine deformity (CSD) represents an uncommon yet severely debilitating condition. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential-including global or focal realignment in the sagittal and coronal planes. Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity.
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