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Stabilization of the Spine

  • H. A. Crockard
  • A. O. Ransford
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 17)

Abstract

The theme of this chapter is the prevention of spinal instability and deformity secondary to trauma, surgery and diseases of the spine. The treatment of established scoliosis and/or kyphosis is not within its remit. The bony and ligamentous damage consequent on trauma can produce deformity in later years. It comes as a shock to some clinicians that wide surgical destruction of the supportive elements of the vertebral column will also have the same effect. In part, this attitude has been engendered by the short survival prospects of many malignant “spinal” patients. A sequential approach has been adopted on the grounds that if the patient survived long enough, secondary corrective surgery might be considered. The problems of course are complex; maximum exposure for neurosurgery will mean almost certain spinal instability and/or deformity. Despite improved surgical awareness, there are far too many occasions when a simple laminectomy in an adult is undertaken in such a way that the pars interarticularis is knowingly or unknowingly fractured with the consequential risk of segmental instability. A more devasting error is widespread excisive laminectomy for spinal tumour in the immature skeleton without any consideration of the effects of the bony destruction on longitudinal spinal growth.

Keywords

Vertebral Body Pedicle Screw Disc Height Posterior Longitudinal Ligament Craniocervical Junction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Boucher HH (1959) A method of spinal fusion. J Bone Joint Surg [Br] 41: 248 – 259Google Scholar
  2. 2.
    Buck JE (1980) Direct repair of defect in spondylolisthesis—preliminary report. J Bone Joint Surg [Br] 52: 432 – 437Google Scholar
  3. 3.
    Caspar W (1987) Anterior stabilization with the trapezial osteosynthetic plate technique in cervical spine injuries. In: Kehr P, Weidner A (eds) Cervical Spine I, Strasbourg 1985. Springer, Wien New York, pp 198 – 204Google Scholar
  4. 4.
    Cloward RB (1958) The anterior approach for removal of ruptured cervical disc. Neurosurgery 15: 602 – 617CrossRefGoogle Scholar
  5. 5.
    Crockard HA (1987) When should spinal extradural metastases be treated surgically? In: Garfield W (ed) More dilemmas in the management of the neurological patient. Churchill Livingstone, London, pp 106 – 117Google Scholar
  6. 6.
    Crockard HA (1988) Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 34: 389 – 416PubMedGoogle Scholar
  7. 7.
    Crockard HA, Ransford AO (1990) The transoral approach to the cervical spine. Operative Surg. Rob and Smith (eds) Orthopaedics, 4th ed. Butterworth Scientific, BristolGoogle Scholar
  8. 8.
    Dennis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8: 817 – 831CrossRefGoogle Scholar
  9. 9.
    Findlay GF (1984) Adverse effects of the management of malignant spinal cord compression. J Neurol Neurosurg Psychiatry 47: 761 – 768PubMedCrossRefGoogle Scholar
  10. 10.
    Garlick R, Crockard HA (1988) Spinal injuries. In: Hadfield J, Hobsley M, Arnold E (eds) Essential surgical practice, vol 4. Arnold, London, pp 261 – 284Google Scholar
  11. 11.
    Grob D, Magerl F (1987) Operative stabilization in C 1-2 fractures. Orthopade 16: 46 – 54PubMedGoogle Scholar
  12. 12.
    Guttman L (1973) Spinal cord injuries: comprehensive management and research. Blackwell Scientific, OxfordGoogle Scholar
  13. 13.
    Hamblen DL (1967) Occipitocervical fusion. Indications techniques and results. J Bone Joint Surg [Br] 49: 33 – 45Google Scholar
  14. 14.
    Harrington PR, Dickson JH (1973) An eleven year clinical investigation of Harrington instrumentation, a preliminary report of 578 cases. Clin Orthop 93: 113 – 130CrossRefGoogle Scholar
  15. 15.
    Levack B, Kernohan J, Edgar MA, Ransford AO (1986) Observations on the current and future surgical management of hydatid disease affecting vertebrae. Spine 11: 583 – 590PubMedCrossRefGoogle Scholar
  16. 16.
    McLaurin RL, Vernal R, Salmon JH (1972) Treatment of fractures of the atlas and axis by wiring without fusion. J Neurosurg 36: 773 – 780PubMedCrossRefGoogle Scholar
  17. 17.
    McSweeney T (1976) Deformities of the spine following injuries to the cord. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 26. Amsterdam: North-Holland Pub Co, pp 159 – 174Google Scholar
  18. 18.
    Paraicz E (1987) Laminectomy or laminotomy. Zentralbl Neurochir 48: 327 – 334PubMedGoogle Scholar
  19. 19.
    Pasztor E, Lazar L, Benedek T, Gabor A, Kozma L, Dombai M (1987) Total body replacement with iliac bone graft and metal plate stabilization in lower cervical spine. Acta Neurochir (Wien) 85: 159 – 167CrossRefGoogle Scholar
  20. 20.
    Ransford AO, Crockard HA, Pozo JL, Thomas NP, Nelson IW (1986) Craniocervical instability treated by contoured loop fixation. J Bone Joint Surg [Br] 68: 173 – 177Google Scholar
  21. 21.
    Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96: 223 – 224Google Scholar
  22. 22.
    Van Gilder JC, Menezes AH, Dalan KD (1987) The craniovertebral junction and its abnormalities. Futura Publishing, New YorkGoogle Scholar
  23. 23.
    Winter R, Lonstein J, Chou S (1982) Scoliosis, kyphosis and lordosis. In: Youmans JR (ed) Neurological surgery, vol 4. WB Saunders, Philadelphia, pp 2629 – 2655Google Scholar

Copyright information

© Springer-Verlag/Wien 1990

Authors and Affiliations

  • H. A. Crockard
    • 1
  • A. O. Ransford
    • 1
  1. 1.The National Hospitals for Nervous DiseasesThe Royal National Orthopaedic HospitalLondonUK

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