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Topic Editor Regis W. Haid

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The future in the care of the cervical spine: interbody fusion and arthroplasty

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Praveen V. Mummaneni and Regis W. Haid

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion.

Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty.

In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

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The future in the care of the cervical spine: interbody fusion and arthroplasty

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Praveen V. Mummaneni and Regis W. Haid

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion.

Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty.

In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

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Eric W. Scott, Regis W. Haid Jr., and David Peace

✓ Only four cases of Type I odontoid fracture have been previously described in the English literature. Most authors consider this lesion to be stable, although the mechanism(s) of injury has not been clearly elucidated. A case of Type I odontoid fracture in association with atlanto-occipital and atlantoaxial dislocation resulting in death is presented. The normal ligamentous anatomy is reviewed and proposed mechanisms for this injury are discussed. The radiographic features of all reported cases of this type are reviewed. It is proposed that the Type I odontoid fracture is a likely manifestation of atlanto-occipital instability and rarely occurs as an isolated or stable injury.

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Alexander F. Post, Prithvi Narayan, and Regis W. Haid Jr.

✓ The authors report on the management of occipital neuralgia secondary to an abnormality of the atlas in which the posterior arch was separated by a fibrous band from the lateral masses, resulting in C-2 nerve root compression. The causes and treatments of occipital neuralgia as well as the development of the atlas are reviewed.

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Lumbar interbody fusion: state-of-the-art technical advances

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Praveen V. Mummaneni, Regis W. Haid, and Gerald E. Rodts

✓ During the past few decades, three techniques have been used to achieve circumferential lumbar interbody fusion (LIF). They include posterior LIF, anterior LIF with supplemental posterior fixation, and transforaminal LIF. In this article, the authors describe the indications and contraindications for the use of interbody fusion. The advantages and disadvantages of each will be discussed in detail. Additionally, strategies for minimally invasive access and options for interbody spacer materials will be discussed.

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Atul Goel

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Harel Deutsch, Regis W. Haid, Gerald E. Rodts, and Praveen V. Mummaneni

Postlaminectomy cervical kyphosis is an important consideration when performing surgery. Identifying factors predisposing to postoperative deformity is essential. The goal is to prevent postlaminectomy cervical kyphosis while exposing the patient to minimal additional morbidity. When postlaminectomy kyphosis does occur, surgical correction is often required and performed via an anterior, posterior, or combined approach. The authors discuss the indications for surgical approaches as well as clinical results.

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Regis W. Haid, Kevin T. Foley, Gerald E. Rodts, and Bryan Barnes

The authors review historical and biomechanical aspects of anterior cervical plate (ACP) systems. They propose a novel classification system for ACPs based on the biomechanical and graft-loading properties of these systems.

A retrospective review of the literature comprising both clinical and laboratory investigations regarding the ACP system was undertaken. Comparison of each system is considered in the context of the biomechanical attributes and graft-loading properties of each type of plate. Salient characteristics reviewed include restriction of screw backout, screw-angle variability, and mobility at the screw–plate interface. A new classification system for ACPs is proposed that primarily considers the ability of the construct to restrict screw backout, as well as the properties of the plate–screw interface—that is, the capacity for rotational or translational movement.

A new classification system is presented that provides unified, biomechanically descriptive nomenclature. Using this nomenclature, the ACP devices currently available and those developed in the future can be uniformly categorized.