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Henry A. Shenkin and Cecil J. Hash

. References 1. Amuso SJ , Neff RS , Coulson DB , et al : The surgical treatment of spondylolisthesis by posterior element resection. A long term follow-up study. J Bone Joint Surg 52A : 529 – 536 , 1970 Amuso SJ, Neff RS, Coulson DB, et al: The surgical treatment of spondylolisthesis by posterior element resection. A long term follow-up study. J Bone Joint Surg 52A: 529–536, 1970 2. Briggs H , Krause J : The intervertebral foraminotomy for relief of sciatic pain. J Bone Joint Surg 27 : 475

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Edward L. Seljeskog and Shelley N. Chou

. 11 Our experience in managing 22 of 26 cases in a closed, nonoperative manner with a minimum of morbidity and with adequate healing and stability further supports this proposal. Most injuries of this type can be successfully managed in this fashion and open reduction and/or cervical fusion are required only in special circumstances. From the classical hangman's fracture, in which there is disruption of the posterior elements of C-2 along with a subluxation of C-2 on C-3, the spectrum of injury progresses to the C-2 posterior element avulsion injury without

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Paul R. Cooper, Kenneth R. Maravilla, Frederick H. Sklar, Sarah F. Moody and W. Kemp Clark

of his deformity. Adjunct to Cervical Fusion In one patient the halo was successfully used as an adjunct to posterior cervical fusion. This patient had suffered subluxation at the C4–5 level. A persistently locked facet prevented adequate reduction. There were fractures involving the C-3 pedicle and lamina and the C-6 lamina. The subluxation was surgically reduced, and posterior fusion and wiring was performed. Because the posterior element fractures might have prevented optimum immobilization and healing, a halo was applied postoperatively. Fusion was

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Carole A. Miller, Richard C. Dewey and William E. Hunt

by minimal laminectomy. The laminar spreader between intact spinous processes is an invaluable aid in anterolateral exploration for reduction or removal of displaced fragments of the vertebral body. We consider it an essential instrument. In none of these cases was herniated disc material encountered. Fig. 3. Demonstration of a laminar spreader between T-12 and L-2. Once the dissection of muscle and ligaments is complete and the spinous processes above and below the lesion are freed, the laminar spreader can be placed and often allows reduction of posterior-element

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Roy P. Baker and Robert L. Grubb Jr.

the anterior longitudinal ligament, separation of the intervertebral disc at the vertebral end-plates, separation of the posterior longitudinal ligament from the vertebral body, and fracture of the facets. Hyperextension is known to cause posterior element fractures also. 4 We believe that in our patient the rupture of the ligamentous structures allowed the C-6 body to be dislocated, but the posterior elements remained in good alignment because of the multiple fractures, thereby “decompressing” the spinal canal. Pitman, et al. , 3 in discussing a case of complete

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myelopathy than is currently recognized. Since the publication of our paper, we have heard of similar cases from other neu- rosurgeons. Computer-assisted imaging, such as axial computerized tomography scanning or parasagittal magnetic resonance imaging, can provide an antemortem diagnosis. In their case, the spinal cord section (their Fig. 1 right ) graphically displays the late consequences of the disorder as well as the site of impingement by the posterior element on the left posterior and lateral column. A similar concavity was seen in vivo when our patients

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Richard Whitehill, Anthony D. Cicoria, William E. Hooper, William W. Maggio and John A. Jane

posterior element bone was roughened with a Hall drill and burrs to increase adherence of the cement. A transverse hole or a notch was made in the base of the cephalad posterior spinous process. Stainless steel wire (No. 18 or No. 20) was then passed through the hole or notch and looped under the spinous process of the caudad segment to be included. In some cases, one or even two additional loops of wire were passed around all spinous processes in addition to the initial loop. The ends of the wire were twisted upon themselves. Cement was mixed and applied as in the C1

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Lennart Brandt, Carsten Feldborg Nielsen, Hans Säveland and Hans Wingstrand

spinous processes ventral to the Rissler pin and tightened until no movement can be seen in the damaged segment ( Fig. 1 ). The wires should not be too tight because of the risk of compressing the nerve roots and pressing disc material into the spinal canal. In cases with unstable posterior element fracture, the closest available intact vertebra should be chosen for a stable osteosynthesis. No bone graft is used. If indicated (as in the presence of additional postoperative neurological symptoms), computerized tomography or magnetic resonance (MR) imaging is performed to

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Leonard F. Hirsh, Luis E. Duarte, Eric H. Wolfson and Wilhelm Gerhard

pain and require definitive surgical treatment. Cervical spinous fractures can be produced by several mechanisms. A direct blow to the posterior aspect of the neck causing spinous process fractures has been reported by Meyer, et al. , 10 although they reported the presence of other posterior element fractures as well. Cervical hyperflexion and hyperextension injuries may lead to spinous process fractures due to avulsion of the process tip by the interspinous and supraspinous ligaments. 2, 4, 6 Nieminen 11 reported 25 isolated cervical spinous process

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Joseph F. Cusick, Narayan Yoganandan, Frank A. Pintar and John M. Reinartz

total with supraspinous and interspinous ligament section ( Fig. 2 ). Medial and total facetectomies were done with a high-speed drill and a fine osteotome. The initial medial facetectomy included partial opening of the interlaminar ligament with removal of the base of the superior lamina and the top of the inferior lamina. Fig. 2. Diagram of the three-segment specimen, posteroanterior view, depicting the posterior element surgical changes. The input load and deflection data were collected using a force gauge and a linear variable differential