Document Detail


Adjacent-Level Range of Motion and Intradiscal Pressure Following Posterior Cervical Decompression and Fixation: An In Vitro Human Cadaveric Model.
MedLine Citation:
PMID:  22228326     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Study Design. This in vitro human cadaveric study measured adjacent-level kinematics following posterior cervical decompression and fixation.Objective. Quantify adjacent-level changes in ROM and intradiscal pressure following posterior cervical decompression and fixation.Summary of Background Data. Optimal length of instrumentation following posterior decompression is unclear. Longer posterior cervical fixation constructs may increase risk of adjacent-segment degeneration.Methods. Eight cervicothoracic spines were evaluated intact; with C3-C6 laminectomy; C3-C6 laminectomy + C3-C6 fixation; C3-C6 laminectomy + C3-C7 fixation; C3-C7 laminectomy; C3-C7 laminectomy + C3-C7 fixation; C3-C7 laminectomy + C2-C7 fixation; C3-C7 laminectomy + C3-T2 fixation; C3-C7 laminectomy + C2-T2 fixation. Testing included intact moments (±2.0 Nm) in flexion/extension, axial rotation, and lateral bending, with quantification of ROM at C2-C3, C6-C7, and C7-T1 normalized to the intact spine. Intradiscal pressures were also measured at each level.Results. For the C3-C6 laminectomy group, there were no differences in adjacent-level flexion/extension ROM or intradiscal pressure based on construct length, except at C6-C7, where ROM was significantly decreased when fixation was extended to C7 (p < 0.05). Following C3-C7 laminectomy and reconstruction, the greatest increase in C2-C3 flexion/extension ROM and intradiscal pressure occurred in the C3-T2 fixation subgroup [ROM: 348% (p < 0.05); intradiscal pressure: 319±243 psi versus 65±41 psi intact (p < 0.05)]. At C7-T1, the greatest increase in flexion/extension ROM and intradiscal pressure occurred following C2-C7 fixation [ROM: 531% (p < 0.05); intradiscal pressure: 152±83 psi versus 21±14 psi intact (p < 0.05)].Conclusion. For C3-C6 laminectomy, instrumentation to C7 significantly decreased flexion/extension ROM and intradiscal pressure at C6-C7 without significantly increasing either measure at C2-C3 or C7-T1 relative to C3-C6 fixation. In the setting of a C3-C7 laminectomy, when instrumenting to either C2 or T2, consideration should be given to including both levels within these constructs.
Authors:
Ryan M Kretzer; Wesley Hsu; Nianbin Hu; Hidemasa Umekoji; George I Jallo; Paul C McAfee; P Justin Tortolani; Bryan W Cunningham
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-5
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aDepartment of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287 bThe Orthopaedic Spinal Research Laboratory, St. Joseph Medical Center, Towson, MD 21204 cScoliosis and Spine Center, St. Joseph Medical Center, Towson, MD 21204 dUnion Memorial Orthopedics & Sports Medicine, Baltimore, MD 21218.
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