Posterior cervical fusion to C2

1. Posterior Cervical Laminectomy and Fusion to C2 for adjacent
segment degeneration
Upper Chesapeake Medical Center
Spine Conference
Friday November 6, 2015

2. 80 year old woman
cc: neck pain
HPI: Many years of pain, hand trembles,
find practice from the internet, L hand
spasms and claws up, L hand trembles,
diffuse body pain; nonspecific L arm pain,
minimal symptoms in hands
PMH: C4C7 ACDF 2008 with good results,
appy, tonsils, TAHBSO, CABG 2004, MI, HTN,
Chol
Meds: carvedilol, fluoxetine, HCTZ,
synthroid, Lisinopril, omeprazole,
Wellbutrin, ASA, alprazolam, setia
SH: RHD lives with son, widow, 4 children,
no smoke/EtOH
Exam: 5’6” 170lb, nl gait, negative
hoffmans, normal motor, ROM neck 30
degrees R&L, 2 fingers flex to chest,
minimal extension

8. C2 C2 C2C3
C2C3
C3
C3C4
C4
C4 C7T1

9. Mid-sagittal diameter: width
1:5 ratio leads to necrosis of gray
matter
• Ogino H: Canal diameter, anteroposterior compression ratio
and spondylotic myelopathy of the cervical spine. Spine 1983;
8:1-15
• Cord compression causes ischemia and direct mechanical
trauma

11. Spine 2015 Apr 1;40(7)Longer plate-to-disc distance prevents adjacent-level ossification development but
does not influence adjacent-segment degeneration.
Yang H1, Lu X, He H, Yuan W, Wang X, Liao X, Chen D
PDD
Fusion behind implant
Posterior osteophyte
C7T1
facet

12. Preoperative planning

15. occiput
Atlas C1
Axis C2
50% of flex/ext and
Rotation is from occiput
C1C2
Spine (Phila Pa 1976). 1988 Jul;13(7):726-30.
Three-dimensional movements of the upper cervical spine.
Panjabi M1, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, Bueff HU.

16. FALLSTON 1940

20. Lateral mass screws

27. Problem List
1. Neck pain and stiffness
2. Severe stenosis from discs C3C4>C4C5
3. Advanced age and comorbidities
4. C7T1 spondylolisthesis
5. Bone graft?
6. Anterior v. posterior v. both

28. Non-union and implant failure
Bone Fusion

34. thanks