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Posterior Arthrodesis of the Subaxial C-spine

- Discussion:
    - cervical kyphosis is a general contra-indication for posterior decompression;

- Surgical Approach:
    - prone position using Mayfield head holder w/ neck in neutral;
    - during operative procedure, erector spinae muscles should not be dissected laterally beyond the facets;
           - this avoids denervation of posterior cervical muscles, condition that may cause postoperative kyphosis

- Internal Fixation:
    - wires may be used to simultaneously bind bone grafts to spinous processes or, w/ laminectomy, to bind grafts to facets;
    - spinous process wiring;
           - hole is made in cephalad part of base of spinous process of cephalad vertebra to prevent wire from slipping
                    off on downward-directed inclined plane of cephalad segment;
           - wire is passed beneath caudad vertebra & is tied using Harris wire-tightener, which grasps knot & applies tension in depths of wound;
           - of note, sublaminar cervical wiring is associated w/ high rate of neurologic injury, except at the C1-C2 levels;
    - atlanto-axial arthrodesis:
          - wires are passed beneath laminae of first two cervical segments;
          - sublaminar wiring caudad to Axis may damage spinal cord;
    - laminoplasty:
          - canal expansive laminoplasty can help decrease incidence of instability assoc w/ multilevel laminectomy;
    - foraminotomy is useful for single level radiculopathy;
    - laminectomy:
          - multi-level laminectomy may fail due to:
                - failure to adequately relieve anterior compression;
                - due to progressive kyphosis, which may require anterior decompression & fusion w/ strut graft to correct deformity;
          - other complications include:
                - subluxation if facets are sacrificed:
                - swan neck deformity:
                - direct spinal cord injury with quadriparesis

A modified technique for cervical facet fusions.

Cervical facet fusion for control of instability following laminectomy.

Posterior wiring without bony fusion in traumatic distractive flexion injuries of the mid to lower cervical spine. Long-term follow-up in 30 patients.

Vulnerability of vertebral artery in anterolateral decompression for cervical spondylosis.

Neurological deterioration after posterior wiring of the cervical spine.