Radiographic illustrations of restoring the middle-column height in an 80-year old-woman with a complex C4-C5 and C5-C6 fracture subluxation with retropulsion.

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Radiographic illustrations of restoring the middle-column height in an 80-year old-woman with a complex C4-C5 and C5-C6 fracture subluxation with retropulsion of the C5 vertebral body causing Asia B paralysis. Radiographic illustrations of restoring the middle-column height in an 80-year old-woman with a complex C4-C5 and C5-C6 fracture subluxation with retropulsion of the C5 vertebral body causing Asia B paralysis. (A) Preoperative radiograph showing the measurement of the middle column illustrated as a yellow line (82 mm). (B) Postoperative radiograph after realigning the spine following C5 corpectomy, partial C6 corpectomy, and spacer insertion. The corresponding postoperative measurement of the middle column is shown as a yellow line (also 82 mm). (C) There was severe enough ligamentous disruption that the normal ligamentous tension could not be utilized to gauge correct height restoration using intraoperative distraction-type instruments (no endpoint was reached). Therefore the middle-column measurement on intraoperative radiographs was used to achieve the correct height of the reconstructed spacers. The preoperative and postoperative posterior longitudinal ligament length is shown in yellow as 82 mm. The direct straight-line measurement from the same endpoints is shown in blue as 65.4 mm. The difference between the 2, referred to as the middle-column mismatch, is shown in green: 82 mm − 65.4 mm = 16.6 mm. This means that the combined height of the middle column spacers inserted at surgery should total 16.6 mm from C2 to C7. The cervical sagittal vertical line and coronal balance was also restored. PAUL C. McAFEE et al. Int J Spine Surg 2018;12:160-171 ©International Society for the Advancement of Spine Surgery