Failed Anterior Cervical Discectomy and Arthrodesis. Analysis and Treatment of Thirty-five Patients* by THOMAS A. ZDEBLICK, STEVEN S. HUGHES, K. DANIEL.

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Presentation transcript:

Failed Anterior Cervical Discectomy and Arthrodesis. Analysis and Treatment of Thirty-five Patients* by THOMAS A. ZDEBLICK, STEVEN S. HUGHES, K. DANIEL RIEW, and HENRY H. BOHLMAN J Bone Joint Surg Am Volume 79(4): April 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-D: Illustrations of types of failure of anterior cervical arthrodesis and of types of operative treatment. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B: Collapse of the graft can lead to a sharp angular kyphosis, which, combined with the non-union, causes compression of the cord. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-C: Decompression is carried out through the anterior approach. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-D: Anterior bone-grafting is performed with a tricortical Smith-Robinson bone graft countersunk into position. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A and 2-B: Radiographs of Case 1. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B: Two years after the revision, which was performed at the age of forty-three years, a solid fusion was seen at the level between the fifth and sixth cervical vertebrae. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A through 3-D: Case 22. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B: Radiograph made after repeat anterior arthrodesis with a Cloward dowel-type graft (arrowheads), performed elsewhere. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C Computed tomography scan made with contrast medium, showing that the dowel graft had been impacted into the spinal canal, flattening the spinal cord (arrowhead). THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D Radiograph made after hemicorpectomies of the bodies of the fifth and sixth cervical vertebrae, performed at the age of thirty-nine years with use of a high-speed burr to ensure complete decompression of the canal. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A through 4-D: Case 35. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B Computed tomography scan made with contrast medium, showing the posterior position of the osteophyte (arrowhead) and the resulting compression of the spinal cord. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-C Myelogram revealing compression at the level between the third and fourth cervical vertebrae. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-D Radiograph made after fibular strut-grafting and corpectomies of the fourth, fifth, and sixth cervical vertebrae, performed at the age of fifty-two years, which resulted in a solid union and relief of the symptoms. THOMAS A. ZDEBLICK et al. J Bone Joint Surg Am 1997;79: ©1997 by The Journal of Bone and Joint Surgery, Inc.