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Complications Related to Posterior Approach

  • Luca DenaroEmail author
  • Domenico D'Avella
  • Vincenzo Denaro

The posterior approach through a midline longitudinal incision provides the most direct access to the posterior elements of the cervical spine. Through this approach, the posterior elements of the cervical spine can be removed, and access to the posterior aspect of the spinal cord and nerve roots from the occiput to C7 can be obtained. The posterior approach to the cervical spine allows excellent exposure to perform several surgical techniques, with or without internal fixation. It can also be a useful rostral extension of a longer posterior thoracic spinal approach [1].

The posterior elements of the cervical spine play an important role in the stabilization of the cervical spine. Indeed, their removal in patients undergoing wide laminectomies (i.e., for the management of pathologies such as the spondylotic myelopathy, or extra- or intra-medullary tumors) may cause subluxation, or severe kyphotic angulation of the spine (i.e., swan neck), causing increased compression of the neural elements and worsening of neurological defi-cits [1].

Keywords

Cervical Spine Vertebral Artery Fibrin Glue Posterior Approach Posterior Element 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Denaro V (1991) Stenosis of the cervical spine. Springer, BerlinCrossRefGoogle Scholar
  2. 2.
    D'Alpa F, Scandurra L, Savuto R, et al (1989) Pre-, intra- and postoperative somatosensory evoked potentials in cervical vertebral and spinal cord injuries. Minerva Anestesiol 55:115–118PubMedGoogle Scholar
  3. 3.
    Denaro V, Gulino G, Papapietro N, et al (1998) Treatment of metastases of the cervical spine. Chir Organi Mov 83:127–137PubMedGoogle Scholar
  4. 4.
    Denaro V, Denaro L, Gulino G, et al (1998) Complicanze nella chirurgia cervicale. Giornale Italiano di Ortopedia e Traumatologia 24:681–688Google Scholar
  5. 5.
    Roy-Camille R, Judet TH, Saillant G, et al (1981) Tumeurs du rachis. Techniques chirugucales, Orthopedie. Encycl Med Chir Paris 44165:4.06.04Google Scholar
  6. 6.
    Boni M, Cherubino P, Denaro V, et al (1984) Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9:358–362PubMedCrossRefGoogle Scholar
  7. 7.
    Boni M, Denaro V (1980) Surgical treatment of traumatic lesions of the middle and lower cervical spine (C3–C7). Ital J Orthop Traumatol 6:305–320PubMedGoogle Scholar
  8. 8.
    Boni M, Denaro V (1982) The cervical stenosis syndrome with a review of 83 patients treated by operation. Int Orthop 6:185–195PubMedCrossRefGoogle Scholar
  9. 9.
    Boni M, Denaro V (1982) Surgical treatment of cervical arthrosis. Follow-up review (2–13 years) of the 1st 100 cases operated on by anterior approach. Rev Chir Orthop Reparatrice Appar Mot 68:269–280PubMedGoogle Scholar
  10. 10.
    Silvani V, Brambilla G, Rainoldi F, et al (1987) Vertebral osteomyelitis with chronic cervical extradural abscess in a heroin addict. Neurochirurgia (Stuttg) 30:91–94Google Scholar
  11. 11.
    Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99:41–50CrossRefGoogle Scholar
  12. 12.
    Cammisa FP Jr, Girardi FP, Sangani PK, et al (2000) Incidental durotomy in spine surgery. Spine 25:2663–2667PubMedCrossRefGoogle Scholar
  13. 13.
    Fountas KN, Kapsalaki EZ, Johnston KW (2005) Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report. Spine 30: E277–E280PubMedCrossRefGoogle Scholar
  14. 14.
    Clarck CR (2005) The cervical spine, 4th edn. Lippincott Williams & Wilkins, philadelphiaGoogle Scholar
  15. 15.
    Eismont FJ, Wiesel SW, Rothman RH (1981) Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 63:1132–1136PubMedGoogle Scholar
  16. 16.
    Hodges SD, Humphreys SC, Eck JC, et al (1999) Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine 24:2062–2064PubMedCrossRefGoogle Scholar
  17. 17.
    Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80:1728–1732PubMedCrossRefGoogle Scholar
  18. 18.
    Hannallah D, Lee J, Khan M, et al (2008) Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am 90:1101–1105PubMedCrossRefGoogle Scholar
  19. 19.
    Narotam PK, Jose S, Nathoo N, et al (2004) Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine 29:2861–2867; discussion 2868–2869PubMedCrossRefGoogle Scholar
  20. 20.
    Graham JJ (1989) Complications of cervical spine surgery. A five-year report on a survey of the membership of the Cervical Spine Research Society by the morbidity and mortality committee. Spine 14:1046–1050PubMedCrossRefGoogle Scholar
  21. 21.
    Yamada S, Aiba T, Endo Y, et al (1994) Creutzfeldt-Jakob disease transmitted by a cadaveric dura mater graft. Neurosurgery 34:740–743; discussion 743–744PubMedCrossRefGoogle Scholar
  22. 22.
    Takemitsu M, Cheung KM, Wong YW, et al (2008) C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation. J Spinal Disord Tech 21:267–272PubMedCrossRefGoogle Scholar
  23. 23.
    Sakaura H, Hosono N, Mukai Y, et al (2003) C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine 28:2447–2451PubMedCrossRefGoogle Scholar
  24. 24.
    Epstein JA (1996) Extradural tethering effects as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine 21:1839–1840PubMedCrossRefGoogle Scholar
  25. 25.
    Hirabayashi K, Toyama Y, Chiba K (1999) Expansive lamin-oplasty for myelopathy in ossification of the longitudinal ligament. Clin Orthop Relat Res 359:35–48PubMedCrossRefGoogle Scholar
  26. 26.
    Tsuzuki N, Abe R, Saiki K, et al (1996) Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine 21:203–211PubMedCrossRefGoogle Scholar
  27. 27.
    Uematsu Y, Tokuhashi Y, Matsuzaki H (1998) Radiculopathy after laminoplasty of the cervical spine. Spine 23:2057–2062PubMedCrossRefGoogle Scholar
  28. 28.
    Yonenobu K, Hosono N, Iwasaki M, et al (1991) Neurologic complications of surgery for cervical compression myelopa-thy. Spine 16:1277–1282PubMedCrossRefGoogle Scholar
  29. 29.
    Satomi K, Nishu Y, Kohno T, et al (1994) Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine 19:507–510PubMedCrossRefGoogle Scholar
  30. 30.
    Shimizu T, Shimada H, Edakuni H (1996) Post-laminoplasty palsy of upper extremities, with special reference to the spinal cord factors. Bessatsu Seikeigeka 29:188–194Google Scholar
  31. 31.
    Chiba K, Toyama Y, Matsumoto M, et al (2002) Segmental motor paralysis after expansive open-door laminoplasty. Spine 27:2108–2115PubMedCrossRefGoogle Scholar
  32. 32.
    Komagata M, Nishiyama M, Endoh K (2002) Clinical study of the post operative C5 palsy after cervical laminoplasty; Efficacy of bilateral partial foraminotomy for prevention the C5 palsy. J Jpn Spine Res Soc 131:237Google Scholar
  33. 33.
    Sasai K, Saito T, Akagi S, et al (2003) Preventing C5 palsy after laminoplasty. Spine 28:1972–1977PubMedCrossRefGoogle Scholar
  34. 34.
    Minoda Y, Nakamura H, Konishi S, et al (2003) Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine. Spine 28:1123–1127PubMedGoogle Scholar
  35. 35.
    Chen Y, Chen D, Wang X, et al (2007) C5 palsy after lamine-ctomy and posterior cervical fixation for ossification of posterior longitudinal ligament. J Spinal Disord Tech 20:533–535PubMedCrossRefGoogle Scholar
  36. 36.
    Neo M, Fujibayashi S, Miyata M, et al (2008) Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine 33:779–785PubMedCrossRefGoogle Scholar
  37. 37.
    Zhao L, Xu R, Hu T, et al (2008) Quantitative evaluation of the location of the vertebral artery in relation to the transverse foramen in the lower cervical spine. Spine 33:373–378PubMedCrossRefGoogle Scholar
  38. 38.
    Lu J, Ebraheim NA, Georgiadis GM, et al (1998) Anatomic considerations of the vertebral artery: implications for anterior decompression of the cervical spine. J Spinal Disord 11:233–236PubMedCrossRefGoogle Scholar
  39. 39.
    Pateder DB, Carbone JJ (2006) Lateral mass screw fixation for cervical spine trauma: associated complications and effi-cacy in maintaining alignment. Spine J 6:40–43PubMedCrossRefGoogle Scholar
  40. 40.
    Yamaguchi S, Eguchi K, Kiura Y, et al (2008) Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography. J Neurosurg Spine 9:167–174PubMedCrossRefGoogle Scholar
  41. 41.
    Abumi K, Shono Y, Ito M, et al (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969PubMedCrossRefGoogle Scholar
  42. 42.
    Deen HG, Birch BD, Wharen RE, et al (2003) Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up. Spine J 3:489–495PubMedGoogle Scholar
  43. 43.
    Haid RW Jr, Subach BR, McLaughlin MR, et al (2001) C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery 49:65–68; discussion 69–70PubMedGoogle Scholar
  44. 44.
    Heller JG, Silcox DH 3rd, Sutterlin CE 3rd (1995) Complications of posterior cervical plating. Spine 20:2442–2448PubMedCrossRefGoogle Scholar
  45. 45.
    Madawi AA, Casey AT, Solanki GA, et al (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968PubMedCrossRefGoogle Scholar
  46. 46.
    Wright NM, Lauryssen C (1998) Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/ Congress of Neurological Surgeons. J Neurosurg 88:634–640PubMedCrossRefGoogle Scholar
  47. 47.
    Gluf WM, Schmidt MH, Apfelbaum RI (2005) Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2:155–163PubMedCrossRefGoogle Scholar
  48. 48.
    Mendez JC, Gonzalez-Llanos F (2005) Endovascular treatment of a vertebral artery pseudoaneurysm following posterior C1–C2 transarticular screw fixation. Cardiovasc Intervent Radiol 28:107–109PubMedCrossRefGoogle Scholar
  49. 49.
    Prabhu VC, France JC, Voelker JL, et al (2001) Vertebral artery pseudoaneurysm complicating posterior C1–2 tran-sarticular screw fixation: case report. Surg Neurol 55:29–33; discussion 33–24PubMedCrossRefGoogle Scholar
  50. 50.
    Arnautovic KI, al-Mefty O, Pait TG, et al (1997) The suboccipital cavernous sinus. J Neurosurg 86:252–262PubMedCrossRefGoogle Scholar
  51. 51.
    Ebraheim NA, Xu R, Ahmad M, et al (1998) The quantitative anatomy of the vertebral artery groove of the atlas and its relation to the posterior atlantoaxial approach. Spine 23:320–323PubMedCrossRefGoogle Scholar
  52. 52.
    Abd el-Bary TH, Dujovny M, Ausman JI (1995) Microsurgical anatomy of the atlantal part of the vertebral artery. Surg Neurol 44:392–400; discussion 400–391CrossRefGoogle Scholar
  53. 53.
    Cacciola F, Phalke U, Goel A (2004) Vertebral artery in relationship to C1–C2 vertebrae: an anatomical study. Neurol India 52:178–184PubMedGoogle Scholar
  54. 54.
    Rhoton AL Jr (2000) The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery 47:S195–S209PubMedCrossRefGoogle Scholar
  55. 55.
    Buna M, Coghlan W, deGruchy M, et al (1984) Ponticles of the atlas: a review and clinical perspective. J Manipulative Physiol Ther 7:261–266PubMedGoogle Scholar
  56. 56.
    Cushing KE, Ramesh V, Gardner-Medwin D, et al (2001) Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol 43:491–496PubMedCrossRefGoogle Scholar
  57. 57.
    Hasan M, Shukla S, Siddiqui MS, et al (2001) Posterolateral tunnels and ponticuli in human atlas vertebrae. J Anat 199:339–343PubMedCrossRefGoogle Scholar
  58. 58.
    Le Minor JM, Trost O (2004) Bony ponticles of the atlas (C1) over the groove for the vertebral artery in humans and primates: polymorphism and evolutionary trends. Am J Phys Anthropol 125:16–29PubMedCrossRefGoogle Scholar
  59. 59.
    Manjunath KY (2001) Posterior bridging of the atlas verte-bra in south Indians. Indian J Med Sci 55:488–490PubMedGoogle Scholar
  60. 60.
    Senoglu M, Gumusalan Y, Yuksel KZ, et al (2006) The effect of posterior bridging of C-1 on craniovertebral junction surgery. J Neurosurg Spine 5:50–52PubMedCrossRefGoogle Scholar
  61. 61.
    Peng CW, Chou BT, Bendo JA, et al (2009) Vertebral artery injury in cervical spine surgery-anatomical considerations, management, and preventive measures. Spine J 9(1):70–76PubMedCrossRefGoogle Scholar
  62. 62.
    Coric D, Branch CL Jr, Wilson JA, et al (1996) Arteriovenous fistula as a complication of C1–2 transarticular screw fixa-tion. Case report and review of the literature. J Neurosurg 85:340–343PubMedCrossRefGoogle Scholar
  63. 63.
    Smith MD, Emery SE, Dudley A, et al (1993) Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br 75:410–415PubMedGoogle Scholar
  64. 64.
    Weidner A, Wahler M, Chiu ST, et al (2000) Modification of C1–C2 transarticular screw fixation by image-guided surgery. Spine 25:2668–2673; discussion 2674PubMedCrossRefGoogle Scholar
  65. 65.
    Wahlberg E, Olofsson P, Goldstone J (2007) Vascular injuries to the neck. In: Wahlberg E, Olofsson P, Goldstone J (eds) Emergency vascular surgery — a practical guide. Springer, Berlin, pp 3–14Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Luca Denaro
    • 1
    Email author
  • Domenico D'Avella
    • 1
  • Vincenzo Denaro
    • 2
  1. 1.Department of NeuroscienceUniversity of PaduaPaduaItaly
  2. 2.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityRomeItaly

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