Objective:. To observe the incidence of intra-operative vascular injuries during anterior cervical decompression and fusion (ACDF). Secondly, management and monitoring of the outcome post vascular injury during ACDF. Methods:. This a prospective study. A review of all spinal patients' records was performed from June 2006 to April 2011. A comprehensive literature review was also utilized. Inclusion criteria – all patients had ACDF post trauma. All non-traumatic cases were excluded. Results:. The study consisted of 55 patients; 15 were females and 40 were males. The age distribution was 23–65 years. Two patients were excluded due to non-traumatic causes. Of the remaining 53 patients, four sustained intra-operative vascular injuries during ACDF surgery. All 4 patients had corpectomies, and one case was an iatrogenic injury. The commonly injured vessel during the ACDF surgery was the left vertebral artery. Haemostatic control was achieved via tamponade and haemostatic agents. The left common carotid was iatrogenically injured in one case and was treated by microvascular repair. Three patients were treated with antiplatelet therapy for three months duration. The patient with an iatrogenic injury was treated with anticoagulation therapy for three months duration. All computerized tomographic angiograms at three months follow up illustrated patent vessels. Conclusion:. There is an increased incidence of intra operative vascular injuries during ACDF associated with corpectomies. It is essential to be aware of the low incidence of intra operative arterial injury during ACDF and to have a management approach, such as tamponade or microvascular repair. Anticoagulation and antiplatelet therapy is effective in decreasing the complications of vascular injuries post ACDF

Purpose of study. Transarticular screw fixation offers acceptably high fusion rates but is not possible in 18% of patients due to a high riding vertebral artery. It also requires pre-operative anatomical reduction which is not always possible. The Harms' technique utilises a posterior C1 lateral mass and C2 pedicle screw. This allows easier access due to the angle of drilling and has become an increasingly popular surgical technique. The aim of this study is to review and compare the above techniques with regard to surgery, complications and outcome. Description of methods. This study is a retrospective chart and radiographic review of patients undergoing posterior C1-2 fusion in a single institution in the period 2003 to 2011. The most common aetiology was rheumatoid arthritis and post-traumatic instability. All atlanto-axial instability patients that came to surgery are included in this study, and only cases with less than six months follow-up were excluded. We report on surgical indications, surgical outcomes, complications and radiographic outcomes. Summary of results. No statistically significant differences were found in blood loss (p=0.47) or surgical time (p=0.44) using the Mann-Whitney U test. Complications in patients undergoing transarticular screw fixation included the need to abandon transarticular screws in two cases due to technical difficulty, metalware failure in two cases and intra-operative cerebrospinal fluid leaks in 2 cases. The Harms technique was associated with a single case of cerebrospinal fluid leak. Conclusion. There is no significant difference in surgical time and blood loss between the two techniques. Both are reliable in terms of fusion. The Harms technique offers the advantage of intra-operative reduction and a smaller wound due to the direction of access. The decision to use one or the other is based on the surgeons skill levels, ability to pre-operative reduce the joint and possibly the cost. NO DISCLOSURES

The posterior midline approach used in spinal surgery has been associated with a significant rate of wound dehiscence. This study investigates anatomical study of the arterial supply of the cervical and thoracic spinal muscles and overlying skin at each vertebral level. It aimed to provide possible anatomical basis for such wound complications. A dissection and angiographic study was undertaken on 8 cadaveric neck and posterior torso from 6 embalmed and 2 fresh human cadavers. Harvested cadavers were warmed and hydrogen peroxide was injected into the major arteries. Lead oxide contrast mixture was injected in stepwise manner into the subclavian and posterior intercostal arteries of each specimen. Specimens were subsequently cross-sectioned at each vertebral level and bones elevated from the soft tissue. Radiographs were taken at each stage of this process and analysed. The cervical paraspinal muscles were supplied by the deep cervical arteries, transverse cervical arteries and vertebral arteries. The thoracic paraspinal muscles were supplied by the superior intercostal arteries, transverse cervical arteries and posterior intercostal arteries. In the thoracic region, two small vessels provide the longitudinal connection between the segmental arteries and in the cervical region, deep cervical arteries provide such connection from C3 to C6. The arterial vessels supplying the paraspinal muscles on the left and right side anastomose with each other, posterior to the spinous processes in all vertebral levels. At cervical vertebral levels, source arteries travel near the surgical field and are not routinely cauterised; Haematoma is postulated to be the cause of wound complications. At thoracic levels, source arteries travel in the surgical field and tissue ischemia is a contributing factor to wound complications, especially in operations over extensive levels. Post-operative wound complications is a multi-factorial clinical problem, the anatomical findings in this study provide possible explanations for wound dehiscence in the posterior midline approach. It is postulated that drain tubes may reduce the incidence of haematoma in the cervical level

Neck pain can be caused by pressure on the spinal cord or nerve roots from bone or disc impingement. This can be treated by surgically decompressing the cervical spine, which involves excising the bone or disc that is impinging on the nerves or widening the spinal canal or neural foramen. Conventional practise is to fuse the adjacent intervertebral joint after surgery to prevent intervertebral motion and subsequent recompression of the spinal cord or nerve root. However fusion procedures cause physiological stress transfer to adjacent segments which may cause Adjacent Segment Degeneration (ASD), a rapid degeneration of the adjacent discs due to increased stress. ASD is more likely to occur in fusions of two or more levels than single level fusions and is more common where there is existing degeneration of the adjacent discs, which is not unusual in people over 30 years of age. Partial dynamic stabilisation, which generally involves a semi-rigid spinal fixation, allows a controlled amount of intervertebral motion (less than physiological, but more than fusion) to prevent increased stress on the adjacent segments (potentially preventing ASD) whilst still preventing neural recompression. Partial dynamic stabilisation is suitable for treating spinal instability after decompression as well as certain degenerative instabilities and chronic pain syndromes. Dynamic stabilisation and semi-rigid fixation systems for the spine are typically fixated posteriorly. However, choice of posterior surgical stabilisation techniques in the cervical spine is limited due to the size of the osseous material available for fixation and the close proximity of the neural structures and the vertebral artery. Posterior dynamic stabilisation systems for stabilisation of the lumbar spine often use the pedicle as an anchor point. Using the pedicle of the cervical spine as an anchor point is technically difficult because of its small size, angulation and proximity to neurovascular structures. Therefore, one of the main challenges to provide stabilisation in the cervical spine is the limitations of the anatomy. This presentation will introduce a novel spinal implant (patent pending) which is proposed for the cervical spine to provide partial dynamic stabilisation in the C3 to T1 region from a posterior approach. The implant is a single unit with a safe and technically simple insertion technique into the lateral masses. The implant uses a simple mechanism to allow limited intervertebral motion at each instrumented level. It is hoped that the simplicity of the device and removing the need to provide a bone graft anteriorly may reduce the cost of the procedure compared to traditional fusion and competing surgeries

We reviewed 234 benign solitary schwannomas treated between 1984 and 2004. The mean age of the patients was 45.2 years (11 to 82). There were 170 tumours (73%) in the upper limb, of which 94 (40%) arose from the brachial plexus or other nerves within the posterior triangle of the neck. Six (2.6%) were located within muscle or bone. Four patients (1.7%) presented with tetraparesis due to an intraspinal extension.

There were 198 primary referrals (19 of whom had a needle biopsy in the referring unit) and in these patients the tumour was excised. After having surgery or an open biopsy at another hospital, a further 36 patients were seen because of increased neurological deficit, pain or incomplete excision. In these, a nerve repair was performed in 18 and treatment for pain or paralysis was offered to another 14.

A tender mass was found in 194 (98%) of the primary referrals. A Tinel-like sign was recorded in 155 (81%). Persistent spontaneous pain occurred in 60 (31%) of the 194 with tender mass, impairment of cutaneous sensibility in 39 (20%), and muscle weakness in 24 (12%).

After apparently adequate excision, two tumours recurred. No case of malignant transformation was seen.