overview of surgical approaches for cervical spine injury

AADO Trauma Series I - Spinal Injury Workshop OLC, PWH Feb 2014

Dr Kin Cheung MAK Associate ConsultantDepartment of Orthopaedics & TraumatologyQueen Mary Hospital University of Hong Kong

outline

axial

open mouth

posterior

subaxial

anterior

posterior

dens fracture classificationtype I - avulsion, alar ligament, collar

type II - 30-50% non-union, esp. > 65 y-o, > 5mm displacement or 10° angulation

type III - may heal with immobilisation (halo jacket) but need 12 wks; screw is option

subaxial cervical spine fracture classification

Sub-axiaL Injury Classification (SLIC) & Severity Scale

comprehensive - morphology, neurology, disco ligamentous complex

prognosis

management

earlier classification systems

Harris, Ferguson & Allen

posterior cervical approach

posterior approaches

midline dorsal

C3-7

occipitocervical

lateral mass screw

pedicle screw

C1/2 fixation

C1/2 fusion options

anterior cervical approach

anterior approaches

open mouth

high anterior

workhorse - Smith Robinson (anterolateral)

extended approaches - sternotomy, manubriectomy

Smith-Robinson (anterolateral)

manubriectomy

high cervical

dens screw

open mouth

summary:posterior cervical approach

midline

extend cephalad or caudal

anterior cervical approach

anterolateral (Smith-Robinson)

high cervical & open mouth

manubriectomy/sternotomy

thank you

drmak.spine@gmail.com