Spectrum of pathology

• Prolapsed discs and osteophytic compression; ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis

• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts

43 yr male, brachalgia C5 right

Spectrum of pathology

• Prolapsed discs, osteophytic compression: ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts• Infection: discitis, osteomyelitis, epidural

abscess

•S.R. - Male, Age 77•Severe Rheumatoid Arthritis•Past multiple joint replacements and episodes of steroid Px•Progressive upper and lower limb long tract symp/signs•Neck Pain and Stiffness

Occipitocervical fixation

Halo support post-op

Sub axial rheumatoid deformity

Seronegative arthritis

Ankylosing spondylitis

Spectrum of pathology

• Prolapsed discs, osteophytic compression: ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts• Infection: discitis, osteomyelitis, epidural

abscess

Odontoid fracture

Odontoid screw fixation

Hangman’s fracture

C6 Crush fracture, posterior ligamentous injury

Interspinous ligamentous disruption

Hyperextension injury, ALL disrupted

Rotatory subluxation

Pre reduction MR

Interspinous ligamentous disruption

Posterior reduction and fixation techniques

• Currette or hook• Drilling/ nibbling the superior aspect of the inferior facet• Wires • Hooks or clamps• Screws/ Plates• Screws/ Rod combinations

Spectrum of pathology

• Prolapsed discs, osteophytic compression: ‘wear and repair’

• Inflammatory: rheumatoid, ankylosing spondylitis• Trauma: odontoid, rotatory subluxation• Neoplastic: meningiomas, schwannomas,

metastatic cord compression• Congenital Klippel Feil, fused, Down’s,

enterogenous cysts• Infection: discitis, osteomyelitis, epidural

abscess

Ependymoma Gd 2

51 years neck , arm pain

NHL cervical cord compression

CT pelvis: right inguinal lymphadenopathy

2 years post op

Patchell, Lancet 2005

Complications

General (DVT, MI, Infection, haematoma)

Specific: Recurrent and sup laryngeal n

Dysphasia

Retropharyngeal haematoma

Nerve root injury

Spinal cord injury

Vertebral artery injury

The future

• Better analysis of results

• Better constructs• Clearer indications• More work

• Ceramic vs plastics vs metal

• Interface with bone • Bone growth

stimulants• Genetically

engineered solutions