Neurological deterioration after posterior wiring of the cervical spine.
Posterior cervical wiring is commonly performed for patients with spinal instability, but has inherent risks. We report eight patients who had neurological deterioration after sublaminar or spinous process wiring of the cervical spine; four had complete injuries of the spinal cord, one had residual leg spasticity and three recovered after transient injuries. We found no relation between the degree of spinal canal encroachment and the severity of the spinal-cord injury, but in all cases neurological worsening appeared to have been caused by either sublaminar wiring or spinous process wiring which had been placed too far anteriorly. Sublaminar wiring has substantial risks and should be used only at atlantoaxial level, and then only after adequate reduction. Fluoroscopic guidance should be used when placing spinous process wires especially when the posterior spinal anatomy is abnormal.
Lundy
D W
DW
Shepherd Center, Atlanta, Georgia 30360, USA.
Murray
H H
HH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001368:Axis, Cervical Vertebra / Q000601:surgery; D001864:Bone Wires / Q000009:adverse effects*; D001270:Cervical Atlas / Q000601:surgery; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology; D009809:Odontoid Process / Q000002:abnormalities / Q000601:surgery; D010003:Osteoarthritis / Q000601:surgery; D010243:Paralysis / Q000209:etiology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D013115:Spinal Canal / Q000601:surgery; D013119:Spinal Cord Injuries / Q000209:etiology; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects; D014057:Tomography, X-Ray Computed