title: Management of complex cervical instability.
abstract: OBJECTIVE
  Illustrative cases are presented to demonstrate the surgical management of complex instability of the cervical spine.
  
  
  METHODS
  Six patients with different underlying pathologies are presented along with their clinical and radiologic findings, surgical procedures, complications, and outcomes.
  
  
  RESULTS
  Five patients underwent anteroposterior (AP) decompression and stabilization, of which two required secondary posterior stabilization because of dislocation or subsidence of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy, a stable situation was achieved with an anterior approach only. The outcomes, measured according to Odom's criteria, were excellent in one patient, good in three patients, and fair in two patients.
  
  
  CONCLUSIONS
  In cases of complex cervical instability, combined AP decompression and stabilization minimizes the risk of anterior plate failure or dislocation of the vertebral body prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore, a combined procedure should be considered in selected patients. Not all patients with cervical instability require circumferential surgery. In two-level corpectomy cases, the decision between the less invasive anterior-only approach and the more stable combined approach can be difficult. However, in patients with proof of poor bone quality or with metabolic disorders, a more stable combined approach should be considered.
authors.affiliation: Department of Neurosurgery, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Stefan Alexander
authors.initials: SA
authors.lastname: König
authors.affiliation: Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ranguis
authors.affiliation: Department of Neurosurgery, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Spetzger
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome