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The evolution of spinal instrumentation for the management of occipital cervical and cervicothoracic junctional injuries.

Smucker JD, Sasso RC

Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA.

STUDY DESIGN/SETTING: Independent computer-based literature review of articles pertaining to instrumentation and fusion of junctional injuries of the cervical spine. OBJECTIVE: To review and discuss the evolution of instrumentation techniques and systems used in the treatment of cervical spine junctional injuries. SUMMARY OF BACKGROUND DATA: Instrumentation of junctional injuries of the cervical spine has been limited historically by failure to achieve rigid internal fixation in multiple planes. The evolution of these techniques has required increased insight into the morphology and unique biomechanics of the structures to be instrumented. METHODS: Computer-based literature search of Ovid and PubMed databases. RESULTS: Extensive literature search yielded insights into the evolution of systems initially based on onlay bone graft combined with wiring techniques. Such techniques have come to include systems incorporating rigid, longitudinal struts that accommodate multiplanar screws placed in the lateral masses, pedicles, transarticular regions, and occipital bone. CONCLUSIONS: Despite a rapid evolution of techniques and instrumentation technologies, it remains incumbent on the physician to provide the patient with a surgical procedure that balances the likelihood of a favorable outcome with the risk inherent in the implementation of the procedure.

Published 10 May 2006 in Spine, 31(11): S44-52; discussion S61.
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