Degenerative Disease Of The Cervical Spine

The principles of fusion include adequate preparation and decortication of the host site, a source of bone graft (which, if possible, should be placed under compression) and immobilization of the osseous elements involving the fusion. Typically, the ability to effect fusion in the cervical spine is good, as compared to fusion success rates in the lumbar spine [20].

Fusion can be achieved by an anterior or posterior approach. The induction of fusion implies bony bridging between adjacent vertebrae. Bone graft provides a scaffolding upon which osteoblasts migrate between the two adjacent vertebrae. Immobilization of the involved segment is critical to allow for proper bony fusion. A rigid cervical collar or a halo brace are the external fixators most commonly utilized. Internal fixation is now frequently used as an adjunct to promote fusion.

The instrumentation devices available for the cervical spine are strictly internal fixation devices, with no reduction capability. Therefore, cervical manipulation, either by external or internal force application, and placement of the bone graft produce reduction and spinal re-alignment. The fixation device contributes to immediate stabilization of the segment intended to be fused. Long-term stabilization depends upon maturation of the fusion.

As for the previously described decompressive procedures, cervical fusion procedures were initially performed by a posterior approach. The placement of on-laid bone graft supplemented with a halo represents one of the earliest techniques for effecting fusion. Fixation by wiring the posterior elements in various configurations represented some of the early internal fixation techniques [21] (Fig. 31.6). The effectiveness of these procedures is limited and loss of reduction and fixation can occur. An interspinous wire would recreate the extensor tension band posteriorly and limit motion in flexion and extension. In cases of ligamentous injury in trauma, this confers some stabilization to the involved motion segments. Sub-laminar wiring would also have a similar effect, with a high risk of spinal cord injury during the sublaminar pass. The translational biomechanics of these techniques are limited and dependent upon the integrity of the facets. The Bowman a

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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