Spine Disease. In (eds) Fundamentals of 2019 https://doi.org/10.1007/978-3-030-17649-5_16 High cervical spine surgery Neurosurgery. Springer,in Joaquim et al the United States: Wang et al 2005 https://pubmed.ncbi.nlm.nih.gov/19352223/ High Medicare Spine beneficiaries, Surgery Using the Liu et al 2017 10.1097/BRS.0000000000001999 High National Inpatient spinal fusion for cervical spondylotic Lad et al 2009 https://pubmed.ncbi.nlm.nih.gov/18514286/ High Review of Past Nouri et al 2020 https://pubmed.ncbi.nlm.nih.gov/32079075/ Medium Perspectives, Present Spectrum of Related Disorders Bhadiwala et al 2019 https://pubmed.ncbi.nlm.nih.gov/26378358/ High longitudinal ligament versus other types of Kwok et al 2020 https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03830-0#Sec1 High decompression and degenerative cervical fusion: a review of Badie et al 2020 https://pubmed.ncbi.nlm.nih.gov/32309669/ Medium cervical spine incidence, risksurgery factors,in the United States: Wang et al 2009 https://pubmed.ncbi.nlm.nih.gov/19352223/ High Myelopathy: Medicare beneficiaries, Pathophysiology and Choi et al 2019 https://www.asianspinejournal.org/journal/view.php?doi=10.31616/asj.2020.0490 Medium decompression Current Treatment and fusion: a review of Badiee et al 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154364/ High incidence,Laminectomy Posterior risk factors, and Fusion Badiee et al 2019 https://academic.oup.com/neurosurgery/article/66/Supplement_1/nyz310_409/5551874 Medium benefit of C2 vs. Passias et al 2019 https://jss.amegroups.com/article/view/4581/html Medium https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626746/ subaxial cervical upper- accuracy and Bransford et al 2011 https://pubmed.ncbi.nlm.nih.gov/21289565/ Medium complications foramen and high- riding vertebral artery: Elgafy et al 2014 https://doi.org/10.1016/j.spinee.2014.01.054 High implication on C1–C2 transpedicular versus Reddy et al 2007 https://doi.org/10.3171/SPI-07/10/414 Medium translaminar Introduction of C-2a screw Novel Risk of vertebral artery doi: Posterior Surgical Kepler et al 2020 High injury: comparison 10.1097/BRS.0b013e3181bc9cb5 Technique C2 For Upper Pars/Pedicle Screws between C1-C2 Yeom et al 2013 https://pubmed.ncbi.nlm.nih.gov/23684237/ Medium in Management transarticular andofC2 Accuracy and Craniocervical safety and of 2014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996339/ pedicle Comparison C2 screws pedicle screw Eshra orofpars Medium Upper Cervical malposition and screw placement: a Instability Azimi et al 2020 https://pubmed.ncbi.nlm.nih.gov/32690035/ High vertebral systematicartery review injury and of C2 pedicle and meta-analysis Elliot et al 2014 https://pubmed.ncbi.nlm.nih.gov/22614268/ High Degenerative transarticular cervical Biomechanical screws: myelopathy comparison meta-analysis - update ofand Bhadiwala et al 2020 https://pubmed.ncbi.nlm.nih.gov/31974455/ High and future review directions transpedicular of the versus literature Benke et al 2011 https://pubmed.ncbi.nlm.nih.gov/21192213/ intralaminar C2 fixation in C2-C6 subaxial constructs spondylotic changes is the most Keycommon arguments cause of spinal cord Category Type of study Limitations dysfunction in older adults. It is generally treated surgically, especially in Background Book chapter cervical those with spine are commonly progressive diagnosed, worsening." and seensigns "Recognizing radiographically and symptoms in of over half of the population aged 55 years or greater." Background Quantitative degenerative conditions in the 2001-2013 NIS database. The most Background Quantitative common type of surgery performed was anterior cervical fusion (ACF) number of spinal fusions for CSM from 1993 to 2002. Despite continued Background Quantitative increases in patient medical comorbidities, overall complication rates of disc and vertebral height, resulting in the in-folding of the Pathology Qualitative ligamentum coexist in theflavum, same patient. which may In such alsocases hypertrophy where there in response. is equipoise,As a 51 Pathology & surgeon preference also plays a role. " Epidemiology & Book chapter approaches and is unclear when either method is more suitable or ACLF vs PCLF ACLF Vs PCLF Quantitative preferred. There complications has long with associated beenPCF debateand theon the best approach corresponding for cervical prevention strategies optimize patient outcomes." Quantitative In the elderly, adjusted rates of cervical spine fusions rose 206% from Background Quantitative 1992 to 2005. ACLF vc PCLF Quantitative invasiveness of the planned procedure, thus increase complications. PCLF & Second, wound healing and arthrodesis may be impaired due to poor Qualitative complications blood flow due short-term clinicalto various patient factors or radiographic differences such between as smoking, a C2diabetes, and C3 UIV UIV at C2 vs C3 Quantitative when adjustingand improvement forhad baseline characteristics. complication profilesThese similarresults may aid to subaxial UIV UIV at C2 vs sub- patients, demonstrating the radiographic benefit and minimal functional Quantitative axial spines "To loss compare associated a dissection. the Therewithrisk of vertebral extending were artery fusion no neurologic injury by constructs injuries. toC1-C2 Mean C2.CT the treatment C2 screw types and Intransarticular measurements screw versus C2 pedicle screwand in an overallwidth patient population peri-operative Quantitative of pedicle height, axial width, laminar were 8.1, 5.8, and and 5.7 subsets screws. In of patients with aberrant a high-riding anatomyvertebralsuchartery and a narrow as a high-riding complications "Degenerative cervical Atypical CVA Quantitative pedicle using vertebral artery (VA) ormyelopathy computed tomography the presence (DCM) (CT) isarcuate of anscan theimages leading and foramen cause at of three- C1,spinal there fixation, cord generally dysfunction dimensional (3D) in the former adults screw type worldwide. trajectory of fixation was DCM encompasses software." associated "Overall, neither with various less C2 Instrumentation Quantitative motion transverse acquired technique than the foramen (age-related) has morelatter." and "When and inherentvertebral pedicle congenital anatomicartery screws (VA) risk in C-2 ofprecludes pathologies areartery related vertebral placement to injury. of on Cadavers such screws degeneration However, in in theofuppresence the to cervical 26% of ofpatients.4,5 spinal athat column, high-riding Invertebral cases includingwhere VA placement anatomy of C2 instrumentation hypertrophy artery, Quantitative "The prevents and/or pooledthe analysis safe calcification ofreveals placement thescrews ofsafer ligaments, the intervertebral aispedicle accuracy screw, rates a pars were discsscrew93.8% and is anforeasy osseous C2 apedicle pedicle "The use screw of screw is pars/pedicle significantly free-hand, 93.7% a forthe than very pars the placement effective, screw sound, free-hand, of a safe 92.2% and for "To compare the incidence ofpedicles, screw malposition and C2 instrumentation Quantitative tissues. surgical navigated These transarticular modality C2 pathologies screw. pedicle Narrow for treating screw, narrow andcraniocervical, 86.2%(TAS) spinal which canal, might atlantoaxial for navigated bevertebral leading C2 toupper anticipated and pars artery chronic screwto(all, injury spinal lead to(VAI) cord higher with compression risk transarticular for a and pedicle screws disability. screw Owing than a and to C2the pedicle transarticularageing screws population, screw, did cervical P value Six <instabilities. 0.001). fresh-frozen (C2PS) No cadaveric Increasing statistically cervical studies significant spines for the biomechanics differences underwent were rigidity of this in observed testing C2 instrumentation Quantitative rates not ofusing result important DCM in ameta-analysis are region increasing. significant andand longer techniques." Expeditious difference periods because "With diagnosis of follow-upsmosttraining, and patients are experience, treatment (82%) necessary ofand with to between the DCM intact anatomic the accuracy condition knowledge, arepedicles needed to avoid of both placement after TAS a permanent and C2 destabilizing C2PS pedicle can disability. C3-C6 be versus inserted Over C2 the pars laminectomy. screws accurately past patients." 10 years, and narrow document with the the free-hand had usefulness a concurrent technique of this and high-riding modality the when free-hand vertebral treating C2 artery pedicle such that group also C2 Instrumentation versus Meta-analysis Specimens safely. advances increased However, in were thebasic risk instrumented improper science and with a transarticularinwith insertion 20 and mm translational VAI screw. pedicle can and Excepthave and clinical 20 mm incatastrophic research case ofthere have a high- the navigated intralaminar consequences. C2 screws Our pedicle at reviewC2, group and (all, with identified P 14 value mm a higher > 0.05)." lateral mass"Overall, screws from was C3- improved riding no our understanding vertebral difference artery, inorder, the safety our and of thesuggest resultsaccuracy thatrisk pathophysiology between ofsurgeon thethe VAI, of DCM neurological free-hand andopt can and for C2 instrumentation helped Meta-analysis C6. In random injury, delineate either andevidence-based techniqueclinically and three significant expect conditions practicesmalpositions similar for (C2 pedicle diagnosis anatomic with risks screws, TAS andof C2 laminar compared treatment. vertebral with artery navigated techniques. Further well-conducted studies with Background Qualitative screws, C2PS. Surgical injury." and These C2 data decompression laminar provide screws with offset is preliminary recommended supportconnectors) for for moderate and detailed were the supposition testedthat severe in DCM; stratification flexion-extension, C2PS have a are lower needed axial risk of to complement rotation, morbidity." and our lateral the best strategy for mild myelopathy remains unclear. Next-generation findings." bending. quantitative microstructural MRI and neurophysiological recordings Laminar promise screws to enable in C2-C6 constructs quantification were equivalent of spinal cord tissuetodamage transpedicular and help fixation in flexion-extension predict clinical outcomes. Here, (P =we 0.985), provide were significantly more a comprehensive, rigid evidence- than basedpedicle reviewscrews of DCM, in including axial rotation (P = 0.002), its definition, and were significantly epidemiology, less rigid than pedicle pathophysiology, clinical screws in lateral bending presentation, diagnosis(Pand = 0.002). Laminar differential screw constructs diagnosis, were more rigid and non-operative than the intact and operative conditionWith management. in allthis planes Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted." My notes