European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Lateral mass (LM) fixation has become a standard in cervical spine instability treatment; however, maximal biomechanical stability combined with low morbidity remains a challenge. We evaluated our own patient cohort for bicortical screw placement and complication rates and investigated optimal screw trajectories with preoperative multiplanar computed tomography (CT) scans. ⋯ The optimal LM trajectory varied for each subaxial segment. The knowledge of LM geometry allows for safe, long and even bicortical screw placements using preoperative sagittal CT imaging evaluations.
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Basilar invagination is a rare craniocervical malformation which may lead to neurological deficits related to compression of brainstem and upper cervical cord as well as instability of the craniocervical junction. This study presents results of a treatment algorithm developed over a 20-year period focussing on anatomical findings, short-term and long-term outcomes. ⋯ The great majority of patients with basilar invagination report postoperative improvements with this management algorithm. Most patients without ventral compression can be managed by foramen magnum decompression alone. The majority of patients with ventral compression can be treated by posterior decompression, realignment and stabilization alone, reserving anterior decompressions for patients with profound, symptomatic brainstem compression.
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To determine if adding flexion and extension MRI studies to the traditional neutral views would be beneficial in the diagnosis of cervical disc bulges. ⋯ A significant increase in the degree of cervical disc bulge was found by examining extension views when compared with neutral views alone. Kinematic MRI views provide valuable added information, especially in situations where symptomatic radiculopathy is present without any abnormalities demonstrated on traditional neutral MRI.