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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This anatomic, radiographic study investigated locational differences in the C2 pedicle and isthmus [pediculoisthmic component (PIC)] and characterized its narrowest section for clinical application in posterior C2 screw fixation. ⋯ The PIC is located between superior and inferior C2 facets. The superior flat area is the isthmus and the inferomedial area connecting the inferior facet and vertebral body is the pedicle. The pedicle is partially tubular and projects posteromedially to the transverse foramen. The narrowest PIC section is the narrowest point of the C2 pedicle. Considering its thin lateral cortical bone, medial and superior pedicle screw placement and preoperative CT reconstruction are recommended.
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To test the usefulness of a novel performance test, the tally counter test (counter test), which uses a hand tally counter to objectively assess the severity of cervical myelopathy. ⋯ The tally counter test is objective and quantitative assessment method for patients with cervical myelopathy. The test is simple, reliable, and capable of detecting small functional changes.
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Great care should be taken to minimise damage to the pharynx and upper oesophagus during an anterior approach to the cervical spine. If noticed at the time of surgery primary repair should be carried out; if noticed in the postoperative period, thorough cleaning and placement of a pharyngocutaneous drain will result in spontaneous healing of the majority of fistula. For persistent fistula secondary repair is required using well-vascularised tissue.