Abstract
Purpose Illustrative cases are presented to demonstrate the surgical management of complex
instability of the cervical spine.
Methods Six patients with different underlying pathologies are presented along with their
clinical and radiologic findings, surgical procedures, complications, and outcomes.
Results Five patients underwent anteroposterior (AP) decompression and stabilization, of
which two required secondary posterior stabilization because of dislocation or subsidence
of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy,
a stable situation was achieved with an anterior approach only. The outcomes, measured
according to Odom's criteria, were excellent in one patient, good in three patients,
and fair in two patients.
Conclusions In cases of complex cervical instability, combined AP decompression and stabilization
minimizes the risk of anterior plate failure or dislocation of the vertebral body
prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore,
a combined procedure should be considered in selected patients. Not all patients with
cervical instability require circumferential surgery. In two-level corpectomy cases,
the decision between the less invasive anterior-only approach and the more stable
combined approach can be difficult. However, in patients with proof of poor bone quality
or with metabolic disorders, a more stable combined approach should be considered.
Keywords
surgical management - cervical spine - instability
