Index.php/Overview: Head neck joint stabilization therapy
From Head-neck-joints instability conditions
Table of contents Available documents from the overview:
The surgical method
With a craniocervical passage that has become unstable through torn ligaments or over-expansion after an accident, the aim of the operation is a stabilisation. Since up to now it is not possible to restore the original state in a way that the torn Ligamentum alare or the ruptured (partially torn) Ligamentum transversus atlantis be replaced ventrally – i.e. from the front -, the only remaining method is the stabilising operation at the craniocervical passage in a dorsal way, i.e. from the rear.
The surgical technique
Patients are operated in general anaesthesia. The bearing takes place in a face-down position, with the head a little ventrally bent (slightly bent forward) supported on a headrest. The image converter is already integrated and aseptically covered. The incision (surgical cut) is carried out in the middle line in the area of the craniocervical passage. After the incision over the spinal processes the relocation of the paravertebral musculature is effected - the rear musculature at the cervical spine is put aside -, as well as the attachment of spreaders. With that, the surgical field has been reached. Now the motion sequence at the passage from neck to head is observed. By moving the head during the open operation situs it can very well be determined to which extent the single ligaments lying ventrally (in the front) function and how far a disharmonious motion sequence at single vertebral bodies is visible. Furthermore it is possible to gain insight in the area of the articular capsule C1/C2 and thus to assess it intra-operatively. With all operated patients the instability determined before surgery proved true during surgery as well. However, different consequences of injuries could be detected, mostly a combined instability between the vertebrae C0/C1, C1/C2 and C2/C3, with C0 being the occipital bone. In many cases a rotatory luxation , Stabilisierungsoperation (wrench) or subluxation between C1 and C2 had additionally occurred. Under the control of the image converter an ideal physiological position of the upper cervical vertebral joints is adjusted. The position of the head compared to the neck is also taken into account. From the C2 vertebral arch towards the Massa lateralis of C1, a drilling is performed, and at first titanium screws are temporarily placed with compression. This screw connection leads to an immediate stabilisation between C1/C2. Afterwards, a titanium plate is bent according to the anatomy at the craniocervical passage, so that a screw connection of the plate at C0, C1, C2 to C3 is possible. This titanium plate is attached at the occipital bone with very short screws after a corresponding, careful spot drilling of the skull bone. In the middle the transarticular C1/C2 screw is fastened, which mostly requires a screw with 40 mm of length. This screw also stabilizes the C1/C2 joint.
Furthermore the small vertebral joint C3 is still included in the stabilisation with the plate. This way a fixed entity between C0/C1/C2 up to and including C3 is created which does not allow any abnormal movements. After inserting a Redon drainage the neck musculature is then again completely sewed on the spinal processes in the middle line. Not until that is the wound sewed in layers and bandaged.
The result of the operation
After the operation, 85% of all patients reported a significant improvement of their disorders. A clear decrease in headache, dizziness symptoms and ringing in the ears could be noticed. At the moment, the crucial factor seems to be the time between trauma and surgical treatment. The shorter the discomfort lasted, the more positive were patients’ reactions to the operation result
X-ray image of the cervical spine after the operation (the titanium plates can be recognized) A small improvement can be registered in concentration capability and the loss of power. Of course such a stabilisation at the cervical spine also has consequences: A clear limitation in mobility of 75% in all levels remains in the entire cervical spine. This limitation is individually different and was until now mostly well tolerated by the patients since the disorders already mentioned had clearly decreased. The permanent medication with analgesics before the operation is clearly reduced. The pain reduction after the operation was specified by the patients at 70 – 80%. According to the patients, especially daily activities are to a large extent possible again after the operation. 20% of the patients can exercise a profession again. Only with 5% of the patients the expectations in the operation were not fulfilled at all.
Surgery overview
This successful surgery was done in Germany.
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |