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Treatment of cervical spine deformities may depend on several factors

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ORLANDO, Fla. — Preoperative measurements of patients with cervical spinal deformities can affect the surgical decision-making processes and the surgical technique used, according to a presenter at the Cervical Spine Research Society Annual Meeting, here.

K. Daniel Riew, MD, said determining several specific measurements prior to surgery can help surgeons settle what technique will be most effective to treat patients with cervical spine deformities. The first aspect that should be determined, he said, it to determine if the patient’s deformity is flexible or rigid.

Riew said he will set a patient down on an examining table for a determined amount of time. When he returns to the room, Riew said he observes whether the patient’s head is laying on the table or is being held in the air. If the patient’s head is in the air, Riew said the deformity is most likely rigid.

“If you have someone with a flexible deformity, it doesn’t really matter what you do. You just have to put their neck back to the position that they want to be in, and you just have to nail it. Whether you do it from the back alone or the anterior or posterior, it can be done,” he said.

Riew said he also relies on CT scans and sagittal reconstructive views to see which facet joints are fused. About 1 out of 10 patients you see, he said, with degenerative changes will have a facet fusion whether dealing with a deformity or not.

The use of a plum line is also effective, he said, which he drops from the tip of C2. It will either fall behind the manubrium or in front of it. If it falls behind the manubrium, it is a cervical spine problem in 99.9% of instances, he said.

“In conclusion, look at where the baseline plum line is, make sure that you are not dealing with an upper thoracic spine, and if you can’t, come to one of your partners who take care of that spine so you don’t have to deal with it, and make sure it [the deformity] is flexible or rigid, and look at all your lines and measurements,” he said. – by Robert Linnehan

Reference:

Riew KD. How preoperative measurements affect surgical decision-making. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 4-6, 2014; Orlando, Fla.

Disclosure: Riew has no relevant financial disclosures.