Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion

The authors report on 32 consecutive patients with instability at the crani ocervical, cervical and cervicothoracic regions suffering from various path ologies, who were treated with posterior instrumentation and fusion using t he posterior hooks-rods-plate cervical compact Cotrel-Dubousset (CCD) instr umentation alone or, in three patients, in combination with anterior operat ion. The patients were observed postoperatively for an average of 31 months (range 25-44 months) and evaluated both clinically and radiographically us ing the following parameters: spine anatomy and reconstruction, sagittal pr ofile, neurologic status, functional level, complications and status of art hrodesis. All patients but one (who died) achieved a solid arthrodesis base d on plain and flexion/extension roentgenograms. Cervical lordosis (skull-C 7) and cervicothoracic kyphosis (C7-T2) was improved by instrumentation tow ards a physiological lateral curve by an average of 33% (P<0.05) and 28% (P <0.05) respectively. Anterior vertebral olisthesis was reduced in the crani ocervical and cervicothoracic region, by 73% and 90% respectively. At final follow-up there was an improvement of the neurologic Frankel status by an average of 1.2 grades and of myelopathy in 75% of the operated patients. Go od to excellent functional results were seen in 77% of the operated patient s, while acute and chronic pain was reduced by an average of 2.4 grades, on a scale of 0-3, in operated patients. No neurovascular or pulmonary compli cations arose from surgery. There was no significant change in lateral spin e profile and olisthesis at the latest follow-up evaluation. There were no instrument-related failures. One patient requested hardware removal in the hope of reducing postoperative pain in the cervicothoracic region. The poor and fair results were related to the lack of improvement of neurologic imp airment and myelopathy. The results of this study demonstrate that cervical CCD instrumentation applied in the region of the skull to the upper thorac ic region for various disorders is a simple and safe instrumentation that r estores lateral spine alignment, improves the potential for a solid fusion and offers sufficient functional results in the vast majority of the operat ed patients. However, the use of hooks in spinal stenosis is contraindicate d.