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72

Takachika Shimizu

Purpose

Prerequisites

Segmental spinal instrumentation with sublaminar wiring has been utilized for deformity surgery in thoracic-lumbar region [1]. And, this technique has also been used for cervical fixation [2–4]. Lateral mass screws and/or pedicle screws are used as cervical anchors in cervical spinal instrumentation surgery in recent years, and sublaminar wiring is losing popularity to be used. This “old-fashioned” anchoring technique still has significant role especially in fragile bone cases [3, 4] and is useful in long instrumentation with combined use of other anchors, e.g., lateral mass/pedicle screws [4]. The author would like to show how to reduce the risk of spinal cord compression by sublaminar wiring and make spine surgeons become aware of its clinical usefulness (Table 72.1).

The vertebrae in which sublaminar wiring is planned to be done must have enough space for wire passage between lamina and spinal cord. Because of unexpected epidural adhesion, sublaminar wiring is to be avoided in the vertebrae with previous surgery. In the deformed cases, preoperative realignment with or without traction is recommended, because this surgical procedure has potential risk to neural damage and should be used only after adequate reduction.

Electronic Supplementary Material  The online version of this chapter (https://doi.org/10.1007/978-3-319-934327_72) contains supplementary material, which is available to authorized users. T. Shimizu (*) Department of Orthopaedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan e-mail: [email protected]

 urgical Planning and Preoperative S Preparation For the purpose of safe wire passage, dorsal extradural space should be examined precisely prior to surgery. Spinal canal size is roughly recognized by plain lateral radiograph. Sagittal reconstruction and axial section of MRI/CT myelogram are quite useful to know the spinal canal size and its pathological condition. CT angiogram of vertebral arteries (VA) is needed in cases of C1–C2 fixation using sublaminar wire. In case with abnormal VA that locates in dorsal epidural space between C1 and C2, we should take care not to injure the VA by passing sublaminar wires. Multilevel sublaminar wires/bands wrapped around rods are to form a nonrigid construct but create sagittal realignment by their

© Springer Nature Switzerland AG 2019 H. Koller, Y. Robinson (eds.), Cervical Spine Surgery: Standard and Advanced Techniques, https://doi.org/10.1007/978-3-319-93432-7_72

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Table 72.1  Pitfalls and complications Main complication and risks (%) Spinal cord damage (the author’s personal data: no case in the past 30 years) Lamina cut by wires

translational force. On the other hand, vertical realignment cannot be realized by this type of construct. We should take these biomechanical features into consideration in surgical planning.

Patient Positioning The patient is placed in the prone position with skull tong device. The so-called military tuck position is generally