What are the pitfalls and complications of a cervical osteotomy

Potential pitfalls include osteotomy at the wrong level. If osteotomy is performed proximal to C7, injury to the vertebral arteries may occur. If osteotomy is performed below C7-T1, little or no correction is obtained. Radiographic confirmation is always necessary to prevent this pitfall. Other pitfalls include inadequate or excessive removal of bone, resulting in too little or too great correction.

Neurologic injuries may occur. The dura may infold in the region of the osteotomy and result in kinking of the spinal cord. If this problem is noted, the dura can be carefully opened to relieve compression. Most C8 nerve root problems resolve as long as they are partial. Some postoperative distraction through the halo vest can be carried out if C8 nerve root compression is noted.

Other potential complications include air embolism because surgery is performed in the sitting position. A Doppler monitor with sound amplification is fixed to the patient's chest preoperatively and monitored during the procedure. To prevent embolus, the wound should be filled with irrigation fluid and wet sponges.

Figure 69-6. Outline of area of bony resection for a cervical osteotomy. The lines of resection of the laterally fused facet joints are beveled slightly away from each other, extending posteriorly so that the two surfaces will be parallel and in apposition following correction. The pedicles must be undercut to avoid impingement on the C8 nerve roots. The midline resection is beveled on its deep surface above and below to avoid impingement against the dura following extension correction. (From Simmons ED Jr, Simmons EH. Ankylosing spondylitis. Spine State Art Rev 1994;8:589-604, with permission.)

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