Posterior cervical spine stabilization under local anesthesia

A technique is described for posterior cervical stabilization with spinous process wiring and fusion performed with the patient under local anesthesia and using corticocancellous demineralized bone matrix allograft. In patients with unstable cervical spines, posterior stabilization and fusion with local anesthesia allowed patient interaction with the surgeon during crucial parts of the operation. The technique was well tolerated and no untoward complications occurred. The technique has not been described for the neurologically intact patient with cervical spine trauma. The purpose of this report is to document the facility and advantages of this technique over traditional general anesthesia with autograft use. Nineteen patients were treated surgically at the author's institution. Local anesthesia was used in 12, and general anesthesia was used in 7. Allograft was used in 12 and autologous iliac crest graft was used in 7 patients. The indications for surgery were instability or neurologic deficit. Blood loss and operative times were favorable when compared with general anesthesia and autograft. The fusion extended by one level in 6 of 19 patients. One patient had preoperative neurologic deficit. All 19 follow-up patients were Frankel grade E. There is no need for endotracheal intubation, the patient serves as his or her own spinal cord monitor, and the surgeon is able to be aware immediately of any threat to neurological function. Demineralized bone matrix allograft has been shown to effectively induce osteogenesis by osteoinduction as well as osteoconduction. Its use eliminates the need for autograft harvesting and permits the use of local anesthesia alone for cervical spine posterior stabilization. The more neurologically intact the patient, the more this technique is indicated.