(LITTLE ROCK, AR) - The cover for the premier issue of the Journal of Neurosurgery:Spine, features an innovative technique to reconnect the head to the neck. Following a serious accident or illness, reattaching the head to the neck has always been a major challenge for surgeons. Arkansas neurosurgeon Dr. T. Glenn Pait's "Inside-Outside" technique can help people with such life-threatening spinal problems.
During a typical hour, your head and neck will move together hundreds of times. When the head and neck are no longer attached to each other, the spinal cord can become pinched or damaged as movement occurs. The patient can become totally paralyzed. And in certain situations, like Christopher Reeves, people will be on a breathing machine or ventilator for the rest of their days.
The back of the skull is very thin and often does not have the needed amount of bone for insertion of devices such as screws and wires onto which metal rods or plates are attached, Pait said. "Using screws or wires placed from the outside of the skull to the inside often does not bring about the needed stability for a bone graft to grow and mature into a solid bony construct between the skull and bones of the neck."
To stabilize and strengthen the thin skull bone, which must support the bone graft, Pait developed the Inside-Outside technique. He said, "A keyway is made into the base of the skull. This is the same type of keyway that is used in woodworking. A special flat-headed screw or stud is placed through a hole in the skull so that the head of the screw is inside the skull and the threads of the screw face to the outside. A special reconstruction bone plate is then secured with special nuts to the screw. This bone reconstruction plate is then attached to the bones in the neck."
Over a two-year period of time, 20 individuals benefited from this operation. Eight children and 12 adults have undergone the inside-to-outside technique. At the time of their surgery, their ages ranged from 4 to 81 years. These patients had problems resulting from accidents, tumors, cancer, congenital abnormalities, and rheumatoid arthritis. Dr. Ossama Al-Mefty , chairman of neurosurgery and an internationally recognized skull base surgeon, and Pait work closely together to reunite the skull and spine after tumor removal.
Pait said, "This technique offers several advantages over the other current techniques for affixing the head to the neck. Screws are no longer placed in a blind fashion. The surgeon can see where they are going. The inside-outside screw also is much stronger than the other techniques. Recent laboratory testing has shown that it is about three times stronger than any techniques where you screw or wire from the outside to the inside."
This new technique, which was developed at the University of Arkansas for Medical Sciences, is now being used at other institutions, Pait said. "Any stabilization technique, whether it be in medicine or in the world of construction, should be simple and safe. The instrumentation should be designed to prevent injury to nearby structures while providing maximum stabilization and promotion a sold long-term bone fusion. This new technique of using the inside-outside method fulfills these demands."
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Media contact: Bonnie Brandsgaard 501-686-8013, [email protected]
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