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Papers by Scott Meyer
World Neurosurgery, 2016
Cervical approaches to the dens are limited by the presence of several structures, including the ... more Cervical approaches to the dens are limited by the presence of several structures, including the spinal cord, vertebral arteries, C1 articular pillars, and C2 nerves. Surgical approaches to access the high anterior cervical spine classically encompass the extended anterior retropharyngeal route, transoral route, and extreme lateral route, each of which has its own pattern of morbidity or complications. Percutaneous procedures to drain infections in this area have a limited yield. Osteomyelitis of the dens is a rare but serious condition that is associated with significant mortality. Patients with cervical osteomyelitis and epidural abscess are likely to have significant coexistent medical comorbidities and are often poor candidates for extensive surgical procedures. A minimally invasive approach that gives access to the entire odontoid process would allow for more aggressive treatments and potentially even a complete odontoidectomy without resection of the C1 anterior arch. We describe a minimally invasive approach to drainage and debridement of an atlantoaxial epidural abscess and osteomyelitis. Using minimally invasive techniques from a posterolateral trajectory in a cadaveric specimen, we were able to safely access the anterior epidural space, odontoid, and retropharynx. We then performed this approach in our patient who was unable to tolerate a large surgical procedure. We developed, tested, and then applied a minimally invasive approach that combined tubular retractors with positioning of the head and neck to optimize the exposure in a patient with a complex abscess that involved the ventral epidural space, odontoid process, and retropharyngeal space. The abscesses were successfully drained along with local tissue debridement without complication. A posterolateral minimally invasive approach is a safe alternative in patients with an atlantoaxial epidural abscess, odontoid osteomyelitis, or retropharyngeal abscess with significant medical comorbidities who are unlikely to tolerate a more extensive surgery. It can also be used for resections of lesions of an oncologic nature and could even be used to resect pannus or os odontoideum, without necessitating an anterior approach or resection even of the C1 arch.
Seminars in Spine Surgery, 2012
Cervical arthroplasty was developed and is used to preserve segmental motion of the cervical spin... more Cervical arthroplasty was developed and is used to preserve segmental motion of the cervical spine for selected patients who require cervical diskectomy. There are now 3 cervical arthroplasty devices available for use in the United States. The data from the PRESTIGE ST US Food and Drug Administration Investigational Device Exemption trial and the relevant literature published on cervical arthroplasty devices were reviewed. The history of development, current clinical outcomes reports, and adverse events reports are summarized. Cervical arthroplasty is a safe and effective option for patients with single-level cervical disk disease with radiculopathy, who have normal facets. The appropriate inclusion and exclusion criteria for cervical arthroplasty from the US Food and Drug Administration trials must not be overlooked. Appropriate surgical technique will help optimize patient outcomes. Semin Spine Surg 24:14-19
World Neurosurgery, 2016
Cervical approaches to the dens are limited by the presence of several structures, including the ... more Cervical approaches to the dens are limited by the presence of several structures, including the spinal cord, vertebral arteries, C1 articular pillars, and C2 nerves. Surgical approaches to access the high anterior cervical spine classically encompass the extended anterior retropharyngeal route, transoral route, and extreme lateral route, each of which has its own pattern of morbidity or complications. Percutaneous procedures to drain infections in this area have a limited yield. Osteomyelitis of the dens is a rare but serious condition that is associated with significant mortality. Patients with cervical osteomyelitis and epidural abscess are likely to have significant coexistent medical comorbidities and are often poor candidates for extensive surgical procedures. A minimally invasive approach that gives access to the entire odontoid process would allow for more aggressive treatments and potentially even a complete odontoidectomy without resection of the C1 anterior arch. We describe a minimally invasive approach to drainage and debridement of an atlantoaxial epidural abscess and osteomyelitis. Using minimally invasive techniques from a posterolateral trajectory in a cadaveric specimen, we were able to safely access the anterior epidural space, odontoid, and retropharynx. We then performed this approach in our patient who was unable to tolerate a large surgical procedure. We developed, tested, and then applied a minimally invasive approach that combined tubular retractors with positioning of the head and neck to optimize the exposure in a patient with a complex abscess that involved the ventral epidural space, odontoid process, and retropharyngeal space. The abscesses were successfully drained along with local tissue debridement without complication. A posterolateral minimally invasive approach is a safe alternative in patients with an atlantoaxial epidural abscess, odontoid osteomyelitis, or retropharyngeal abscess with significant medical comorbidities who are unlikely to tolerate a more extensive surgery. It can also be used for resections of lesions of an oncologic nature and could even be used to resect pannus or os odontoideum, without necessitating an anterior approach or resection even of the C1 arch.
Seminars in Spine Surgery, 2012
Cervical arthroplasty was developed and is used to preserve segmental motion of the cervical spin... more Cervical arthroplasty was developed and is used to preserve segmental motion of the cervical spine for selected patients who require cervical diskectomy. There are now 3 cervical arthroplasty devices available for use in the United States. The data from the PRESTIGE ST US Food and Drug Administration Investigational Device Exemption trial and the relevant literature published on cervical arthroplasty devices were reviewed. The history of development, current clinical outcomes reports, and adverse events reports are summarized. Cervical arthroplasty is a safe and effective option for patients with single-level cervical disk disease with radiculopathy, who have normal facets. The appropriate inclusion and exclusion criteria for cervical arthroplasty from the US Food and Drug Administration trials must not be overlooked. Appropriate surgical technique will help optimize patient outcomes. Semin Spine Surg 24:14-19