Recent Advances in Spine Surgery

Managing cervical spine fractures and disk lesions was difficult before the development of safe treatment methods. Surgeons mainly used traction, plaster casts, and braces, avoiding surgery whenever they could. Stabilizing abnormal spinal segments was not commonly practiced, and inaccessible areas posed challenges for treating infections and tumors.

Although surgical advancements have enhanced treatment options, traditional methods still have a role. The paper seeks to describe current approaches, leaving their effectiveness to be assessed in the future. Surgeons must consider their skills and the circumstances to determine the optimal approach for each patient.

Benefits of Internal Stabilization for Dislocations, Fractures, and Fracture-Dislocations of the Cervical Spine

The conservative approach to managing cervical spine fractures often neglects patients with unstable spines who haven’t yet experienced cord or root injury. It also fails to address the issue of cervical root pain. Torn ligaments are generally weaker, increasing the risk of late subluxation.

Protecting patients from additional cord injury is crucial, even if most fractures eventually stabilize. Identifying unstable ligaments through X-rays is challenging, and determining the appropriate time to remove protective measures poses a difficult decision.

Potential mechanical instability arises following dislocation, fractures, or fracture-dislocations in the cervical spine, posing risks to important structures. To address this, it is both sensible and safe to internally stabilize the affected spinal segments using wires and bone grafts after precise reduction.

This approach safeguards the spinal cord by establishing stability through the use of stabilized bone. Neglecting to treat unreduced or unstable injuries and persistent root pains is not advisable.

However, it is crucial to assess each case individually and contemplate surgical interventions that restrict head and neck movements based on specific indications. Collaborative efforts between neurologic and orthopedic surgeons can yield improved outcomes when managing these intricate concerns.

Management of Fractures and Dislocations in the Cervical Spine

Handling the Patient

The physician in charge takes great caution when dealing with a patient suspected of having a cervical spine injury, as the precise level of instability is unknown. Before conducting radiographic examinations, the patient’s head is supported with five to ten pounds of head-halter traction, a brace, or other external support in a neutral position.

If there are clear indications of spinal cord damage, skull tongs should be promptly applied under local anesthesia. Traction should be applied straight, at approximately 10 to 15 pounds, until X-rays are obtained.


When dealing with a patient in the emergency room, it is of utmost importance to minimize their movement while obtaining X-rays (roentgenograms). The responsible physician must carefully maintain the alignment of the head and body during the imaging process. To ensure accurate visualization of the vertebrae, it is necessary to obtain clear anteroposterior, lateral, oblique, and open mouth views.

Typically, this can be achieved by positioning the patient’s upper extremities alongside their body, applying gentle traction, and exerting straight traction on the head to bring the shoulders downward.

Mechanism of Injuries

By meticulously assessing the patient’s medical background, scrutinizing head injuries, and examining X-ray results, it becomes feasible to ascertain the precise mechanism of injury and discern the ligaments that have been impacted. Evidently, anterior compression fractures and dislocations manifest themselves more prominently, whereas hyperextension injuries may be less visibly discernible.

Flexion injuries commonly exhibit anterior fragmentation and compression, while vertical and extension injuries tend to result in lateral mass fragmentation and alterations in the angles of the affected facets, which can occasionally resemble flexion injuries.

Skeletal Traction

In situations of uncertainty, employing skull traction is a beneficial approach to safeguard the spinal cord. The use of tongs is warranted for fractures, dislocations, or destructive lesions that result in angulation or subluxation of the cervical vertebrae, particularly when spinal cord or root damage is present.

The application of tongs can be conveniently performed under local anesthesia, without the need for patient movement. To ensure a sterile environment, the tongs can be securely maintained in position for an extended duration. Managing patients in skull traction is best accomplished using turning beds, as they allow for more convenient care.

In cases of flexion fractures accompanied by bilateral facet dislocations, disengagement typically necessitates 25 to 40 pounds of traction, followed by reduction using a lighter traction force. For extension, hyperextension, and vertical injuries, 20 pounds of straight traction often proves sufficient for reduction, with a subsequent reduction to 10 pounds for maintenance purposes.

Open Reduction and Fusion without Laminectomy

Reducing unilateral facet dislocation, which involves a combination of flexion and rotation, proves challenging when employing skull traction and can go unnoticed without clear oblique views.

Early implementation of the Rogers’ method for open reduction is recommended, especially in cases with noticeable severe root pain. If reduction is successful and there is improvement in neurological signs without any spinal fluid blockage, a nonoperative approach becomes a feasible choice. Sustaining traction until reaching maximum improvement permits subsequent stabilization through the application of a head-body cast.

Employing internal fixation using the Rogers’ method offers various advantages, such as decreased deformity, alleviated pressure on the spinal cord and nerve roots, earlier recovery of mobility, and improved safeguarding of the spinal cord and related structures.

Post-reduction and Laminectomy Stabilization

When reduction is unsuccessful and symptoms persist, including nerve root pain, lack of spinal cord recovery, worsening spinal cord signs, or quadriplegia, a nonoperative approach provides minimal prospects for patient improvement. Laminectomy, open reduction, and internal stabilization are the preferred choices when they can be performed.

Internal stabilization enhances nursing care by alleviating traction on nerve roots and permits earlier removal of external support, thereby uplifting psychological well-being. Internal stabilization diminishes the risk of subluxation and additional spinal cord damage. Although there may be a possibility of increased mortality among operated quadriplegics, the advantages of this approach outweigh the potential risks.

Occipitocervical Fusion

Fractures affecting the odontoid process commonly exhibit suboptimal healing and are susceptible to effortless shifting, leading to a significant likelihood of neurological complications.

Although the use of traction can aid in reducing the injury, there is a higher probability of subsequent dislocation in comparison to injuries that require less uncomplicated reduction. Occipitocervical fusion is necessary for tumors in specific instances. Forsythe noted that incorporating C-3 into the fusion procedure improves the stability of occipital fractures.

Anterior Cervical Fusion

Over the past two decades, a range of established procedures have emerged to tackle pain and neural issues associated with cervical vertebrae conditions. These encompass foramenotomy or posterior unroofing for root pain caused by cervical disk protrusion, laminectomy and dentate ligament sectioning for spinal cord compression, and posterior fusion for pain arising from neck instability.

Additionally, anterior cervical fusion is a common procedure for patients experiencing neck pain, radiating symptoms, and signs of disk degeneration. Optimal results have been noted in cases confined to one or two segments of the lower cervical vertebrae.

The procedure is performed under general anesthesia with endotracheal intubation. An incision is made above the left clavicle to reach the cervical vertebrae. Lumbar puncture needles are used to evaluate the condition of the affected disk spaces.

Degenerated material is removed and a graft from the iliac crest is inserted to repair the disks. The incision is closed, and the patient is kept in a supine position for 24 hours. Ambulation is allowed after 48 hours, and a cervical brace is worn for three months. Complications are infrequent and can be prevented with meticulous surgical technique.

Anterior Cervical Spine Biopsy, Excision Of Spurs, And Curettage

Access to the entire cervical vertebrae is achievable through the longitudinal incision technique described. This approach allows for various procedures such as cleaning infections, excising tumors, and performing drainage. Excision of localized tumors in the C1 and C2 vertebrae can be conducted via the pharynx. Removing spurs can provide relief from dysphagia caused by cricopharyngeus interference.

Thorough examination and imaging are vital for confirming the association between the spur and swallowing difficulties. Effective management necessitates collaboration among otolaryngologists, radiologists, and orthopedic surgeons.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.