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Lvov I, Grin A, Talypov A, Smirnov V, Kordonskiy A, Barbakadze Z, Abdrafiev R, Krylov V. Efficacy and Safety of Goel-Harms Technique in Upper Cervical Spine Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 167:e1169-e1184. [PMID: 36089281 DOI: 10.1016/j.wneu.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development. METHODS A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate. RESULTS This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications. CONCLUSIONS The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.
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Affiliation(s)
- Ivan Lvov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.
| | - Andrey Grin
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Aleksandr Talypov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vladimir Smirnov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Anton Kordonskiy
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Zaali Barbakadze
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Rinat Abdrafiev
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vladimir Krylov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Niu G, Cheng J, Liu L, Li C, Zhou G, Chen H, Liu T, Nie H, Sun Z, Jiang W, Zhou Q, Zhao B, Zhu J, Yu R, Guo Y, Yang Y, Bai J. Individualized 3D printed navigation template-assisted atlantoaxial pedicle screws vs. free-hand screws for the treatment of upper cervical fractures. Front Surg 2022; 9:932296. [PMID: 36225218 PMCID: PMC9549244 DOI: 10.3389/fsurg.2022.932296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare the efficacy and safety of freehand atlantoaxial pedicle screws against custom 3D printed navigation template screws in the treatment of upper cervical fractures. Methods In our institution from 2010 to 2020, a retrospective cohort analysis of 23 patients with upper cervical fractures was done. These patients were separated into two groups: group A (N = 12), which received customized 3D printed navigation template-assisted screws with virtual reality techniques, and group B (N = 11), which received freehand screws assisted by intraoperative fluoroscopy. Every patient was monitored for more than 1 year. The two groups were contrasted in terms of screw implant accuracy, cervical spine Japanese Orthopaedic Association (JOA) score, American Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, surgical time, fluoroscopy times, and intraoperative blood loss. Results A total of 88 atlantoaxial pedicle screws in all, 46 in group A and 42 in group B, were implanted. In group A, the screw insertion accuracy rate was 95.7%, compared to 80.0% in group B (P < 0.05). When compared to group B, group A had shorter surgery times, less blood loss, fewer fluoroscopies, a higher short-term JOA score, and overt pain reduction (P < 0.05). However, there was no discernible difference between the two groups' VAS scores, long-term JOA scores, or ASIA scores (sensory and motor), at the most recent follow-up. Conclusion Individualized 3D printed guide leads to significant improvement in the screw safety, efficacy, and accuracy, which may be a promising strategy for the treatment of upper cervical fractures.
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Affiliation(s)
- Guoqi Niu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
| | - Jiawei Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Lutan Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Chao Li
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Gong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hui Chen
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Tao Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hu Nie
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Zheng Sun
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Weili Jiang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Qiankun Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Baoyin Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jun Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Ruochen Yu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yalong Guo
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yi Yang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jianzhong Bai
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
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Azimi P, Yazdanian T, Benzel EC, Aghaei HN, Azhari S, Sadeghi S, Montazeri A. Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:272. [PMID: 32690035 PMCID: PMC7372824 DOI: 10.1186/s13018-020-01798-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
Study design Systematic review and meta-analysis. Aim The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg’s test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran.
| | | | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hossein Nayeb Aghaei
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Shirzad Azhari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Ali Montazeri
- Population Health Research Group, Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Chen Q, Brahimaj BC, Khanna R, Kerolus MG, Tan LA, David BT, Fessler RG. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. JOURNAL OF SPINE SURGERY 2020; 6:164-180. [PMID: 32309655 DOI: 10.21037/jss.2020.03.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Posterior atlantoaxial fusion is an important surgical technique frequently used to treat various pathologies involving the cervical 1-2 joint. Since the beginning of the 20th century, various fusion techniques have been developed with improved safety profile, higher fusion rates, and superior clinical outcome. Despite the advancement of technology and surgical techniques, posterior C1-2 fusion is still a technically challenging procedure given the complex bony and neurovascular anatomy in the craniovertebral junction (CVJ). In addition, vascular anomalies in this region are not uncommon and can lead to devastating neurovascular complications if unrecognized. Thus, it is important for spine surgeons to be familiar with various posterior atlantoaxial fusion techniques along with a thorough knowledge of various vascular anomalies in the CVJ. Intimate knowledge of the various surgical techniques in combination with an appreciation for anatomical variances, allows the surgeon develop a customized surgical plan tailored to each patient's particular pathology and individual anatomy. In this article, we aim to provide a comprehensive review of existing posterior C1-2 fusion techniques along with a review of common vascular anomalies in the CVJ.
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Affiliation(s)
- Qi Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Lee A Tan
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
| | - Brian T David
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Buchmann N, Schweizer C, Kirschke JS, Rienmüller A, Gempt J, Ringel F, Meyer B, Ryang YM. C1–C2 posterior screw fixation in atlantoaxial fractures revisited: technical update based on 127 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1036-1042. [DOI: 10.1007/s00586-019-06244-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/13/2019] [Accepted: 11/28/2019] [Indexed: 11/28/2022]
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Serratrice N, Fievet L, Aulanier A, Pech Gourg G, Scavarda D, Fuentes S. C1–C2 type Harms internal fixation for unstable C2 fracture in a 6-year-old boy: Case report. Neurochirurgie 2019; 65:417-420. [DOI: 10.1016/j.neuchi.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
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A Modified Posterior C1/C2 Fusion Technique for the Management of Traumatic Odontoid Type II Fractures by Using Intraoperative Spinal Navigation: Midterm Results. J Orthop Trauma 2018; 32:e366-e371. [PMID: 29905624 DOI: 10.1097/bot.0000000000001241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess midterm safety and efficacy of a modified Goel-Harms technique for the treatment of odontoid instabilities. DESIGN Longitudinal prospective cohort study. SETTING Urban Level 1 Trauma Center in Southwest Germany. PATIENTS/PARTICIPANTS Orthopaedic and neurosurgical trauma patients older than 18 years admitted for ≤24 hours. MAIN OUTCOME MEASUREMENTS The outcome was evaluated with respect to neurological outcome, radiological outcome and surgical complications. For the functional assessment, the EQ-5D questionnaire was used. Furthermore, the Neck Disability Index and visual analog scale for neck pain were determined. A median follow-up of 39 months (range: 6-97 months) was given. RESULTS Of the total sample (n = 56), 26 patients with an acute traumatic odontoid fracture type II underwent posterior atlantoaxial instrumentation using spinal navigation. Neck pain evaluated with visual analog scale and Neck Disability Index showed a significant decrease at final follow-up compared to preoperative values (P < 0.05). According to the EQ-5D, the valuation of quality of life after C1/C2 fusion showed an excellent outcome with complete recovery in most cases (0.7-1). CONCLUSIONS Our results demonstrate satisfactory and maintained midterm clinical and radiological results after a median follow-up of 39 months. With the use of intraoperative spinal navigation, we demonstrate a modified C1/C2 posterior fusion technique, rendering accuracy, feasibility, and overall safety. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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8
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Herzog JP, Zarkadis NJ, Prabhakar G, Kusnezov NA. Biomechanical comparison of a novel C1 posterior U-construct with four other techniques in a C1-C2 fixation model. J Orthop 2018; 15:741-745. [PMID: 29881231 DOI: 10.1016/j.jor.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background Compare the biomechanical stability of a novel "U" posterior cervical fixation construct to four other posterior cervical atlantoaxial fixation constructs. Methods Eight fresh frozen human cadaver spines were tested after a simulated odontoid fracture, and following stabilization with each construct. Results All constructs significantly decreased flexion-extension and axial rotation compared to the destabilized spine. The U construct provided significantly more axial stability than the Brooks wire technique. Conclusion The novel U construct demonstrated comparable biomechanical stability to the existing constructs in all three planes of motion with the exception of axial rotation, in which it was inferior to TAS.
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Affiliation(s)
- Joshua P Herzog
- Orthopaedic Spine Center, Massachusetts General Hospital, Boston, MA, United States
| | - Nicholas J Zarkadis
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, United States
| | - Gautham Prabhakar
- Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, United States
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Ottenhausen M, Alalade AF, Rumalla K, Nair P, Baaj A, Hartl R, Kacker A, Greenfield JP, Anand VK, Schwartz TH. Quality of Life After Combined Endonasal Endoscopic Odontoidectomy and Posterior Suboccipital Decompression and Fusion. World Neurosurg 2018; 116:e571-e576. [PMID: 29775769 DOI: 10.1016/j.wneu.2018.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Basilar invagination can result from systemic diseases that can weaken structural integrity of the craniocervical junction. Definitive treatment often requires ventral decompression and posterior decompression and fusion. Endonasal odontoidectomy is a relatively new minimal access procedure; quality of life (QOL) after this procedure has not been reported. METHODS We reviewed a consecutive database of endonasal odontoidectomy cases and identified patients having posterior decompression and fusion. Two QOL questionnaires were administered postoperatively: Sino-Nasal Outcome Test and 36-Item Short Form Survey. Comparisons with other endonasal or Chiari procedures were performed. RESULTS The study comprised 14 patients; 79% had Chiari malformation in addition to basilar invagination. Mean follow-up was 17.2 months. Symptomatic improvement occurred in 78.6% after surgery. Average postoperative Sino-Nasal Outcome Test scores were 39.2 ± 17.93, with worst scores in areas related to fatigue and sleep patterns but not nasal function. 36-Item Short Form Survey scores were lower in areas of physical function and general health but better for emotional health and pain. Compared with patients undergoing Chiari malformation surgery without endonasal odontoid resection or fusion, patients undergoing odontoidectomy had higher QOL in areas of role emotional, emotional well-being, and pain but worse QOL in general health and role physical. CONCLUSIONS Patients undergoing posterior decompression and fusion with endonasal odontoidectomy do well after surgery with respect to nasal function and emotional health. Patients who also have severe basilar invagination associated with systemic diseases demonstrate reduced QOL after surgery in areas of physical function and sleep leading to fatigue, irritability, and concentration difficulty, likely related to their systemic disease.
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Affiliation(s)
- Malte Ottenhausen
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Andrew F Alalade
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Prakash Nair
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Ali Baaj
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Hartl
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA; Department of Neuroscience, Weill Cornell Medical School, New York Presbyterian Hospital, New York, New York, USA.
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Ishak B, Schneider T, Gimmy V, Unterberg AW, Kiening KL. Early Complications, Morbidity, and Mortality in Octogenarians and Nonagenarians Undergoing Posterior Intra-Operative Spinal Navigation-Based C1/2 Fusion for Type II Odontoid Process Fractures. J Neurotrauma 2017. [DOI: 10.1089/neu.2017.4968] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Schneider
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Valerie Gimmy
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Karl L. Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Maki S, Koda M, Iijima Y, Furuya T, Inada T, Kamiya K, Ota M, Saito J, Okawa A, Takahashi K, Yamazaki M. Medially-shifted rather than high-riding vertebral arteries preclude safe pedicle screw insertion. J Clin Neurosci 2016; 29:169-72. [DOI: 10.1016/j.jocn.2015.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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12
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Impact of Starting Point and C2 Nerve Status on the Safety and Accuracy of C1 Lateral Mass Screws. ACTA ACUST UNITED AC 2015; 28:171-85. [PMID: 23429321 DOI: 10.1097/bsd.0b013e3182898aa9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Du JY, Aichmair A, Kueper J, Wright T, Lebl DR. Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine 2015; 22:151-61. [DOI: 10.3171/2014.10.spine13805] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The unique and complex biomechanics of the atlantoaxial junction make the treatment of C1–2 instability a challenge. Several screw-based constructs have been developed for atlantoaxial fixation. The biomechanical properties of these constructs have been assessed in numerous cadaver studies. The purpose of this study was to systematically review the literature on the biomechanical stability achieved using various C1–2 screw constructs and to perform a meta-analysis of the available data.
METHODS
A systematic search of PubMed through July 1, 2013, was conducted using the following key words and Boolean operators: “atlanto [all fields]” AND “axial [all fields]” OR “C1–C2” AND “biomechanic.” Cadaveric studies on atlantoaxial fixation using screw constructs were included. Data were collected on instability models, fixation techniques, and range of motion (ROM). Forest plots were constructed to summarize the data and compare the biomechanical stability achieved.
RESULTS
Fifteen articles met the inclusion criteria. An average (± SD) of 7.4 ± 1.8 cadaveric specimens were used in each study (range 5–12). The most common injury models were odontoidectomy (53.3%) and cervical ligament transection (26.7%). The most common spinal motion segments potted for motion analysis were occiput–C4 (46.7%) and occiput–C3 (33.3%). Four screw constructs (C1 lateral mass–C2 pedicle screw [C1LM–C2PS], C1–2 transarticular screw [C1–C2TA], C1 lateral mass–C2 translaminar screw [C1LM-C2TL], and C1 lateral mass–C2 pars screw [C1LM–C2 pars]) were assessed for biomechanical stability in axial rotation, flexion/extension, and lateral bending, for a total of 12 analyses. The C1LM–C2TL construct did not achieve significant lateral bending stabilization (p = 0.70). All the other analyses showed significant stabilization (p < 0.001 for each analysis). Significant heterogeneity was found among the reported stabilities achieved in the analyses (p < 0.001; I2 > 80% for all significant analyses). The C1LM–C2 pars construct achieved significantly less axial rotation stability (average ROM 36.27° [95% CI 34.22°–38.33°]) than the 3 other constructs (p < 0.001; C1LM–C2PS average ROM 49.26° [95% CI 47.66°–50.87°], C1–C2TA average ROM 47.63° [95% CI 45.22°–50.04°], and C1LM–C2TL average ROM 53.26° [95% CI 49.91°–56.61°]) and significantly more flexion/extension stability (average ROM 13.45° [95% CI 10.53°–16.37°]) than the 3 other constructs (p < 0.001; C1LM–C2PS average ROM 9.02° [95% CI 8.25°–9.80°], C1–C2TA average ROM 7.39° [95% CI 5.60°–9.17°], and C1LM–C2TL average ROM 7.81° [95% CI 6.93°–8.69°]). The C1–C2TA (average ROM 5.49° [95% CI 3.89°–7.09°]) and C1LM–C2 pars (average ROM 4.21° [95% CI 2.19°–6.24°]) constructs achieved significantly more lateral bending stability than the other constructs (p < 0.001; C1LM–C2PS average ROM 1.51° [95% CI 1.23°–1.78°]; C1LM–C2TL average ROM −0.07° [95% CI −0.44° to 0.29°]).
CONCLUSIONS
Meta-analysis of the existing literature showed that all constructs provided significant stabilization in all axes of rotation, except for the C1LM–C2TL construct in lateral bending. There were significant differences in stabilization achieved in each axis of motion by the various screw constructs. These results underline the various strengths and weaknesses in biomechanical stabilization of different screw constructs. There was significant heterogeneity in the data reported across the studies. Standardized spinal motion segment configuration and injury models may provide more consistent and reliable results.
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Gautschi OP, Payer M, Corniola MV, Smoll NR, Schaller K, Tessitore E. Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management. Clin Neurol Neurosurg 2014; 123:131-5. [PMID: 25012025 DOI: 10.1016/j.clineuro.2014.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Magerl transarticular technique and the Harms-Goel C1 lateral mass-C2 isthmic screw technique are the two most commonly used surgical procedures to achieve fusion at C1-C2 level for atlanto-axial instability. Despite recent technological advances with an increased safety, several complications may still occur, including vascular lesions, neurological injuries, pain at the harvested bone graft site, infections, and metallic device failure. METHODS We retrospectively analyzed all patients (n=42 cases) undergoing a Harms-Goel C1-C2 fixation surgery with polyaxial C1 lateral mass screws and C2 isthmic screws at two different institutions between 2003 and 2012 and report clinical and radiological complications. One patient was lost to follow-up. The mean follow-up of the remaining 41 patients was 18.7 months (range 12-90). A clinically relevant complication was defined as a complication determining the onset of a new neurological deficit or requiring the need for a revision surgery. RESULTS A total of 14 complications occurred in 10 patients (24.4% of 41 patients). Greater occipital nerve neuralgia was evident in 4 patients (9.8%). All but one completely resolved at the end of the follow-up. Persistent neck pain was reported by 3 patients (7.3%), hypoesthesia by 1 patient (2.4%), and anesthesia in the C2 area on both sides in 1 patient (2.4%). Furthermore, a superficial, a deep, and a combined superficial and deep wound infection occurred in 1 patient each (2.4%). One patient (2.4%) had pain at the iliac bone graft donor site for several weeks with spontaneous resolution. A posterior progressive intestinal herniation through the iliac scar was seen in 1 case (2.4%), which required surgical repair. No vascular damages occurred. Altogether, 5/41 patients (12.2%) had a clinically relevant complication including 4 patients necessitating a revision surgery at the C1-C2 level (9.8%). CONCLUSIONS Atlanto-axial fixation surgery remains a challenging procedure because of the proximity of important neurovascular structures. Nevertheless, on the basis of our current experience, the C1 lateral mass-C2 isthmic screw technique appears to be safe with a low incidence of clinically relevant complications. Postoperative C2 neuralgia, as the most frequent problem, is due to surgical manipulation during preparation of the C1 screw entry point.
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Affiliation(s)
- O P Gautschi
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland.
| | - M Payer
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland; Neurosurgical Spine Unit, Hirslanden Klinik, Zurich, Switzerland
| | - M V Corniola
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
| | - N R Smoll
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland; Gippsland Medical School, Monash University, Victoria, Australia
| | - K Schaller
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
| | - E Tessitore
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
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Oh CH, Ji GY, Seo HS, Yoon SH, Hyun D, Park HC. Repeated complication following atlantoaxial fusion: a case report. KOREAN JOURNAL OF SPINE 2014; 11:7-11. [PMID: 24891865 PMCID: PMC4040632 DOI: 10.14245/kjs.2014.11.1.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Abstract
A patients with atlantoaixial instability and osodontoideum underwent atlantoaixial fusion (Harms and Melcher technique) with demineralized bone matrix. But, unfortunately, the both pedicle screws in C2 were fractured within 9 weeks follow-up periods after several suspected episode of neck hyper-flexion. Fractured screws were not contact to occipital bone in several imaging studies, but it could irritate the occipital bone when neck extension because the relatively close distance between the occipital bone and C1 posterior arch. The patient underwent revision operation with translaminar screw fixation with autologus iliac bone graft. Postsurgical course were uneventful except donor site pain, but the bony fusion was not satisfied after 4 months follow-up. The patient re-underwent revision operation in other hospital. Continuous complication after atlantoaixial fusion is rare, but the clinical course could be unlucky to patients. Postoperative immobilization could be important to prevent the unintended clinical course of patients.
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Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro TeunTeun Hospital, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Guro TeunTeun Hospital, Seoul, Korea
| | - Hyun Sung Seo
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Dongkeun Hyun
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Hyeong-Chun Park
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
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Li-jun L, Ying-chao H, Ming-jie Y, Jie P, Jun T, Dong-sheng Z. Biomechanical analysis of the longitudinal ligament of upper cervical spine in maintaining atlantoaxial stability. Spinal Cord 2014; 52:342-7. [DOI: 10.1038/sc.2014.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/07/2014] [Accepted: 01/13/2014] [Indexed: 11/09/2022]
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Ringel F, Villard J, Ryang YM, Meyer B. Navigation, robotics, and intraoperative imaging in spinal surgery. Adv Tech Stand Neurosurg 2014; 41:3-22. [PMID: 24309918 DOI: 10.1007/978-3-319-01830-0_1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Spinal navigation is a technique gaining increasing popularity. Different approaches as CT-based or intraoperative imaging-based navigation are available, requiring different methods of patient registration, bearing certain advantages and disadvantages. So far, a large number of studies assessed the accuracy of pedicle screw implantation in the cervical, thoracic, and lumbar spine, elucidating the advantages of image guidance. However, a clear proof of patient benefit is missing, so far. Spinal navigation is closely related to intraoperative 3D imaging providing an imaging dataset for navigational use and the opportunity for immediate intraoperative assessment of final screw position giving the option of immediate screw revision if necessary. Thus, postoperative imaging and a potential revision surgery for screw correction become dispensable.Different concept of spinal robotics as the DaVinci system and SpineAssist are under investigation.
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Affiliation(s)
- Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany,
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Atlantoaxial Fusion: Transarticular Screws versus Screw-Rod Constructs. World Neurosurg 2013; 80:516-7. [DOI: 10.1016/j.wneu.2012.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/09/2012] [Indexed: 12/13/2022]
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Riesenburger RI, Jones GA, Roguski M, Krishnaney AA. Risk to the vertebral artery during C-2 translaminar screw placement: a thin-cut computerized tomography angiogram-based morphometric analysis: clinical article. J Neurosurg Spine 2013; 19:217-21. [PMID: 23746092 DOI: 10.3171/2013.5.spine12790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to characterize the anatomy relevant to placement of crossing C-2 translaminar screws, including morphometric data, and to evaluate the risk of violating the vertebral artery (VA) during the screw placement. Placement of bilateral crossing C-2 translaminar screws has become an increasingly popular method for dorsal C-2 instrumentation as it is felt to avoid the known risk of VA injury associated with C1-2 transarticular screw fixation and C-1 lateral mass-C-2 pars screw fixation. METHODS The source images from 50 CT angiograms of the neck obtained from October to November 2007 were studied. Digital imaging software was used to measure lamina thickness and maximum screw length, perform angulation of screw trajectories in the axial plane, and evaluate the potential for VA injury. In cases where the VA could be injured, the distance between the maximal screw length and artery was measured. Logistic regression was performed to evaluate lamina width, axial angle, and screw length for predicting the potential for VA injury. RESULTS Mean lamina thickness, axial angle, and maximal screw length were determined for 100 laminae, and a potential for VA injury was noted in 55 laminae. The anatomically defined ideal screw length was longer in laminae with potential for VA injury than in laminae with no apparent risk (35.2 vs 33.6 mm, p = 0.0131). Only increasing optimal screw length was noted to be a statistically significant predictor of potential VA injury (p = 0.0159). The "buffer zone" (the distance between an optimally placed screw and the VA) was 5.6 ± 1.9 mm (mean ± SD, range 1.8-11.4 mm). A screw limited to 28 mm in length appeared to be safe in all laminae studied. CONCLUSIONS Crossing C-2 translaminar screws have been reported to be safe and effective. In addition to morphometric characteristics, the authors have found that screws placed in this trajectory could jeopardize the vertebral arteries in the foramen transversarium or the C1-2 interval. A C-2 translaminar screw limited to 28 mm in length appeared to be safe in all 100 screw trajectories studied in this series.
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Affiliation(s)
- Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
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Wang J, Xia H, Ying Q, Lu Y, Wu Z, Ai F, Ma X. An anatomic consideration of C2 vertebrae artery groove variation for individual screw implantation in axis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1547-52. [PMID: 23661034 PMCID: PMC3698349 DOI: 10.1007/s00586-013-2779-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/07/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To identify the variation of C2 vertebral artery groove (VAG) based on the thin-slice computed tomography (CT) scan and choose an individual screw placement method to decrease risk of malposition. BACKGROUND C2 pedicle screws can be successful anchors for a variety of cervical disorders. However, variations of VAG may cause malposition and breach when C2 transpedicle screw was inserted. Recognizing the variations of vertebrae artery groove (VAG) in C2 and choosing an individual screw placement method (transpedicle or translaminar) may be helpful for avoiding violation and decreasing the operation risk in upper cervical surgery. METHODS From January 2009 to December 2010, a total 45 patients with upper cervical disorders underwent 1-mm-thin-slice CT scans along the C2 pedicle direction to obtain the consecutive spectrum of C2 VAG were included in this study. The C2 VAG (types I, II, III, and IV) was subgrouped based on parameter e (the vertical distance from the apex of VAG to the upper facet joint surface) and parameter a (horizontal distance from the entrance of VAG to the vertebrae canal). Subsequently, individual strategy was used to avoid the VAG violation. RESULTS The variations of C2 VAG in these 45 patients include the following: type I 53 (58.9%), type II 16 (17.8%) type III 13 (14.4%), and type IV 8 (8.9%). Transpedicle screws of C2 were used in types I, III, and IV VAGs (n = 74); translaminar screws were inserted in type II subgroup (n = 16). Postoperative CT scans showed that there were two pedicle screws violated into the artery groove, and no translaminar screw breached into the vertebrae canal. All the other screws were in right position. None of the 45 patients had severe complications such as spinal cord injury, dura tear, and infection. CONCLUSION Thin-slice CT scan along the C2 pedicle direction to analysis the variations of C2 VAG can help choose an individual screw placement method (transpedicle or translaminar) with minimal complication for C2 screw fixation.
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Affiliation(s)
- Janhua Wang
- Department of Orthopaedic Surgery, Liu Hua Qiao Hospital (General Military Hospital of Guangzhou Command), 111 Liuhua Road, Yuexiu District, 510010 Guangzhou, China.
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Kantelhardt SR, Keric N, Giese A. Management of C2 fractures using Iso-C(3D) guidance: a single institution's experience. Acta Neurochir (Wien) 2012; 154:1781-7. [PMID: 22790839 DOI: 10.1007/s00701-012-1443-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND About 20 % of cervical fractures involve the C2 vertebra. Many surgical techniques have been proposed according to the type of fracture. However, morbidity and mortality of these procedures is often high, which can be attributed to the old age and significant co-morbidities of the affected population and the complex anatomy of C2. To target the latter, several authors have applied iso-C(3D) guidance for most of the common techniques. We here present our experience using a fixed protocol and iso-C(3D) guidance in all cases of traumatic C2 fractures. METHODS Sixteen patients were operated upon between April 2011 and April 2012 using Iso-C(3D) guidance, following a fixed routine protocol. The screw position was verified by CT-scanning. Intraoperative and clinical parameters were evaluated. RESULTS Six patients received anterior lag-screw fixation of odontoid fractures. Two underwent isolated posterior lag-screw fixation of hangman's fracture. C1 and/or C3 lateral mass, and/or C2 isthmic screws were placed in eight patients. No screw had to be revised, 3 minor breachings of the cortical bone of <2 mm were observed.The same standard protocol for draping, registration of the navigation and Iso-C(3D) guided drilling could be applied for anterior and posterior procedures, leaving only two variables. This led to rapid acceptance of the technique among OR-staff and surgeons, who felt comfortable with iso-C(3D) guidance after only five cases. CONCLUSIONS Iso-C(3D) guidance is a safe and straightforward technique for anterior and posterior screw placement in the upper cervical spine.
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