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Sasapardhi SB, Verma PK, Srivastava AK, Das KK, Kumar A, Dikshit P, Maurya VP, Bhaisora KS, Mehrotra A, Jaiswal AK, Mishra P, Behari S, Kumar R, Mishra H, Shahare K. An institutional study on accuracy of freehand cervical C1 C2 screws placement by knock and drill technique in craniovertebral anomalous bony anatomy: An evaluation of more than 600 screws based on SGPGI screw accuracy criteria. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:83-91. [PMID: 38644916 PMCID: PMC11029100 DOI: 10.4103/jcvjs.jcvjs_116_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To assess the accuracy of freehand cervical C1 C2 screws placement by knock and drill (K and D) technique in craniovertebral anomalous bony anatomy. Materials and Methods From January 2017 to December 2022, 682 consecutive C1 C2 screws in 215 patients with craniovertebral junction (CVJ) anomalies were enrolled. All patients underwent posterior fixation with K and D technique without any fluoroscopic guidance. The patient's demographic details, clinical details, radiological details, major intraoperative events, and postoperative complications were noted. The screws malposition grades and direction on CT images in the axial and sagittal plane were defined as new per proposed "SGPGI accuracy criteria." All patients had a clinical evaluation at 3-month follow-up. Results Total 682 C1, C2 screws were placed in 215 patients for CVJ anomalies using K and D technique. The accuracy of screws placement by freehand technique was 84.46% (576/682). So with technique explained the rate of malplacement in simple (16.35%) and complex (15.19%) groups were almost comparable and comparison difference was not significant (P = 0.7005). Conclusion The freehand technique, as described, is effective in cases of anomalous bony anatomy, and it is mandatory in complex CVJ anomalies. The accuracy of screw placement and VA injury is comparable with major studies. This technique is supposedly cost-effective and less hazardous to both health-care workers and patients.
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Affiliation(s)
- Sudhir Bisan Sasapardhi
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harshit Mishra
- Department of Neuroanesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kalyani Shahare
- Department of Neuroanesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Xiao Y, Wang B, Chen Y, Chen L, Lou Z, Gong Z. Risk Factors of Postoperative Cerebrospinal Fluid Leak After Craniovertebral Junction Anomalies Surgery: A Case-Control Study. Neurospine 2023; 20:255-264. [PMID: 37016872 PMCID: PMC10080451 DOI: 10.14245/ns.2244772.386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/05/2022] [Indexed: 04/03/2023] Open
Abstract
Objective: To identify potential risk factors for cerebrospinal fluid (CSF) leakage after craniovertebral junction (CVJ) anomaly surgery and to provide a reference for clinical practice.Methods: Sixty-six patients who underwent elective CVJ anomaly surgery during a 6-year period (April 2013 to September 2019) were retrospectively included. Research data were collected from the patients’ medical records and imaging systems. Patients were divided into CSF leak and no CSF leak groups. Univariate tests were performed to identify potential risk factors. For statistically significant variables in the univariate tests, a logistic regression test was used to identify independent risk factors for CSF leakage.Results: The overall prevalence of CSF leakage was 13.64%. Univariate tests showed that a basion-dental interval (BDI) > 10 mm and occipitalized atlas had significant intergroup differences (p < 0.05). Multivariate analysis indicated that a BDI > 10 mm was an independent risk factor for CSF leakage, and patients with CVJ anomalies with a BDI > 10 mm were more likely to have postoperative CSF leaks (odds ratio, 14.67; 95% confidence interval, 1.48–30.88; p = 0.004).Conclusion: It is necessary to maintain vigilance during CVJ anomaly surgery in patients with a preoperative BDI > 10 mm to avoid postoperative CSF leaks.
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Affiliation(s)
- Yu Xiao
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bing Wang
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Corresponding Author Bing Wang Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China
| | - Yulian Chen
- Department of ENT, The First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lingqiang Chen
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhenkai Lou
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiqiang Gong
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Sardhara J, Behari S. Reply to Commentary on "A Universal Craniometric Index for Establishing the Diagnosis of Basilar Invagination". Neurospine 2021; 18:646-647. [PMID: 34610697 PMCID: PMC8497262 DOI: 10.14245/ns.2142516.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, India
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Goyal N, Bali S, Ahuja K, Chaudhary S, Barik S, Kandwal P. Posterior Arthrodesis of Atlantoaxial Joint in Congenital Atlantoaxial Instability Under 5 Years of Age: A Systematic Review. J Pediatr Neurosci 2021; 16:97-105. [PMID: 35018176 PMCID: PMC8706584 DOI: 10.4103/jpn.jpn_270_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shivkumar Bali
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sunny Chaudhary
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sardhara J, Singh S, Srivastava A, Behari S. Anomalous craniovertebral junction (CVJ) anomalies in pediatric population: Impact of digital three-dimensional animated models in enhancing the surgical decision-making. J Pediatr Neurosci 2021; 16:175-181. [PMID: 36160613 PMCID: PMC9496608 DOI: 10.4103/jpn.jpn_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/29/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022] Open
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Singh S, Sardhara J, Raiyani V, Saxena D, Kumar A, Bhaisora KS, Das KK, Mehrotra A, Srivastava AK, Behari S. Craniovertebral junction instability in Larsen syndrome: An institutional series and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:276-286. [PMID: 33824557 PMCID: PMC8019120 DOI: 10.4103/jcvjs.jcvjs_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Larsen syndrome (LS) is characterized by osteo-chondrodysplasia, multiple joint dislocations, and craniofacial abnormalities. Symptomatic myelopathy is attributed to C1-C2 instability and sub-axial cervical kyphosis. In this article, we have analyzed the surgical outcome after posterior fixation in LS with craniovertebral junction instability. Methods Ten symptomatic pediatric patients, operated between 2011 and 2019, were included, and the clinical outcome was assessed by Nurick grade, neurological improvement, and complications. The requirement of anti-spasticity drugs, the degree of bony fusion, and restriction of neck movement were also noted. At last follow-up, patient satisfaction score (PSS) and back to school status were studied. We also reviewed the literature and categorized two types of presentation of reported LS patients and discussed the pattern of disease progression among both. Results Ten patients, age range 1.5-16 years, underwent 12 surgeries (6 C1-C2 fixation, 4 long-segment posterior cervical fixation, and 2 trans-oral decompressions as the second stage); the mean follow-up was 23 (range, 6-86 months). All the ten patients in our study had the characteristic "dish-" like face and nine patients had acral anomalies. The median Nurick grade improved from preoperative (median = 4) to follow-up (median = 3). The requirement of anti-spasticity drugs decreased in seven patients and the neck-pain improved in nine patients. The median satisfaction at follow-up was good (median PSS = 2); five patients were going back to school. Conclusion Craniovertebral junction instability in LS is rare and surgically challenging. Early posterior fixation showed a promising outcome with a halt in the disease progression.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vandan Raiyani
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepti Saxena
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Deora H, Singh S, Sardhara J, Behari S. A 360-Degree Surgical Approach for Correction of Cervical Kyphosis and Atlantoaxial Dislocation in the Case of Larsen Syndrome. J Neurosci Rural Pract 2020; 11:196-201. [PMID: 32140028 PMCID: PMC7055606 DOI: 10.1055/s-0039-3402624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Larsen syndrome is chronic debilitating disease that presents with multiple joint dislocations and severely affects the cervical spine in the form of cervical kyphosis and atlantoaxial dislocation. Children usually present in early with a myriad of deficits, compressive myelopathy being the most common. In addition to a bony compression, there is sometimes a soft tissue component, which is seldom addressed. We present here a case of atlantoaxial dislocation with cervical kyphosis due to Larsen syndrome, and along with our previous experience on syndromic atlantoaxial dislocations, we try to define an algorithm for the treatment approach of these onerous challenges. The importance of early intervention is also emphasized with a literature review of similar cases. In addition to the obvious physical damage, early intervention can also avoid the more sinister socioeconomic face of this debilitating disease.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sardhara J, Behari S, Sindgikar P, Srivastava AK, Mehrotra A, Das KK, Bhaisora KS, Sahu RN, Jaiswal AK. Evaluating Atlantoaxial Dislocation Based on Cartesian Coordinates: Proposing a New Definition and Its Impact on Assessment of Congenital Torticollis. Neurosurgery 2019; 82:525-540. [PMID: 28472514 DOI: 10.1093/neuros/nyx196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Conventional 2-dimensional (2-D) definition of atlantoaxial dislocation (AAD) is inadequate for coexisting 3-D displacements. OBJECTIVE To prospectively classify AAD and its related abnormalities along 3 Cartesian coordinates and assess their association with torticollis. METHODS One hundred and fifty-four patients with congenital AAD were prospectively classified according to their C1-2 displacement along 3 Cartesian coordinates utilizing 3-D multiplanar CT. The impact of this 3-D dislocation on occurrence of clinically manifest torticollis was also evaluated and surgical treatment was planned. RESULTS Three dimensional CT assessment detected the following types of C1-2 dislocations: I:translational dislocation (along Z coordinate, n = 37 [24%]); II: central dislocation (along Y coordinate, n = 10 [6.5%]); III: translational+central dislocation (along Z+Y coordinates, n = 42 [27.3%]); IV: translational dislocation+ rotational dislocation+coronal tilt (along Z+X coordinates, (n = 6 [3.9%]); V: central dislocation (basilar invagination)+rotational dislocation+coronal tilt (along Y+X coordinates, n = 11 [7.1%]); VI: translational dislocation+ central dislocation+ rotational dislocation+ coronal tilt (along all 3 axes, n = 48 [31%]). Assessing degree of relative C1-2 rotation revealed that 27 (37%) of 85 patients with <50 rotation and 54 (78%) of 69 patients with >5° rotation had associated torticollis. Translational dislocation had negative association (odds ratio [OR] 0.1, 95% confidence interval [CI; 0.47-0.32], P = .00), while type VI (OR 5.0, 95% CI [2.2-11.19], P = .00), type V (OR 4.44, 95% CI [0.93-21.26], P = .04), and type IV (OR 1.84, 95% CI [0.32-10.38], P = .48) dislocations had strong positive association with torticollis. Sixty-two (40%) patients improved, 68 (44%) remained unchanged, and 24 (16%) patients worsened postoperatively. Twenty-eight patients required second-stage transoral decompression following posterior distraction-fusion due to neurological nonimprovement. CONCLUSION Three-dimensional assessment of AAD including evaluation of culpable C1-2 facet joints addresses anomalous displacements in 3 Cartesian planes. This provides targets for adequate cervicomedullary decompression-stabilization, and helps in the management of accompanying torticollis.
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Affiliation(s)
- Jayesh Sardhara
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pavaman Sindgikar
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rabi N Sahu
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadhesh K Jaiswal
- Department of Neurosurgery, Sanjay Ga-ndhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Muthukumar N. Problems in Instrumentation of Syndromic Craniovertebral Junction Anomalies - Case Reports. Neurospine 2019; 16:277-285. [PMID: 31261467 PMCID: PMC6603826 DOI: 10.14245/ns.1938176.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to highlight the complications of instrumentation in the setting of syndromic craniovertebral junction (CVJ) anomalies. The records of patients with syndromic CVJ anomalies treated by this author during the period of 2012-2017 were retrospectively reviewed. Patients in whom intraoperative difficulties and complications were encountered were culled out from the database. Complications were divided into (1) technique related, (2) neural injury, (3) vascular injury, (4) instrumentation pull out/breakage, (5) inaccurate screw placement and, (6) where postoperatively, the surgeon felt an alternate surgical technique could have yielded better results. Four patients with either unexpected intraoperative difficulties or complications or in whom the technique could have been refined were identified. There were 2 patients with proatlas segmentation anomalies and 2 with Morquio's-Brailsford disease. The first patient had cage migration which necessitated a second procedure during craniovertebral realignment, the second had partial penetration of the screw into the transverse foramen, the third with bipartite atlas underwent a C1-2 fixation without a horizontal cross-connector and, the fourth had screw pull outs from the subaxial cervical spine intraoperatively during an attempted occipitocervical fusion. In children with syndromic CVJ anomalies, the surgeon should be aware of the high risk of intraoperative difficulties and complications. Potential pitfalls and the ways to avoid these complications are discussed.
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Pavlova OM, Ryabykh SO, Burcev AV, Gubin AV. Anomaly-Related Pathologic Atlantoaxial Displacement in Pediatric Patients. World Neurosurg 2018; 114:e532-e545. [DOI: 10.1016/j.wneu.2018.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
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Watanabe K, Hirano T, Katsumi K, Ohashi M, Shoji H, Hasegawa K, Ito T, Endo N. Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years. Spine Surg Relat Res 2017; 1:14-19. [PMID: 31440607 PMCID: PMC6698536 DOI: 10.22603/ssrr.1.2016-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/06/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose: This study aimed to investigate radiographic outcomes after posterior spinal fusion (PSF) for pediatric patients younger than 10 years with upper cervical disorders. Methods: Thirteen patients (mean age at surgery, 5.9 years; range, 1 to 9 years) who underwent PSF with a minimum of 2 years of follow-up (mean, 5.8 years) were included. Diagnoses were atlanto-axial instability due to congenital disorders for 11 patients and atlanto-axial rotatory fixation for 2 patients. The fusion area was occipito-cervical for 7 patients and C1/2 for 6 patients. PSF was performed using rigid screw-rod constructs for 6 patients and conventional techniques for 7 patients. Ten patients required halo immobilization after surgery. Fusion status, perioperative complications, radiographic alignment, and range of motion (ROM) from C2 to C7 were evaluated. Results: Twelve patients successfully achieved bony fusion (fusion rate, 92%), but complications occurred in 5 patients. Regarding radiographic measures (preoperative/postoperative/final follow-up), the mean atlanto-dental interval was significantly reduced (8.0 mm/2.7 mm/3.5 mm) and the C2-7 ROM was increased (from 49.4 degrees to 66.0 degrees) at the final follow-up (both comparisons, p<0.05). Sagittal alignment was unchanged. Conclusion: Use of rigid screw-rod instrumentation in the upper cervical spine with careful radiological evaluation is amenable for pediatric patients younger than 10 years. However, conventional procedures such as wiring fixation with rigid external immobilization are still alternative options for preventing serious neurological and vascular complications.
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Affiliation(s)
- Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
| | - Keiichi Katsumi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
| | - Hirokazu Shoji
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
| | | | - Takui Ito
- Department of Orthopedic Surgery, Niigata City General Hospital, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Japan
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Wang Z, Wang X, Jian F, Zhang C, Wu H, Chen Z. The changes of syrinx volume after posterior reduction and fixation of basilar invagination and atlantoaxial dislocation with syringomyelia. 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 2016; 26:1019-1027. [DOI: 10.1007/s00586-016-4740-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/23/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
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13
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Shamshery C, Haldar R, Srivastava A, Kaushal A, Srivastava S, Singh PK. An unusual cause of unilateral facial injuries caused by horseshoe headrest during prone positional craniovertebral junction surgery. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:62-4. [PMID: 27041889 PMCID: PMC4790152 DOI: 10.4103/0974-8237.176629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pressure injuries are an accepted complication of prone positioning during the neurosurgical procedures. Horseshoe headrest are intended to reduce the incidence and severity of such injuries by allowing limited areas of contact between the skin of dependent areas of contact and the supporting surfaces. We report a case where a patient positioned prone over a horseshoe headrest developed inadvertent unilateral facial pressure injuries following a 6-h long craniovertebral junction (CVJ) surgery. We attempt to highlight this complication, analyze its causation, and briefly review the existing literature related to similar reported injuries.
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Affiliation(s)
- Chetna Shamshery
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kaushal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shashi Srivastava
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhat K Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Intraoperative electrophysiological monitoring during posterior craniocervical distraction and realignment for congenital craniocervical anomaly. 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 2015; 24:671-8. [DOI: 10.1007/s00586-015-3791-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
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Futane S, Salunke P. Klippel-Feil syndrome with atlanto-axial dislocation, anomalous vertebral artery, dextrocardia and situs inversus. Clin Neurol Neurosurg 2013; 115:2304-6. [PMID: 23998718 DOI: 10.1016/j.clineuro.2013.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/03/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Sameer Futane
- Department of Neurosurgery, PGIMER, Chandigarh, India.
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