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Jian Q, Hou Z, Zhao X, Wang Y, Liang C, Fan T. A screw algorithm for congenital C2-3 fusion with high-riding vertebral arteries: feasibilities and clinical outcomes of five different fixation techniques. Neurosurg Rev 2024; 47:520. [PMID: 39222163 DOI: 10.1007/s10143-024-02719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/07/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To propose a screw algorithm and investigate the anatomical feasibilities and clinical outcomes of five distinct fixation methods for C2-3 fused vertebra with high-ridding vertebral arteries (VA) (HRVA) when the C2 pedicle screw placement is unfeasible. METHODS Thirty surgical patients with congenital C2-3 fusion, HRVA, and atlantoaxial dislocation (AAD) were included. We designed a algorithm for alternative screw implantation into C2-3 fused vertebrae, including C2 pedicle screw with in-out-in (passing VA groove) technique (in-out-in screw), subfacetal screw, translaminar screw, lateral mass screw, C3 pedicle screw. VA diameter and position, C2 and C3 pedicles, superior facets, fused lamina, and fused lateral mass dimensions were evaluated for screw implantation indication. Implant failure, reduction loss, implant placement accuracy were investigated by computed tomography. RESULTS A total of 5 VAs were identified as distant VAs; a total of 2 VAs were categorized as occlusive VAs. Sufficient dimension of lateral mass and lamina provided the broadest indications for screw implantation, while the distant or occlusive VA provided the most limited indications for in-out-in screw. The indications of five alternative methods ranged from narrowest to widest as follows: in-out-in screw, C3 pedicle screw, subfacetal screw, translaminar screw, lateral mass screw. The translaminar screws and the lateral mass screws increased the probability of implant failure. All patients who received in-out-in screws, C3 pedicle screws, and subfacetal screws achieved fusion. The accuracy ranged from lowest to highest as follows: C3 pedicle screw, lateral mass screw, in-out-in screw, subfacetal screw, translaminar screw. No translaminar screws deviated. CONCLUSIONS The algorithm proved to be a valuable tool for screw selection in cases of C2-3 fused vertebrae with HRVAs. The subfacetal screw, boasting broad indications, a high fusion rate, and exceptional accuracy, stood as the primary preferred alternative.
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Affiliation(s)
- Qiang Jian
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhe Hou
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xingang Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yinqian Wang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cong Liang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tao Fan
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China.
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Liu J, Jia L, Zeng M, Xu H, Zhang R, Pang Q. C2 pedicle screw insertion assisted by mobilization of the vertebral artery in cases with high-riding vertebral artery. Heliyon 2024; 10:e34924. [PMID: 39170302 PMCID: PMC11336369 DOI: 10.1016/j.heliyon.2024.e34924] [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: 02/22/2024] [Revised: 06/13/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024] Open
Abstract
Objective To describe the feasibility, safety and efficacy of mobilization of the vertebral artery for C2 pedicle screws in cases with the high-riding vertebral artery (HRVA).
. Methods During the period January 2020 to September 2022, fifteen patients underwent posterior occipitocervical fixation in our department. All patients had unilateral HRVA on at least one side that prohibited the insertion of C2 pedicle screws. There were 2 males and 13 females aged 47 ± 11.9 years (range: 17-64 years). After the correction of the vertical dislocation during the operation, the C2 pedicle screw insertion and occipitocervical fixation and fusion were performed using the vertebral artery mobilization technique. A routine three-dimensional reconstructed CT examination was executed to confirm the trajectory of C2 pedicle screws post-operation, and a CT angiography examination was performed when necessary. Neurological function was assessed using the Japanese Orthopedic Association (JOA) scale. The preoperative and postoperative JOA score and the main radiological measurements, including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, and clivus-canal angle (CCA), were collected and compared by paired t-test. Results All 15 patients had atlas assimilation, among which 12 patients had C2-C3 fusion (Klippel-Feil syndrome). Mobilization of the HRVA was successfully completed, and C2 pedicle screws were then fulfilled after the vertebral artery was protected. There was no injury to the vertebral artery during the operation. Meanwhile, no severe surgical complications such as cerebral infarction or aggravated neurological dysfunction occurred during the perioperative period. Satisfactory C2 pedicle screw placement and reduction were reached in all 15 patients. All the patients achieved bone fusion 6 months after surgery. No looseness and shift of internal fixation or reduction loss was observed during the follow-up period. Compared to the preoperative, the postoperative JOA score and the main radiological measurements were remarkably improved and statistically significant. Conclusions C2 pedicle screw insertion assisted by mobilization of the vertebral artery is safe and considerably effective, providing a choice for internal fixation in cases with high-riding vertebral arteries.
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Affiliation(s)
- Jiang Liu
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Ji'nan, Shandong, 250021, China
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Li Jia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Minghui Zeng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Hao Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Rui Zhang
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Ji'nan, Shandong, 250021, China
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, China
| | - Qi Pang
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Ji'nan, Shandong, 250021, China
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, 250021, China
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Bajaj J, Patidar J, Bajaj D, Vikram A, Yadav O, Yadav N, Sharma M, Hedaoo K, Sinha M, Ratre S, Parihar VS, Swamy MN, Yadav YR. The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01249. [PMID: 38995047 DOI: 10.1227/ons.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/26/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Atlantoaxial dislocation (AAD) poses a complex surgical challenge. Surgical approaches vary for reducible and irreducible cases. Challenges persist in reducing the atlantodental interval, especially in cases with oblique or vertical C1-C2 joints. The Rocker instrument (MJ Surgical), a less-explored technique, seeks to simplify instrumentation, reduce complexity, and enhance translation and retroflection reduction of AAD. METHODS This prospective observational study was conducted from January 2022 to July 2023 at a tertiary neurosurgical center. Inclusion criteria covered all age groups with AAD, with or without basilar invagination. Exclusions included medically unstable patients and severe osteoporotic spine conditions. Preoperative assessments included dynamic X-rays, magnetic resonance imaging, and computed tomography scans. The Rocker technique was used, and patients were followed up for 6 to 12 months. RESULTS Fifty-five patients (30 males, 25 females) underwent surgery. The mean age was 40.41 ± 15.01 years. Successful Rocker technique application was observed in 53 cases. Functional outcomes, assessed using Modified Ranawat grading, showed improvement postoperatively. Radiological outcomes revealed a significant reduction in the anterior atlantodental interval (7.21 ± 0.94 to 2.98 ± 0.78). Basilar invagination was reduced in all cases, whenever present. The technique exhibited versatility, applicability in various joint orientations, and cost-effectiveness. CONCLUSION The Rocker technique is a safe and effective alternative for managing both reducible and irreducible AADs, with or without basilar invagination. It simplifies the reduction process, offering advantages over established techniques. Further trials, especially in rotational deformities, are warranted for validation.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Jayant Patidar
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Diya Bajaj
- Department of Neuropathology, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Aditya Vikram
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Omprakash Yadav
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Nishtha Yadav
- Department of Neuroradiology, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Mukesh Sharma
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Mallika Sinha
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Shailendra Ratre
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Vijay S Parihar
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - M N Swamy
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, India
| | - Y R Yadav
- Neurosciences, Apex Hospital & Research Center, Jabalpur, India
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Guo Q, Chen F, Zhang M, Wang H, Guo X, Lu X, Ni B. Posterior Reduction and Intra-Articular Cage Fusion With a C2 Nerve Root Preservation Technique for Treating Posterior Atlantoaxial Dislocation Secondary to Os Odontoideum. Oper Neurosurg (Hagerstown) 2023; 25:365-371. [PMID: 37432014 DOI: 10.1227/ons.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Posterior C1-C2 interlaminae compression fusion with iliac bone graft may lead to donor site complications and recurrent C1 posterior dislocation for posterior atlantoaxial dislocation (AAD) secondary to os odontoideum. C1-C2 intra-articular fusion often needs C2 nerve ganglion transection to facilitate exposing and manipulating the facet joint, leading to bleeding from the venous plexus and suboccipital numbness or pain. Therefore, this study was conducted to evaluate the outcomes of posterior C1-C2 intra-articular fusion with a C2 nerve root preservation technique in the treatment of posterior AAD secondary to os odontoideum. METHODS Data of the 11 patients who underwent C1-C2 posterior intra-articular fusion because of posterior AAD secondary to os odontoideum were retrospectively reviewed. Posterior reduction was performed using C1 transarch lateral mass screws and C2 pedicle screws. Intra-articular fusion was performed using a polyetheretherketone cage filled with autologous bone from the caudal edge of the C1 posterior arch and cranial edge of the C2 laminar. Outcomes were evaluated by using the Japanese Orthopaedics Association score, Neck Disability Index, and visual analog scale for neck pain. Bone fusion was evaluated by using computed tomography and 3-dimensional reconstruction. RESULTS The average follow-up duration was 43.9 ± 9.5 months. All patients achieved good reduction and bone fusion, without transection of the C2 nerve roots. The mean bone fusion time was 4.3 ± 1.1 months. There was no complication related to the surgical approach and instrumentation. Function of the spinal cord manifested by the Japanese Orthopaedics Association score significantly improved ( P < .05). The Neck Disability Index score and visual analog scale for neck pain markedly decreased (all P < .05). CONCLUSION Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique was a promising treatment of posterior AAD secondary to os odontoideum.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Mei Zhang
- Department of Traditional Chinese Medicine Rehabilitation, Jing'an Zhabei Central Hospital, Shanghai, People's Republic of China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xiang Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xuhua Lu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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Guo Q, Wu Y, Zhang M, Chen F, Wang H, Wu J, Lu X, Ni B. Sagittal Reconstruction of the Atlantoaxial Lateral Mass Complex with an Intra-Articular Cage Fusion Technique for Degenerative Atlantoaxial Instability. World Neurosurg 2023; 175:e129-e133. [PMID: 36921711 DOI: 10.1016/j.wneu.2023.03.039] [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: 10/13/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To evaluate outcomes of sagittal reconstruction of the atlantoaxial lateral mass complex using a modified intra-articular cage fusion technique for treating degenerative atlantoaxial instability. METHODS Data from 15 patients with degenerative atlantoaxial instability were retrospectively reviewed. All patients underwent posterior reduction and intra-articular fusion with a cage filled with local autologous bone. Atlantodental interval values on plain radiography in flexion before and after surgery were recorded. Bone fusion was evaluated on computed tomography reconstruction, and bone fusion time was recorded. Lateral atlantoaxial joint space height before and after surgery was measured on coronal computed tomography reconstruction. Japanese Orthopaedic Association score and visual analog scale score for neck pain before surgery and at final follow-up were compared. RESULTS Mean follow-up time was 40.7 ± 13.4 months. All patients achieved good reduction and solid bone fusion at follow-up. Mean fusion time was 4.4 ± 1.1 months. Atlantodental interval decreased from 8.6 ± 1.5 mm preoperatively to 1.9 ± 0.5 mm at final follow-up (P < 0.05). Lateral atlantoaxial joint space height significantly improved from 1.7 ± 0.5 mm preoperatively to 4.7 ± 0.3 mm at final follow-up (P < 0.05). Japanese Orthopaedic Association score significantly improved from 14.9 ± 1.5 preoperatively to 16.7 ± 0.6 at final follow-up (P < 0.05). Visual analog scale score for neck pain markedly decreased from 4.5 ± 1.8 preoperatively to 0.5 ± 0.6 at final follow-up (P < 0.05). CONCLUSIONS Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique is effective in treatment of degenerative atlantoaxial instability. Satisfactory reconstruction of the sagittal alignment and the height of atlantoaxial complex can be achieved.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yaming Wu
- Department of Orthopedics, Kunshan First People's Hospital, Jiangsu University, Kunshan, China
| | - Mei Zhang
- Department of Traditional Chinese Medicine Rehabilitation, Jing'an Zhabei Central Hospital, Shanghai, China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xuhua Lu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
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Guo Q, Xu T, Wang H, Chen F, Guo X, Lu X, Ni B. One-Stage Anterior Retropharyngeal Release Followed by Posterior Open Reduction and Intra-Articular Cage Fusion for Treating Chronic Fixed Type III Atlantoaxial Rotatory Fixation. World Neurosurg 2022; 167:e1413-e1418. [PMID: 36122856 DOI: 10.1016/j.wneu.2022.09.052] [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: 07/15/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To verify the effectiveness of anterior retropharyngeal release followed by posterior open reduction using long arm reduction screws combined with intra-articular fusion with a cage filled with the local autologous bone for treating fixed Type III atlantoaxial rotatory fixation (AARF). METHODS Data from 6 children with fixed AARF were retrospectively reviewed. All patients underwent anterior retropharyngeal release followed by posterior open reduction using long-arm reduction screws combined with intra-articular fusion with a cage filled with local autologous bone. Outcomes were measured using the atlantodental interval value, the Japanese Orthopedic Association score and visual analog scale for neck pain. Patient age, sex, operation time, blood loss, and bone fusion time were recorded. Complications related to the operation were also recorded. RESULTS All patients achieved complete reduction and solid bone fusion at follow-up. The atlantodental interval dropped to 2.1 ± 0.5 mm after the operation from a preoperative score of 15.3 ± 3.1 mm (P < 0.05). Japanese Orthopedic Association score significantly improved from a preoperative score of 15.3 ± 0.5 to 17 ± 0 at the final follow-up (P < 0.05). Visual analog scale for neck pain markedly decreased from preoperative 4.5 ± 1.0 to 0.2 ± 0.4 at the final follow-up (P < 0.05). No complication related to the surgical approach or instrumentation was observed. CONCLUSIONS One-stage anterior retropharyngeal release followed by posterior open reduction combined with intra-articular cage fusion is effective in treating chronic fixed type III AARF.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Tianming Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China; Department of Orthopedics, 905th Hospital of PLA Navy, Shanghai, People's Republic of China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xiang Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Xuhua Lu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
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Wu C, Deng J, Wang Q, Shen D, Qin B, Li T, Wang X, Zeng B. Comparison of Perpendicular to the Coronal Plane versus Medial Inclination for C2 Pedicle Screw Insertion Assisted by 3D Printed Navigation Template. Orthop Surg 2022; 15:563-571. [PMID: 36220773 PMCID: PMC9891962 DOI: 10.1111/os.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE C2 pedicle screw insertion is very important in posterior upper cervical surgery. The traditional screw placement technique requires us to consider both medial inclination and cephalad angle, it is difficult to operate intraoperatively. This paper is to explore a novel method of C2 pedicle screw placement compared with traditional C2 pedicle screw. METHODS A total of 44 patients diagnosed with atlantoaxial fracture or instability from May 2018 to November 2020 were involved in this retrospective study, and they were divided into C2-PPS group (perpendicular to the coronal plane C2 screw, 24 patients) and C2-TPS group (traditional C2 pedicle screw, 20 patients). The diameter of the maximum tangential circle, distance between geometric center and median sagittal plane and screw length of PPS and TPS were measured based on the 3D model of C2, respectively. Then the 3D printed navigation templated were designed and manufactured by 3D printing to assisted the PPS and TPS placement, respectively. The surgical time and radiation exposure times during operation were recorded; the post-operative grading criteria, deviation of screw entry point and deviation of screw angle of two groups were evaluated, respectively. RESULTS A total of 48 screws were inserted in the C2-PPS group, and 40 screws were inserted in the C2-TPS group. There were 46 screws with grade 0 (95.8%) in the PPS group and 31 screws with grade 0 (77.5%) in the TPS group, (P = 0.03). The radiation exposure times in the C2-PPS group and C2-TPS group were 4.7 ± 1.5 and 7.8 ± 3.8, respectively, (P = 0.045). The deviations of screw entry point in the C2-PPS group and C2-TPS group were 1.2 ± 0.8 mm and 3.2 ± 1.3 mm, respectively; the deviations of screw angle in the C2-PPS group and C2-TPS group were 2.1 ± 1.6° and 4.8 ± 2.0°, respectively, (P = 0.000). The diameters of the maximum tangential circle in the C2-PPS group and C2-TPS group were 5.5 ± 1.0 mm and 5.3 ± 0.9 mm, respectively. The distances between the geometric center and median sagittal plane in the C2-PPS group and C2-TPS group were 15.4 ± 2.3 mm and 18.0 ± 3.3 mm, respectively; The screw lengths in the C2-PPS group and C2-TPS group were 25.9 ± 3.2 mm and 27.6 ± 3.7 mm, respectively, (P = 0.000). CONCLUSION Eighty percent of C2-PPS corridor can accommodate a 3.5 mm diameter screw, and with an average screw length of 26 mm. Navigation templates assisted the C2-PPS placement is less surgical time, less radiation exposure times, more safe and more accurate than C2-TPS.
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Affiliation(s)
- Chao Wu
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina,Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Jiayan Deng
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Qing Wang
- Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
| | - Danwei Shen
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Binwei Qin
- Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
| | - Tao Li
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina
| | - Xiangyu Wang
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina
| | - Baifang Zeng
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina,Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
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Abstract
Craniocervical injuries (CCJs) account for 10% to 30% of all cervical spine trauma. An increasing number of patients are surviving these injuries due to advancements in automobile technology, resuscitation techniques, and diagnostic modalities. The leading injury mechanisms are motor vehicle crashes, falls from height, and sports-related events. Current treatment with urgent rigid posterior fixation of the occiput to the cervical spine has resulted in a substantial reduction in management delays expedites treatment of CCJ injuries. Within CCJ injuries, there is a spectrum of instability, ranging from isolated nondisplaced occipital condyle fractures treated nonoperatively to highly unstable injuries with severely distracted craniocervical dissociation. Despite the evolution of understanding and improvement in the management of cases regarding catastrophic failure to diagnose, subsequent neurologic deterioration still occurs even in experienced trauma centers. The purpose of this article is to review the injuries that occur at the CCJ with the accompanying anatomy, presentation, imaging, classification, management, and outcomes.
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Affiliation(s)
- Catherine Olinger
- Harborview Medical Center, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA.
| | - Richard Bransford
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Spine Fellowship Program, University of Washington Department of Orthopaedics and Sports Medicine, 908 Jefferson Street, Fifth Floor, Seattle, WA, USA
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