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Xu Z, Wu J, Chen F, Ding Y, Ni B, Xu P, Guo Q. Atlantoaxial intra-articular cage fusion by posterior intermuscular approach for treating reducible atlantoaxial dislocation: a technique note with case series. 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 2024:10.1007/s00586-024-08318-2. [PMID: 38816537 DOI: 10.1007/s00586-024-08318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). METHODS An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. RESULTS The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. CONCLUSIONS AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach.
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Affiliation(s)
- Zhenji Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Yiyang Ding
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Peng Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
| | - Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
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Lian P, Chen H, Wang W, Zhu C, Tu Q, Ma X, Xia H, Yi H. Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study. Orthop Surg 2024; 16:943-952. [PMID: 38433589 PMCID: PMC10984822 DOI: 10.1111/os.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE Minimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point. METHODS Dissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test. RESULTS The point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery. CONCLUSIONS The intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery.
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Affiliation(s)
- Peirong Lian
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Hu Chen
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Wanshun Wang
- The Second Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Changrong Zhu
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Qiang Tu
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Xiangyang Ma
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Hong Xia
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Honglei Yi
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
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Keidan L, Barash A, Lenzner Z, Pick CG, Been E. Sexual dimorphism of the posterior cervical spine muscle attachments. J Anat 2021; 239:589-601. [PMID: 33876427 PMCID: PMC8349410 DOI: 10.1111/joa.13448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 01/14/2023] Open
Abstract
Cervical spinal injury and neck pain are common disorders with wide physical implications. Neck pain and disability are reported to occur in females more often than in males, and chronic or persistent neck pain after whiplash is twice as common in females. Female athletes also sustain a higher percentage of concussions compared to male athletes. Still, while sexual differences in clinical presentation and outcome are well-established, the underlying etiology for the disparity remains less clear. It is well-established that the origin and insertion landmarks of posterior neck muscles are highly variable, but we do not know if these interindividual differences are associated with sex. Expanding our knowledge on sexual dimorphism in the anatomy of the cervical muscles is essential to our understanding of the possible biomechanical differences between the sexes and hence improves our understanding as to why females suffer from cervical pain more than males. It is also of paramount importance for accurate planning of posterior cervical spine surgery, which cuts through the posterior cervical musculature. Therefore, our main objective is to characterize the anatomy of posterior neck musculature and to explore possible sexual differences in the location of their attachment points. Meticulous posterior neck dissection was performed on 35 cadavers, 19 females, and 16 males. In each specimen, 8 muscle groups were examined bilaterally at 45 osseous anatomical landmarks. Muscles and their attachment sites were evaluated manually then photographed and recorded using Microscribe Digitizer technology built into 3D models. A comparison of attachment landmarks between males and females for each muscle was conducted. Out of the eight muscles that were measured, only two muscles demonstrated significant sex-related anatomical differences-Spinotranversales (splenius capitis and cervicis) and Multifidus. Male Spinotransversales muscle has more attachment points than female. It showed more cranial insertion points in the upper cervical attachments (superior nuchal line, C1 posterior tubercle, and mastoid process) and more caudal insertion points in the spinous processes and transverse processes of the lower cervical and upper thoracic vertebrae. Thus, the male subjects in this study exhibited a greater coverage of the posterior neck both cranially and caudally. Female Multifidus has more attachment points on the spinous processes and articular processes at middle and lower cervical vertebrae and at the transverse processes of the upper thoracic vertebrae. All remaining muscles exhibited no sexual differences. Our findings highlight, for the first time, a sexual dimorphism in attachment points of posterior cervical musculature. It reinforces the notion that the female neck is not a scaled version of the male neck. These differences in muscle attachment could partially explain differences in muscle torque production and range of motion and thus biomechanical differences in cervical spine stabilization between sexes. It sheds a much-needed light on the reason for higher whiplash rates, concussion, and chronic cervical pain among females. Surgeons should take these sexual morphological differences into consideration when deliberating the best surgical approach for posterior cervical surgery.
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Affiliation(s)
- Lee Keidan
- Department of Anatomy and AnthropologySackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Alon Barash
- Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Ziv Lenzner
- Screen Based Art DepartmentBezalel Academy of Arts and DesignJerusalemIsrael
| | - Chaim G. Pick
- Department of Anatomy and AnthropologySackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- The Dr. Miriam and Sheldon G. Adelson Chair and Center for the Biology of Addictive DiseasesTel‐Aviv UniversityTel‐AvivIsrael
- Sylvan Adams Sports InstituteTel Aviv UniversityTel AvivIsrael
| | - Ella Been
- Department of Anatomy and AnthropologySackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Department of Sports TherapyFaculty of Health ProfessionsOno Academic CollegeKiryat OnoIsrael
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[Minimally invasive techniques for traumatic injuries of the cervical spine]. Unfallchirurg 2020; 123:783-791. [PMID: 32936323 DOI: 10.1007/s00113-020-00863-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nowadays, although minimally invasive procedures are the standard for the treatment of thoracolumbar spinal injuries, these techniques are not yet established for the cervical spine. This is due to anatomical and technical reasons and also due to the fact that the classical anterior decompression and fusion procedure already fulfils the criteria of minimally invasiveness and is suitable for the vast majority of injuries. The existing literature consists mainly of case reports and small comparative cohort studies, the results of which are presented. There is a minimally invasive variant for nearly all open procedures, mainly in the upper cervical spine but also in the lower cervical spine. The further development of these promising techniques is still pending.
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