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Park CK, Choi MK. Direct C1 posterior arch screws for reduction and osteosynthesis in the treatment of Jefferson fracture. Acta Neurochir (Wien) 2024; 166:31. [PMID: 38265602 DOI: 10.1007/s00701-024-05914-5] [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: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
The surgical treatment of Jefferson fractures generally involves solid fusion, which limits the range of motion of the upper cervical spine. Herein, we present a case of a Jefferson fracture that was surgically treated using direct C1 posterior arch screw reduction and osteosynthesis instead of fusion surgery. Postoperative computed tomography (CT) and plain radiography revealed that both C1 posterior arch screws were well positioned, and placing lag screws at the C1 level played a key role in fracture reduction. The present case highlights a surgical technique, which can preserve neck motion by using lag screws for reduction and osteosynthesis.
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Affiliation(s)
- Chang Kyu Park
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
| | - Man Kyu Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea.
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Liu Y, Li X, Chen T, Chen J, Zhu Y, Chu G, Yang H, Jiang W. Minimally invasive percutaneous new designed transpedicular lag-screw fixation for the management of Hangman fracture using O-arm-based navigation: a clinical study. BMC Musculoskelet Disord 2023; 24:494. [PMID: 37322465 DOI: 10.1186/s12891-023-06614-4] [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: 12/26/2022] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND To investigate the outcomes and safety of using minimally invasive percutaneous new transpedicular lag-screw fixation with intraoperative, full rotation, three-dimensional image (O-arm)-based navigation for the management of Hangman fracture. METHODS Twenty-two patients with Hangman fracture were treated with minimally invasive percutaneous new transpedicular lag-screws using intraoperative, full rotation, and three-dimensional image (O-arm)-based navigation. The preoperative and postoperative conditions of the patients were evaluated according to the ASIA (American Spinal Injury Association) scale. The patient's VAS (visual analog scale) scores before and after surgery, operation time, cervical vertebral activity, intervertebral angle and bone healing were recorded and collected, and repeated measures analysis of variance was used for statistical analysis. RESULTS All patients were satisfactorily repositioned after surgery, and the VAS scores for neck pain were significantly lower than those before surgery on the first day and at 1 month, 3 months and the last follow-up (P < 0.001). According to the ASIA scale, four patients recovered from preoperative grade D to postoperative grade E. Bony fusion was achieved for all cases, and the range of neck rotation was restored to normal at the last follow-up. The post-surgery angular displacement (AD) demonstrated the stability of C2-3 after our new screw fixation for the treatment of Hangman fracture. CONCLUSIONS Minimally invasive percutaneous new transpedicular lag-screw fixation using intraoperative, full rotation, three-dimensional image (O-arm)-based navigation achieved satisfactory clinical results with the advantages of immediate stability, safety and effectivity. We suggest that it is a reliable and advanced technique for the management of Hangman fracture.
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Affiliation(s)
- Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Xuefeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Tangyiheng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Jie Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Yi Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China.
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Street, Suzhou, 215006, China.
| | - Weimin Jiang
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, 9 Chongwen Road, Suzhou, 215124, Jiangsu Province, China.
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Tumbiolo S, Lombardo MC, Porcaro S, Adorno A, La Fata G, Tiziana C, Brunasso L, Paolini S, Visocchi M, Iacopino DG, Maugeri R. New Trend in Craniovertebral Junction Surgical Strategy: Technical Note for the Treatment of Hangman's Fractures Through a Minimally Invasive Approach. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:283-289. [PMID: 38153483 DOI: 10.1007/978-3-031-36084-8_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The reduction, stabilization, and maintenance of alignment are the main goals in the surgical treatment of unstable hangman's fractures. The choice of the surgical strategy remains poorly standardized; anterior and/or posterior fusion could be performed; and none of the available clinical studies in the literature have shown significant differences in outcomes or complication rates. Vertebral anatomy, age, comorbidities, patient factors, and surgical experience may guide the treatment choice. METHODS We present a case of a polytraumatized young woman with an unstable hangman's fracture type II, according to Levine-Edwards classification. We treated the fracture by using a plate with four holes to fix C2-C3 without discectomy and body fusion. RESULTS We performed a small incision, such as those used for the fixation of odontoid screws, where the working angle allowed us to easily and quickly position the plate by using a minimally invasive approach. CONCLUSION The stabilization alone, without discectomy and body fusion with the cage, in the same way favored the natural healing of the bone fracture. In our opinion, in some select cases, fixation of C2-C3 alone through a minimally invasive approach allows for bone healing with fewer risks and an easier surgery.
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Affiliation(s)
- Silvana Tumbiolo
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Maria Cristina Lombardo
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Simona Porcaro
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Alessandro Adorno
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Giuseppe La Fata
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Costanzo Tiziana
- Division of Neurosurgery, Department of Emergency and Neuroscience, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Saverio Paolini
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy
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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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