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Palmieri G, Cofano F, Marengo N, Ajello M, Zenga F, Garbossa D. Posterior arch reconstruction in cervical surgery to restore the global biomechanics of the Atlas: a technical note. Br J Neurosurg 2023; 37:1402-1405. [PMID: 33554670 DOI: 10.1080/02688697.2021.1881042] [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: 07/20/2019] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
The posterior arch of the atlas is usually not considered one of the main stabilizers of the cranio-cervical junction, allowing surgeons to its removal when needed with a relative certainty to preserve the stability of the atlo-axial segment. However, these considerations do not reflect the importance to examine the integrity of the posterior arch in the whole biomechanics of the atlas. Authors like Gebauer and Panjabi revealed, respectively in experimental and clinical conditions, how the atlas responds to an axial loading force, proving that the whole atlas is involved into horizontal conversion of axial forces and providing evidence supporting the preservation of the posterior arch. Other authors evaluated the risk for anterior arch fracture following C1 laminectomy. In this technical note three different techniques of posterior atlas arch reconstruction after surgical iatrogenic disruption are presented, considering both neoplastic and degenerative disease.
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Affiliation(s)
- Giuseppe Palmieri
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Nicola Marengo
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Marco Ajello
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
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Seok SY, Lee DH, Lee HR, Cho JH, Hwang CJ, Lee CS, Yoon SM. Floating Laminoplasty for the Treatment of Compressive Myelopathy Accompanied by C1 Posterior Ring Hypoplasia: A Technical Note and Case Series. World Neurosurg 2023; 174:69-73. [PMID: 36787857 DOI: 10.1016/j.wneu.2023.01.075] [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: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023]
Abstract
Posterior ring hypoplasia of the atlas (C1) is not common and in most cases is found by chance without symptoms. This disorder is sometimes accompanied by a mild C1-C2 instability or the presence of a space-occupying lesion such as ossification of posterior longitudinal ligament, pannus, or retro-odontoid pseudo-tumor, which are indications for surgery if symptomatic cord compression is present. A C1 posterior arch resection has been the procedure of choice but is associated with several fatal complications. We here present a novel posterior arch decompression technique that is relatively safer and easier and that involves mobilization and posterior translation of the posterior arch as a whole, similar to a vertebral body sliding osteotomy.
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Affiliation(s)
- Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggido, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Meen Yoon
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju University School of Medicine, Jejudo, Korea
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Kayalar AE, Yaltırık CK, Kalyoncu E, Bolat B, Temiztas BA, Etli MU, Çalışaneller AT, Naderi S. Maximum Safety Limits of Laminectomy of the C1 Vertebra for Chiari Malformation Surgery: A Finite Element Analysis. Indian J Orthop 2023; 57:884-890. [PMID: 37214376 PMCID: PMC10192479 DOI: 10.1007/s43465-023-00870-1] [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: 08/22/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Background The treatment of Chiari malformations generally consists of posterior fossa decompression. C1 laminectomy is required in selected cases. However, cases of iatrogenic anterior arch fractures at C1 without high-energy trauma have been reported. Developing theoretical models of atlas C1 bones that have undergone a laminectomy can help researchers identify the regions where fractures may occur as a result of sudden loads. Methods In this study, we created a detailed three-dimensional solid finite element model of the human atlas bone (C1) using geometric data. The loadings of the laminectomy dimension were evaluated on the basis of three groups. Group I comprised atlas bones that had not undergone a laminectomy. For Group II, the lateral border of the laminectomy was determined as the projection of the lateral mass medial border on the lamina. For Group III, the bilateral sulcus arteriosus was determined as the border for the lateral border of the laminectomy. The analysis results, which are in good agreement with those of previous reports, showed high concentrations of localized stress in the anterior and posterior arches of the atlas bone. Results The analysis results showed that the stress increased in the laminectomy models. The maximum stress observed was consistent with the clinical observations of fracture sites in previous studies. Conclusion In the treatment of patients with Chiari malformations, C1 laminectomy is often required. The width of this laminectomy can lead to iatrogenic anterior arch fractures. This is the first study to evaluate C1 laminectomy width using finite element modeling.
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Affiliation(s)
- Ali Erhan Kayalar
- Department of Neurosurgery, Health Sciences University, Haydarpasa Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Cumhur Kaan Yaltırık
- Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Enes Kalyoncu
- Department of Machinery, Istanbul Gelisim Vocational School, Istanbul, Turkey
| | - Berna Bolat
- Faculty of Mechanical Engineering, Yıldız Technical University, Istanbul, Turkey
| | | | - Mustafa Umut Etli
- Department of Neurosurgery, Siverek State Hospital, Şanlıurfa, Turkey
| | - Arif Tarkan Çalışaneller
- Department of Neurosurgery, Health Sciences University, Haydarpasa Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, İstanbul Brain and Spine Center, Istanbul, Turkey
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Kawasaki T, Takayama M, Maki Y, Nakajima K, Kobayashi T, Saiki M, Ioroi Y. A case of anterior arch fracture of the atlas associated with C1 laminectomy. Surg Neurol Int 2023; 14:136. [PMID: 37151459 PMCID: PMC10159283 DOI: 10.25259/sni_254_2023] [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: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Background Spontaneous anterior arch fracture of the atlas after a C1 laminectomy (CIL) is an extremely rare complication. Case Description A 72-year-old male presented with the sudden onset of neck pain. His prior history included; a CIL for atlantoaxial subluxation, shunt closure for a spinal dural arteriovenous fistula at C3, a cervical laminoplasty from C3 to C6 for stenosis, and a prior anterior C4/5 and C5/6 fusion 14 years ago. Once the computed tomography documented a right C1 anterior arch fracture, and occipital-cervical fusion was performed utilizing C2 laminar screws and C4 pedicle screws with halo-vest placement. Postoperatively, the neck pain resolved and he remained stable. Conclusion Neurosurgeons should be aware of the risk of anterior arch fractures following a CIL and may alternatively consider a C1 laminoplasty in the future.
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Affiliation(s)
- Toshinari Kawasaki
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
- Corresponding author: Toshinari Kawasaki, Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan.
| | - Motohiro Takayama
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Japan
| | - Kota Nakajima
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tamaki Kobayashi
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaaki Saiki
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
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Chen L, Zhu X, He B, Chen Q, Li F. Effect of C 1 Single-door Laminoplasty on Symptomatic Atlas Canal Stenosis. Orthop Surg 2022; 14:2757-2765. [PMID: 36028926 PMCID: PMC9531081 DOI: 10.1111/os.13352] [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: 01/22/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To verify the effect of single-door laminoplasty combined with atlantoaxial fusion in the treatment of symptomatic atlas canal stenosis. METHODS This is a single-center retrospective analysis. From February 2014 to January 2019, 16 patients (five were females) with an average age of 63.4 years (56-71 years) were enrolled in this study. Patients with compressive cervical myelopathy with CT scan showed an inner sagittal diameter (ISD) of C1 less than 29 mm or C1 canal space available for cord (SAC) of <12 mm were included, while isolated C1 stenosis without myelopathy or isolated C1 stenosis without atlantoaxial subluxation were excluded in this study. All patients underwent continuous heavy-weight skull traction, atlas single-door laminoplasty and atlantoaxial fusion. The differences in the pre- and post-operative inner sagittal diameter, space available for cord, atlas-dens interval (ADI) and compression of the spinal cord were analyzed by using CT and MRI. Functional evaluation was performed by using the Japanese Orthopaedic Association scoring system and the Neck Disability Index scoring system. RESULTS Single-door laminoplasty provided a full decompression for the spinal cord while retaining the whole posterior arch. No complications were encountered except a superficial wound infection in one patient. At final follow-up, The ADI was significantly reduced from 5.2 ± 1.8 mm to 1.7 ± 0.6 mm after surgery on average (P < 0.05). Average inner sagittal diameter of C1 was increased from 26.3 ± 2.6 mm to 34.9 ± 2.9 mm and the space available for cord was increased from 6 ± 1.7 mm to 17.8 ± 3.6 mm (P < 0.05). Meanwhile, the Japanese Orthopaedic Association (JOA) score of the 16 cases was improved from 11.4 ± 1.8 to 14.1 ± 1.4 on average (P < 0.05). The postoperative neck pain VAS score decreased significantly, from 2.6 ± 1.0 preoperatively to 1.3 ± 0.9 postoperatively (P < 0.05). The influence of neck pain on patient's life was improved from 17.8 ± 3.9 to 13.9 ± 3.3 after surgery (P < 0.05). At the last follow-up, the healing of the hinge fracture and the fusion between atlas and axis were observed in all patients. CONCLUSIONS Single-door laminoplasty combined with atlantoaxial fusion not only provides enough space for decompression but also offers intact arch for bone grafting, suggesting that it might provide a more feasible method for the correction of symptomatic atlas canal stenosis.
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Affiliation(s)
- Linwei Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xiuliang Zhu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Bin He
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Qixin Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fangcai Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Fujiwara Y, Harada T, Kotaka S, Ohta R, Nishimori M, Adachi N. Anterior Atlas Fracture After C1 Laminectomy Which Was Successfully Treated by Brace Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00048. [PMID: 34319946 DOI: 10.2106/jbjs.cc.21.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of a 67-year-old male patient who underwent a C1 laminectomy with laminoplasty at C2-3 because of cervical ossification of the posterior longitudinal ligament. At 6 weeks after surgery, neck pain occurred after minor trauma without neurological deterioration. Computed tomography (CT) demonstrated C1 anterior atlas fracture with a 3-mm gap. After a 3-month brace therapy using a Philadelphia collar, the patient's neck pain disappeared with complete bone union according to the CT. CONCLUSION Among 14 cases that were reported previously, none of the adult patients achieved bone union by brace therapy. Therefore, this is the only case report in which bone union could be achieved by brace therapy.
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Affiliation(s)
- Yasushi Fujiwara
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Takahiro Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Ryo Ohta
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Makoto Nishimori
- Orthopedics and Microscopic Spine and Spinal Cord Surgery Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Tarukado K, Ikuta K, Iida K, Tono O, Doi T, Harimaya K. Radiographic and Clinical Results of C1 Laminoplasty for the Treatment of Compressive Myelopathy. Asian Spine J 2020; 14:459-465. [PMID: 31992026 PMCID: PMC7435313 DOI: 10.31616/asj.2019.0190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/19/2019] [Indexed: 01/01/2023] Open
Abstract
Study Design Case series. Purpose To evaluate the radiographic and clinical results of C1 laminoplasty without fusion. Overview of Literature C1 laminectomy has been the standard procedure for decompression at the C1 level. However, there have been some reports of trouble cases after C1 laminectomy. C1 laminoplasty might be superior to C1 laminectomy with regard to maintaining the original C1 anatomical shape, preventing compression from the posterior soft tissue, and ensuring an adequate bone-grafting site around the C1 posterior part if additional salvage fusion surgery is necessary afterward. Methods Seven patients with spinal cord compression without obvious segmental instability at the C1/2 level treated by C1 laminoplasty were included. The indication of C1 laminoplasty was same as that of C1 laminectomy. C1 laminoplasty was performed in the same way as subaxial double-door laminoplasty. The imaging findings were evaluated using X-ray, computed tomography, and magnetic resonance imaging. The clinical results were evaluated using the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and JOA score. Peri- and postoperative complications were also investigated. Results No patient showed increased C1/2 segmental instability after the surgery. The mean pre- and postoperative JOA scores were 8.6 and 11.7, respectively. The mean recovery rate was 40.2%. The effective rate in the JOACMEQ was 50% for the cervical spine function, 33% for the upper extremity function, 50% for the lower extremity function, 17% for the bladder function, and 17% for the quality of life. No major complication that seemed to be unique to C1 laminoplasty was observed over a period of about 4 years follow-up. Conclusions C1 laminoplasty for patients without obvious segmental instability might be a viable alternative procedure to C1 laminectomy.
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Affiliation(s)
- Kiyoshi Tarukado
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Ko Ikuta
- Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Osamu Tono
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Toshio Doi
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan
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Incidence and Risk Factors of Anterior Arch Fracture of the Atlas Following C1 Laminectomy Without Fusion. Spine (Phila Pa 1976) 2018; 43:667-674. [PMID: 28885292 DOI: 10.1097/brs.0000000000002402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter study. OBJECTIVE To identify the incidence of anterior arch fracture (AAF) of the atlas following C1 (first cervical vertebra) laminectomy without fusion, and its risk factors. SUMMARY OF BACKGROUND DATA C1 laminectomy without fusion is a widely accepted surgical procedure performed to decompress the spinal cord that is compromised at the C1/C2 level, but without instability. Several case series have reported spontaneous AAF following this procedure. However, the incidence of post-laminectomy AAF and its risk factors have not been studied. METHODS This retrospective study included patients who underwent C1 laminectomy without fusion in any of the four participating institutions between April 2002 and March 2016. The incidence of AAF following C1 laminectomy was determined, and the included patients were grouped into those who developed AAF (AAF group) and those who did not (non-AAF group). Patient demographics and radiographic parameters including subaxial cervical balance on x-ray (C2-7 sagittal vertical axis, C2-7 lordosis, C2-7 coronal cobb angle, and T1-slope), and morphology of the atlas on computed tomography (CT) scan were compared with the AAF and non-AAF groups. RESULTS Seventy patients who underwent C1 laminectomy without fusion were included in the study. The incidence of AAF was 14.2% (10/70). Multivariate analysis revealed that a large inferior facet angle (IFA, defined as the coronal inclination angle of the C1/2 facet as measured on CT) and the presence of subaxial ankylosis (bony ankylosis below C2 on CT) were independent risk factors for AAF. There were no significant differences in the subaxial cervical balance as measured on x-ray between the AAF and non-AAF groups (P > 0.05). CONCLUSION The incidence of AAF after C1 laminectomy without fusion is not uncommon. Preoperative assessment using CT may identify patients at high risk of AAF. LEVEL OF EVIDENCE 4.
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