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Beucler N, Sellier A, Dagain A. Motion-preserving C1 lateral mass fixation with compression for unstable Jefferson fracture of the Atlas: technical note. Neurosurg Rev 2024; 47:650. [PMID: 39302548 DOI: 10.1007/s10143-024-02898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/02/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, Cedex 9, 83800, Toulon, France.
| | - Aurore Sellier
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, Cedex 9, 83800, Toulon, France
| | - Arnaud Dagain
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, Cedex 9, 83800, Toulon, France
- Val de Grâce Military Academy, 1 Place Alphonse Laveran, Cedex 5, 75230, Paris, France
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Wada K, Mori S, Shimamoto S, Inoue T, Tamaki R, Okazaki K. Surgical outcomes of intraoperative O-arm versus C-arm fluoroscopy in occipitocervical fixation: a retrospective analysis. Br J Neurosurg 2023:1-6. [PMID: 38146209 DOI: 10.1080/02688697.2023.2297879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aims to compare the effect of using O-arm and C-arm fluoroscopy on the surgical outcomes of occipitocervical fixation. METHODS The study included patients who underwent occipitocervical fixation using O-arm or C-arm between 2005 and 2021. Of 56 patients, 34 underwent O-arm-assisted surgery (O-group) and 22 underwent C-arm-assisted surgery (C-group). We assessed surgical outcomes, including operative time, intraoperative blood loss, perioperative complications, and bone union. RESULTS Almost half of the patients had rheumatoid arthritis-related disorders in both groups. Sixteen cases (47.1%) in the O-group and 12 cases (54.5%) in the C-group were fixed from occipito (Oc) to C3, 12 cases (38.2%) in the O-group and 7 cases (31.8%) in the C-group from Oc to C4-7, 5 cases (14.7%) in the O-group, and 3 cases (13.6%) in the C-group from Oc to T2 (p = 0.929). There was no significant difference in operative time (p = 0.239) and intraoperative blood loss (p = 0.595) between the two groups. Dysphagia was the most common complication in both groups (O-group vs. C-group, 11.7% vs. 9.1%). Regarding implant-related complications, occipital plate dislodgement was observed in four cases (18.2%) in the C-group (p = 0.02). The bone union rate was 96.3% in the O-group and 93.3% in the C-group (P = 1). CONCLUSIONS O-arm use is associated with a reduced rate of occipital plate dislodgment and has a similar complication incidence compared with C-arm-assisted surgery and does not prolong operative time despite the time needed for setting and scanning. Accordingly, an O-arm is safe and useful for occipitocervical fixation surgery.
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Affiliation(s)
| | | | - Shuji Shimamoto
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohisa Inoue
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Tamaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Haemmerli J, Ferdowssian K, Wessels L, Mertens R, Hecht N, Woitzik J, Schneider UC, Bayerl SH, Vajkoczy P, Czabanka M. Comparison of intraoperative CT- and cone beam CT-based spinal navigation for the treatment of atlantoaxial instability. Spine J 2023; 23:1799-1807. [PMID: 37619869 DOI: 10.1016/j.spinee.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/18/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT Due to the complexity of neurovascular structures in the atlantoaxial region, spinal navigation for posterior C1-C2 instrumentation is nowadays a helpful tool to increase accuracy of surgery and safety of patients. Many available intraoperative navigation devices have proven their reliability in this part of the spine. Two main imaging techniques are used: intraoperative CT (iCT) and cone beam computed tomography (CBCT). PURPOSE Comparison of iCT- and CBCT-based technologies for navigated posterior instrumentation in C1-C2 instability. STUDY DESIGN Retrospective study. PATIENT SAMPLE A total of 81 consecutive patients from July 2014 to April 2020. OUTCOME MEASURES Screw accuracy and operating time. METHODS Patients with C1-C2 instability received posterior instrumentation using C2 pedicle screws, C1 lateral mass or pedicle screws. All screws were inserted using intraoperative imaging either using iCT or CBCT systems and spinal navigation with autoregistration technology. Following navigated screw insertion, a second intraoperative scan was performed to assess the accuracy of screw placement. Accuracy was defined as the percentage of correctly placed screws or with minor cortical breach (<2 mm) as graded by an independent observer compared to misplaced screws. RESULTS A total of 81 patients with C1-C2 instability were retrospectively analyzed. Of these, 34 patients were operated with the use of iCT and 47 with CBCT. No significant demographic difference was found between groups. In the iCT group, 97.7% of the C1-C2 screws were correctly inserted; 2.3% showed a minor cortical breach (<2 mm); no misplacement (>2 mm). In the CBCT group, 98.9% of screws were correctly inserted; no minor pedicle breach; 1.1% showed misplacement >2 mm. Accuracy of screw placement demonstrated no significant difference between groups. Both technologies allowed sufficient identification of screw misplacement intraoperatively leading to two screw revisions in the iCT and three in the CBCT group. Median time of surgery was significantly shorter using CBCT technology (166.5 minutes [iCT] vs 122 minutes [CBCT]; p<.01). CONCLUSIONS Spinal navigation using either iCT- or CBCT-based systems with autoregistration allows safe and reliable screw placement and intraoperative assessment of screw positioning. Using the herein presented procedural protocols, CBCT systems allow shorter operating time.
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Affiliation(s)
- Julien Haemmerli
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Kiarash Ferdowssian
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Lars Wessels
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Robert Mertens
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Ulf C Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Simon H Bayerl
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany.
| | - Marcus Czabanka
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
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Harel R, Kimchi G, Perry A, Knoller N. C1 lateral mass screw insertion using cannulated, navigated screws: preliminary results of a novel technique. Br J Neurosurg 2023; 37:1624-1627. [PMID: 35341430 DOI: 10.1080/02688697.2022.2054948] [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: 02/02/2022] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The upper cervical spine region is densely populated by neural and vascular structures impeding the approach for fusion surgery. Technological advancement simplify the approach to C1-C2 fusion, thus reduce risks. The current paper purpose is to describe initial experience with a novel technique modification for C1 lateral screw insertion that incorporates cannulated-navigated screw system with intra-operative 3D imaging. METHODS A single-center single surgeon database was reviewed to identify all patients who underwent placement of C1 lateral mass screw insertion using the novel technique modification described below, on 2020. This cohort was retrospectively analyzed and compared with a cohort of patients who were operated on by the same surgeon with non-cannulated, navigated screws with intra-operative 3D imaging (O-arm, Medtronic, USA) between 2011 and 2019. Following navigated starting hole and drilling of the C1 lateral mass, a blunt guide-wire is used to palpate the hole and cannulated screw is advanced to the correct position over the wire. After initial purchase, a navigated screw driver is used for final screw depth position. RESULTS Twelve C1 lateral mass screws were inserted in six patients using this novel cannulated-navigated screw placement technique and compared to 24 patients operated using navigated non-cannulated screws. Minimal Estimated Blood Loss (EBL) was recorded in five of six cases undergoing the novel cannulated navigated placement of C1 lateral mass screws. Comparison to non-cannulated cohort demonstrated an EBL of 83CC vs. 354CC (Not significant). Mean surgery time was 97min and 118min for the cannulated-navigated and navigated only procedures (p = 0.03, statistically significant) respectively. In the current cohort, all screws were rated in optimal position and no repositioning procedures were performed. CONCLUSION The new method presented allows for faster and possibly safer and more accurate C1 lateral mass screw insertion.
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Affiliation(s)
- Ran Harel
- Department of Neurologic Surgery, Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel
| | - Gil Kimchi
- Department of Neurologic Surgery, Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel
| | - Avital Perry
- Department of Neurologic Surgery, Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel
| | - Nachshon Knoller
- Department of Neurologic Surgery, Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel
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Tessitore E, Mastantuoni C, Cabrilo I, Schonauer C. Novelties for increased safety in cranio-vertebral surgery: a review. Acta Neurochir (Wien) 2023; 165:3027-3038. [PMID: 37659044 PMCID: PMC10542741 DOI: 10.1007/s00701-023-05769-2] [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: 10/04/2022] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
The cranio-vertebral junction (CVJ) was formerly considered a surgical "no man's land" due to its complex anatomical and biomechanical features. Surgical approaches and hardware instrumentation have had to be tailored in order to achieve successful outcomes. Nowadays, thanks to the ongoing development of new technologies and surgical techniques, CVJ surgery has come to be widely performed in many spine centers. Accordingly, there is a drive to explore novel solutions and technological nuances that make CVJ surgery safer, faster, and more precise. Improved outcome in CVJ surgery has been achieved thanks to increased safety allowing for reduction in complication rates. The Authors present the latest technological advancements in CVJ surgery in terms of imaging, biomaterials, navigation, robotics, customized implants, 3D-printed technology, video-assisted approaches and neuromonitoring.
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Affiliation(s)
- Enrico Tessitore
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
| | - Ciro Mastantuoni
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
| | - Ivan Cabrilo
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Fiorenza V, Ascanio F, Brunasso L, Lo Duca B, Fimognari AM, Grippi L, Giovannini EA, Maugeri R, Iacopino DG. Nuance in Craniovertebral Junction Surgical Approach for Posterior C1-C2 Harms Stabilization: "Window Transposition" of the External Vertebral Venous Plexus for Bloodless C1 Lateral Mass Screw Insertion: Anatomical Aspects and Technical Notes. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:307-313. [PMID: 38153486 DOI: 10.1007/978-3-031-36084-8_47] [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
Atlas and axis instrumentation may be necessary in cases of several craniocervical junction pathologies. According to the Harms technique, C1-C2 polyaxial screws are inserted respectively in the C1 lateral masses and in C2 pedicles. C1 lateral mass screw insertion requires the careful subperiosteal dissection of the posterior elements of C1, the identification of the screw entry point by the downward distraction of C2 nerve root, and the cautious sparing of the overlying posterior external vertebral venous plexus (peVVP), whose bleeding, obstructing the surgical field, is sometimes barely controlled by hemostatic agents and swabbing. The authors describe in detail the anatomical aspects of an alternative surgical technique developed for the microsurgical transposition of the C1-C2 interposed external vertebral venous plexus in the case of Harms C1-C2 screw stabilization. The longitudinal median incision of the atlantoaxial membrane, followed by bilateral subperiosteal dissection and microsurgical section respectively at the inferior borders of the C1 laminae and at the superior borders of the C2 laminae, allows, as a "window opening," the symmetrical mediolateral transposition of the peVVP. This procedure provides a faster and cleaner anatomical exposition of the posterior surface of the C1 lateral mass and the C2 isthmus, preventing troublesome intraoperative venous bleeding that hinders C1 lateral mass screw insertion.
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Affiliation(s)
- Vito Fiorenza
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Francesco Ascanio
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Lara Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Benedetto Lo Duca
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Anna Maria Fimognari
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Luisa Grippi
- U.O.C. Neurochirurgia, Dipartimento Testa-Collo, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Evier Andrea Giovannini
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurologic Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", University of Palermo, Palermo, Italy
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Zhou X, Yang YB, Meng Y, Lin T, Zhou X, Wang C. Comparison of surgical outcomes of C1-2 fusion surgery between O-arm-assisted operation and C-arm assisted operation in children with atlantoaxial rotatory fixation. Front Pediatr 2023; 11:1059844. [PMID: 36891232 PMCID: PMC9986453 DOI: 10.3389/fped.2023.1059844] [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: 10/02/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Objective Placement of the pedicle screw is technically challenging during C1-2 fusion surgery in children and different intraoperative image-guided systems have been developed to reduce the risk of screw malposition. The purpose of the present study was to compare surgical outcomes between C-arm fluoroscopy and O-arm navigated pedicle screw placement in the treatment of atlantoaxial rotatory fixation in children. Methods We retrospectively evaluated charts of all consecutive children with atlantoaxial rotatory fixation who underwent C-arm fluoroscopy or O-arm navigated pedicle screw placement from April 2014 to December 2020. Outcomes including operative time, estimated blood loss (EBL), accuracy of screw placement (Neo's classification) and completed fusion time were evaluated. Results A total of 340 screws were placed in 85 patients. The accuracy of screw placement of the O-arm group was 97.4%, which was significantly higher than that of the C-arm group (91.8%). Both groups had satisfied bony fusion (100%). Statistical significance (230.0 ± 34.6 ml for the C-arm group and 150.6 ± 47.3 ml for the O-arm group, p < 0.05) was observed with respect to the median blood loss. There were no statistically significant difference (122.0 ± 16.5 min for the C-arm group and 110.0 ± 14.4 min for the O-arm group, p = 0.604) with respect to the median operative time. Conclusion O-arm-assisted navigation allowed more accurate screw placement and less intraoperative blood loss. Both groups had satisfied bony fusion. O-arm navigation did not prolong the operative time despite the time required for setting and scanning.
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Affiliation(s)
- Xin Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yue Benny Yang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yichen Meng
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China.,Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Lin
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xuhui Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ce Wang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Lvov I, Grin A, Talypov A, Smirnov V, Kordonskiy A, Barbakadze Z, Abdrafiev R, Krylov V. Efficacy and Safety of Goel-Harms Technique in Upper Cervical Spine Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 167:e1169-e1184. [PMID: 36089281 DOI: 10.1016/j.wneu.2022.09.016] [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: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development. METHODS A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate. RESULTS This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications. CONCLUSIONS The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.
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Affiliation(s)
- Ivan Lvov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.
| | - Andrey Grin
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Aleksandr Talypov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vladimir Smirnov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Anton Kordonskiy
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Zaali Barbakadze
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Rinat Abdrafiev
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Vladimir Krylov
- Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Accuracy and Safety of Robot-Assisted versus Fluoroscopy-Guided Posterior C1 Lateral Mass and C2 Pedicle Screw Internal Fixation for Atlantoaxial Dislocation: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8508113. [PMID: 36132077 PMCID: PMC9484877 DOI: 10.1155/2022/8508113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the accuracy, efficiency, and safety of robotic assistance (RA) and conventional fluoroscopy guidance for the placement of C1 lateral mass and C2 pedicle screws in posterior atlantoaxial fusion. Methods The data of patients who underwent posterior C1–C2 screw fixation (Goel-Harm's technique) in our hospital from August 2014 to March 2021 were retrospectively evaluated, including 14 cases under fluoroscopic guidance and 11 cases under RA. The hospital records, radiographic results, surgical data, and follow-up records were reviewed. Accuracy of screw placement was assessed using the Gertzbein and Robbins scale, and clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), modified MacNab criteria, and postoperative complications. Results Baseline characteristics of both groups were similar. The mean estimated blood loss in the fluoroscopic guidance and RA groups was 205.7 ± 80.3 mL and 120.9 ± 31.9 mL, respectively (p = 0.03). The mean surgical duration was 34 min longer with RA compared to that performed with free-hand (FH) method (p = 0.15). In addition, lower intraoperative radiation exposure was detected in the RA group (12.4 ± 1.4 mGy/screw) versus the FH (19.9 ± 2.1 mGy/screw) group (p = 0.01). The proportion of “clinically acceptable” screws (graded 0 and I) was higher in the RA group (93.2%) than that in the FH group (87.5%, p = 0.04). There was no significant difference in the increase of JOA score and decrease of VAS score between the two surgical procedures. Furthermore, there were no significant differences in overall clinical outcome between the two groups and no neurovascular complications associated with screw insertion. Conclusions RA is a safe and potentially more accurate alternative to the conventional fluoroscopic-guided FH technique for posterior atlantoaxial internal fixation.
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Lee HR, Lee DH, Cho JH, Hwang ES, Seok SY, Park S, Lee CS. Feasibility of lateral mass screw insertion in patients with the risky triad of C1: evaluation of the over-the-arch technique. J Neurosurg Spine 2022; 36:822-829. [PMID: 34826808 DOI: 10.3171/2021.8.spine21695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility and complications of the over-the-arch (OTA) technique for screw insertion into the C1 lateral mass in patients in whom conventional techniques (i.e., posterior arch [PA] and inferior lateral mass [ILM]) are not feasible due to 1) PA with a very small height (< 3.5 mm), 2) a caudally tilted PA blocking the inferior part of the C1 lateral mass, or 3) loss of height at the ILM (< 3.5 mm). METHODS The authors reviewed the medical records of 60 patients who underwent C1 screw fixation with the OTA technique (13 screws) and the PA/ILM technique (107 screws) between 2011 and 2019. Vertebral artery (VA) injuries, screw malposition, and bony union were radiologically assessed. Clinical outcome measures, including Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and occipital neuralgia, were recorded. RESULTS Thirteen OTA screws were successfully inserted without any major complications. NDI and JOA scale scores did not show significant differences between the two groups at final follow-up. No VA injuries were recognized during screw insertion. There was no evidence of ischemic damage to the VA or bony erosion in the occiput or atlas. Medial wall violation was observed in 1 screw (7.7%); however, no C0-1, C1-2, or lateral wall violations were observed. No patients developed new-onset neuralgia postoperatively after C1 fixation with the OTA technique. CONCLUSIONS The OTA technique was safe and useful for C1 screw fixation in patients in whom conventional techniques could not be employed.
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Affiliation(s)
- Hyung Rae Lee
- 1Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbusi, Republic of Korea
| | - Dong-Ho Lee
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eui Seung Hwang
- 3College of Art and Science, Emory University, Atlanta, Georgia
| | - Sang Yun Seok
- 4Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Republic of Korea; and
| | - Sehan Park
- 5Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea
| | - Choon Sung Lee
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tatter C, Fletcher-Sandersjöö A, Persson O, Burström G, Edström E, Elmi-Terander A. Fluoroscopy-Assisted C1-C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010114. [PMID: 35056423 PMCID: PMC8779556 DOI: 10.3390/medicina58010114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 04/21/2023]
Abstract
Background and Objectives: Posterior C1-C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1-C2 fixation, using TAS or CRS, between 2005-2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88% to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1-C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.
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Affiliation(s)
- Charles Tatter
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +46-8-517-74-126
| | - Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Oscar Persson
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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12
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Jannelli G, Moiraghi A, Paun L, Cuvinciuc V, Bartoli A, Tessitore E. Atlantoaxial posterior screw fixation using intra-operative spinal navigation with three-dimensional isocentric C-arm fluoroscopy. INTERNATIONAL ORTHOPAEDICS 2022; 46:321-329. [PMID: 34993554 DOI: 10.1007/s00264-021-05276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Intra-operative image acquisition coupled with navigation aims to increase screw placement accuracy, and it is particularly helpful in complex spinal procedures. The aim of this study is to analyze the accuracy and reliability of posterior atlanto-axial fixation using spinal navigation combined with intra-operative 3D isocentric C-arm. METHODS We retrospectively reviewed all patients presenting with C1-C2 instability and treated by posterior atlanto-axial fixation in our center between December 2016 and September 2018. Screw positioning was guided by intra-operative navigation, registered with surface matching procedure on a previously obtained CT scan and controlled by intra-operative 3D isocentric C-arm. Age, sex, pre- and post-operative neurological status, duration of surgery, presence/absence of vertebral artery injury, and screw placement were retrospectively collected from patients' records. All patients underwent clinical and radiological follow-up at three months after surgery. Radiological assessment of screw positioning was performed by an independent radiologist using the Gertzbein and Robbins grading. RESULTS N = 11 (7F, 4 M) consecutive patients were included, with a mean age of 72 years (range from 51 to 85). N = 44 navigated screws were inserted and controlled with intra-operative 3D fluoroscopy at the end of the procedure. An acceptable screw positioning (Gertzbein-Robbins grade A and B) was obtained in all cases (100%). No vertebral artery injury was observed. Mean operating time was 123 minutes. At three months, no screw loosening or displacement was observed. CONCLUSION In our experience, spinal navigation coupled with intra-operative 3D fluoroscopy proved to be reliable and safe for C1-C2 screw placement.
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Affiliation(s)
- Gianpaolo Jannelli
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Alessandro Moiraghi
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Université de Paris, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Paris, France
| | - Luca Paun
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | | | - Andrea Bartoli
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Enrico Tessitore
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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13
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Ansari D, Chiu RG, Kumar M, Patel S, Almadidy Z, Chaudhry NS, Mehta AI. Assessing the Clinical Safety Profile of Computer-Assisted Navigation for Posterior Cervical Fusion: A Propensity-Matched Analysis of 30-Day Outcomes. World Neurosurg 2021; 150:e530-e538. [PMID: 33746104 DOI: 10.1016/j.wneu.2021.03.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Computer-assisted navigation (CAN) has been shown to improve accuracy of screw placement in procedures involving the posterior cervical spine, but whether the addition of CAN affects complication rates, neurologic or otherwise, is presently unknown. The objective of this study is to determine the effect of spinal CAN on short-term clinical outcomes following posterior cervical fusion. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2018. Patients receiving posterior cervical fusion were identified and separated into CAN and non-CAN cohorts on the basis of a propensity score matching algorithm to select similar patients for comparison. Rates of 30-day unplanned readmission, reoperation, and other complications were evaluated. A separate matching algorithm was used to generate a subgroup of patients undergoing C1-C2 or occiput-C2 fusion for comparison of the same outcomes. RESULTS A total of 12,578 patients met inclusion criteria, of which 689 received CAN and 11,889 did not. After adjusting for baseline differences, patients receiving CAN experienced longer operations and had higher total relative value units associated with care. There were no significant differences in 30-day complication, readmission, or revision rates. At the occipitocervical junction, there were more hardware revisions in the non-CAN group, but this effect did not reach statistical significance (2 vs. 0; P = 0.155). CONCLUSIONS Surgeons should embrace navigation in the cervical spine at their own discretion, as use of CAN does not appear to be associated with increased rates of surgical complications or readmissions despite longer operative time.
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Affiliation(s)
- Darius Ansari
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Megh Kumar
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Zayed Almadidy
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA.
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14
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Kirnaz S, Gebhard H, Wong T, Nangunoori R, Schmidt FA, Sato K, Härtl R. Intraoperative image guidance for cervical spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:93. [PMID: 33553386 PMCID: PMC7859826 DOI: 10.21037/atm-20-1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intraoperative image-guidance in spinal surgery has been influenced by various technological developments in imaging science since the early 1990s. The technology has evolved from simple fluoroscopic-based guidance to state-of-art intraoperative computed tomography (iCT)-based navigation systems. Although the intraoperative navigation is more commonly used in thoracolumbar spine surgery, this newer imaging platform has rapidly gained popularity in cervical approaches. The purpose of this manuscript is to address the applications of advanced image-guidance in cervical spine surgery and to describe the use of intraoperative neuro-navigation in surgical planning and execution. In this review, we aim to cover the following surgical techniques: anterior cervical approaches, atlanto-axial fixation, subaxial instrumentation, percutaneous interfacet cage implantation as well as minimally invasive posterior cervical foraminotomy (PCF) and unilateral laminotomy for bilateral decompression. The currently available data suggested that the use of 3D navigation significantly reduces the screw malposition, operative time, mean blood loss, radiation exposure, and complication rates in comparison to the conventional fluoroscopic-guidance. With the advancements in technology and surgical techniques, 3D navigation has potential to replace conventional fluoroscopy completely.
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Affiliation(s)
- Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Harry Gebhard
- Department of Surgery, Canton Hospital Baden, Switzerland.,Department of Trauma, University Hospital Zurich, University of Zurich, Switzerland
| | - Taylor Wong
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Raj Nangunoori
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Franziska Anna Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Kosuke Sato
- Hospital for Special Surgery, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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15
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Hagiwara K, Wada K, Tamaki R, Inoue T, Okazaki K. Osteochondroma of the C2 Vertebral Body Totally Resected Using an Intraoperative O-arm Navigation System: A Case Report. Spine Surg Relat Res 2020; 4:380-383. [PMID: 33195867 PMCID: PMC7661022 DOI: 10.22603/ssrr.2020-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kenji Hagiwara
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiji Wada
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Tamaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohisa Inoue
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
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16
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Farah K, Meyer M, Prost S, Dufour H, Blondel B, Fuentes S. Cirq® Robotic Assistance for Minimally Invasive C1-C2 Posterior Instrumentation: Report on Feasibility and Safety. Oper Neurosurg (Hagerstown) 2020; 19:730-734. [PMID: 32710770 DOI: 10.1093/ons/opaa208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate screw placement remains very challenging especially in the upper cervical spine. OBJECTIVE To present our first experience of a percutaneous posterior C1-C2 fixation for a traumatic fracture. METHODS This is a case report of a non-neurological patient, harboring a type II odontoid fracture. She underwent a posterior percutaneous fixation using Cirq® Robotic Assistance coupled to the AIRO® intraoperative computed tomography (iCT)-scan and BrainLab® navigation system (all by BrainLab AG). Routine CT was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated. RESULTS The C1-C2 posterior percutaneous fixation was performed with cannulated VERTEX® Reconstruction System (Medtronic). Overall, 4 screws were placed. All of them were rated as acceptable (100%). Radiation dose received by the patient was 4.13 mSv. Radiation dose received by the surgical staff was 0 mSv. Postoperative course was excellent. CONCLUSION Posterior percutaneous fixation using Cirq® Robotic Assistance coupled with iCT navigation system is a major innovation that can improve pedicle screw positioning's accuracy with acceptable patient radiation and reduced surgical team exposure.
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Affiliation(s)
- Kaissar Farah
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Mikael Meyer
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Solene Prost
- Department of orthopedic surgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Henry Dufour
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Benjamin Blondel
- Department of orthopedic surgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Stephane Fuentes
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
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17
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Xu HT, Zheng S, Dong RP, Yu T, Zhao JW. Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion: A case report. Medicine (Baltimore) 2020; 99:e21838. [PMID: 33120726 PMCID: PMC7581057 DOI: 10.1097/md.0000000000021838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE The misplaced cervical screw can cause catastrophic surgical complications, such as nerve root damage, vertebral artery compromise, spinal cord injury, and even paraplegia. Thus, the present study aims to describe a novel technique of 3-dimensional printing model (3DPM) combined with 3-dimensional fluoroscopic navigation (3DFN) to facilitate C2 pedicle screw insertion. PATIENT CONCERNS A 56-year-old male patient presented hypoesthesia of the trunk and extremities, accompanied by a walking disorder. DIAGNOSES Congenital atlantoaxial malformation with atlantoaxial dislocation. INTERVENTIONS He underwent an occipital cervical fusion. We used 3DPM and 3DFN technology to guide C2 pedicle screws insertion. OUTCOMES We inserted 2 pedicle screws and 4 lateral mass screws using the combined 3DPM and 3DFN technology. All screws were classified as excellent position postoperatively. The surgical duration, total fluoroscopic time, and the bleeding volume were 258 minutes, 3.9 minutes, and 237 mL, respectively. No surgical complications, such as neurological compromise, nonunion, dysphagia, infection, polypnea, fixation failure, pseudarthrosis formation, or revision surgery, were observed. The follow-up duration lasted 30 months. LESSONS The combination of 3DPM and 3DFN to promote C2 pedicle screws implantation is a safe, accurate, reliable, and useful technology, which can achieve an excellent therapeutic effect and avoid surgical complications. However, using the 3DPM and 3DFN technology may increase the financial burden of patients.
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18
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Paterson A, Byrne S, Hansen M, Kuru R. Modified C1 lateral mass screw insertion using a threaded K-wire. A technical note. J Clin Neurosci 2020; 79:95-99. [PMID: 33070927 DOI: 10.1016/j.jocn.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/24/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
Instrumented fixation of the C1-C2 motion segment is a standard surgical technique to stabilise that spinal segment. Instability at C1-C2 can arise from a number of conditions. Fixation of the C1 lateral mass usually involves dissection and exposure of the C2 nerve root and the posterior wall of the C2 lateral mass which can result in significant bleeding from the venous plexus. Whilst image guidance is increasing in accessibility, there are few public hospitals in Australia that have access to this technology. The authors describe their technique for insertion of a C1 lateral mass screw over a threaded K-wire to avoid extensive dissection of the C2 nerve root, reducing the risk of significant haemorrhage from the epidural venous plexus during the procedure. A retrospective analysis was undertaken on 18 consecutive patients who underwent C1-C2 instrumented fixation using this technique. Indications for C1-C2 instrumented fixation included traumatic injury (10 patients), failure of non-operative management of odontoid fractures (5 patients), pathological fractures of C2 (2 patients) and inflammatory conditions (1 patient). All patients underwent successful C1-C2 stabilisation using this technique. Blood loss did not exceed 400mls in any patient. There were no vertebral artery injuries and no patient experienced a neurological deterioration. The authors propose that their technique for insertion of a C1 lateral mass screw over a threaded K-wire is safe and effective with a low risk of neurological or vertebral artery injury. The technique may be considered as a slight modification of the Harm's procedure to reduce disturbance of the adjacent venous plexus and thereby reduction in intraoperative bleeding and operative time.
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Affiliation(s)
- Amanda Paterson
- Department of Neurosurgery, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
| | - Stephen Byrne
- Department of Neurosurgery, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia; Department of Orthopaedics, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Mitchell Hansen
- Department of Neurosurgery, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Robert Kuru
- Department of Orthopaedics, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
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19
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Yi HJ, Hong JT, Lee JB, Park JH, Lee JJ, Kim IS, Yang SH, Sung JH. Analysis of Risk Factors for Posterior C1 Screw-Related Complication: A Retrospective Study of 358 Posterior C1 Screws. Oper Neurosurg (Hagerstown) 2020; 17:509-517. [PMID: 31062023 DOI: 10.1093/ons/opz068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although C1 screw fixation is becoming popular, only a few studies have discussed about the risk factors and the patterns of C1 screw complications. OBJECTIVE To investigate the incidence of C1 screw complications and analyze the risk factors of the C1 screw complications. METHODS A total of 358 C1 screws in 180 consecutive patients were analyzed for C1 screw complications. Screw malposition, occipital neuralgia, major complications, and total C1 screw complications were analyzed. RESULTS The distribution of C1 screw entry point is as follows: inferior lateral mass, 317 screws (88.5 %); posterior arch (PA), 38 screws (10.7 %); and superior lateral mass, 3 screws (0.8 %). We sacrificed the C2 root for 127 screws (35.5 %). C1 instrumentation induced 3.1 % screw malposition, 6.4 % occipital neuralgia, 0.6 % vascular injury, and 3.4 % major complications. In multivariate analysis, deformity (odds ratio [OR]: 2.10, P = .003), traumatic pathology (OR: 4.97, P = .001), and PA entry point (OR: 3.38, P = .001) are independent factors of C1 screw malposition. C2 root resection can decrease the incidence of C1 screw malposition (OR: 0.38, P = .012), but it is a risk factor of occipital neuralgia (OR: 2.62, P = .034). Advanced surgical experience (OR: 0.09, P = .020) correlated with less major complication. CONCLUSION The incidence of C1 screw complications might not be uncommon, and deformity or traumatic pathology and PA entry point could be the risk factors to total C1 screw complications. The PA screw induces more malposition, but less occipital neuralgia. C2 root resection can reduce screw malposition, but increases occipital neuralgia.
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Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.,Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Beom Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jong-Hyeok Park
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jung Jae Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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20
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Wada K, Tamaki R, Inoue T, Hagiwara K, Okazaki K. Comparison of Atlantoaxial Fusion with Transarticular Screws and C1 Lateral Mass-C2 Screws Using Intraoperative O-Arm Navigation. World Neurosurg 2020; 141:e1005-e1009. [PMID: 32599199 DOI: 10.1016/j.wneu.2020.06.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study compared the surgical outcomes of atlantoaxial fusion with transarticular screws (TASs) and C1 lateral mass-C2 screws (screw-rod constructs [SRCs]) using the intraoperative O-arm navigation system (O-arm). METHODS Among a total of 28 patients who underwent atlantoaxial fixation, 13 underwent TAS fixation and 15 underwent SRC fixation using the O-arm. All patients underwent Brooks procedure with iliac bone graft in addition to screw fixation. TAS fixation was performed for cases without high-riding vertebral artery (hVA). In the SRC group, pars or lamina screws were inserted for the side with a C2 hVA. Operative time, intraoperative bleeding, perioperative complications, screw accuracy, and bone union were evaluated. RESULTS There were statistically significant differences in mean operative time between the 2 procedures (166 minutes in the TAS group vs. 212 minutes in the SRC group, P < 0.05) and in mean blood loss (80 vs. 185 mL, respectively; P < 0.01). Two patients developed temporary postoperative occipital neuralgia probably related to C2 nerve root in the SRC group. No screws violated the cortex in either group. Complete bone union was observed in all cases. CONCLUSIONS O-arm-assisted TAS fixation had less intraoperative blood loss, shorter operative time, and fewer screw insertion complications than O-arm-assisted SRC fixation. O-arm-assisted TAS fixation is preferable for atlantoaxial fusion in patients without hVA.
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Affiliation(s)
- Keiji Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ryo Tamaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohisa Inoue
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Hagiwara
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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21
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Surgical Results of Intraoperative C-arm Fluoroscopy Versus O-arm in Transarticular Screw Fixation for Atlantoaxial Instability. World Neurosurg 2020; 139:e686-e690. [PMID: 32339745 DOI: 10.1016/j.wneu.2020.04.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study compared the surgical results of transarticular screw (TAS) fixation for atlantoaxial instability between C-arm fluoroscopy and O-arm. METHODS Of 58 patients who underwent TAS fixation for atlantoaxial instability, 35 underwent C-arm-assisted surgery (C-group) and 23 underwent O-arm-assisted surgery (O-group). In total, 78 TASs were placed: 39 in the C-group and 39 in the O-group. Unilateral and bilateral TAS fixation was performed in 38 and 20 patients, respectively. All patients underwent Brook's procedure with TAS. TAS fixation accuracy on postoperative computed tomography, operative time, intraoperative bleeding, perioperative complications, and bone union were evaluated. Screw accuracy was assessed using Neo's classification: grade (G) 0, no perforation; G1, perforation <2 mm; G2, perforation 2-4 mm; G3, perforation >4 mm. RESULTS TAS fixation accuracy was greater in the O-group than the C-group: G0: 38, 97.4%; G1: 1, 2.6% (O-group) vs G0: 22, 56.4%; G1: 11, 28.2%; G2: 3, 7.7%; G3: 3, 7.7% (C-group) (P < 0.001). Median operative time and median blood loss were similar between both groups. Bone union rate was greater with bilateral than unilateral TAS fixation (P < 0.05). There were no complications regarding screw malposition. Deep wound infection was observed in 1 case in the C-group. CONCLUSIONS O-arm use improved TAS fixation accuracy. Blood loss was equivalent between the groups. O-arm-assisted TAS fixation did not prolong operative time despite the time required for setting and scanning. The O-arm is safe and useful for TAS fixation in atlantoaxial instability.
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22
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Cervical Pedicle Screw Insertion Using O-Arm-Based 3D Navigation: Technical Advancement to Improve Accuracy of Screws. World Neurosurg 2020; 139:e182-e188. [PMID: 32272275 DOI: 10.1016/j.wneu.2020.03.171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to report the technical advancement to improve the accuracy of cervical pedicle screw (CPS) placement using O-arm-based 3D navigation. METHODS Sixty-four patients who underwent CPS using O-arm in the spine level of C2 to C7 between June 2013 and February 2020 were involved. In the first phase, a reference frame was placed onto the spinous process of the cranial vertebrae and used it at a maximum of 3 vertebral levels. The navigation guide sleeve was used to drill a screw hole. In the second phase, a reference frame that can hold 3 vertebrae was introduced. In the third phase, a drill guide sleeve to minimize bending of the drill tip was developed. In the fourth phase, navigated surgical drill was introduced. Screw accuracy was assessed using Neo classification: grade (G) 0, no perforation; G1, perforation <2 mm; G2, perforation 2-4 mm; and G3, perforation >4 mm. RESULTS Mean age at surgery was 67 (19-88) years. A total of 317 CPSs were inserted. In total, 83 screws were inserted in the first phase, 60 in the second phase, 87 in the third phase, and 87 in the fourth phase. The total proportion of malpositioning was 3.8% (12/317 screws) and all were G1; 6.0% (5/83 screws) in the first phase, 8.3% (5/60 screws) in the second phase, 1.2% (1/87 screws) in the third phase, and 1.2% (1/87 screws) in the fourth phase (P < 0.05). CONCLUSIONS O-arm use improved CPS placement accuracy with the advancement of techniques and instruments.
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Lee JS, Son DW, Lee SH, Ki SS, Lee SW, Song GS. Comparative Analysis of Surgical Outcomes of C1-2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation. J Korean Neurosurg Soc 2020; 63:237-247. [PMID: 32120457 PMCID: PMC7054113 DOI: 10.3340/jkns.2019.0172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. METHODS We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. RESULTS A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. CONCLUSION Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.
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Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Soon Ki
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Harel R, Nulman M, Knoller N. Intraoperative imaging and navigation for C1-C2 posterior fusion. Surg Neurol Int 2019; 10:149. [PMID: 31528484 PMCID: PMC6744764 DOI: 10.25259/sni_340_2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Cervical axial spine fusion is challenging as the anatomy is extremely variable, and screw misplacement can lead to severe complications. C1 lateral mass screws and C2 pedicle screws are routinely placed under either fluoroscopic guidance or imaging-assisted navigation. Here, we compared the two for axial screw placement. Methods: We retrospectively evaluated patients’ treated from 2011–2016 utilizing the Harm’s procedure for C1-C2 screw fixation performed under either fluoroscopic guidance (nine patients) or image-assisted O-arm navigation (five patients). The groups had similar demographic and risk factors. Variables studied included operative time, estimated blood loss (EBL), accuracy of screw placement, screw reposition rates, and reoperation rates. Results: The mean EBL was 555CC and 260CC, respectively (not a significant difference) utilizing fluoroscopic versus O-arm navigation. Of interest, the mean surgical duration was 27 min longer in the O-arm versus fluoroscopy group (P = 0.03). Ten C2 pedicle screws were performed using O-arm navigation. Alternatively, as 9 of 18 C2 pedicles were considered “risky” for the placement of fluoroscopic-guided pedicle screws, laminar screws were utilized. Although the accuracy rate of C1 and C2 screw placement was higher for the navigated group, this finding was not significant. Similarly, despite complications involving two unacceptably placed screws from the fluoroscopic guidance group, there were no neurological sequelae. Conclusion: Axial cervical spine instrumentation is challenging. Utilization of Imaging-assisted navigation increases the accuracy and safety of screw placement.
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Affiliation(s)
- Ran Harel
- Department of Neurosurgery, Spine Surgery Division, Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Nulman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachshon Knoller
- Department of Neurosurgery, Spine Surgery Division, Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
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Zhu XC, Liu YJ, Li XF, Yan H, Zhang G, Jiang WM, Sun HY, Yang HL. Min-invasive surgical treatment for multiple axis fractures: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i6.898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zhu XC, Liu YJ, Li XF, Yan H, Zhang G, Jiang WM, Sun HY, Yang HL. Min-invasive surgical treatment for multiple axis fractures: A case report. World J Clin Cases 2019; 7:898-902. [PMID: 31024962 PMCID: PMC6473124 DOI: 10.12998/wjcc.v7.i7.898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.
CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography (CT) scan revealed an axis injury consisting of an odontoid Type III fracture associated with a Hangman fracture categorized as a Levine-Edwards Type I fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.
CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.
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Affiliation(s)
- Xuan-Chen Zhu
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Yi-Jie Liu
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Xue-Feng Li
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Han Yan
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Ge Zhang
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Wei-Min Jiang
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Hou-Yi Sun
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China
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Kashiro H, Wada K, Yui M, Tamaki R, Numaguchi D, Hagiwara K, Okazaki K. Atlantoaxial Fixation in a Patient with Bilateral Persistent First Intersegmental Vertebral Artery Anomaly Using an O-arm Navigation System: A Case Report. Spine Surg Relat Res 2018; 3:196-198. [PMID: 31435576 PMCID: PMC6690083 DOI: 10.22603/ssrr.2018-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/14/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hideaki Kashiro
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiji Wada
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Yui
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Tamaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Numaguchi
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Hagiwara
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
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