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Beucler N. The summit of the isthmic crest of the axis as a new entry point for C2 pedicle screw: an anatomical study. Neurosurg Rev 2024; 47:107. [PMID: 38456988 DOI: 10.1007/s10143-024-02346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, Toulon Cedex 9, 83800, France.
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2
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Zhou LP, Zhang RJ, Zhang HQ, Jiang ZF, Shang J, Shen CL. Effect of High-Riding Vertebral Artery on the Accuracy and Safety of C2 Pedicle Screw Placement in Basilar Invagination and Related Risk Factors. Global Spine J 2024; 14:458-469. [PMID: 35719094 PMCID: PMC10802529 DOI: 10.1177/21925682221110180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the effect of HRVA on the intrapedicular accuracy of C2PS placement through the freehand method in patients with BI and analyse the possible risk factors for C2PS malpositioning. METHOD A total of 91 consecutive patients with BI who received 174 unilateral C2PS placements through the freehand method were retrospectively included. The unilateral pedicles were assigned to the HRVA and non-HRVA groups. The primary outcome was the intrapedicular accuracy of C2PS placement in accordance with the Gertzbein-Robbins scale. Moreover, the risk factors that possibly affected intrapedicular accuracy were assessed. RESULTS The rate of intrapedicular accuracy in C2PS placement in patients with BI was 23.6%. Results showed that the non-HRVA group had remarkably higher rates of optimal and clinically acceptable C2PS placement than the HRVA group. Nevertheless, the HRVA group exhibited similar results for grade B classification as the non-HRVA group. Moreover, in the HRVA and non-HRVA groups, the most common direction of screw deviations was the lateral direction. Furthermore, the multivariate analyses showed that the obliquity of the lateral atlantoaxial joint in the sagittal plane ≥15°, and that in the coronal plane ≥ 20°, isthmus height < 4.3 mm, and distance from the skin to the spinous process ≥ 2.8 cm independently contributed to a high rate of screw malpositioning in BI patients. CONCLUSION The presence of HRVA in BI patients contributed to the high rate of malpositioning in C2PS placement via the freehand method. However, the rates of intrapedicular accuracy in patients with BI with and without HRVA were considerably low.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ren-Jie Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua-Qing Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Cai-Liang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Martins RS, Pereira CS, Lemos C, Rodrigues-Pinto R. Posterior Atlantoaxial Screw Placement in a Portuguese Population: A Morphometric Analysis Based on Computed Tomography Scan Measurements. Rev Bras Ortop 2023; 58:48-57. [PMID: 36969775 PMCID: PMC10038719 DOI: 10.1055/s-0042-1744502] [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: 01/02/2022] [Accepted: 01/20/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The present study aims to evaluate the screw length and trajectory angles for posterior atlantoaxial fixation in a Portuguese population, through the study of cervical computed tomography (CT) scans. Methods Cervical CT scans of 50 adults were measured according to predefined screw trajectories of C1-C2 transarticular (C1C2TA), C1 lateral mass (C1LM), C2 pedicle (C2P), C2 pars and C2 laminar (C2L) screws. For each of these trajectories, screw length and angles were measured and compared between males and females. Results For the C1C2TA screw trajectory, the mean length, medial, and cranial angles were 34.12 ± 3.19 mm, 6.24° ± 3.06, and 59.25° ± 5.68, respectively, and for the C1LM screw trajectory, they were 27.12 ± 2.15 mm, 15.82° ± 5.07, and 13.53° ± 4.80, respectively. The mean length, medial, and cranial angles for the C2P screw trajectory were 23.44 ± 2.49 mm, 27.40° ± 4.88, and 30.41° ± 7.27, respectively; and for the C2 pars screw trajectory, they were 16.84 ± 2.08 mm, 20.09° ± 6.83, and 47.53° ± 6,97. The mean length, lateral, and cranial angles for the C2L screw trajectory were 29.10 ± 2.48 mm, 49.80° ± 4.71, and 21.56° ± 7.76, respectively. There were no gender differences except for the lengths of the C1C2TA ( p = 0,020) and C2L ( p = 0,001) screws, which were greater in males than in females. Conclusion The present study provides anatomical references for the posterior atlantoaxial fixation in a Portuguese population. These detailed data are essential to aid spine surgeons to achieve safe and effective screw placement.
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Affiliation(s)
- Rita Santos Martins
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Carolina Lemos
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Unidade Vertebro-Medular, Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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De Abreu Pineda M, Atallah E, Wainwright J, Schaefer J, Mahtabfar A, Harrop J, Prasad S, Heller J, Sharan A, Sivaganesan A, Jallo J. Hypoglossal nerve injury with C1 lateral mass screw placement: A case report and review of the literature. Radiol Case Rep 2022; 17:4594-4598. [PMID: 36193267 PMCID: PMC9525811 DOI: 10.1016/j.radcr.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maria De Abreu Pineda
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, USA
- Corresponding author.
| | - Elias Atallah
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - John Wainwright
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Joseph Schaefer
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Aria Mahtabfar
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - James Harrop
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Srinivas Prasad
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Joshua Heller
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Ashwini Sharan
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Ahilan Sivaganesan
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Jack Jallo
- Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
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Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3443-3451. [PMID: 36117232 DOI: 10.1007/s00586-022-07385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the Atlas (C1) lateral mass screw placement between screw trajectories of 0° and 15° medial angulation while using the intersection between lateral mass and inferomedial edge of the posterior arch. METHODS Forty-eight Atlas lateral masses were prepared and divided into 2 groups: Group 1; screws inserted at 3 mm lateral to the reference point with screw trajectory of 0° angulation(N = 24) and Group 2; those inserted with screw trajectory of 15° medial angulation(N = 24). We evaluated the atlas anatomy, screw purchase and the presence of any breaches using CT scan. RESULTS The radiographic parameters for Groups 1 and 2 were found statistically different (p-value < 0.05): bilateral intraosseous screw lengths (17.92 ± 1.47 mm. vs. 20.71 ± 2.4 mm.), bilateral screw length (29.92 ± 1.72 mm. vs. 33.13 ± 1.78 mm.), left screw medial angulation (x°) (0.67° ± 0.78° vs.14.17° ± 3.51°), right screw medial angulation (y°) (0.83° ± 1.03° vs.14.25° ± 2.53°) and bilateral screw medial angulation (0.75° ± 0.9° vs. 14.21° ± 2.99°). Twenty-two screws (91.67%) using the 0° medial angulation and nineteen screws (79.17%) using the 15° medial angulation had no cortical violations (Grade 0). However, two screws (8.33%) with 0° medial angulation and five screws (20.83%) with 15° medial angulation had breach less than 2 mm (Grade 1). There were no screws with breach between 2 and 4 mm (Grade 2) or greater than 4 mm. (Grade 3). CONCLUSION A starting point of 3-mm lateral to the intersection between lateral mass and inferomedial edge of the Atlas posterior arch can be safely and effectively used to insert C1 lateral mass using both 0° and 15° medial angulation.
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Asymmetry of the C2 pars interarticularis: a clinical anatomical study with relevance to screw placement. Surg Radiol Anat 2022; 44:423-429. [PMID: 35217894 DOI: 10.1007/s00276-022-02901-2] [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: 09/13/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Potential asymmetries of the C2 posterior elements pose a problem for the spine surgeon seeking to make the best choice for spinal stabilization while reducing morbidity. METHODS A digital caliper was used to measure the pars interarticularis height and length on left and right sides of 25 adult C2 vertebrae. The pars interarticularis was defined as the bone between the posterior most aspect of the superior articular process and the anterior most aspect of the inferior articular process of C2. Also, the C2 vertebrae from 49 patients were scanned by CT. Parasagittal images were reviewed and using the same definitions as were used for the skeletal specimens, the length and the height of the C2 pars interarticularis from both the left and right sides were measured using CT. The image slices were acquired at 3 mm intervals. The pars interarticularis height was determined on sagittal CT reconstruction, while the pars interarticularis length was calculated on the basis of the axial images. RESULTS The lengths and the heights of the left and right pars interarticularis were compared using CTs of patients and skeletal specimens. No significant differences were found in the length and height measurements of the CT images on both sides. However, in the skeletal specimens, the left and right pars interarticularis did not differ significantly in length but differed significantly in height (p = 0.003). The mean height of the left pars interarticularis was approximately two times larger than the right in the skeletal specimens. Absolute differences were calculated between the side with the greater length and height and the side with the lesser length and height irrespective of their left-right orientations. For CT measurements, most differences in length and height between the greater pars interarticularis and lesser pars interarticularis occurred between 0 and 1 mm with each successive disparity interval yielding lower numbers. Skeletal measurements revealed a similar length disparity distribution to the CT measurements. However, height measurements in the skeletal specimens varied widely. Eight pars interarticularis specimens demonstrated a height difference between 0 and 1 mm. No dry bone pars interarticularis specimens demonstrated a height difference between 1 and 2 mm. The pars interarticularis of nine specimens demonstrated a height difference between 2 and 3 mm. Two demonstrated a height difference between 3 and 4 mm. Four demonstrated a height difference between 4 and 5 mm and two demonstrated a height difference greater than 5 mm. The greater pars interarticularis lengths and heights were combined and compared to their lesser counterparts on CT and skeletal measurements. In all measurements of this type, significant differences were found in the pars interarticularis length and height, whether measured through CT or via digital calipers. CONCLUSION Asymmetry between the left and right C2 pars interarticularis as shown in the present study can alter surgical planning. Therefore, knowledge of this anatomical finding might be useful to spine surgeons.
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Wang B, Jin J, Shao ZX, Yang GY, Lin Y, Xu HZ, Xie CL, Chen JX, Zhang XL, Hong ZH, Wang XY. Wright's Technique with the Addition of Visualized Axial Cortical Windows in Odontoid Fractures. Orthop Surg 2021; 14:443-450. [PMID: 34914198 PMCID: PMC8867410 DOI: 10.1111/os.13012] [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: 07/14/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m2 , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China.,Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Zhen-Xuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Guang-Yong Yang
- Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Yan Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Hua-Zi Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Cheng-Long Xie
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Jiao-Xiang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Xiao-Lei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Zheng-Hua Hong
- Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
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Burkhardt BW, Podolski W, Pitzen TR, Ruf M. The Feasibility of C1-C2 Screw-rod Fixation in the Children 5 Years of Age and Younger. J Pediatr Orthop 2021; 41:e651-e658. [PMID: 34238864 DOI: 10.1097/bpo.0000000000001899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atlantoaxial fixation is technically challenging in younger children. The C1-C2 screw-rod fixation technique is established for adults but limited data about the clinical and radiographical outcome for the treatment of children with 5 years of age or younger is available. METHODS All files of children who were consecutively treated for spinal disorders were reviewed. Inclusion criteria for further evaluation were: 0 to 5 years of age at initial procedure; detailed surgical report of a posterior C1-C2 fusion with mass lateral and pedicle screw-rod fixation as described by Harms; a minimum clinical and radiographical follow-up of 24 months. The postoperative and last follow-up computed tomography scan and radiographs were used to assess the positioning and stability of the C1-C2 screw-rod construct. RESULTS Eleven patients (3 boys) with a mean age of 46 months (range: 8 to 66 mo) fulfilled inclusion criteria and were evaluated retrospectively. The mean clinical and radiographical follow-up was 79 months (range: 24 mo to 170 mo). The diagnosis was atlantoaxial rotatory dislocation (4 cases), C1-C2 instability with subluxation (3 cases), atlantoaxial dislocation and os odontoideum (1 case), type II odontoid fracture (1 case), traumatic odontoid epiphysiolysis (1 case), and traumatic rupture of the transverse ligament with C1 subluxation (1 case). Intraoperatively and postoperatively no new neurovascular or vascular complication occurred. C1 lateral mass screws were placed correctly in all cases. Twenty-two C2 pedicle screws were placed correctly (85.7%), and 3 screws showed penetration of the pedicle wall (14.3%). No implant revision, implant failure, and pseudarthrosis were noted. Loss of correction was noted in 1 patient with unilateral C1-C2 fixation and a repeated dorsal fusion procedures were performed. A repeat procedure for implant removal and segmental release was performed in 3 patients to increase the axial rotation of the head. CONCLUSIONS The C1-C2 screw-rod fixation is a safe technique that achieves solid fixation of the atlantoaxial complex in young children with various disorders. The technique preserves the joint and allows for segmental release via implant removal.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar
| | - Wladislaw Podolski
- Center for Spine Surgery, Orthopedics and Traumatology, SRH-Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Tobias R Pitzen
- Center for Spine Surgery, Orthopedics and Traumatology, SRH-Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Michael Ruf
- Center for Spine Surgery, Orthopedics and Traumatology, SRH-Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
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Bunmaprasert T, Puangkaew W, Sugandhavesa N, Liawrungrueang W, Riew KD. The Intersection Between Lateral Mass and Inferomedial Edge of the C1 Posterior Arch: A Reference Point for C1 Lateral Mass Screw Insertion. Neurospine 2021; 18:328-335. [PMID: 34218613 PMCID: PMC8255764 DOI: 10.14245/ns.2040814.407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using the intersection between the lateral mass and inferomedial edge of the posterior arch as an easily identifiable and reproducible medial reference point. Selection of an ideal entry point and trajectory of C1 lateral mass screw insertion can help to minimize neurovascular injuries. While various techniques for screw insertion have been proposed in the past, they all require extensive dissection of the C1 lateral mass, which can cause profuse bleeding.
Methods Ninety-three 3-dimensional computed tomography reconstructed images of C1 lateral masses in adult patients were utilized to simulate the placement of C1 lateral mass screws via 4 entry points and 2 trajectory angles referencing off of a medial reference point using Vero’s VISI 17 software. The safety during screw insertion simulation, as well as the screw length, were evaluated.
Results We found that C1 lateral mass screws could be safely placed bilaterally at 3 mm lateral to the reference point in both 0° and 15° medial screw angulation without violation of the cortex. The 15° medial angulation allowed for longer (18 mm) screws than the 0° angulation.
Conclusion We recommend starting C1 lateral mass screws 3 mm lateral to the intersection between the lateral mass and inferomedial edge of the posterior arch at a 15° medial angulation.
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Affiliation(s)
- Torphong Bunmaprasert
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watcharapong Puangkaew
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nantawit Sugandhavesa
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - K Daniel Riew
- Department of Orthopedic Surgery, NewYork-Presbyterian Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Dilbone E, Gupta R, Stephens B. Analyzing parsicle screws as a viable alternative to pars screws and pedicle screws for C2 posterior instrumentation fixation. J Orthop 2021; 25:220-223. [PMID: 34045826 DOI: 10.1016/j.jor.2021.05.024] [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: 04/10/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction This study examined the possible clinical utility of "parsicle screws" in securing C2 instrumentation. Methods Ten patients' C2 vertebrae were virtually reconstructed using computer-aided design software. Pedicle, pars, and parsicle screws were virtually placed in the vertebrae. Results In addition to establishing the trajectory and theoretical safety of parsicle screws, this study determined that parsicle screws were significantly longer than pars screws (p = 0.005). Conclusion The additional length of parsicle screws may improve construct stability. As such, parsicle screws should be examined as an alternative to pars screws in patients unable to receive C2 pedicle screws.
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Affiliation(s)
- Eric Dilbone
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Rishabh Gupta
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Byron Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Sai Kiran NA, Vidyasagar K, Sivaraju L, Raj V, Aryan S, Thakar S, Mohan D, Hegde AS. Outcome of Surgery for Congenital Craniovertebral Junction Anomalies with Atlantoaxial Dislocation/Basilar Invagination: A Retrospective Study of 94 Patients. World Neurosurg 2020; 146:e313-e322. [PMID: 33096283 DOI: 10.1016/j.wneu.2020.10.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI. METHODS AND RESULTS All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI. CONCLUSIONS Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
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Affiliation(s)
- Narayanam Anantha Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
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Azimi P, Yazdanian T, Benzel EC, Aghaei HN, Azhari S, Sadeghi S, Montazeri A. Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:272. [PMID: 32690035 PMCID: PMC7372824 DOI: 10.1186/s13018-020-01798-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
Study design Systematic review and meta-analysis. Aim The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg’s test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran.
| | | | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hossein Nayeb Aghaei
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Shirzad Azhari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Ali Montazeri
- Population Health Research Group, Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Kovalenko RA, Rudenko VV, Kashin VA, Cherebillo VY, Ptashnikov DA. [Assessment of the safety and accuracy of implantation of screws into the C2 vertebra using individual 3D-navigation matrices]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:42-50. [PMID: 32412193 DOI: 10.17116/neiro20208402142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Individual 3D-navigation matrices are valuable to increase the safety of screw implantation into the axis. Objective To analyze safety and accuracy of screw deployment into the axis using individual 3D-navigation matrices compared to free hand technique. Material and methods A retrospective analysis included 23 patients (group 1) who underwent implantation of 44 screws into the axis using the «free hand» technique. The screws were installed along the transpedicular or pars trajectory. A prospective analysis enrolled 17 patients (group 2) who underwent installation of 34 screws using individual navigation matrices. 3D-printing technology was applied for manufacturing these matrices. Implantation results were evaluated considering postoperative CT data and SGT (Screw Guide Template) system. Results In the 1st group («free hand»), grade 0 and 1 (no malposition or less than 50% of screw diameter) were recorded for 29 (65.91%) screws, grade 2 - for 13 (29.55%) screws, grade 3 - for 2 (4.45%) screws. Intraoperative injury of the vertebral artery without postoperative neurological deficit occurred in 4 (8.89%) patients. In the 2nd group, 97% of screws were implanted in accordance with grades 1 and 2. Deviation grade 2 was registered in 11 cases (32.35%). Mean deviation was 1.8 ± 1.0 mm. In the 2nd group, 28 (82.35%) out of 34 screws were completely within the bone structures (grade 0), 4 (11.76%) screws perforated pedicles for less than 50% of their diameter (grade 1). There were 2 cases of malposition grade 2 and 3 without vertebral artery injury. Conclusion Individual 3D navigation matrix is an effective method for screw installation into the axis. This approach exceeds fluoroscopy-assisted "free hand" technique in terms of safety of implantation.
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Affiliation(s)
- R A Kovalenko
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - V V Rudenko
- R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
| | - V A Kashin
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - V Yu Cherebillo
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - D A Ptashnikov
- R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
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Deng X, Xiong X, Shi H, Wan D, Cui W, Song S, Mei G, Hou W. [Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1419-1423. [PMID: 31650759 PMCID: PMC8337464 DOI: 10.7507/1002-1892.201902026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 09/16/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD). METHODS A clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT. RESULTS All incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant ( Z=-0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups ( t=-9.033, P=0.000; t=-15.835, P=0.000); while no significant difference was found between the two groups ( t=-0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups ( Z=-0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups ( Z=-0.681, P=0.496). CONCLUSION For RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.
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Affiliation(s)
- Xuangeng Deng
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041,
| | - Xiaoming Xiong
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Huagang Shi
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Dun Wan
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Wei Cui
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Simao Song
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Guolong Mei
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Wei Hou
- Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
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