1
|
Jian Q, Zhao X, Hou Z, Wang Y, Fan T. Modified interfacet technique using shaped autologous occipital bone mass for basilar invagination. Clin Neurol Neurosurg 2023; 232:107848. [PMID: 37419081 DOI: 10.1016/j.clineuro.2023.107848] [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: 04/27/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE In economically undeveloped areas, surgery for basilar invagination (BI) is still a serious economic burden for people. This study introduces a modified interfacet technique for the treatment of BI using shaped autologous occipital bone mass to reduce BI and to save economical expenditure. METHODS The data of 6 patients with BI who underwent modified interfacet technique using shaped autologous occipital bone mass in our hospital from April 2020 to February 2021 were retrospectively analyzed. During the operation, osteotomy at the external occipital protuberance was performed using ultrasonic osteotome, followed by interfacet release and implantation of shaped autologous occipital bone mass to complete vertical reduction. The atlantodental interval (ADI), Chamberlain's line violation (CLV), clivo-axial angle (CXA) and cervico-medullary angle (CMA) were compared before and after surgery. Additionally, we observed implant stability during the follow-up period to assess the long-term success of the modified interfacet technique. RESULTS The surgical procedure was successful in all six patients, with no reported incidents of vascular injury, spinal cord injury, or dural tear. Following the operation, improvements were observed in the ADI, CLV, CXA, and CMA. Throughout the follow-up period, the implants remained stable, demonstrating no complications such as bone resorption of the autologous occipital bone mass, implant fracture, or displacement. CONCLUSION The utilization of shaped autologous occipital bone mass in atlantoaxial interfacet bone grafting has demonstrated effectiveness and feasibility. This technique offers simplicity, ease of preparation, and cost-effectiveness, making it a viable option for treating BI.
Collapse
Affiliation(s)
- Qiang Jian
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xingang Zhao
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhe Hou
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China; Department of Neurosurgery, Beijing Luhe Hospital, Capital Medica University, Beijing, People's Republic of China
| | - Yinqian Wang
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tao Fan
- Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People's Republic of China.
| |
Collapse
|
2
|
Li T, Du YQ, Yin YH, Xing SL, Qiao GY. Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis. Global Spine J 2022; 12:909-915. [PMID: 33138641 PMCID: PMC9344496 DOI: 10.1177/2192568220970164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECT To evaluate the outcomes of a head frame reduction and atlantoaxial arthrodesis technique for the treatment of reducible basilar invagination (BI) and atlantoaxial dislocation (AAD). METHODS Seventy-two reducible BI and AAD cases who were treated with the head frame reduction and atlantoaxial arthrodesis technique from June 2015 to December 2018 were retrospectively analyzed. Radiological measurements including the atlantodental interval (ADI), the height of odontoid process above Chamberlain line, Wackenheim line, clivus-canal angle (CCA) and JOA score were evaluated. RESULTS There was no death in this series. The follow-up period ranged from 6 to 32 months (mean: 21.2 months). Radiological, complete or 90% reduction was attained and complete decompression was demonstrated in all patients. The CCA increased from 123.22 ± 8.36 preoperatively to 143.05 ± 8.79 postoperatively (P < 0.01). There was no patient found postoperative dysphagia. Neurological improvement was observed in all patients, with the JOA scores increasing from 12.53 ± 1.93 preoperatively to 16.13 ± 1.23 postoperatively (P < 0.01). Solid bony fusion was demonstrated in 69 patients at follow-up (95.8%). CONCLUSION Head frame reduction technique is a simple and effective treatment which could relief neurologic compression and adjust the CCA in patients with reducible AAD and BI with lower potential risks. Atlantoaxial fixation with short segmental fixation, strong purchase and low shearing force could maintain superior stabilization. The safety and long-term efficacy of such fixation and reduction technique were favorable, which illustrated that it could be a promising treatment algorithm for such kind of disease.
Collapse
Affiliation(s)
- Teng Li
- Department of Neurosurgery, The
First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yue-Qi Du
- Department of Neurosurgery, The
First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yi-Heng Yin
- Department of Neurosurgery, The
First Medical Centre, Chinese PLA General Hospital, Beijing, China,Guang-Yu Qiao and Yi-Heng Yin, Department of
Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing
Road, Haidian District, Beijing 100853, China.
;
| | - Shao-Ling Xing
- Department of Anesthesia and
Operative Services, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, The
First Medical Centre, Chinese PLA General Hospital, Beijing, China,Guang-Yu Qiao and Yi-Heng Yin, Department of
Neurosurgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing
Road, Haidian District, Beijing 100853, China.
;
| |
Collapse
|
3
|
Du YQ, Yin YH, Li T, Qiao GY, Yu XG. Can C1 lateral mass and C3 pedicle screw fixation be used as an option for atlantoaxial reduction and stabilization in Klippel-Feil patients? A study of its morphological feasibility, technical nuances, and clinical efficiency. Neurosurg Rev 2022; 45:2183-2192. [PMID: 35022938 DOI: 10.1007/s10143-021-01729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/04/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
In Klippel-Feil patients with atlantoaxial dislocation, narrow C2 pedicles are often encountered preventing pedicle screw placement. Alternative techniques, including translaminar screws, pars screws, and inferior process screws could not achieve 3-column rigid fixation, and have shown inferior biomechanical stability. The present study aimed to evaluate the feasibility, safety, and efficacy of C3 pedicle screws (C3PSs) as an option for atlantoaxial stabilization in Klippel-Feil patients, and to introduce a freehand technique, the "medial sliding technique," for safe and accurate C3PS insertion. Thirty-seven Klippel-Feil patients with congenital C2-3 fusion who have received atlantoaxial fixation were reviewed. Preoperative CT and CT angiography were acquired to evaluate the feasibility of C3PS placement. C1 lateral mass and C3PS constructs were used for atlantoaxial stabilization. The "medial sliding technique" was introduced to facilitate C3PS insertion. Clinical outcomes and complications were evaluated, and screw accuracy was graded on postoperative CT scans. Morphological measurements showed that more than 80% C3 pedicles could accommodate a 3.5-mm screw. Fifty-eight C3PSs were placed in 33/37 patients using the medial sliding technique. Overall, 96.7% screws were considered safe and there was no related neurovascular complications; 27/33 patients exhibited neurological improvement and 30/33 patients had a solid bone fusion at an average 19.3-month follow-up. Therefore, the C3PS was a feasible option for atlantoaxial fixation in Klippel-Feil patients. The clinically efficiency of C3PS was satisfied with high fusion rates and low complications. The medial sliding technique we used could facilitate safe and accurate placement of C3PSs in Klippel-Feil patients with fused C2-3 vertebra.
Collapse
Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yi-Heng Yin
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
| | - Teng Li
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China.
| | - Xin-Guang Yu
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
| |
Collapse
|
4
|
A novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability: technical details, accuracy assessment and perioperative complications. 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 2021; 30:1585-1595. [PMID: 33704580 DOI: 10.1007/s00586-021-06780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To introduce a novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability, and to categorize the screw accuracy and perioperative complications regarding this technique in a large case series. METHODS Between January 2015 and January 2020, patients who had atlas assimilation, basilar invagination and atlantoaxial instability, and underwent atlantoaxial fixation using C1 lateral mass screws were reviewed. C1 lateral mass screws were placed with a novel surgical protocol following a series key steps, including posterior para-odontoid ligament release, panoramic exposure of the invaginated lateral mass, and diligent protection of the abnormal VA. Screw accuracy and related complications were specifically evaluated. RESULTS A total of 434 C1 lateral mass screws were placed. Fifteen screws (3.5%) were classified as unacceptable, 54 screws (12.4%) were classified as acceptable, and 365 screws (84.1%) were classified as ideal. Overall, 96.5% of screws were deemed safe. There were no cases of vascular injury or permanent neurological defects. One patient with an unacceptable screw presented with hypoglossal nerve paralysis and recovered after an immediate revision surgery. Thirty-seven patients complained about occipital neuralgia and were successfully managed with medication. CONCLUSION Placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability following this surgical protocol is safe and accurate. Thorough para-odontoid ligamental release, wide exposure of the invaginated lateral mass, and diligent protection of the vertebral artery are critical to maximize the chances of successful screw placement.
Collapse
|
5
|
Du YQ, Qiao GY, Yin YH, Li T, Yu XG. Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes. Clin Neurol Neurosurg 2020; 194:105793. [PMID: 32283470 DOI: 10.1016/j.clineuro.2020.105793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/21/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the technical nuances and clinical outcomes of posterior atlantoaxial facet joint reduction, fixation and fusion (AFRF) technique as a revision procedure for BI and AAD patients with failed suboccipital decompression and large occipital bone defect. PATIENTS AND METHODS We reviewed 32 patients with BI and AAD who were misdiagnosed as a simple Chiari malformation and received a suboccipital decompression surgery before admission. All patients underwent AFRF as a revision surgery. The separating, fusing, opacifying and false-coloring-volume rendering (SFOF-VR) technique was used to identify the course of the VA. Clinical and radiological outcomes were assessed after revision surgeries. RESULTS Clinical symptoms improved in all patients. The postoperative atlantodens interval, Wackenheim line and clivus-canal angle significantly improved (all P < 0.01). Intraoperative dural tear and cerebrospinal fluid leakage occurred in 3 patients and were managed by suture repair and lumbar drain. Abnormal VA was identified in 7 patients and no VA injury occurred with the aid of SFOF-VR technique. The average follow-up was 19.1 months and atlantoaxial bone fusion was confirmed in 31 patients. CONCLUSION For BI and AAD patients with failed suboccipital decompression, revision surgery is challenging. Occipitocervical fixation and posterior midline bone grafting are rather difficult due to the large occipital bone defect. The current study demonstrated that the posterior AFRF is a simple, safe and highly effective technique in revision surgery for such cases. For VA variations, the SFOF-VR technique is an effective tool to delineate the course VA.
Collapse
Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yi-Heng Yin
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Teng Li
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xin-Guang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
6
|
Du YQ, Li T, Ma C, Qiao GY, Yin YH, Yu XG. Biomechanical evaluation of two alternative techniques to the Goel-Harms technique for atlantoaxial fixation: C1 lateral mass-C2 bicortical translaminar screw fixation and C1 lateral mass-C2/3 transarticular screw fixation. J Neurosurg Spine 2020; 32:682-688. [PMID: 31952043 DOI: 10.3171/2019.11.spine191178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to investigate the biomechanical feasibility and stability of C1 lateral mass-C2 bicortical translaminar screw (C1LM-C2TL) fixation, C1 lateral mass-C2/3 transarticular screw (C1LM-C2/3TA) fixation, and C1LM-C2/3TA fixation with transverse cross-links (C1LM-C2/3TACL) as alternative techniques to the Goel-Harms technique (C1 lateral mass-C2 pedicle screw [C1LM-C2PS] fixation) for atlantoaxial fixation. METHODS Eight human cadaveric cervical spines (occiput-C7) were tested using an industrial robot. Pure moments that were a maximum of 1.5 Nm were applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). The specimens were first tested in the intact state and followed by destabilization (a type II odontoid fracture) and fixation as follows: C1LM-C2PS, C1LM-C2TL, C1LM-C2/3TA, and C1LM-C2/3TACL. For each condition, the authors evaluated the range of motion and neutral zone across C1 and C2 in all directions. RESULTS Compared with the intact spine, each instrumented spine significantly increased in stability at the C1-2 segment. C1LM-C2TL fixation demonstrated similar stability in FE and LB and greater stability in AR than C1LM-C2PS fixation. C1LM-C2/3TA fixation was equivalent in LB and superior in FE to those of C1LM-C2PS and C1LM-C2TL fixation. During AR, the C1LM-C2/3TA-instrumented spine failed to maintain segmental stability. After adding a cross-link, the rotational stability was significantly increased in the C1LM-C2/3TACL-instrumented spine compared with the C1LM-C2/3TA-instrumented spine. Although inferior to C1LM-C2TL fixation, the C1LM-C2/3TACL-instrumented spine showed equivalent rotational stability to the C1LM-C2PS-instrumented spine. CONCLUSIONS On the basis of our biomechanical study, C1LM-C2TL and C1LM-C2/3TACL fixation resulted in satisfactory atlantoaxial stabilization compared with C1LM-C2PS. Therefore, the authors believe that the C1LM-C2TL and C1LM-C2/3TACL fixation may serve as alternative procedures when the Goel-Harms technique (C1LM-C2PS) is not feasible due to anatomical constraints.
Collapse
Affiliation(s)
- Yue-Qi Du
- 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing; and
| | - Teng Li
- 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing; and
| | - Chao Ma
- 2Key Laboratory of Modern Measurement and Control Technology, Ministry of Education, Beijing Information Science and Technology University, Beijing, China
| | - Guang-Yu Qiao
- 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing; and
| | - Yi-Heng Yin
- 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing; and
| | - Xin-Guang Yu
- 1Department of Neurosurgery, Chinese PLA General Hospital, Beijing; and
| |
Collapse
|
7
|
Du YQ, Qiao GY, Yin YH, Li T, Tong HY, Yu XG. Usefulness of 3D Printed Models in the Management of Complex Craniovertebral Junction Anomalies: Choice of Treatment Strategy, Design of Screw Trajectory, and Protection of Vertebral Artery. World Neurosurg 2019; 133:e722-e729. [PMID: 31589981 DOI: 10.1016/j.wneu.2019.09.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the usefulness of 3-dimensional (3D) printed models as an aid for the treatment of complex CVJ anomalies. METHODS 3D printed models were fabricated for 21 patients with complex CVJ anomalies, including vertebral artery anomaly, thin C2 pedicle, vertical atlantoaxial facet joint, or rotational dislocation combined with atlantoaxial dislocation and basilar invagination. Preoperative planning, surgical simulation, and intraoperative reference were achieved using the 3D model during the surgical treatment. The usefulness of 3D printed models, and postoperative clinical and radiological outcomes were assessed. RESULTS Direct posterior reduction and atlantoaxial fixation were achieved in 19 patients. Transoral odontoidectomy followed by posterior fixation was implemented for 2 patients with vertical facet joint and rotational dislocation. All screws were safely inserted with no complication, and 90% patients achieved a >60% reduction of both horizontal and vertical dislocation. Clinical symptoms improved in all patients, with the averaged Japanese Orthopedic Association scores increasing from 11.14 to 14.43 (P < 0.01). CONCLUSIONS The patient-specific 3D printed model would be an effective tool for evaluation of the reducibility of the atlantoaxial dislocation and basilar invagination, decision making in choosing the optimal surgical approach and way of fixation, and precise placement of the screw while protecting the vertebral artery and spinal cord. The risk of neurovascular injury was minimized, and encouraging outcomes were achieved with the aid of this technique.
Collapse
Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Yi-Heng Yin
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China.
| | - Teng Li
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Huai-Yu Tong
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Xin-Guang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| |
Collapse
|
8
|
Goel A. C2 Inferior Facet Screws. World Neurosurg 2018; 121:291. [PMID: 30557934 DOI: 10.1016/j.wneu.2018.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Atul Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
| |
Collapse
|