Resultados de la fijación transarticular C1-C2 en una serie de 20 pacientes

A Study to Analyses Pattern and Treatment of Upper Cervical Spine Injuries Experience From Developing World

Background:

The literature regarding the different patterns of upper cervical spine injuries, their appropriate management, and management development of such injuries is scarce in the world.

Objectives:

The current study aimed to present the experience regarding the high velocity trauma of upper cervical spine injuries.

Patients and Methods:

Thirty patients (22 males, 8 females) with upper cervical spine injuries were treated and followed-up for an average of 24 months. The corresponding data were analyzed with respect to various types of injuries and different treatment modalities used to treat such patients keeping the basic healthcare facilities in view.

Results:

The clinical as well as radiological outcomes of the treatment of such injuries were mostly achievable with minimum facilities in India, with only few complications.

Conclusions:

Managing such patients needs a proper transport facility, proper care during transport, appropriate evaluation in the hospital and prompt conservative or operative treatment. Treatment is usually safe and effective by well trained professionals with good clinical and radiological outcomes.

Transarticular screw and C1 hook fixation for os odontoideum with atlantoaxial dislocation

OBJECTIVE

To introduce a fixation device composed of C1-2 transarticular (TA) screws and C1 hooks and explore its indication and clinical outcome for os odontoideum with atlantoaxial dislocation (AAD).

METHODS

From January 2004 to December 2008, 12 patients with os odontoideum (5 men and 7 women, average age 37.7 years [range 14-62 years]) were treated in the authors' hospital. All patients had AAD with local symptoms, and 10 had myelopathy. All patients underwent a posterior atlantoaxial fixation with C1-2 TA screws and C1 hooks. Clinical and radiographic analyses were performed at 3, 6, and 12 months postoperatively and annually thereafter.

RESULTS

The follow-up period was 12-66 months (average follow-up period 35.5 months). No neurologic or vascular complications occurred in these cases, and the device was placed well with no loosening or breakage. Plain radiographs and three-dimensional reconstruction of computed tomography (CT) images revealed solid bony fusion with a good alignment of C1 and C2 at 3 months postoperatively. No hardware failure, pseudarthrosis, or instability was noted during the follow-up period. All patients had relief of pain within 3 months, and neurologic symptoms were substantially improved.

CONCLUSIONS

When appropriate patients are selected, C1-2 TA screws combined with C1 hooks can be used to treat os odontoideum with AAD effectively with a relatively simple procedure resulting in excellent biomechanical strength and high bone fusion rate. Preoperative planning is crucial for the management of os odontoideum with AAD.

Simultaneous Anterior Arthrodesis C2-3 and Anterior Odontoid Screw Fixation for Stabilization of a 4-Part Fracture of the Axis—A Technical Description

Multiple fractures of the axis are rare and present challenging patterns of instability in cervical spine surgery. Once a surgeon is faced with a combination of fractures in the axis vertebra, including stable and unstable components, a sound treatment concept must be worked out to achieve primary stability, early mobilization, and superior outcome. We demonstrate an operative technique for the stabilization of a 4-part fracture of the axis. Utilizing anterior odontoid screw fixation and C2-3 arthrodesis, an unstable traumatic spondylolisthesis with fracture of the odontoid type IIA, and lateral mass of C2 was successfully stabilized at once. The technique enabled early postoperative mobilization of our patient, who, after 1 year, showed a favorable outcome with a pain-free range of motion. The basic thoughts guiding to treatment options in multiple fractures of the axis are discussed and our therapy concept is presented.

Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols

STUDY DESIGN

Prospective observational study.

OBJECTIVE

To assess the incidence and clinical consequence of intraoperative adverse events from a wide variety of spinal surgical procedures.

SUMMARY OF BACKGROUND DATA

In this study, adverse events were defined as any unexpected or undesirable event(s) occurring as a result of spinal surgery. A complication was defined as a disease or disorder, which, as a consequence of a surgical procedure, will negatively affect the outcome of the patient. We hypothesized that most adverse events would not result in complications that would be normally flagged through traditional practice audit approaches. By defining the incidence and types of adverse events seen in a spine surgical practice, we hope to develop preventative approaches to enhance patient safety.

METHODS

All postoperative clinical sequelae (i.e., complications) were prospectively identified, classified as to type, and graded (0 [none] to IV [death]) in 700 consecutive patients who underwent spine surgery (excluding > 300-day surgery microdiscectomies) at a university center from January 2002 to June 2003. To confirm data accuracy and assess the clinical sequelae of any adverse events, the medical records of these 700 patients were reviewed.

RESULTS

The overall incidence of intraoperative adverse events was 14% (98/700). A total of 23 adverse events led to postoperative clinical sequelae for an overall intraoperative complication incidence of 3.2% (23/700). Specific adverse events included dural tears (n = 58), spinal instrumentation-related events (n = 12), blood loss exceeding 5000 mL (n = 10), anesthesia/medical (n = 4), suspected or actual vertebral artery injury (n = 3), approach-related events (n = 3), esophageal/pharyngeal injury (n = 2), and miscellaneous (n = 6).

CONCLUSIONS

Adverse events can frequently occur (14%) during spinal surgery, however, the majority (76.5%) are not associated with complications. Improved patient safety can only be maximized by independent practice audit and the development of prospective methods to record adverse event data so that enhanced, evidence-based, clinical protocols can be developed.

Anterior retropharyngeal fixation C1-2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description and preliminary results

Posterior transarticular screw fixation C1-2 with the Magerl technique is a challenging procedure for stabilization of atlantoaxial instabilities. Although its high primary stability favoured it to sublaminar wire-based techniques, the close merging of the vertebral artery (VA) and its violation during screw passage inside the axis emphasizes its potential risk. Also, posterior approach to the upper cervical spine produces extensive, as well as traumatic soft-tissue stripping. In comparison, anterior transarticular screw fixation C1-2 is an atraumatic technique, but has been neglected in the literature, even though promising results are published and lectured to date. In 2004, anterior screw fixation C1-2 was introduced in our department for the treatment of atlantoaxial instabilities. As it showed convincing results, its general anatomic feasibility was worked up. The distance between mid-sagittal line of C2 and medial border of the VA groove resembles the most important anatomic landmark in anterior transarticular screw fixation C1-2. Therefore, CT based measurements on 42 healthy specimens without pathology of the cervical spine were performed. Our data are compiled in an extended collection of anatomic landmarks relevant for anterior transarticular screw fixation C1-2. Based on anatomic findings, the technique and its feasibility in daily clinical work is depicted and discussed on our preliminary results in seven patients.

C1-C2 Transarticular Screw Fixation for Atlantoaxial Instability

OBJECTIVES

The atlantoaxial segment of the cervical spine is commonly destabilized in a variety of disorders. Transarticular screw fixation of the C1-C2 joint has been proposed as a biomechanically superior therapeutic modality. The authors present their experience with this technique.

METHODS

A retrospective analysis of 23 patients treated with this technique was performed. The mean follow-up period was 39.5 +/- 0.1 months.

RESULTS

Mean duration of hospitalization was 3.4 +/- 0.1 days (range, 2 to 11 days). No intraoperative or early postoperative complications were detected. Four patients (17.4%) had postoperative complications unrelated to the primary procedure. The position of the screw was judged as satisfactory in 21 patients (91.3%). Two patients (8.7%) with suboptimal positioning of the screws were neurologically intact but needed no reoperation. Solid osseous fusion was detected in 19 patients (82.6%).

CONCLUSIONS

Transarticular C1-C2 screw fixation appears to be a safe and surgically reliable technique. Criteria for its application and refinements in its technical considerations continue to advance its clinically versatile therapeutic potential.