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Bindels BJJ, Dronkers BEG, Smits MLJ, Verlaan JJ. Accurate Placement and Revisions for Cervical Pedicle Screws Placed With or Without Navigation: A Systematic Review and Meta-Analysis. Global Spine J 2024; 14:1018-1037. [PMID: 37596998 PMCID: PMC11192121 DOI: 10.1177/21925682231196456] [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] [Indexed: 08/21/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To evaluate the accuracy of placement for cervical pedicle screws with and without the use of spinal navigation. METHODS A structured search was conducted in electronic databases without any language or date restrictions. Eligible studies reported the proportion of accurately placed cervical pedicle screws measured on intraoperative or postoperative 3D imaging, and reported whether intraoperative navigation was used during screw placement. Randomized Studies (MINORS) criteria were used to evaluate the methodological quality of how accuracy was assessed for cervical pedicle screws. RESULTS After screening and critical appraisal, 4697 cervical pedicle screws from 18 studies were included in the meta-analysis. The pooled proportion for cervical pedicle screws with a breach up to 2 mm was 94% for navigated screws and did not differ from the pooled proportion for non-navigated screws (96%). The pooled proportion for cervical pedicle screws placed completely in the pedicle was 76% for navigated screws and did not differ from the pooled proportion for non-navigated screws (82%). Intraoperative screw reposition rates and screw revision rates as a result of postoperative imaging also did not differ between navigated and non-navigated screw placement. CONCLUSIONS This systematic review and meta-analysis found that the use of spinal navigation systems does not significantly improve the accuracy of placement of cervical pedicle screws compared to screws placed without navigation. Future studies evaluating intraoperative navigation for cervical pedicle screw placement should focus on the learning curve, postoperative complications, and the complexity of surgical cases.
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Affiliation(s)
- B. J. J. Bindels
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B. E. G. Dronkers
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. L. J. Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. J. Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Lee S, Hur JW, Oh Y, An S, Yun GY, Ahn JM. Current Concepts in the Treatment of Traumatic C2 Vertebral Fracture : A Literature Review. J Korean Neurosurg Soc 2024; 67:6-13. [PMID: 37461838 PMCID: PMC10788552 DOI: 10.3340/jkns.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 01/17/2024] Open
Abstract
The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Younggyu Oh
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gi-Yong Yun
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Can Axis C be a navigation route - CT comparison study between actual and virtual C1 transpedicular screw insertion. J Clin Neurosci 2023; 111:11-15. [PMID: 36913898 DOI: 10.1016/j.jocn.2023.02.016] [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: 11/09/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Previous studies mainly reported perpendicular and medial inclination insertion methods for C1 transpedicular screw insertion (TSI). Our recent study showed the ideal C1 transpedicular screw trajectory (TST) can be achieved by medial inclination, perpendicular or even lateral inclination insertion, and Axis C can be a reliable trajectory. The purpose of this study is to confirm Axis C is an ideal C1 TST by comparing the cortical perforation differences between actual C1 TSI and virtual C1 transpedicular screw insertion along Axis C (Virtual C1 Axis C TSI). METHODS Firstly, the cortical perforations of the transverse foramen and vertebral canal caused by C1 TSIs in twelve randomly selected patients were evaluated based on their postoperative CT data. Secondly, Virtual C1 Axis C TSIs were performed based on same patients' preoperative CT data. Thirdly, the cortical perforation differences between actual and virtual screws were compared. RESULTS In actual C1 TSI group, there were thirteen locations of cortical perforation in the axial plane, with five sides in transverse foramen and eight sides in vertebral canal, the cortical perforation rate was 54.2%; the degree of perforation was mild in twelve locations and medium in one location. In contrast, there was no cortical perforation in Virtual C1 Axis C TSI group. CONCLUSIONS Axis C is an ideal trajectory for C1 TSI, it can be utilized as a navigation route for computer assisted surgery system.
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Shin HK, Kim M, Lee S, Lee JJ, Park D, Jeon SR, Roh SW, Park JH. Surgical strategy for metastatic spinal tumor patients with surgically challenging situation. Medicine (Baltimore) 2022; 101:e29560. [PMID: 35801761 PMCID: PMC9259146 DOI: 10.1097/md.0000000000029560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The incidence of spinal metastasis is increasing as cancer patients live longer owing to the improvement of cancer treatments. However, traditional surgery (TS) which fixates at least 2 levels above and 2 levels below the affected vertebrae is sometimes difficult to perform as it is burdensome to the patients. In this article, we introduce our experience and strategy in treating spinal metastasis, focusing particularly on challenging cases. We retrospectively reviewed the data of 110 patients who underwent spinal surgery for metastatic spinal tumors from April 2018 to March 2020. Among them, 5 patients who received anterior approach surgery were excluded. The remaining 105 patients were enrolled. In addition to TS, we also performed cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, depending on the characteristics of the tumor. The overall survival was analyzed, and the local tumor control rate was evaluated using magnetic resonance imaging. Perioperative clinical characteristics including Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score were also investigated. The overall survival rate was 57.9% at 1 year, and the local tumor control rate was 81.1% after surgery. There was a statistically significant difference according to the type of the tumor in the survival analysis: the overall survival rates were 72.7% for favorable tumors and 48.6% for unfavorable tumors at 12 months after surgery (P = .04). Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score was improved after surgery. All surgical methods, including TS, cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, showed good clinical and radiological outcomes. Optimized surgical methods show similarly good clinical outcomes in managing spinal metastasis as TS.
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Affiliation(s)
- Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myeongjong Kim
- Department of Neurosurgery, Seongnam Citizens Medical Center, Seongnam, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Jae Lee
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Danbi Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * Correspondence: Jin Hoon Park, MD, PhD, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
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Cheaney B, Than KD. Commentary: The Results of Interfacetal Fusion Using Local Bone Combined With an Atlantoaxial Instrumentation. Oper Neurosurg (Hagerstown) 2022; 22:e187-e188. [PMID: 35316252 DOI: 10.1227/ons.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Barry Cheaney
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
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Oh Y, Lee BJ, Lee S, Jeon SR, Roh SW, Park JH. The Results of Interfacetal Fusion Using Local Bone Combined With an Atlantoaxial Instrumentation. Oper Neurosurg (Hagerstown) 2022; 22:284-289. [PMID: 35315815 DOI: 10.1227/ons.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies have described different C1-2 fusion techniques that have evolved over time. We introduced an easy and effective C1-2 fusion technique using local bone chips combined with atlantoaxial instrumentation. OBJECTIVE To identify the efficacy of interfacetal fusion using local bone combined with atlantoaxial instrumentation by assessment of clinical outcomes and fusion rate. METHODS We retrospectively reviewed the data from 25 patients who underwent atlantoaxial stabilization surgery using C1-2 pedicle screws and interfacetal bone fusion by a single surgeon between March 2012 and December 2019. RESULTS The demographics were 15 men and 10 women with a mean age of 57.6 years (range, 27-85 years) at the time of surgery. Three patients underwent surgery for myelopathy due to os odontoideum, 9 for C1-2 instability, 9 for trauma, 3 for rheumatoid arthritis, and 1 for bony spur, C1-2. At 3 months postsurgery, 3 and 21 patients showed 2-point and 1-point improvements in the Nurick grade, respectively. There was no difference in the Nurick score in 1 patient. Seven patients had a computed tomography scan at 1 year after surgery, which revealed a bridging trabecular bone. No movement was observed in the x-ray flexion/extension view at 1 year after surgery in all patients. In addition, no patients complained of postoperative occipital neuralgia. CONCLUSION This study showed that interfacetal fusion with C1-2 pedicle screws using the free-hand technique was efficient and simple.
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Affiliation(s)
- Younggyu Oh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Jou Lee
- Department of Neurological Surgery, Inje University, Ilsan Paik Hospital, College of Medicine, Neuroscience and Radiosurgery Hybrid Research Center, Goyang, Republic of Korea
| | - Subum Lee
- Department of Neurological Surgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lenz M, Harland A, Egenolf P, Perera A, Pennig L, Bredow J, Eysel P, Scheyerer MJ. Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities. 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; 30:3614-3619. [PMID: 34559274 DOI: 10.1007/s00586-021-06993-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/15/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE For surgical treatment of instable upper cervical injuries, the Harms technique using lateral mass screws provides rigid fixation and favourable clinical outcomes. The use of the posterior arch of C1 as a "pedicle" allows for screw anchorage, giving improved biomechanical stability. Therefore, the aim of this study was to introduce a bilateral safe zone for C1 pedicle screws, regarding screw angulation and pedicle height. MATERIAL AND METHODS We retrospectively reviewed the CT scans of 500 patients. Three-dimensional reformats were generated for detailed measurements. Centre screw entry point (EP), length of lateral mass as screw trajectory, lateral mass width (LMW), length of screw trajectory (ST), maximal divergence (DI) and maximal convergence (CON) from EP without perforation, and pedicle height (PH) of the posterior arch were measured. RESULTS The 500 cases consisted of 335 males and 165 females, with a mean age of 49.5 years. Measurements did not demonstrate significant side-related differences. The mean screw entry point was 22.8 mm from the midline-axis (left 22.6 mm; right 23.0 mm). From this point, a safe zone between 11.6° of divergence and 19.6° of convergence was detected. Measurements of female patients were generally smaller, with significant differences from male patients (p < 0.05). 158 subjects (31.6%) had a PH < 4 mm. DISCUSSION C1 pedicle screws were feasible in the majority of patients. Proposing a safe zone for screw angulation may provide safety and avoid screw perforation. However, detailed knowledge of the individual C1 anatomy and the preoperative measurement is essential in the operative planning.
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Affiliation(s)
- Maximilian Lenz
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Arne Harland
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
| | - Philipp Egenolf
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
| | - Akanksha Perera
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jan Bredow
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
| | - Max Joseph Scheyerer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany
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Jung YG, Lee BJ, Park W, Park JH. C1-2 Pedicle Screw Fixation for Ponticulus Posticus and Duplication of Vertebral Artery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E298-E299. [PMID: 33372969 DOI: 10.1093/ons/opaa397] [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: 03/31/2020] [Accepted: 09/13/2020] [Indexed: 11/14/2022] Open
Abstract
We previously introduced C1 pedicle screw placement to treat C1-2 pathology in a patient with normal vertebral artery anatomy.1 However, we should prepare to meet various anatomic variations. Ponticulus posticus is a bony prominence arising from the posterior arch or the superior articulating process of the atlas that completely or partially encircles the vertebral artery.2 We herein report a 79-yr-old female who presented with myelopathy and was diagnosed with compressive myelopathy at the C1 level in magnetic resonance imaging. A computed tomography showed ponticulus posticus (complete type to the right side) with duplication of vertebral artery. She underwent surgical treatment of C1-2 pedicle screw placement and reduction of C1 vertebra under a microscopic view. After C1 laminectomy, both-side vertebral arteries were dissected with a microscissor. The mobilization of upper divisions of vertebral artery was identified to secure the entry point and pedicle to insert a C1 pedicle screw. After complete protection of the upper and lower divisions of vertebral artery and identification of pedicle, a C1 pedicle screw was inserted by a freehand technique. We inserted autologous bone chips in the distracted C1-2 facet joint for facet joint fusion, and the C1 vertebra was pulled out by a rod reducer. After surgery, the patient's symptoms disappeared, and no vertebral artery injury was identified in postoperative 3-dimensional computed tomography angiography. Patient consent was obtained prior to performing the procedure.
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Affiliation(s)
- Yoon Gyo Jung
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Gyeonggi, South Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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