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Zhang P, Jin G, Sun Z, Jiang J, Liu Q. An In Vitro Biomechanical Study of the Ectopic Functional Reconstruction of the Transverse Ligament of Atlas. World Neurosurg 2023; 172:e220-e224. [PMID: 36608796 DOI: 10.1016/j.wneu.2022.12.133] [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: 10/30/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the stability and function of the C1-C2 joint after ectopic functional reconstruction (EFR) of the C1 transverse ligament. METHODS Eight human cadaveric cervical spines (C0-C4) were subjected to in vitro biomechanical test with moment control. Spine specimens were tested under the following conditions: 1) left intact; 2) destabilized by severing the transverse ligament of atlas; 3) after EFR of the transverse ligament. Range of motion was measured in flexion, extension, lateral bending, and axial rotation. RESULTS Destabilization significantly increased range of motion in all directions compared with the intact status (P < 0.001). However, after EFR of the transverse ligament, range of motion in all directions was restored to the intact state. Meanwhile, coupling motions were reproduced in the axial rotation. CONCLUSIONS EFR of the transverse ligament virtually recovers all the physiological functions of the native transverse ligament and might be a promising alternative for the treatment of anterior atlantoaxial dislocation. Further studies are warranted before clinical application of EFR of the transverse ligament.
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Affiliation(s)
- Peng Zhang
- Department of Orthopedics, The 904th Hospital of Joint Logistic Support Force of PLA, Shanghai, China
| | - Genyang Jin
- Department of Orthopedics, The 904th Hospital of Joint Logistic Support Force of PLA, Shanghai, China
| | - Zijie Sun
- Department of Orthopedics, The 904th Hospital of Joint Logistic Support Force of PLA, Shanghai, China
| | - Jiayao Jiang
- Department of Orthopedics, The 904th Hospital of Joint Logistic Support Force of PLA, Shanghai, China
| | - Qi Liu
- Department of Pediatric Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Palmisciano P, Al Fawares Y, Woodhouse C, Yang G, Xu A, d'Herbemont S, Hoang S, McGuire JL, Phillips KM, Cheng J, Forbes JA. The Impact of C1 Anterior Arch Preservation on Spine Stability After Odontoidectomy: Systematic Review and Meta-Analysis. World Neurosurg 2022; 167:165-175.e2. [PMID: 36049722 DOI: 10.1016/j.wneu.2022.08.105] [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: 07/21/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Odontoidectomy for symptomatic irreducible ventral brainstem compression at the craniovertebral junction may result in spine instability requiring subsequent instrumentation. There is no consensus on the importance of C1 anterior arch preservation in prevention of iatrogenic instability. We conducted a systematic review of the impact of C1 anterior arch preservation on postodontoidectomy spine stability. METHODS PubMed, Embase, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients undergoing odontoidectomy. Random-effect model meta-analyses were performed to compare spine stability between C1 anterior arch preservation versus removal and posttreatment outcomes between transoral approaches (TOAs) versus endoscopic endonasal approaches (EEAs). RESULTS We included 27 studies comprising 462 patients. The most common lesions were basilar invagination (73.3%) and degenerative arthritis (12.6%). Symptoms included myelopathy (72%) and neck pain (43.9%). Odontoidectomy was performed through TOA (56.1%) and EEA corridors (34.4%). The C1 anterior arch was preserved in 16.7% of cases. Postodontoidectomy stabilization was performed in 83.3% patients. Median follow-up was 27 months (range, 0.1-145). Rates of spine instability were significantly lower (P = 0.004) when the C1 anterior arch was preserved. Postoperative clinical improvement and pooled complications were reported in 78.8% and 12.6% of patients, respectively, with no significant differences between TOA and EEA (P = 0.892; P = 0.346). Patients undergoing EEA had significantly higher rates of intraoperative cerebrospinal fluid leaks (P = 0.002). CONCLUSIONS Odontoidectomy is safe and effective for treating craniovertebral junction lesions. Preservation of the C1 anterior arch seems to improve maintenance of spine stability. TOA and EEA show comparable outcomes and complication rates.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yara Al Fawares
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Cody Woodhouse
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA
| | - George Yang
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alice Xu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sophie d'Herbemont
- Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Stanley Hoang
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Jennifer L McGuire
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Atlantoaxial Non-Fusion Using Biomimetic Artificial Atlanto-Odontoid Joint: Technical Innovation and Initial Biomechanical Study. Spine (Phila Pa 1976) 2022; 47:825-832. [PMID: 34618789 DOI: 10.1097/brs.0000000000004259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro investigation. OBJECTIVE To evaluate the function and stability of self-designed biomimetic artificial atlanto-odontoid joint (BAAOJ) replacement on the atlantoaxial joint. SUMMARY OF BACKGROUND DATA Upper cervical fusion surgery is a common treatment for various atlantoaxial disorders, and favorable clinical outcome has been achieved. However, the fusion surgery results in loss of atlantoaxial motion as well as adjacent segments degeneration, reducing the quality of life of patients and might produce severe neurological symptoms. Non-fusion technology is expected to solve the above problems, but various designed devices have certain defects and are still in the exploratory phase. MATERIALS AND METHODS Biomechanical tests were conducted on 10 fresh human cadaveric craniocervical specimens in the following sequence: 1) intact condition, 2) after the BAAOJ arthroplasty, 3) after BAAOJ fatigue test, 4) after odontoidect-omy, and 5) after anterior rigid plate fixation. Three-dimensional movements of the C1-C2 segment were evaluated to investigate the function and stability of BAAOJ arthroplasty compared with the intact condition after the BAAOJ fatigue test, odontoidect-omy, and rigid plate fixation. RESULTS Comparing the BAAOJ implantation to the intact state, the range of motion and neutral zone were slightly reduced in all directions (P > 0.05). Compared with the rigid plate fixation, the BAAOJ implantation significantly increased the range of motion and neutral zone in all directions, especially in the axial rotation (P < 0.05). CONCLUSION We designed a BAAOJ for correcting atlantoaxial disorders arising from atlantoaxial instability. As a non-fusion device, the most critical feature of BAAOJ replacement is the retention of flexion-extension, lateral bending, and axial rotation range of motion similar to the normal state. It can also stabilize the atlantoaxial complex, and the BAAOJ itself has a good initial stability.Level of Evidence: 4.
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Guo R, Zhou C, Wang C, Tsai TY, Yu Y, Wang W, Li G, Cha T. In vivo primary and coupled segmental motions of the healthy female head-neck complex during dynamic head axial rotation. J Biomech 2021; 123:110513. [PMID: 34038861 DOI: 10.1016/j.jbiomech.2021.110513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/04/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022]
Abstract
While previous studies have greatly improved our knowledge on the motion capability of the cervical spine, few reported on the kinematics of the entire head-neck complex (C0-T1) during dynamic activities of the head in the upright posture. This study investigated in vivo kinematics of the entire head-neck complex (C0-T1) of eight female asymptomatic subjects during dynamic left-right head axial rotation using a dual fluoroscopic imaging system and 3D-to-2D registration techniques. During one-sided head rotation (i.e., left or right head rotation), the primary rotation of the overall head-neck complex (C0-T1) reached 55.5 ± 10.8°, the upper cervical spine region (C0-2) had a primary axial rotation of 39.7 ± 9.6° (71.3 ± 8.5% of the overall C0-T1 axial rotation), and the lower cervical spine region (C2-T1) had a primary rotation of 10.0 ± 3.7° (18.6 ± 7.2% of the overall C0-T1 axial rotation). Coupled bending rotations occurred in the upper and lower cervical spine regions in similar magnitude but opposite directions (upper: contralateral bending of 18.2 ± 5.9° versus lower: ipsilateral bending of 21.4 ± 5.1°), resulting in a compensatory cervical lateral curvature that balances the head to rotate horizontally. Furthermore, upper cervical segments (C0-1 or C1-2) provided main mobility in different rotational degrees of freedom needed for head axial rotations. Additionally, we quantitatively described both coupled segmental motions (flexion-extension and lateral bending) by correlation with the overall primary axial rotation of the head-neck complex. This investigation offers comprehensive baseline data regarding primary and coupled motions of craniocervical segments during head axial rotation.
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Affiliation(s)
- Runsheng Guo
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Wang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Cai X, Yi X, Li H, He X. Preclinical evaluation of a novel anterior non-fusion fixation device for atlantoaxial instability: an in vivo comparison study in a canine model. 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 2019; 28:1225-1233. [PMID: 30761421 DOI: 10.1007/s00586-019-05916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/28/2018] [Accepted: 02/09/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The Anterior Atlantoaxial Non-Fusion Fixation System (AANFS) was a novel motion preservation device for atlantoaxial instability to replace traditional fusion techniques. The purpose of this in vivo study was to evaluate the clinical features and biomechanical properties of this new device in a canine model by comparing it with a conventional method. METHODS Eighteen adult male canines were randomly divided into group 1, which received the AANFS replacement, group 2 which received the Harms rigid fixation procedures, and group 3, which served as the control group. Routine follow-up evaluations were performed postoperatively. Specimens were harvested 12 weeks after the operation. Biomechanical tests were conducted to obtain the range of motion (ROM) and neutral zone (NZ) at C1-C2 segment in different groups. RESULTS The canines successfully tolerated the entire experimental procedure. No significant differences were found in surgery time, blood loss and recovery time between the AANFS group and the Harms rigid fixation group. Radiological examinations revealed that the position of the implant was good. Biomechanical results showed that, compared with the intact group, the mean ROM and NZ in flexion, extension, lateral bending and rotation were significantly reduced after rigid fixation. However, after the AANFS implantation, ROM and NZ in all directions were similar to those of the intact state. CONCLUSIONS This study for the first time provides an animal model for studying non-fusion strategies of upper cervical spine. The AANFS was able to maintain movement function of the atlantoaxial joint and may be an alternative to traditional fusion techniques. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Xuan Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xiaoqing Yi
- Department of Pediatrics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Haopeng Li
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xijing He
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
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Abstract
STUDY DESIGN A radiographic analysis of the anatomy of the C1 lateral mass using computed tomography (CT) scans and Mimics software. OBJECTIVE To define the anatomy of the C1 lateral mass and make recommendations for optimal entry point and trajectory for anterior C1 lateral mass screws. SUMMARY OF BACKGROUND DATA Although various posterior insertion angles and entry points for screw insertion have been proposed for posterior C1 lateral mass screws, no large series have been performed to assess the ideal entry point and optimal trajectory for anterior C1 lateral mass screw placement. MATERIALS AND METHODS The C1 lateral mass was evaluated using CT scans and a 3-dimensional imaging application (Mimics software). Measuring the space available for the anterior C1 lateral mass screw (SAS) at different camber angles from 0 to 30 degrees (5-degree intervals) was performed to identify the ideal camber angle of insertion. Measuring the range of sagittal angles was performed to calculate the ideal sagittal angle. Other measurements involving the height of the C1 lateral mass were also made. RESULTS The optimal screw entry point was found to be located on the anterior surface of the atlas 12.88 mm (±1.10 mm) lateral to the center of the anterior tubercle. This optimal entry point was found to be 6.81 mm (±0.59 mm) superior to the anterior edge of the atlas inferior articulating process. The mean ideal camber angle was 20.92 degrees laterally and the mean ideal sagittal angle was 5.80 degrees downward. CONCLUSIONS These measurements define the optimal entry point and trajectory for anterior C1 lateral mass screws and facilitate anterior C1 lateral mass screw placement. A thorough understanding of the local anatomy may decrease the risk of injury to the spinal cord, vertebral artery, and internal carotid artery. Delineating the anatomy in each case with preoperative 3D CT evaluation is recommended.
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Kuleshov AA, Shkarubo AN, Gavryushenko NS, Gromov IS, Vetrile MS, Fomin LV, Marshakov VV. Comparative Experimental Study of Custom Made Plate for Anterior Stabilization and Dorsal Fixation Systems at C1-C2 Vertebrae Level. ACTA ACUST UNITED AC 2016. [DOI: 10.32414/0869-8678-2016-1-76-81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Experimental study on the evaluation of strength of fixation with metal constructions at the level of C1-C2 vertebrae was performed on the basis of test laboratory for orthopaedic and traumatologic products. Experiments were performed on the cadaver block preparation (4) and plastic models (8) of craniovertebral spine. Authors’ custom made plate, hook system, screw systems by Magerl and Harms were used as fixators. First step was the imitation of the turning of the head to the right (“twisting”), second step - imitation of head tilting forward (“three point pressure”). It was shown that by its strength and stability of craniovertebral segment the elaborated metal plate was not inferior to dorsal fixation systems.
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Affiliation(s)
- A. A. Kuleshov
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
| | - A. N. Shkarubo
- Scientific Research Neurosurgery Institute named after the academician Nikolay Nilovich Burdenko, Moscow, Russia
| | - N. S. Gavryushenko
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
| | - I. S. Gromov
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
| | - M. S. Vetrile
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
| | - L. V. Fomin
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
| | - V. V. Marshakov
- Central Institute of Traumatology and Orthopaedics named after N.N. Priorov, Moscow, Russia
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Goel A. Artificial atlantoaxial joint: Is it a possible option? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:147-8. [PMID: 26692689 PMCID: PMC4660488 DOI: 10.4103/0974-8237.167852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Atul Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
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Chen J, Zhou F, Ni B, Guo Q, Guan H, Xu T, Liu Q. New Posterior Atlantoaxial Restricted Non-Fusion Fixation for Atlantoaxial Instability: A Biomechanical Study. Neurosurgery 2015; 78:735-41. [PMID: 26600279 DOI: 10.1227/neu.0000000000001122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Loss of axial rotation and lateral bending after atlantoaxial fusion reduces a patient's quality of life. Therefore, effective, nonfusion fixation alternatives are needed for atlantoaxial instability. OBJECTIVE To evaluate the initial stability and function of posterior atlantoaxial restricted nonfusion fixation (PAARNF), a new protocol, using cadaveric cervical spines compared with the intact state, destabilization, and posterior C1-C2 rod fixation. METHODS Cervical areas C0 through C3 were used from 6 cadaveric spines to test flexion-extension, lateral bending, and axial rotation range of motion (ROM). With the use of a machine, 1.5-Nm torque at a rate of 0.1 Nm/s was used and held for 10 seconds. The specimens were loaded 3 times, and data were collected in the third cycle and tested in the following sequence: (1) intact, (2) destabilization (using a type II odontoid fracture model), (3) destabilization with PAARNF (PAARNF group), and (4) rod implantation (rod group). The order of tests for the PAARNF and rod groups was randomly assigned. RESULTS The average flexion-extension ROM in the PAARNF group was 7.44 ± 2.05°, which was significantly less than in the intact (P = .00) and destabilization (P = .00) groups but not significantly different from that of the rod group (P = .07). The average lateral bending ROM (10.59 ± 2.33°; P = .00) and axial rotation ROM (38.79 ± 13.41°; P = .00) of the PAARNF group were significantly greater than in the rod group. However, the values of the PAARNF group showed no significant differences compared with those of the intact group. CONCLUSION PAARNF restricted atlantoaxial flexion-extension but preserved axial rotation and lateral bending at the atlantoaxial joint in a type II odontoid fracture model. However, it should not be used clinically until further studies have been performed to test the long-term effects of this procedure.
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Affiliation(s)
- Jinshui Chen
- ‡Department of Orthopedics, Fuzhou General Hospital, Nanjing Military Command, Fuzhou, P.R. China;§Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, P.R. China;¶Department of Orthopedics, No. 451 Hospital of PLA, Xi'an, P.R. China
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Chen G, Li J, Li X, Fan H, Guo Z, Wang Z. Giant cell tumor of axial vertebra: surgical experience of five cases and a review of the literature. World J Surg Oncol 2015; 13:62. [PMID: 25889981 PMCID: PMC4340120 DOI: 10.1186/s12957-015-0438-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Due to the complex anatomy of the upper cervical spinal column region and the variable aggressiveness of giant cell tumors (GCTs), there exists no standard treatment for GCTs of axial vertebra. To the best of our knowledge, there are only a few case reports in the literature and no large sum numbers of clinical trials about the treatment of, or research into, axial vertebra GCTs. Methods Between 2009 and 2013, five patients pathologically diagnosed with axial vertebra GCTs were treated at our hospital. We performed intralesional excision and odontoid process reconstructive surgery to preserve the odontoid process, followed with adjuvant radiation therapy after surgery. Results For those with an intact bone shell, part of the β-TCP (beta tricalcium phosphate) artificial bone could be seen clearly after surgery and became blurred three months after surgery, as seen on a radiograph. One year later, the part of β-TCP artificial bone was fused as a block. Subsequently, autogenous bone regenerated successfully and artificial bone degraded thoroughly. For those with a defective cortical bone, partial fusion of the odontoid process, autograft ilium and third vertebra body could be seen three months after surgery, and complete fusion was seen nine months later. The odontoid process was preserved successfully, and the upper cervical spine was reconstructed effectively, without implant failure or infection. Conclusions In this study, the odontoid process and function of upper cervical vertebra was preserved successfully through lesion curettage, combined with reconstruction with bone grafting, and adjuvant radiation therapy after surgery. During the follow-up periods, no recurrence or complications was observed.
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Affiliation(s)
- Guojing Chen
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Xiangdong Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Hongbin Fan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zheng Guo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
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Posterior reduction and temporary fixation for odontoid fracture: a salvage maneuver to anterior screw fixation. Spine (Phila Pa 1976) 2015; 40:E168-74. [PMID: 25398034 DOI: 10.1097/brs.0000000000000709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To evaluate the outcomes of posterior reduction and temporary fixation using the C1-C2 screw-rod system for odontoid fracture unsuitable for anterior screw fixation. SUMMARY OF BACKGROUND DATA Anterior screw fixation has become the most widely used surgical procedure for the stabilization of odontoid fractures. However, if there is any contraindication for anterior fixation, posterior atlantoaxial fusion is preferred, eliminating the normal rotation of the atlantoaxial complex. METHODS A consecutive series of 22 patients with odontoid fracture unsuitable for anterior screw fixation were involved in this study. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed. Once fracture healing was obtained, instrumentation was removed. The visual analogue scale of neck pain, neck stiffness, American Spinal Injury Association impairment scale, patient satisfaction, and neck disability index were recorded. The range of motion of C1-C2 in flexion-extension and rotation was calculated. RESULTS The average age at internal fixation surgery was 40.2±11.3 years. The mean duration of follow-up was 41.8±26.8 months. There were no complications associated with instrumentation. All patients returned to their preoperative work. Fracture healing was observed in 21 patients and the instrumentation was removed. After removing the instrumentation, the visual analogue scale was reduced and neck stiffness were relieved (all P<0.01). Patient satisfaction and neck disability index had improved (all P<0.01). The range of motion of C1-C2 returned to 4.75°±1.62° and 25.70°±5.51° in flexion-extension and in rotation, respectively. No osteoarthritis was observed at the C1-C2 lateral mass joints. CONCLUSION Posterior reduction and temporary fixation using the C1-C2 screw-rod system was an optimal salvage maneuver to anterior screw fixation for odontoid fracture. It could effectively avoid the motion loss of C1-C2 caused by posterior atlantoaxial fusion. LEVEL OF EVIDENCE 3.
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