1
|
Miao XZ, Xu Z, Zhu FK, Hu H, Liu Y, Yang JS, Yan ZJ, Deng ZL, Chu L, Shi L. Unilateral Biplanar Screw-Rod Fixation Technique for the Treatment of Odontoid Fractures in Patients with Atlantoaxial Bone or Vascular Abnormalities. World Neurosurg 2024; 186:e173-e180. [PMID: 38537785 DOI: 10.1016/j.wneu.2024.03.101] [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: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
OBJETIVE This study aims to introduce the unilateral biplanar screw-rod fixation (UBSF) technique (a hybrid fixation technique: 2 sets of atlantoaxial screws were placed on the same side), which serves as a salvage method for traditional posterior atlantoaxial fixation. To summarize the indications of this technique and to assess its safety, feasibility, and clinical effectiveness in the treatment of odontoid fractures. METHODS Patients with odontoid fractures were enrolled according to special criteria. Surgical duration and intraoperative blood loss were documented. Patients were followed up for a minimum of 12 months. X-ray and computerized tomography scans were conducted and reviewed at 1 day, and patients were asked to return for computerized tomography reviews at 3, 6, 9, and 12 months after surgery until fracture union. Recorded and compared the Neck Visual Analog Scale and Neck Disability Index presurgery and at 1 week and 12 months postsurgery. RESULTS Between January 2016 and December 2022, our study enrolled 7 patients who were diagnosed with odontoid fractures accompanied by atlantoaxial bone or vascular abnormalities. All 7 patients underwent successful UBSF surgery, and no neurovascular injuries were recorded during surgery. Fracture union was observed in all patients, and the Neck Visual Analog Scale and Neck Disability Index scores improved significantly at 1 week and 12 months postoperative (P < 0.01). CONCLUSIONS The UBSF technique has been demonstrated to be safe, feasible, and effective in treating odontoid fractures. In cases where the atlantoaxial bone or vascular structure exhibits abnormalities, it can function as a supplementary or alternative approach to the conventional posterior C1-2 fixation.
Collapse
Affiliation(s)
- Xi-Zi Miao
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Orthopaedics, The Ninth People's hospital of Chongqing, Chongqing, China
| | - Fu-Kuan Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Hu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Liu
- Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Jun-Song Yang
- Department of Orthopaedics, Hong Hui Hospital of Xi'an, Xi'an, China
| | - Zheng-Jian Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Chu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Shi
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China.
| |
Collapse
|
2
|
Accuracy of patient-specific drill guide template for bilateral C1-C2 laminar screw placement: a cadaveric study. World Neurosurg 2022; 162:e225-e234. [PMID: 35259502 DOI: 10.1016/j.wneu.2022.02.126] [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: 01/10/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the accuracy of using patient-specific drill guides to place bilateral laminar screws in C1 and C2. METHODS Nine cervical specimens (8 male; mean age: 66.6 (56-73)) with the occiput attached (C0-C3) were used in this study. Pre-operative CT scans were used to create digital anatomic models for templating and guide creation. A total of 36 screws were placed with the aid of 3D printed patient-specific guides (2 screws at C1 and C2). Post-operative CT scans were performed following screw insertion. The planned and actual trajectories were compared using pre- and post-operative imaging based on the angular and entry point deviation. After screw placement and post-operative imaging, each specimen was dissected and performed a visual inspection for breaches. RESULTS No breaches or violations were observed on post-procedure CT and visual inspection. The average variation of the entry point in the X, Y, and Z-axis was 0.3±0.28, 0.41±0.38, and 0.29±0.24, respectively. No statistically significant difference (p>0.05) was observed between the planned and obtained entry points. There was no significant difference (p>0.05) in the deviation analysis between the planned and obtained angles in the axial and coronal planes. CONCLUSION The study demonstrates that patient-specific drill guides allow for accurate C1 and C2 bilateral laminar screw placement, with a low risk of cortical breach.
Collapse
|
3
|
Which traumatic spinal injury creates which degree of instability? A systematic quantitative review. Spine J 2022; 22:136-156. [PMID: 34116217 DOI: 10.1016/j.spinee.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/30/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic spinal injuries often require surgical fixation. Specific three-dimensional degrees of instability after spinal injury, which represent criteria for optimum treatment concepts, however, are still not well investigated. PURPOSE The aim of this review therefore was to summarize and quantify multiplanar instability increases due to spinal injury from experimental studies. STUDY DESIGN/SETTING Systematic review. METHODS A systematic review of the literature was performed using keyword-based search on PubMed and Web of Science databases in order to detect all in vitro studies investigating the destabilizing effect of simulated and provoked traumatic injury in human spine specimens. Together with the experimental designs, the instability parameters range of motion, neutral zone and translation were extracted from the studies and evaluated regarding type and level of injury. RESULTS A total of 59 studies was included in this review, of which 43 studies investigated the effect of cervical spine injury. Range of motion increase, which was reported in 58 studies, was generally lower compared to the neutral zone increase, given in 37 studies, despite of injury type and level. Instability increases were highest in flexion/extension for most injury types, while axial rotation was predominantly affected after cervical unilateral dislocation injury and lateral bending solely after odontoid fracture. Whiplash injuries and wedge fractures were found to increase instability equally in all motion planes. CONCLUSIONS Specific traumatic spinal injuries produce characteristic but complex three-dimensional degrees of instability, which depend on the type, level, and morphology of the injury. Future studies should expand research on the cervicothoracic, thoracic, and lumbosacral spine and should additionally investigate the destabilizing effects of the injury morphology as well as concomitant rib cage injuries in case of thoracic spinal injuries. Moreover, neutral zone and translation should be measured in addition to the range of motion, while mechanical injury simulation should be preferred to resection or transection of structures to ensure high comparability with the clinical situation.
Collapse
|
4
|
Burtsev AV, Sergeenko OM, Gubin AV. An alternative way of C1 screwing: Supralaminar C1 lateral mass screws. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:191-196. [PMID: 34194167 PMCID: PMC8214239 DOI: 10.4103/jcvjs.jcvjs_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Study Design: This study involves literature review, technical note, and case series. Objectives: The objectives were to analyze indications and contraindications, advantages, and disadvantages for C1 lateral mass screw (LMS) insertion above or partially above the arch, to descript technical features, and to give examples of the practical application of this technique and investigated its safety. Methods: A literature review was carried out in English and Russian in PubMed, Google Scholar, and eLibrary databases. We selected four patients, treated in our clinic, which was carried out partially supralaminar C1 LMS. Results: Only three descriptions of supralaminar C1 LMS were found in the literature. Four adult patients underwent posterior C1–C2 screw fixation with C1 LMS along the superior edge of the C1 arch at our clinic. Partially supralaminar C1 screws were inserted on one of the sides due to the difficulties of using classical techniques. The main reasons for supralaminar screw fixation were narrow C1 lamina, hypertrophied venous plexus, and intraoperative failures of classic techniques application (broken screw trajectory, profuse venous bleeding from the plexus). The average follow-up time for the patients was 2.7 years, no complications were noted, and all had a satisfactory spinal fusion. Conclusions: The proposed types of C1 LMS above or partially above the C1 arch can be useful alternative method of C1 screwing in selected patients. Indications for the use of the supralaminar C1 LMS method can be narrow C1 posterior arch and pedicle, pronounced C1-C2 venous plexus, some V3 segment anomalies at C1 level, small arthritic inferior part of lateral mass, and intraoperative failures of classic techniques application.
Collapse
Affiliation(s)
| | | | - Alexander V Gubin
- National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov, Moscow, Russia
| |
Collapse
|
5
|
Liu C, Kamara A, Yan Y. Biomechanical study of C1 posterior arch crossing screw and C2 lamina screw fixations for atlantoaxial joint instability. J Orthop Surg Res 2020; 15:156. [PMID: 32303269 PMCID: PMC7165391 DOI: 10.1186/s13018-020-01609-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background The biomechanics of C1 posterior arch screw and C2 vertebral lamina screw techniques has not been well studied, and the biomechanical performance of the constructs cannot be explained only by cadaver testing. Methods From computed tomography images, a nonlinear intact three-dimensional C1-2 finite element model was developed and validated. And on this basis, models for the odontoid fractures and the three posterior internal fixation techniques were developed. The range of motion (ROM) and stress distribution of the implants were analyzed and compared under flexion, extension, lateral bending, and axial rotation. Results All three kinds of fixation techniques completely restricted the range of motion (ROM) at the C1-2 operative level. The C1-2 pedicle screw fixation technique showed lower and stable stress peak on implants. The C1 posterior arch screw + C2 pedicle screw and C1 pedicle screw + C2 lamina screw fixation techniques showed higher stress peaks on implants in extension, lateral bending, and axial rotation. Conclusions As asymmetrical fixations, C1 posterior arch screw + C2 pedicle screw and C1 pedicle screw + C2 lamina screw fixations may offer better stability in lateral bending and axial rotation, but symmetrical fixation C1-2 pedicle screw can put the implants in a position of mechanical advantage.
Collapse
Affiliation(s)
- Chuang Liu
- State Key Laboratory of Mechanical Behavior and System Safety of Traffic Engineering Structures, Shijiazhuang Tiedao University, Shijiazhuang, 050000, Hebei, People's Republic of China.
| | - Allieu Kamara
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China
| | - Yunhui Yan
- School of Mechanical Engineering & Automation, Northeastern University, Shenyang, 110819, Liaoning, People's Republic of China
| |
Collapse
|
6
|
Chen Q, Brahimaj BC, Khanna R, Kerolus MG, Tan LA, David BT, Fessler RG. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. JOURNAL OF SPINE SURGERY 2020; 6:164-180. [PMID: 32309655 DOI: 10.21037/jss.2020.03.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Posterior atlantoaxial fusion is an important surgical technique frequently used to treat various pathologies involving the cervical 1-2 joint. Since the beginning of the 20th century, various fusion techniques have been developed with improved safety profile, higher fusion rates, and superior clinical outcome. Despite the advancement of technology and surgical techniques, posterior C1-2 fusion is still a technically challenging procedure given the complex bony and neurovascular anatomy in the craniovertebral junction (CVJ). In addition, vascular anomalies in this region are not uncommon and can lead to devastating neurovascular complications if unrecognized. Thus, it is important for spine surgeons to be familiar with various posterior atlantoaxial fusion techniques along with a thorough knowledge of various vascular anomalies in the CVJ. Intimate knowledge of the various surgical techniques in combination with an appreciation for anatomical variances, allows the surgeon develop a customized surgical plan tailored to each patient's particular pathology and individual anatomy. In this article, we aim to provide a comprehensive review of existing posterior C1-2 fusion techniques along with a review of common vascular anomalies in the CVJ.
Collapse
Affiliation(s)
- Qi Chen
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Lee A Tan
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
| | - Brian T David
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
7
|
Sangondimath G, Mallepally AR, Salimath S. Computed Tomography-Based Feasibility Study of C1 Posterior Arch Crisscrossing Screw Fixation. Asian Spine J 2020; 14:298-304. [PMID: 31906612 PMCID: PMC7280928 DOI: 10.31616/asj.2019.0199] [Citation(s) in RCA: 2] [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] [Received: 06/20/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Study Design Retrospective radiographic analysis. Purpose Posterior fixation of C1 using screws is the most popular technique among the various methods for C1 stabilization, but it places the surrounding neurovascular structures at risk. Approximately 20% of the population has an anomalous groove for the vertebral artery; therefore, salvage methods are necessary. Therefore, we analyzed the feasibility of a newer C1 posterior arch crisscrossing screw fixation technique and studied its feasibility in the Indian population on the basis of the anatomy of the C1 posterior arch. Overview of Literature Multiple techniques have been described for C1–C2 fixation, such as wiring techniques, interlaminar clamps, transarticular screws, screw-plate/screw-rod system fixation, and hook-screw system fixation techniques, to provide rigid C1–C2 stability. However, although C1 fixation has evolved with time, it is not complication-free. Methods A 100 computed tomography (CT) scans of cervical spines with 1 mm slice thickness in the axial and sagittal sections obtained were randomly selected for the evaluation. Atlantoaxial anomalies due to trauma, deformities, infections, and tumors were excluded. All the images were measured for height of the posterior tubercle, width of the posterior arch, and length of the screw, and the screw projection angle was calculated. Demographic data were collected for all the subjects. Results Out of the 88 CT scans analyzed, the mean height of the posterior tubercle was 7.4 mm, wherein 84.09% exceeded 7 mm, and the width of the posterior tubercle was 5.4 mm, wherein 88.6% (n=78) had posterior arch width >3.5 mm. A total of 13.6% (n=12) vertebrae were not suitable for screw placement, whereas 75% (n=66) vertebrae could accommodate 3.5×15 mm or longer screws. The screw projection angles ranged from 11.2° to 35° on the right and from 15.6° to 38.2° on the left. Conclusions C1 posterior arch screw fixation is a feasible and safe method because it poses little risk of injury to the surrounding neurovascular structures.
Collapse
Affiliation(s)
| | | | - Suman Salimath
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| |
Collapse
|
8
|
Ono Y, Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Kimura R, Iida J, Shimada Y. Posterior spinal fusion using a unilateral C1 posterior arch screw and a C2 laminar screw for atlantoaxial fracture dislocation. SAGE Open Med Case Rep 2019; 7:2050313X19849276. [PMID: 31105959 PMCID: PMC6503600 DOI: 10.1177/2050313x19849276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/16/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction: C1 lateral mass screws and C2 pedicle screws are usually chosen to fix
atlantoaxial (C1–C2) instability. However, there are a few situations in
which these screws are difficult to use, such as in a case with a fracture
line at the screw insertion point and bleeding from the fracture site. A new
technique using a unilateral C1 posterior arch screw and a C2 laminar screw
combined with a contralateral C1 lateral mass screws–C2 pedicle screws
procedure for upper cervical fixation is reported. Case Report: A 24-year-old woman had an irreducible C1–C2 anterior dislocation with a type
III odontoid fracture on the right side due to a traffic accident. The
patient underwent open reduction and posterior C1–C2 fixation. On the left
side, a C1 lateral mass screws and a C2 pedicle screws were placed. Because
there was bleeding from the fracture site and a high-riding vertebral artery
was seen on the right side, a C1 posterior arch screw and a C2 laminar screw
were chosen. Eight months after the surgery, computed tomography scans
showed healing of the odontoid fracture with anatomically correct
alignment. Conclusions: Although there have been few comparable studies, fixation with unilateral C1
posterior arch screw–C2 laminar screw could be a beneficial choice for
surgeries involving the upper cervical region in patients with fracture
dislocation or arterial abnormalities.
Collapse
Affiliation(s)
- Yuichi Ono
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Jumpei Iida
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
9
|
Yuan B, Zhou S, Chen X, Wang Z, Liu W, Jia L. Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients. J Orthop Surg Res 2017; 12:105. [PMID: 28693540 PMCID: PMC5504836 DOI: 10.1186/s13018-017-0607-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022] Open
Abstract
Background The objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique. Methods Data of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively. The visual analog scale (VAS) score and the neck disability index (NDI) were used to evaluate the curative effect. Postoperative radiological outcomes were used to evaluate the stability of atlantoaxial joint and bone fusion. Perioperative parameters such as blood loss, operation time, radiographic exposure times, and hospital expense were also recorded and analyzed. Results Forty-nine patients (36 men and 13 women) were included in this study. The mean age was 41.4 ± 8.9 (range from 19 to 64). All patients were followed up for 24–67 months. Among these patients, 25 of these patients underwent Gallie surgery and 24 underwent SRC surgery. The pain in the occipitocervical area of all the patients has been relieved. NDI scores and VAS scores were lower in Gallie group than in SRC group in early postoperative period. The proportion of the patients who achieved good bone fusion within 3 months after operation was 88.0% (22/25) in the Gallie group and 100% (24/24) in the SRC group. The Gallie group is lower than the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups. Conclusions For patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D’Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT 3D reconstruction, Gallie technique can be chosen as a safe and effective method if atlantoaxial reduction can be achieved preoperatively. Compared with SRC, Gallie technique can relieve the pain in the occipitocervical area earlier and it can shorten operation time and reduce intraoperative bleeding, radiographic exposure times, and hospital expense effectively. However, for patients with irreducible atlantoaxial dislocation, the Gallie technique should be used with caution.
Collapse
Affiliation(s)
- Bo Yuan
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Shengyuan Zhou
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Xiongsheng Chen
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China.
| | - Zhiwei Wang
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Weicong Liu
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Lianshun Jia
- Department of Orthopedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| |
Collapse
|
10
|
Atlantoaxial Stabilization Using C1 and C2 Laminar Screw Fixation. Asian Spine J 2017; 11:314-318. [PMID: 28443177 PMCID: PMC5401847 DOI: 10.4184/asj.2017.11.2.314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/17/2016] [Accepted: 10/02/2016] [Indexed: 11/23/2022] Open
Abstract
We describe the use of a C1 laminar screw in combination with a C2 laminar screw as a salvage technique to treat two patients, one with persistent first intersegmental artery and the other with vertebral artery occlusion after cervical spine fracture. The combined use of C1 and C2 laminar screws allows for good fixation of the atlantoaxial joint with a lower risk of vertebral artery injury; therefore, it can be an alternative surgical procedure for patients with congenital or traumatic anomalous vertebral artery.
Collapse
|
11
|
Guo-Xin J, Huan W. Unilateral C-1 posterior arch screws and C-2 laminar screws combined with a 1-side C1–2 pedicle screw system as salvage fixation for atlantoaxial instability. J Neurosurg Spine 2016; 24:315-320. [DOI: 10.3171/2015.4.spine14517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Atlantoaxial instability often requires surgery, and the current methods for fixation pose some risk to vascular and neurological tissues. Thus, new effective and safer methods are needed for salvage operations. This study sought to assess unilateral C-1 posterior arch screws (PASs) and C-2 laminar screws (LSs) combined with 1-side C1–2 pedicle screws (PSs) for posterior C1–2 fixation using biomechanical testing with bilateral C1–2 PSs in a cadaveric model.
METHODS
Six fresh ligamentous human cervical spines were evaluated for their biomechanics. The cadaveric specimens were tested in their intact condition, stabilization after injury, and after injury at 1.5 Nm of pure moment in 6 directions. The 3 groups tested were bilateral C1–2 PSs (Group A); left side C1–2 PSs with an ipsilateral C-1 PAS + C-2 laminar screw (Group B); and left side C1–2 PSs with a contralateral C-1 PAS + C-2 LS (Group C). During the testing, angular motion was measured using a motion capture platform. Data were recorded, and statistical analyses were performed.
RESULTS
Biomechanical testing showed that there was no significant difference among the stabilities of these fixation systems in flexion-extension and rotation control. In left lateral bending, the bilateral C1–2 PS group decreased flexibility by 71.9% compared with the intact condition, the unilateral C1–2 PS and ipsilateral PAS+LS group decreased flexibility by 77.6%, and the unilateral C1–2 PS and contralateral PAS+LS group by 70.0%. Each method significantly decreased C1–2 movements in right lateral bending compared with the intact condition, and the bilateral C1–2 PS system was more stable than the C1–2 PS and contralateral PAS+LS system (p = 0.036).
CONCLUSIONS
A unilateral C-1 PAS + C-2 LS combined with 1-side C-1 PSs provided the same acute stability as the PS, and no statistically significant difference in acute stability was found between the 2 screw techniques. These methods may constitute an alternative method for posterior atlantoaxial fixation.
Collapse
Affiliation(s)
- Jin Guo-Xin
- Department of Orthopaedic Surgery, Shengjing Hospital, China Medical University, Shenyang City, Liaoning Province, China
| | - Wang Huan
- Department of Orthopaedic Surgery, Shengjing Hospital, China Medical University, Shenyang City, Liaoning Province, China
| |
Collapse
|
12
|
Computed Tomographic Morphometric Analysis of Pediatric C1 Posterior Arch Crossing Screw Fixation for Atlantoaxial Instability. Spine (Phila Pa 1976) 2016; 41:91-6. [PMID: 26335672 DOI: 10.1097/brs.0000000000001156] [Citation(s) in RCA: 4] [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 CT-based study of pediatric atlas. OBJECTIVE The aim of this study was to identify morphometric patterns and dimensions of the pediatric C1 posterior arch to establish guidelines for the posterior arch crossing screw (PACS) fixation. SUMMARY OF BACKGROUND DATA The PACS fixation is an alternative or supplement to the C1 lateral mass screw or pedicle screw constructs. However, the anatomic feasibility of this technique has not been well documented in the pediatric population. METHODS A total of 123 pediatric patients were assigned into 6 groups based on age at an interval of 3 years. The C1 posterior arch unsuited to PACS fixation was classified as type 1 with synchondrosis, and type 2 without synchondrosis. Three subtypes of type 2 were included: the underdeveloped tubercle, the flat arch, and the undersized tubercle (height < 7 mm or width < 3.5 mm), respectively. The C1 posterior tubercle height and arch width, the projected PACS length and angle were measured, respectively. RESULTS There were 19 patients of type 1 and 68 patients of type 2. Type 1 was mostly found in patients under age 3 years, whereas type 2 was largely observed in patients older than 4 years. The tubercle size was the most limiting variable for successful PACS placement. The PACS fixation was feasible for 42% patients over age 7 years and only 5% patients under age 6 years. The posterior tubercle height increased with age, whereas the tubercle width, the PACS length, and axial-plane angle increased with age up to 12 years. The PACS length was between 16 and 18 mm with the angle between 18° and 23° for patients over age 7 years. CONCLUSION The PACS fixation was anatomically feasible in patients over age 7 years, but contraindicated in patients under age 6 years. Pediatric patients for the PACS fixation should be assessed before surgery. LEVEL OF EVIDENCE 4.
Collapse
|
13
|
Huang DG, Hao DJ, He BR, Wu QN, Liu TJ, Wang XD, Guo H, Fang XY. Posterior atlantoaxial fixation: a review of all techniques. Spine J 2015; 15:2271-81. [PMID: 26165477 DOI: 10.1016/j.spinee.2015.07.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/24/2015] [Accepted: 07/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Posterior atlantoaxial fixation is an effective treatment for atlantoaxial instability. Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. However, there is no article reviewing all the posterior atlantoaxial fixation techniques yet. PURPOSE The aim was to review the evolution and advancements of posterior atlantoaxial fixation. STUDY DESIGN This was a literature review. METHODS The application of all posterior fixation techniques in atlantoaxial stabilization, including wiring techniques, interlaminar clamp fixation, transarticular fixation, screw-plate systems, screw-rod systems, and hook-screw systems, are reviewed and discussed. Recent advancements on the novel technique of atlantoaxial fixation are described. The combination of the C1 and C2 screws in screw-rod systems are described in detail. RESULTS All fixation techniques are useful. The screw-rod system appears to be the most popular approach. However, many novel or modified fixation methods have been introduced in recent years. CONCLUSIONS Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. The wiring technique and interlaminar clamps technique have fallen out of favor because of the development of newer and superior fixation techniques. The C1-C2 transarticular screw technique may remain the gold standard for atlantoaxial fusion, whereas screw-rod systems, especially the C1 pedicle screw combined with C2 pedicle/pars screw fixation, have become the most popular fixation techniques. Hook-screw systems are alternatives for atlantoaxial fixation.
Collapse
Affiliation(s)
- Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
| | - Bao-Rong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Qi-Ning Wu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Tuan-Jiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Xiao-Dong Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Hua Guo
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| | - Xiang-Yi Fang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China
| |
Collapse
|
14
|
Xiang GH, Wang C, Lou C, Fang MQ, Tian NF, Xu HZ. Computed tomography morphometric analysis for C-1 posterior arch crossing screw placement in the pediatric cervical spine. J Neurosurg Pediatr 2015; 15:475-9. [PMID: 25658249 DOI: 10.3171/2014.11.peds14191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to evaluate the feasibility of the C-1 posterior arch crossing screw fixation technique in the pediatric age group. METHODS One hundred twenty-three pediatric patients were divided into 6 age groups. Computed tomography morphometric analysis of the C-1 posterior arch was performed. Measurements included height, width, and length. Statistical analysis was performed using the Student t-test and linear regression analysis. RESULTS The mean measurement of the posterior arch was height (6.35 ± 1.80 mm), width (Width 1: 4.48 ± 1.25 mm; Width 2: 4.42 ± 0.68 mm; Width 3: 4.42 ± 0.50 mm), and length (14.48 ± 1.67 mm). Seven (6.93%) of the 101 children in Groups 1-4 and 13 (59.1%) of the 22 children in Groups 5 and 6 could safely accommodate placement of C-1 posterior arch crossing screws. CONCLUSIONS This investigation found that a C-1 posterior arch crossing screw was feasible in this group of Chinese pediatric patients, particularly in those 13 years and older. Preoperative thin-cut CT is essential for identifying children in whom this technique is applicable and for planning screw placement.
Collapse
Affiliation(s)
- Guang-Heng Xiang
- Zhejiang Spine Research Center, Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | | | | | | | | |
Collapse
|
15
|
Nagoshi N, Suda K, Morita T, Matsumoto S, Iimoto S, Yasui K, Komatsu M, Kobayashi Y, Minami A, Toyama Y, Matsumoto M, Nakamura M. C1 posterior arch screw as an auxiliary anchor in posterior reconstruction for atlantoaxial dislocation associated with type II odontoid fracture: a case report and review of the literature. SPRINGERPLUS 2014; 3:672. [PMID: 25485206 PMCID: PMC4234742 DOI: 10.1186/2193-1801-3-672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 11/07/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although pedicle or lateral mass screws are usually chosen to fix atlantoaxial (C1-C2) instability, there is an increased risk for vertebral artery (VA) injury when used in patients with bone or arterial anomalies or osteoporotic bone. Here we report the C1 posterior arch screw as a new technique for upper cervical fixation. CASE DESCRIPTION A 90-year-old man complained of upper cervical pain after falling in his house. The initial computed tomography (CT) scan showed C1-C2 posterior dislocation with a type II odontoid fracture. The patient underwent C2 fracture reduction and posterior C1-C2 fixation. On the right side of C1, because lateral mass screw placement could cause injury to the dominant VA considering a risk in oldest-old osteoporotic patients, a posterior arch screw was chosen instead as an auxiliary anchor. An intralaminar screw was placed on the right side of C2 because a high-riding VA was observed. A lateral mass screw and a pars interarticularis screw were placed on the left side of C1 and C2, respectively. Ten months later, the odontoid fracture had healed, with normal anatomical alignment. Although the patient experienced slight weakness when spreading his bilateral fingers, his overall condition was good. DISCUSSION AND EVALUATION We have presented a novel technique using C1 posterior arch screws for the fixation of a C1-C2 dislocation. Such a screw is an alternative to the C1 lateral mass screw in patients who are at risk for a VA injury because of anomalous bone and arterial structures or poor bone quality. CONCLUSIONS Although there have been few comparable studies, and the long-term outcome is unknown, fixation with a posterior arch screw could be a beneficial choice for surgeries involving the upper cervical region.
Collapse
Affiliation(s)
- Narihito Nagoshi
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan ; Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Kota Suda
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Tomonori Morita
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Satoko Matsumoto
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Seiji Iimoto
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Keigo Yasui
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Miki Komatsu
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Yosuke Kobayashi
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Akio Minami
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| |
Collapse
|