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Wu C, Deng J, Wang Q, Pan J, Hu H, Li G, Tan L, Wei Q. Feasibility of Atlas Pedicle Screw Fixation Perpendicular to the Coronal Plane-A 3D Anatomic Analysis. Global Spine J 2022; 12:1369-1374. [PMID: 33525954 PMCID: PMC9394002 DOI: 10.1177/2192568220980715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN An anatomic analysis. OBJECTIVE To investigate the feasibility of the ideal atlas pedicle screw trajectory perpendicular to the coronal plane via atlas digital 3D reconstruction. METHODS One hundred adult atlases were evaluated in this study. The projection of the corridor for atlas pedicle screw fixation perpendicular to the coronal plane was quickly obtained using the perspective model of 3D reconstruction, and the area, long axis, short axis and width of the pedicle corridor were measured. The inner trajectory was near the lateral wall of the pedicle, and the center of the corridor was point A. The lateral trajectory was near the lateral wall of the transverse foramen, and the center of the trajectory was point C. The midpoint of A and C was B. The length of the inner, middle and lateral trajectorys were measured. The distances from points A, B and C to the posterior tubercle of the atlas and safety swing angle were measured. RESULTS From the dorsal view, the pedicle corridor was fitted into an ellipse with an average long axis of 13.6 mm, an average short axis of 5.2 mm, and an average area of 56.3 mm2. From the axial view, the pedicle corridor had an average width of 9.4 mm. The average lengths of the inner trajectory, middle trajectory and lateral trajectory were 31.7 mm, 28.7 mm and 25.1 mm, respectively; The average distances from the posterior tubercle to points A, B and C were 17.1 mm, 20.8 mm and 24.5 mm, respectively. The average swing angles from points A, B and C were 16.1°, 25.5°, and 28.1°, respectively. CONCLUSION Atlas pedicle screw fixation perpendicular to the coronal plane is feasible for almost all the volunteers. Pedicle screws close to the pedicle lateral wall of the atlas posterior arch perpendicular to the coronal plane is an advanced technique that is easy to master.
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Affiliation(s)
- Chao Wu
- Department of Orthopedics, Affiliated Zigong Fourth People’s Hospital, Zigong, China,Digital Medical Center, Affiliated Zigong Fourth People’s Hospital, Zigong, China
| | - Jiayan Deng
- Digital Medical Center, Affiliated Zigong Fourth People’s Hospital, Zigong, China
| | - Qing Wang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, China,Qing Wang, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jian Pan
- Digital Medical Center, Affiliated Zigong Fourth People’s Hospital, Zigong, China
| | - Haigang Hu
- Department of Orthopedics, Affiliated Zigong Fourth People’s Hospital, Zigong, China
| | - Guangzhou Li
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lun Tan
- Department of Orthopedics, Affiliated Zigong Fourth People’s Hospital, Zigong, China
| | - Qin Wei
- Department of Orthopedics, Affiliated Zigong Fourth People’s Hospital, Zigong, China
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Alshorman J, Zeng L, Wang Y, Zhu F, Chen K, Yao S, Jing X, Qu Y, Sun T, Guo X. Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4562618. [PMID: 34630987 PMCID: PMC8494544 DOI: 10.1155/2021/4562618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/04/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Background The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method Between Jan 2017-Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12-48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.
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Affiliation(s)
- Jamal Alshorman
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lian Zeng
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yulong Wang
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Fengzhao Zhu
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kaifang Chen
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sheng Yao
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xirui Jing
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yanzhen Qu
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tingfang Sun
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaodong Guo
- Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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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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Zhang L, Wang H. Biomechanical Effects of Lateral Inclination C 1 and C 2 Pedicle Screws on Atlantoaxial Fixation. Orthop Surg 2021; 13:2027-2033. [PMID: 34541829 PMCID: PMC8528989 DOI: 10.1111/os.13137] [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: 07/09/2020] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the biomechanical effect of lateral inclination C1 and C2 pedicle screws on the atlantoaxial fixation through vitro human cadaveric study. Methods From January 2016 to December 2017, fresh‐frozen cadaveric cervical spines with intact ligaments from eight donated cadavers at an average age of 71.5 ± 10.6 years, comprising of six males and two females, were collected. There were no fracture and congenital malformation in all specimens according to the imaging examination. The range of motion (ROM) of the specimens were tested in their intact condition and destabilized condition. Next, the specimens were randomly divided into two groups to ensure no differences in sex and age: Group 1 was medial inclination C1 pedicle screw and C2 pedicle screws (C1MPS‐C2PS) and Group 2 was lateral inclination C1 pedicle screw and C2 pedicle screws (C1LPS‐C2PS). The ROM of the fixation scenarios were recorded. Thereafter, all the specimens with fixation constructs were tested for 1,000 cycles of axial rotation and tensile loading to failure was carried out collinearly to the longitudinal axis of all the screws, the data were documented as screw pullout strength (SPS) in newtons. All the recorded data subjected to quantitative analysis. Results The ROM of specimens was increased significantly in destabilized condition and significantly reduced in fixation condition compared with intact condition. In C1LPS‐C2PS groups, the C1‐C2 cervical segment showed 3.96° ±1.21° and 3.75° ± 1.33° in flexion and extension direction, 2.85° ± 0.91° and 2.96° ± 0.71° in right and left lateral bending, 2.20° ± 0.43° and 2.15° ± 0.40° in right and left axial rotation. In C1MPS‐C2PS groups, it showed 4.24° ±1.31° and 3.98° ± 1.21° in flexion and extension direction, 2.76° ± 1.10° and 3.23° ± 0.62° in right and left lateral bending, 2.20° ± 0.46° and 2.21° ± 0.42° in right and left axial rotation. There was no statistically significant difference on ROM and screw pullout strengths (764.29 ± 129.00 N vs 714.55 ± 164.63 N) between the two groups. However, there was one specimen in the C1MPS‐C2PS group showing rupture the inferior wall of the left screw trajectory owing to the relatively thin posterior arch of the atlas, the screw pullout strength was significantly reduced (left pullout strength value: 430.5 N, right pullout strength value: 748.4 N). Therefore, in the case of the thin posterior arch of the atlas, the C1LPS‐C2PS group had strong long‐term biomechanics. Conclusion The lateral inclination C1 pedicle screw can achieve the same biomechanical strength as the traditional atlas pedicle screw. However, for the case where the posterior arch of the atlas is relatively thin, a lateral inclination C1 pedicle screw is more suitable.
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Affiliation(s)
- Lei Zhang
- Department of Spine Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huan Wang
- Department of Spine Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Wu C, Deng J, Zeng B, Zhu YF, Li T. Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. Neurol Res 2021; 43:961-969. [PMID: 34227928 DOI: 10.1080/01616412.2021.1948741] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the corridor for atlas pedicle screw placement perpendicular to the coronal plane and to develop patient-specific navigation templates for pedicle screw placement. METHODS This study is a retrospective analysis. A total of 71 patients (41 males and 30 females) were involved in this study from June 2016 to June 2018, and they were divided into a template group (39 patients) and a conventional group (32 patients). The CT-based 3D reconstruction models were analyzed in the template group. From the perspective of the 3D atlas in a coronal view, the pedicle corridor was obtained. Taking the center of the tangential circle of the pedicle as the entry point, we simulated screw placement perpendicular to the coronal plane. Then, the individual navigation template was designed and used in surgery. In the conventional group, free-hand pedicle screw placement was performed perpendicular to the coronal plane. The diameter of the maximum tangential circle and screw length of the pedicle corridor were measured in the template group. The surgical time, radiation exposure time, screw grading criteria and so on were evaluated and compared between the two groups after surgery. RESULTS ;The diameter of the maximum tangential circle and the distance between the entry point and posterior tubercle were significantly greater in males than in females. The operation was successfully completed in all patients, without aggravation of nerve injury, and the follow-up was 12-20 months, with an average of 15.6 months. A total of 78 screws were inserted in the template group, and 64 screws were inserted in the conventional group. The surgical times in the template group and conventional group were 76.47±24.44 min and 125.63±36.41 min, respectively. The radiation exposure times in the template group and conventional group were 3.51±1.77 and 10.15±4.95, respectively, and there was a significant difference between the two groups. In the template group, the deviation in the screw entry point and screw angle were 1.92±1.67 mm and 2.08±1.98°, respectively. The medial angle deviation between the left and right sides was 2.71±1.88° in the template group, which was significantly less than the deviation of 3.76±2.22° in the conventional group. CONCLUSION A pedicle screw trajectory perpendicular to the coronal plane can be quickly obtained based on the perspective of 3D models. The technique of screw placement perpendicular to the coronal plane assisted by navigation templates has a shorter operative time, lessintraoperative fluoroscopy and a higher safety of screw placement than traditional surgery.
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Affiliation(s)
- Chao Wu
- Orthopedics Center of Zigong Fourth People's Hospital, Zigong, China.,Digital Medical Center of Zigong Fourth People's Hospital, Zigong,China
| | - Jiayan Deng
- Digital Medical Center of Zigong Fourth People's Hospital, Zigong,China
| | - Bofang Zeng
- Orthopedics Center of Zigong Fourth People's Hospital, Zigong, China
| | - Yuan Fang Zhu
- Health Management Center of Zigong Fourth People's Hospital, Zigong, China
| | - Tao Li
- Orthopedics Center of Zigong Fourth People's Hospital, Zigong, China
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Zhou X, Li S, Liu H, Guo Q, Guo X, Chen F, Han Z, Ni B. Comparison of Two Bone Grafting Techniques Applied During Posterior C1-C2 Screw-Rod Fixation and Fusion for Treating Reducible Atlantoaxial Dislocation. World Neurosurg 2020; 143:e253-e260. [PMID: 32711146 DOI: 10.1016/j.wneu.2020.07.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several bone grafting techniques for posterior atlantoaxial arthrodesis have been reported. The techniques of placing a cancellous morselized bone graft (MBG) on decorticated surfaces of the atlantoaxial complex and securing a structural iliac bone graft (SBG) between C1 and C2 have been used widely. The aim of the present study was to compare the outcomes of these 2 bone grafting techniques for atlantoaxial arthrodesis. METHODS The data from 64 patients with reducible atlantoaxial dislocation treated using posterior C1-C2 screw-rod fixation and fusion were retrospectively reviewed. The MBG technique had been used in 32 patients and the SBG technique in 32 patients. The time required for bone fusion was recorded. The outcomes were evaluated using the Japanese Orthopaedic Association scale score, Neck Disability Index, visual analog scale (VAS) score for neck pain, patient satisfaction, and neck stiffness and compared between the 2 groups. The donor site complications were also compared, and donor site pain was assessed using a VAS. RESULTS At the final follow-up, the bone fusion rate was 100% in both groups. No significant differences were found in the bone fusion time or donor site pain between the 2 groups (P > 0.05). Postoperatively, The Japanese Orthopaedic Association scale scores, Neck Disability Index, and VAS score for neck pain had improved significantly within both groups (P < 0.05), with no statistically significant differences between the 2 groups (P > 0.05). Additionally, no differences were found between the 2 groups in patient satisfaction and neck stiffness postoperatively (P > 0.05). CONCLUSIONS The MBG and SBG techniques were both effective for atlantoaxial arthrodesis, with the advantages of reducing the potential risk of catastrophic bleeding of the epidural venous plexus and C2 nerve root injury.
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Affiliation(s)
- Xin Zhou
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Songkai Li
- Orthopedic Center, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Hua Liu
- Orthopedic Center, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Qunfeng Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Fei Chen
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Zhao Han
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Bin Ni
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
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Byeon Y, Lee BJ, Park JH. Freehand Placement of the C1 Pedicle Screw Using Direct Visualization of the Pedicle Anatomy and Serial Dilatation. Korean J Neurotrauma 2020; 16:207-215. [PMID: 33163429 PMCID: PMC7607029 DOI: 10.13004/kjnt.2020.16.e15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/02/2022] Open
Abstract
Objective We designed a method for inserting C1 pedicle screws using the direct visualization technique of the pedicle and serial dilatation technique to reduce complications and malposition of screw, and assessed the accuracy of this method. Methods Free-hand C1 pedicle screw insertion using the direct visualization technique of the pedicle and serial dilatation technique was performed on 5 consecutive patients with C1–2 instability at a single institute from March to December 2018. The method involved protecting the vertebral artery (VA) and C1 root using the Penfield No. 1, securing the entry point of the posterior arch screw and the pedicle was visible directly in Trendelenburg position. The hole at the entry point of the C1 posterior arch was serially dilated using a 2.5×3.0 mm drill bit, and the C1 pedicle screw was inserted with the free hand technique. We measured postoperative radiological parameters and recorded intraoperative complications, postoperative neurological deficits and the occurrence of occipital neuralgia. Postoperative computed tomography (CT) was performed to check screw malposition or construction failure. Results Of the 10 C1 pedicle screws on postoperative CT, 20% of screws (grade A) were in the ideal position while 80% of screws (grade B) occupied a safe position. Overall, 100% of screws were safe (grade A or B). There were no iatrogenic neurological deficits, VA injury. Conclusion Freehand placement of the C1 pedicle screw through the direct visualization technique of the pedicle and serial dilatation technique is safe and effective without intraoperative fluoroscopy guidance.
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Affiliation(s)
- Yukyeng Byeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center, Inje University College of Medicine, Goyang, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee BJ, Kim M, Jeong SK, Lee S, Jeon SR, Roh SW, Park JH. Comparison of the Accuracy of C1 Pedicle Screw Fixation Using Fluoroscopy and Free-Hand Techniques in Patients With Posterior Arch Thickness of Less Than 4 mm. Oper Neurosurg (Hagerstown) 2020; 19:429-435. [DOI: 10.1093/ons/opaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/02/2020] [Indexed: 02/05/2023] Open
Abstract
Abstract
BACKGROUND
C1 pedicle screw insertion is not easy, and more fluoroscopy can be required for safe insertion. Fluoroscopy is time consuming and increases patient radiation exposure. There have been no studies comparing the accuracy of C1 pedicle screw insertion using the fluoroscopy and free-hand techniques.
OBJECTIVE
To describe a free-hand C1 pedicle screw insertion method in patients with the posterior arch thickness of less than 4 mm in the thinnest part of the groove, and to compare the clinical and radiological outcomes of C1 pedicle screw insertion using fluoroscopy vs using the free-hand technique.
METHODS
A total of 25 patients who had atlantoaxial instability with a C1 posterior arch <4 mm and were treated with C1 pedicle screw insertion were included. In 10 patients, fluoroscopy was used for C1 pedicle screw insertion, and 15 patients underwent the free-hand technique. We compared the radiologic and clinical outcomes between the 2 groups.
RESULTS
In patients who underwent the free-hand technique, 96.5% of screws were rated as safe (grade A or B), and 80.0% of screws in the fluoroscopy group were rated as safe. Postoperative occipital neuralgia occurred in one patient in the fluoroscopy group and did not occur in the free-hand technique group. There was no significant difference in the improvement of Nurick grade between the 2 groups.
CONCLUSION
C1 pedicle screw insertion using the free-hand technique is feasible and safe in patients with a C1 posterior arch <4 mm.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Goyang, Republic of Korea
| | - Myeongjong Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong Kyun Jeong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Subum Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Woo Roh
- 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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Zhao ZS, Wu GW, Lin J, Zhang YS, Huang YF, Chen ZD, Lin B, Zheng CS. Management of Combined Atlas Fracture with Type II Odontoid Fracture: A Review of 21 Cases. Indian J Orthop 2019; 53:518-524. [PMID: 31303667 PMCID: PMC6590023 DOI: 10.4103/ortho.ijortho_249_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the therapeutic effects of combined atlas fracture with type II (C1-type II) odontoid fractures and to outline a management strategy for it. PATIENTS AND METHODS Twenty three patients with C1-type II odontoid fractures were treated according to our management strategy. Nonoperative external immobilization in the form of cervical collar and halo vest was used in 13 patients with stable atlantoaxial joint. Surgical treatment was early performed in 10 patients whose fractures with traumatic transverse atlantal ligament disruption or atlantoaxial instability. The visual analog scale (VAS), neck disability index (NDI) scale, and American Spinal Injury Association (ASIA) scale at each stage of followup were then collected and compared. RESULTS Compared to pretreatment, the VAS score, NDI score, and ASIA scale were improved among both groups at followup evaluation after treatment. However, in the nonsurgical group, one patient (1/11) developed nonunion which required surgical treatment in later stage and one patient (1/13) with halo vest immobilization had happened pin site infection. Two patients of the surgical group (2/11) had appeared minor complications: occipital cervical pain in one case and cerebrospinal fluid leakage in one case. Two patients (2/23) were excluded from nonsurgical treatment group because their followup period was less than 12 months. Twenty one patients were followed up regularly with an average of 23.9 months (range 15-45 months). CONCLUSIONS We outlined our concluding management principle for the treatment of C1-type II odontoid fractures based on the nature of C1 fracture and atlantoaxial stability. The treatment principle can obtain satisfactory results for the management of C1-type II odontoid fractures.
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Affiliation(s)
- Zhong-Sheng Zhao
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Guang-Wen Wu
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jie Lin
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying-Sheng Zhang
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yan-Feng Huang
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhi-Da Chen
- Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China
| | - Bin Lin
- Department of Orthopedics, The 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian, China,Address for correspondence: Dr. Chun-Song Zheng, Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian, China. E-mail:
Prof. Bin Lin, Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian, China. E-mail:
| | - Chun-Song Zheng
- Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Address for correspondence: Dr. Chun-Song Zheng, Institute of Orthopedic Diseases, Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Fuzhou 350122, Fujian, China. E-mail:
Prof. Bin Lin, Department of Orthopedics, the 175th Hospital of PLA, The Affiliated Southeast Hospital of Xiamen University, 269 Zhanghua Road, Zhangzhou 363000, Fujian, China. E-mail:
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Zhang L, Wang H. Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch. Kaohsiung J Med Sci 2018; 34:700-704. [DOI: 10.1016/j.kjms.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/06/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
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Zhang QH, Li HD, Min JK. Pedicle screw placement in patients with variant atlas pedicle. J Int Med Res 2016; 44:931-9. [PMID: 27235408 PMCID: PMC5536621 DOI: 10.1177/0300060516643192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate how the anatomy of variant atlas vertebra impacts on the strategy used to place pedicle screws used to treat atlantoaxial instability. Methods The study enrolled patients with cervical instability who had a posterior arch pedicle height <3.5 mm at the anchor point, a vertebral artery groove height <3.5 mm, or both. Pedicle screws were fitted according to the anatomy of the variant atlas vertebra. Patients were followed-up to evaluate accuracy of the screw placement and maintenance of cervical stability. Results A total of 28 patients were enrolled. The mean height of the atlas pedicle proximal section was >5.0 mm. For the vertebral artery groove, the height of the lateral region was significantly greater than that of the medial region. Approximately 60% of atlas vertebrae had lateral heights >3.5 mm (34 of 56). The majority of the posterior arch heights were <3.0 mm. There were no perioperative or postoperative complications observed. Conclusions Pedicle screw placement in the lateral pedicle region is the safest and most reliable strategy to treat variant atlas pedicles.
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Affiliation(s)
- Qiang-Hua Zhang
- Department of Orthopaedics, First People's Hospital of Huzhou City, Huzhou City, Zhejiang Province, China
| | - Hai-Dong Li
- Department of Orthopaedics, First People's Hospital of Huzhou City, Huzhou City, Zhejiang Province, China
| | - Ji-Kang Min
- Department of Orthopaedics, First People's Hospital of Huzhou City, Huzhou City, Zhejiang Province, China
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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.
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