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Xu Z, Wu J, Chen F, Ding Y, Ni B, Xu P, Guo Q. Atlantoaxial intra-articular cage fusion by posterior intermuscular approach for treating reducible atlantoaxial dislocation: a technique note with case series. 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 2024; 33:3060-3068. [PMID: 38816537 DOI: 10.1007/s00586-024-08318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). METHODS An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. RESULTS The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. CONCLUSIONS AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach.
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Affiliation(s)
- Zhenji Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Yiyang Ding
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Peng Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
| | - Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
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Sharma AK, Acharya N, Camino-Willhuber G, Grace K, Bhatia NN. Unilateral C1-C2 Posterior Fusion in a Patient With Right Vertebral Artery Anomaly With Intracanal Trajectory: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00020. [PMID: 39058800 DOI: 10.2106/jbjs.cc.22.00603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
CASE A 59-year-old woman presented with progressively worsening neck pain and radicular symptoms. Cervical radiographs revealed C1-C2 dynamic instability. Magnetic resonance imaging and computed tomographic angiogram revealed an anomalous right vertebral artery with intracanal trajectory at C1. A unilateral left C1-C2 fusion with a C1 lateral mass screw and C2 transarticular screw placement was performed due to the anomalous artery. At 14-month follow-up, the patient's cervical symptoms had resolved. CONCLUSION In this patient with an aberrant vertebral artery who was indicated for C1-C2 fusion, a unilateral contralateral fusion with a C1 lateral mass screw and C2 transarticular screw was a satisfactory treatment option.
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Affiliation(s)
- Abhinav K Sharma
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, California
| | - Nischal Acharya
- University of California, Irvine, School of Medicine, Department of Neurological Surgery, Orange, California
| | - Gaston Camino-Willhuber
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, California
| | - Kyrillos Grace
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, California
| | - Nitin N Bhatia
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, California
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Lin MS, Huang CW, Tsou HK, Tzeng CY, Kao TH, Lin RH, Chen TY, Li CR, Lee CY. Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients. Int J Rheum Dis 2023; 26:1996-2006. [PMID: 37565304 DOI: 10.1111/1756-185x.14855] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
AIM An estimated 88% of rheumatoid arthritis (RA) patients experience various degrees of cervical spine involvement. The excessive movement of the atlantoaxial joint, which connects the occiput to the upper cervical spine, results in atlantoaxial instability (AAI). AAI stabilization is usually achieved by C1 lateral mass-to-C2 pedicle screw-rod fixation (LC1-PC2 fixation), which is technically challenging in RA patients who often show destructive changes in anatomical structures. This study aimed to analyze the clinical results and operative experiences of C1-C2 surgery, with emphasis on the advancement of image-guided surgery and augmented reality (AR) assisted navigation. METHODS We presented our two decades of experience in the surgical management of AAI from April 2004 to November 2022. RESULTS We have performed surgery on 67 patients with AAI, including 21 traumatic odontoid fractures, 20 degenerative osteoarthritis, 11 inflammatory diseases of RA, 5 congenital anomalies of the os odontoideum, 2 unknown etiologies, 2 movement disorders, 2 previous implant failures, 2 osteomyelitis, 1 ankylosing spondylitis, and 1 tumor. Beginning in 2007, we performed LC1-PC2 fixation under C-arm fluoroscopy. As part of the progress in spinal surgery, since 2011 we used surgical navigation from presurgical planning to intraoperative navigation, using the preoperative computed tomography (CT) -based image-guided BrainLab navigation system. In 2021, we began using intraoperative CT scan and microscope-based AR navigation. CONCLUSION The technical complexities of C1-C2 surgery can be mitigated by CT-based image-guided surgery and microscope-based AR navigation, to improve accuracy in screw placement and overall clinical outcomes, particularly in RA patients with AAI.
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Affiliation(s)
- Mao-Shih Lin
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, ROC
| | - Chung-Yuh Tzeng
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Taiwan, ROC
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Medicinal Botanicals and Foods on Health Applications, Da-Yeh University, Changhua, Taiwan, ROC
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ting-Hsien Kao
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Tse-Yu Chen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Cheng-Ying Lee
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Chu ECP, Trager RJ, Tao C. Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report. Cureus 2023; 15:e34630. [PMID: 36891015 PMCID: PMC9988189 DOI: 10.7759/cureus.34630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient's pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.
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Affiliation(s)
- Eric Chun-Pu Chu
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Cliff Tao
- Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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Guo Q, Zhu J, Yang J, Chen F, Wu L, Zhou X, Ni B. Comparison of Atlantoaxial Intra-Articular Fusion and Posterior Structural Bone Grafting Techniques for Treating Atlantoaxial Dislocation. Oper Neurosurg (Hagerstown) 2023; 24:e10-e15. [PMID: 36251432 DOI: 10.1227/ons.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/29/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The structural bone grafting (SBG) technique provided high fusion rate and satisfied outcomes for treating atlantoaxial dislocation, but it is unclear whether the atlantoaxial intra-articular cage (AIC) technique can provide clinical results comparable with SBG technique. OBJECTIVE To compare the outcomes of 2 bone graft techniques applied in posterior C1-C2 screw-rod fixation and fusion surgery for treating atlantoaxial dislocation. METHODS The data from 55 patients with atlantoaxial dislocation were retrospectively reviewed. The SBG technique had been used in 29 patients and the AIC technique in 26 patients. The outcomes were evaluated using the Japanese Orthopedic Association scale score, Neck Disability Index, and visual analog scale score for neck pain and compared between the 2 groups. The donor site complications were also recorded in SBG group, and donor site pain was assessed using a visual analog scale. RESULTS In the final follow-up, the bone fusion rate was 100% in both groups. No significant differences were found in the bone fusion time between the 2 groups ( P > .05). Postoperatively, the Japanese Orthopedic Association, Neck Disability Index, and visual analog scale score for neck pain indexes improved significantly within both SBG (all P < .05) and AIC groups (all P < .05). Nevertheless, there were no statistically significant differences between the 2 groups (all P > .05). CONCLUSION The SBG and AIC techniques were both effective for achieving atlantoaxial arthrodesis, and the AIC technique is a perfect alternative to the SBG technique when the posterior arch of C1 is incompetent.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Changzheng Hospital, The Naval Medical University, Shanghai, China
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Cavalcanti Kußmaul A, Kühlein T, Greiner A, Walter S, Becker CA, Kistler M, Rubenbauer B, Andreß S, Böcker W, Bruder J. Improving stability of atlantoaxial fusion: a biomechanical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03465-y. [PMID: 36544078 PMCID: PMC10368542 DOI: 10.1007/s00590-022-03465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The incidence of atlanto-axial injuries is continuously increasing and often requires surgical treatment. Recently, Harati developed a new procedure combining polyaxial transarticular screws with polyaxial atlas massae lateralis screws via a rod system with promising clinical results, yet biomechanical data is lacking. This biomechanical study consequently aims to evaluate the properties of the Harati technique. METHODS Two groups, each consisting of 7 cervical vertebral segments (C1/2), were formed and provided with a dens axis type 2 fracture according to Alonzo. One group was treated with the Harms and the other with the Harati technique. The specimen was loaded via a lever arm to simulate extension, flexion, lateral flexion and rotation. For statistical analysis, dislocation (°) was measured and compared. RESULTS For extension and flexion, the Harati technique displayed a mean dislocation of 4.12° ± 2.36° and the Harms technique of 8.48° ± 1.49° (p < 0.01). For lateral flexion, the dislocation was 0.57° ± 0.30° for the Harati and 1.19° ± 0.25° for the Harms group (p < 0.01). The mean dislocation for rotation was 1.09° ± 0.48° for the Harati and 2.10° ± 0.31° for the Harms group (p < 0.01). No implant failure occurred. CONCLUSION This study found a significant increase in biomechanical stability of the Harati technique when compared to the technique by Harms et al. Consequently, this novel technique can be regarded as a promising alternative for the treatment of atlanto-axial instabilities.
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Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Titus Kühlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sandy Walter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher A Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Manuel Kistler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Andreß
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jan Bruder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Niu G, Cheng J, Liu L, Li C, Zhou G, Chen H, Liu T, Nie H, Sun Z, Jiang W, Zhou Q, Zhao B, Zhu J, Yu R, Guo Y, Yang Y, Bai J. Individualized 3D printed navigation template-assisted atlantoaxial pedicle screws vs. free-hand screws for the treatment of upper cervical fractures. Front Surg 2022; 9:932296. [PMID: 36225218 PMCID: PMC9549244 DOI: 10.3389/fsurg.2022.932296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare the efficacy and safety of freehand atlantoaxial pedicle screws against custom 3D printed navigation template screws in the treatment of upper cervical fractures. Methods In our institution from 2010 to 2020, a retrospective cohort analysis of 23 patients with upper cervical fractures was done. These patients were separated into two groups: group A (N = 12), which received customized 3D printed navigation template-assisted screws with virtual reality techniques, and group B (N = 11), which received freehand screws assisted by intraoperative fluoroscopy. Every patient was monitored for more than 1 year. The two groups were contrasted in terms of screw implant accuracy, cervical spine Japanese Orthopaedic Association (JOA) score, American Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, surgical time, fluoroscopy times, and intraoperative blood loss. Results A total of 88 atlantoaxial pedicle screws in all, 46 in group A and 42 in group B, were implanted. In group A, the screw insertion accuracy rate was 95.7%, compared to 80.0% in group B (P < 0.05). When compared to group B, group A had shorter surgery times, less blood loss, fewer fluoroscopies, a higher short-term JOA score, and overt pain reduction (P < 0.05). However, there was no discernible difference between the two groups' VAS scores, long-term JOA scores, or ASIA scores (sensory and motor), at the most recent follow-up. Conclusion Individualized 3D printed guide leads to significant improvement in the screw safety, efficacy, and accuracy, which may be a promising strategy for the treatment of upper cervical fractures.
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Affiliation(s)
- Guoqi Niu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
| | - Jiawei Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Lutan Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Chao Li
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Gong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hui Chen
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Tao Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hu Nie
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Zheng Sun
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Weili Jiang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Qiankun Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Baoyin Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jun Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Ruochen Yu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yalong Guo
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yi Yang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jianzhong Bai
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
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González DCN, Ardura Aragón F, Sanjuan JC, Maniega SS, Andrino AL, García Fraile R, Labrador Hernández G, Calabia-Campo J, Caballero-García A, Córdova-Martínez A. C1-C2 Rotatory Subluxation in Adults “A Narrative Review”. Diagnostics (Basel) 2022; 12:diagnostics12071615. [PMID: 35885520 PMCID: PMC9316247 DOI: 10.3390/diagnostics12071615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.
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Affiliation(s)
- David C. Noriega González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
| | - Francisco Ardura Aragón
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Jesús Crespo Sanjuan
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Silvia Santiago Maniega
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Alejandro León Andrino
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Rubén García Fraile
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Gregorio Labrador Hernández
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Juan Calabia-Campo
- Department of Radiology, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain;
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain
- Correspondence:
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Asymmetry of the C2 pars interarticularis: a clinical anatomical study with relevance to screw placement. Surg Radiol Anat 2022; 44:423-429. [PMID: 35217894 DOI: 10.1007/s00276-022-02901-2] [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: 09/13/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Potential asymmetries of the C2 posterior elements pose a problem for the spine surgeon seeking to make the best choice for spinal stabilization while reducing morbidity. METHODS A digital caliper was used to measure the pars interarticularis height and length on left and right sides of 25 adult C2 vertebrae. The pars interarticularis was defined as the bone between the posterior most aspect of the superior articular process and the anterior most aspect of the inferior articular process of C2. Also, the C2 vertebrae from 49 patients were scanned by CT. Parasagittal images were reviewed and using the same definitions as were used for the skeletal specimens, the length and the height of the C2 pars interarticularis from both the left and right sides were measured using CT. The image slices were acquired at 3 mm intervals. The pars interarticularis height was determined on sagittal CT reconstruction, while the pars interarticularis length was calculated on the basis of the axial images. RESULTS The lengths and the heights of the left and right pars interarticularis were compared using CTs of patients and skeletal specimens. No significant differences were found in the length and height measurements of the CT images on both sides. However, in the skeletal specimens, the left and right pars interarticularis did not differ significantly in length but differed significantly in height (p = 0.003). The mean height of the left pars interarticularis was approximately two times larger than the right in the skeletal specimens. Absolute differences were calculated between the side with the greater length and height and the side with the lesser length and height irrespective of their left-right orientations. For CT measurements, most differences in length and height between the greater pars interarticularis and lesser pars interarticularis occurred between 0 and 1 mm with each successive disparity interval yielding lower numbers. Skeletal measurements revealed a similar length disparity distribution to the CT measurements. However, height measurements in the skeletal specimens varied widely. Eight pars interarticularis specimens demonstrated a height difference between 0 and 1 mm. No dry bone pars interarticularis specimens demonstrated a height difference between 1 and 2 mm. The pars interarticularis of nine specimens demonstrated a height difference between 2 and 3 mm. Two demonstrated a height difference between 3 and 4 mm. Four demonstrated a height difference between 4 and 5 mm and two demonstrated a height difference greater than 5 mm. The greater pars interarticularis lengths and heights were combined and compared to their lesser counterparts on CT and skeletal measurements. In all measurements of this type, significant differences were found in the pars interarticularis length and height, whether measured through CT or via digital calipers. CONCLUSION Asymmetry between the left and right C2 pars interarticularis as shown in the present study can alter surgical planning. Therefore, knowledge of this anatomical finding might be useful to spine surgeons.
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An TY, Kang DH, Kim DH. Anastomosis and Endovascular Treatment of Iatrogenic Vertebral Artery Injury. Korean J Neurotrauma 2021; 17:204-211. [PMID: 34760836 PMCID: PMC8558024 DOI: 10.13004/kjnt.2021.17.e28] [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] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022] Open
Abstract
Iatrogenic vertebral artery injury (VAI) that occurs during cervical spine surgery can cause life-threatening complications, such as arteriovenous fistulas, catastrophic bleeding, neurological impairment, cerebral ischemia, and death. We report a case of dominant VAI during surgery and the treatment of a 60-year-old man diagnosed with a C1-2-3 metastatic spine tumor from urothelial carcinoma. Active bleeding occurred during tumor resection using pituitary forceps, immediately followed by gauze packing and manual compression. Post further resection, we found that the vertebral artery (VA) was completely severed. After temporary clamping on both sides of the damaged VA, an artificial graft anastomosis was performed. After verifying that the flow was intact using Doppler Sonography, Occiput-C1-4-5-6 posterolateral fusion was performed. Angiography was performed immediately after surgery. We found a thrombus occluding the left VA, and performed mechanical thrombectomy and stent insertion. The final angiography showed good VA flow with no emboli. In this case, VA anastomosis and endovascular treatment were performed within a relatively short period of time post VAI, and the patient was able to recover without any neurological deficits.
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Affiliation(s)
- Tae Yong An
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong Hwan Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Liu DD, Rivera-Lane K, Leary OP, Pertsch NJ, Niu T, Camara-Quintana JQ, Oyelese AA, Fridley JS, Gokaslan ZL. Supplementation of Screw-Rod C1-C2 Fixation With Posterior Arch Femoral Head Allograft Strut. Oper Neurosurg (Hagerstown) 2021; 20:226-231. [PMID: 33269389 DOI: 10.1093/ons/opaa336] [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: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous C1-C2 fixation techniques exist for the treatment of atlantoaxial instability. Limitations of screw-rod and sublaminar wiring techniques include C2 nerve root sacrifice and dural injury, respectively. We present a novel technique that utilizes a femoral head allograft cut with a keyhole that rests posteriorly on the arches of C1 and C2 and straddles the C2 spinous process, secured by sutures. OBJECTIVE To offer increased fusion across C1-C2 without the passage of sublaminar wiring or interarticular arthrodesis. METHODS A total of 6 patients with atlantoaxial instability underwent C1-C2 fixation using our method from 2015 to 2016. After placement of a C1-C2 screw/rod construct, a cadaveric frozen femoral head allograft was cut into a half-dome with a keyhole and placed over the already decorticated dorsal C1 arch and C2 spinous process. Notches were created in the graft and sutures were placed in the notches and around the rods to secure it firmly in place. RESULTS The femoral head's shape allowed for creation of a graft that provides excellent surface area for fusion across C1-C2. There were no intraoperative complications, including dural tears. Postoperatively, no patients had sensorimotor deficits, pain, or occipital neuralgia. 5 patients demonstrated clinical resolution of symptoms by 3 mo and radiographic (computed tomography) evidence of fusion at 1 yr. One patient had good follow-up at 1 mo but died due to complications of Alzheimer disease. CONCLUSION The posterior arch femoral head allograft strut technique with securing sutures is a viable option for supplementing screw-rod fixation in the treatment of complex atlantoaxial instability.
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Affiliation(s)
- David D Liu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kendall Rivera-Lane
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nathan J Pertsch
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Raut S, Kundnani VG, Meena MK, Patel JY, Asati S, Patel A. Anthropometric evaluation for surgical feasibility of C1-C2 transarticular screw stabilization in Indian population. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:129-135. [PMID: 34194158 PMCID: PMC8214229 DOI: 10.4103/jcvjs.jcvjs_175_20] [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: 10/11/2020] [Accepted: 01/18/2021] [Indexed: 11/05/2022] Open
Abstract
Study Design: This study was a radiographic observational study for C1–C2 anthropometry. Purpose: The purpose of the study was to understand the anatomic relationship of C1–C2 in view of transarticular screw (TAS) fixation, to overcome the difficulties related with TAS placement, and to minimize the technique-related complications. Materials and Methods: It was an anthropometric observational study with retrospectively obtained anatomical data of randomly selected 116 patients from a single center. The anatomical measurements such as pars width, pars height, screw trajectory, and length were evaluated on the axial, sagittal, and three-dimensional reconstructed cervical CT scan using the radiant DICOM viewer software by the two fellowship trained spine surgeons which were blind to the study group details. The intra- and interobserver reliability with regard to the measured parameters was statistically analyzed. Results: The mean age of male and female was 28 and 29 years. The average BMI was calculated to be 23.5 and 25 for males and females, respectively. The mean right pars width in males was 5.78 ± 0.93 (range: 3.1–6.5 mm), while in female, it was 5.84 ± 0.95 (range: 3.1–6.5). The mean left pars width in males was 5.95 ± 1.13 (range: 3.8–8.1 mm), while in females, it was 5.70 ± 1.18 (range: 3.7–8.1 mm). Right side mean pars height in males was 5.90 ± 1.2 (range: 3.7–9.4 mm), and in females, it was 6.11 ± 1.04 (range: 3.8–9.3 mm). Left-sided mean pars height in males was 6.0 ± 1.1 (range: 3.2–9.4 mm) as compared to females, in which it was 5.77 ± 1.23 (range: 4.1–9.3 mm). The mean lateral angulation angle in males was 9.99° ± 1.70° (8.1°–15°), while in females, it was 10.15° ± 1.73° (8.1°–15°). The mean sagittal angulation in males was 26.33° ± 3.32° (21.0°–32.80°), while in females, it was 27.18 ± 3.05 (21.0°–32.10°). The average screw length in males was 41.74 ± 5.63 (34–54.8 mm), whereas in females, it was 41.35 ± 4.77 (34–54.8 mm). Conclusion: This study provides a morphometric database which is characteristic of the C1–C2 vertebrae in the normal Indian population with regard to the anatomic feasibility of the TAS fixation for various C1–C2 pathologies. The C2 pars width and height measured in the current study can guide the selection of TAS screws in the Indian population. This study could serve in providing the baseline anatomic parameters assessed in the healthy individuals to design and develop customized screws and related implant assembly which might provide wider clinical applicability.
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Affiliation(s)
- Saijyot Raut
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vishal G Kundnani
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Mohit Kumar Meena
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Jwalant Y Patel
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Sanjeev Asati
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ankit Patel
- Department of Orthopaedics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Henderson FC, Rosenbaum R, Narayanan M, Koby M, Tuchman K, Rowe PC, Francomano C. Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization. Neurosurg Rev 2021; 44:1553-1568. [PMID: 32623537 PMCID: PMC8121728 DOI: 10.1007/s10143-020-01345-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 02/05/2023]
Abstract
Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a normal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15 months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (P < 0.001), numbness in the hands and lower extremities (P = 0.001), headaches, pre-syncope, and lightheadedness (all P < 0.01), vertigo and arm weakness (both P = 0.01), and syncope, nausea, joint pain, and exercise tolerance (all P < 0.05). The diagnosis of Fielding type 1 AAI requires directed investigation with dynamic imaging. Alignment and stabilization is associated with improvement of pain, syncopal and near-syncopal episodes, sensorimotor function, and exercise tolerance.
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Affiliation(s)
- Fraser C Henderson
- Department of Neurosurgery, University of Maryland Capital Region Health Prince George's Hospital Center, Cheverly, MD, USA.
- Doctors Community Hospital, Lanham, MD, USA.
- Metropolitan Neurosurgery Group LLC, Silver Spring, MD, USA.
| | - Robert Rosenbaum
- Department of Neurosurgery, University of Maryland Capital Region Health Prince George's Hospital Center, Cheverly, MD, USA
- Doctors Community Hospital, Lanham, MD, USA
- Metropolitan Neurosurgery Group LLC, Silver Spring, MD, USA
- Department of Neurosurgery, Walter Reed-Bethesda National Military Medical Center, Bethesda, MD, USA
| | - Malini Narayanan
- Department of Neurosurgery, University of Maryland Capital Region Health Prince George's Hospital Center, Cheverly, MD, USA
- Doctors Community Hospital, Lanham, MD, USA
- Metropolitan Neurosurgery Group LLC, Silver Spring, MD, USA
| | - Myles Koby
- Doctors Community Hospital, Lanham, MD, USA
| | - Kelly Tuchman
- Metropolitan Neurosurgery Group LLC, Silver Spring, MD, USA
| | - Peter C Rowe
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Clair Francomano
- Medical and Molecular Genetics, Indiana University Health Physicians, Indianapolis, IN, USA
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Harati A, Oni P. Three-point atlantoaxial fixation with C1-C2 transarticular screws and C1 lateral mass screws. J Orthop Surg (Hong Kong) 2020; 27:2309499019854201. [PMID: 31189418 DOI: 10.1177/2309499019854201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Based on established posterior atlantoaxial fixation techniques, we present a novel technique that uses a polyaxial screw rod system and utilizes a combination of C1 lateral mass and C1-C2 transarticular screws. METHODS We conducted a retrospective review of six men and four women (mean age: 57, range: 20-86). Indication for atlantoaxial fixation was type II odontoid fractures or pseudarthrosis after odontoid fracture (n = 7), rheumatoid arthritis (n = 2) and os odontoideum (n = 1). RESULTS The mean follow-up time was 48 months (range: 24-72). There were no intraoperative complications such as vertebral artery, nerve root or spinal cord injury. Post-operative imaging showed no screw malposition. During follow-up, no patient had screw loosening, screw fracture or bone absorption around the screws. Clinically, patient neck pain improved in all cases. CONCLUSIONS C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation is a novel and potentially effective surgical technique for achieving immediate rigid immobilization of the C1-C2 motion segment. However, further biomechanical studies should be performed to prove our clinical results.
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Affiliation(s)
- Ali Harati
- Neurosurgical Department, Klinikum Dortmund, Dortmund, Germany
| | - Paul Oni
- Neurosurgical Department, Klinikum Dortmund, Dortmund, Germany
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[Application of transarticular C1/2 screws connected with C1 lateral mass screws in a rod-screw system]. Unfallchirurg 2020; 123:408-412. [PMID: 32125438 DOI: 10.1007/s00113-020-00776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fractures of the second cervical vertebra with involvement of the odontoid process can mostly be treated conservatively by immobilization. In the case of high-grade unstable fractures and pseudarthrosis dorsal C1/2 spondylodesis should be considered.Based on established atlantoaxial osteosynthesis techniques for dorsal C1/2 spondylodesis, a polyaxial screw-rod system with C1/2 transarticular screws connected with C1 lateral mass screws was carried out in a 56-year-old male patient with dislocated odontoid fracture.No intraoperative or postoperative complications occurred. During a follow-up of 36 months there was no screw loosening or dislocation.The presented alternative technique of dorsal C1/2 spondylodesis is a safe and effective method for stabilizing the atlantoaxial movement segment in cases of posttraumatic instability.
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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.
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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
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Koffie RM, Larsen AMG, Grannan BL, Hadzipasic M, Yanamadala V, Beaver LV, Shankar GM, Shin JH. Novel Technique for C1-2 Interlaminar Arthrodesis Utilizing a Modified Sonntag Loop-Suture Graft With Posterior C1-2 Fixation. Neurospine 2020; 17:659-665. [PMID: 32054143 PMCID: PMC7538353 DOI: 10.14245/ns.1938344.172] [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] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022] Open
Abstract
Objective Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1–2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1–2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.
Methods This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation.
Results We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p<0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications.
Conclusion We demonstrate a novel technique for C1–2 arthrodesis that is a safe and effective option for atlantoaxial fusion.
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Affiliation(s)
- Robert M Koffie
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Benjamin L Grannan
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Muhamed Hadzipasic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Van Beaver
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Odontoid fractures represent one of the most common and controversial injury types affecting the cervical spine, being associated with a high incidence of nonunion, morbidity, and mortality. These complications are especially common and important in elderly patients, for which ideal treatment options are still under debate. Stable fractures in young patients maybe treated conservatively, with immobilization. Although halo-vest has been widely used for their conservative management, studies have shown high rates of complications in the elderly, and therefore current evidence suggests that the conservative management of these fractures should be carried out with a hard cervical collar or cervicothoracic orthosis. Elderly patients with stable fractures have been reported to have better clinical results with surgical treatment. For these and for all patients with unstable fractures, several surgical techniques have been proposed. Anterior odontoid fixation can be used in reducible fractures with ideal fracture patterns, with older patients requiring fixation with 2 screws. In other cases, C1-C2 posterior fixation maybe needed with the best surgical option depending on the reducibility of the fracture and vertebral artery anatomy. In this paper, current evidence on the management of odontoid fractures is discussed, and an algorithm for treatment is proposed.
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Formentin C, Andrade EJD, Maeda FL, Ghizoni E, Tedeschi H, Joaquim AF. Axis screws: results and complications of a large case series. ACTA ACUST UNITED AC 2019; 65:198-203. [PMID: 30892444 DOI: 10.1590/1806-9282.65.2.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used. METHODS Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws. RESULTS Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series. CONCLUSION Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used.
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Affiliation(s)
- Cleiton Formentin
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Erion Junior de Andrade
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Fernando Luis Maeda
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Enrico Ghizoni
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Helder Tedeschi
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Andrei F Joaquim
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
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Chan JJ, Shepard N, Cho W. Biomechanics and Clinical Application of Translaminar Screws Fixation in Spine: A Review of the Literature. Global Spine J 2019; 9:210-218. [PMID: 30984502 PMCID: PMC6448194 DOI: 10.1177/2192568218765995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
STUDY DESIGN Broad narrative review. OBJECTIVES Translaminar screw (TLS) fixation was first described as a salvage technique for fixation of the axial spine. Better understanding of the spine anatomy allows for advancement in surgical techniques and expansion of TLS indications. The goal of this review is to discuss the anatomic feasibility of the TLS fixation in different region of the spine. METHODS A review of the current literatures on the principles, biomechanics, and clinical application of the translaminar screw technique in the axial, subaxial, and thoracolumbar spine. RESULTS Anatomic feasibility and biomechanical studies have demonstrated that TLS is a safe and strong fixation methods for fusion beyond just the axial spine. However, not all spine segments have wide enough lamina to accept TLS. Preoperative computed tomography scan can help ensure the feasibility and safety of TLS insertion. Recent clinical reports have validated the application of TLS in subaxial spine, thoracic spine, hangman's fracture, and pediatric population. CONCLUSIONS TLS can be used beyond axial spine; however, TLS insertion is only warranted when the lamina is thick enough to avoid further complications such as breakage. Preoperative computed tomography scans can be used to determine feasibility of such fixation construct.
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Affiliation(s)
- Jimmy J. Chan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas Shepard
- New York University Hospital for Joint Diseases, New York, NY, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY,
USA
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Evaluate radiographic and clinical outcomes for infants and children, who underwent rigid occipito-cervical fixation for traumatic craniocervical dissociation (tCCD). SUMMARY OF BACKGROUND DATA Traumatic craniocervical dissociation is devastating. Children are at high risk but make up a large number of survivors. Non-rigid fixation has traditionally been favored over screw and rod constructs due to inherent challenges involved with instrumenting the pediatric craniocervical junction. Therefore, outcomes for rigid occipito-cervical instrumentation in infants and young children with tCCD remain uncertain. METHODS Retrospective review of children who survived tCCD between 2006 and 2016 and underwent rigid occipito-cervical fixation. RESULTS Fifteen children, from 8 months to 8 years old (mean, 3.8 yr), were either a passenger (n = 11) or a pedestrian (n = 4) in a motor vehicle accident. Seven patients had weakness: five with quadriplegia, one with hemiparesis, and one with bilateral upper extremity paresis. Ten patients had concurrent C1-2 instability. At last follow-up, four patients had improved motor function: one with bilateral upper extremity paresis and one with hemiparesis regained full strength, one with quadriplegia regained function on one side while another regained function in bilateral upper extremities. All underwent rigid posterior occipito-cervical fixation, with two patients requiring additional anterior and posterior fixation at non-contiguous levels. Fourteen patients were stable on flexion-extension x-rays at a mean follow-up of 31 months (9-1 yr or longer, 7-2 yr or longer). There were no cases of deformity, growth disturbance, or subaxial instability. CONCLUSION Children who survive tCCD may regain function after stabilization. Rigid internal rod and screw fixation in infants and young children safely provided long-term stability. We advocate using C2 translaminar screws to exploit the favorable anatomy of pediatric lamina to minimize the risks of occipitocervical (OC) instrumentation. LEVEL OF EVIDENCE 4.
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Chang H, Park JB, Choi BW, Kang JW, Chun YS. Posterior Sublaminar Wiring and/or Transarticular Screw Fixation for Reducible Atlantoaxial Instability Secondary to Symptomatic Os Odontoideum: A Neglected Technique? Asian Spine J 2018; 13:233-241. [PMID: 30518199 PMCID: PMC6454275 DOI: 10.31616/asj.2018.0155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
Study Design Retrospective case analysis. Purpose We retrospectively evaluated the clinical and radiological outcomes of posterior sublaminar wiring (PSLW) and/or transarticular screw fixation (TASF) for reducible atlantoaxial instability (AAI) secondary to os odontoideum. Overview of Literature Limited information is available about the surgical outcomes of symptomatic os odontoideum with AAI. Methods We examined 23 patients (12 women and 11 men) with os odontoideum and reducible AAI. The average age of the patients at the time of the operation was 44.2 years. The average follow-up duration was 4.5 years. Thirteen patients with anterior AAI underwent PSLW alone, while 10 patients with combined (anterior+posterior) AAI underwent PSLW and TASF. An autogenous iliac bone graft was used for all patients. Nine patients complained of neck or suboccipital pain, and 14 complained of myelopathy. Results Angulational instability (preoperative 18.7°±8.9° vs. postoperative 2.1°±4.6°, p<0.001), translational instability (16.3±4.9 mm vs. 1.8±2.2 mm, p<0.001), and segmental angle of the C1–C2 joint (23.7°±7.2° vs. 28.4°±3.8°, p<0.05) showed significant improvement postoperatively. Neck Visual Analog Scale score (6.2±2.4 vs. 2.5±1.8, p<0.05) and the modified Japanese Orthopedic Association (9.1±3.1 vs. 13.2±2.6, p<0.05) score also improved, with a recovery rate of 51.8%. Among the three patients who developed nonunion and/or wire breakage, one underwent revision surgery with repeat PSLW and was finally able to achieve fusion. The final fusion rate was 91.3%. Conclusions PSLW and/or TASF provided satisfactory clinical and radiological outcomes in reducible AAI secondary to os odontoideum without significant neurological complications. Our results suggest that PSLW and/or TASF can be considered a viable surgical option over segmental fixation in highly selected cases of os odontoideum with reducible AAI.
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Affiliation(s)
- Han Chang
- Department of Orthopedic Surgery, Busan Korea Hospital, Busan, Korea
| | - Jong-Beom Park
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wan Choi
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong-Won Kang
- Department of Orthopedic Surgery, Sun Hospital, Daejeon, Korea
| | - You-Seung Chun
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, Liu X. Posterior temporary C1-2 fixation for 3-part fractures of the axis (odontoid dens and Hangman fractures). Medicine (Baltimore) 2018; 97:e12957. [PMID: 30508884 PMCID: PMC6283111 DOI: 10.1097/md.0000000000012957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Case series study.To report the clinical outcomes of posterior temporary C1-2 fixation for 3-part fracture of the axis (Type II odontoid fracture according to Grauer classification combined with Hangman fracture).The 3-part fracture of the axis is rare and the treatment is controversy.A total of 8 patients with 3-part fracture of the axis were included in this study. X-rays, CT, and MRI prior to surgery were used to evaluate the cervical spine injury. Grauer classification, fracture angulation, and fracture translation were used to evaluate the fracture of dens. The neck disability index (NDI) and range of neck rotary motion were used to assess the neck function.The preoperative fracture angulation and fracture translation were 4.6 ± 1.3° and 2.4 ± 0.6 mm, respectively. The average operation time and blood loss were 109 ± 27 minutes and 49 ± 15 mL. No infection, vascular injuries or neural structure injuries was observed. All patients acquired bone healing at 5.9 ± 2.0 months. The temporary instrumentation was removed at 10.8 ± 1.3 months. The average NDI before and 2 days after removal of instrumentation were 10.1 ± 4.0 and 7.1 ± 3.0, respectively. At 1-year follow-up after instrumentation removal, the NDI was 1.8 ± 0.7, which was much better than immediate NDI after instrumentation removal. The neck rotary motion (left rotation + right rotation) before and 2-day after instrumentation removal were 70.4 ± 6.3° and 119.6 ± 13.1°, respectively. At 1-year follow-up, the average neck rotary motion was 153.1 ± 9.1°, which had significant different with rotary motion 2-day after the removal of temporary instrumentation.With regard to the high fracture fusion rates, low complications, and excellent predictable outcomes in patients treated with posterior temporary C1-2 pedicle screw fixation, the technique may be a suitable choice for 3-part fracture of the axis.
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Affiliation(s)
- Suomao Yuan
- Spine Center, Qilu Hospital of Shandong University
| | - Bin Wei
- Reproductive Medicine Center, Maternal and Child Health Care Hospital of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China
| | - Yonghao Tian
- Spine Center, Qilu Hospital of Shandong University
| | - Jun Yan
- Spine Center, Qilu Hospital of Shandong University
| | - Wanlong Xu
- Spine Center, Qilu Hospital of Shandong University
| | - Lianlei Wang
- Spine Center, Qilu Hospital of Shandong University
| | - Xinyu Liu
- Spine Center, Qilu Hospital of Shandong University
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Thayaparan GK, Owbridge MG, Thompson RG, D'Urso PS. Designing patient-specific 3D printed devices for posterior atlantoaxial transarticular fixation surgery. J Clin Neurosci 2018; 56:192-198. [DOI: 10.1016/j.jocn.2018.06.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/24/2018] [Indexed: 11/25/2022]
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Sai Kiran NA, Sivaraju L, Vidyasagar K, Aryan S, Raj V, Rajagopal N, Mohan D, Thakar S, Rao AS, Hegde AS. Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws. World Neurosurg 2018; 118:e304-e315. [DOI: 10.1016/j.wneu.2018.06.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Zhang JH, Zhang ZJ, Zhu Y, Shi JD, Li B, Lu YS. C1 Titanium Cables Combined with C2 Pedicle Screw-Rod Fixation for Atlantoaxial Instability Not Suitable for Placement of C1 Screws. World Neurosurg 2018; 120:e453-e456. [PMID: 30149165 DOI: 10.1016/j.wneu.2018.08.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to develop a new posterior fusion technique composed of bilateral C1 titanium cables and C2 pedicle screw-rods for treatment of atlantoaxial instability not suitable for C1 screw placement. METHODS A study was conducted of 18 patients with atlantoaxial instability who had C1 broken screw trajectory or anatomic anomalies. All patients underwent posterior fixation with bilateral C1 titanium cables and C2 pedicle screws. The follow-up period was a minimum 1 year. Clinical outcomes measurements included visual analog scale score for neck pain assessment, the American Spinal Injury Association Impairment Scale and Japanese Orthopaedic Association score for neurologic status and function. According to preoperative computed tomography (CT) reconstruction and CT angiography, the patients selected in this study were not suitable for C1 screw placement. Postoperative plain radiographs and CT reconstruction were performed to evaluate the reduction, bony fusion, and implant position. All outcomes were evaluated at each follow-up. RESULTS The average clinical follow-up period was 24 months (range 12-36 months). All patients had complete neck pain relief at postoperative 6 months. Their neurologic symptoms had improved significantly at 1-year follow-up. Radiologic outcomes indicated good bony fusion and construction stability in all patients without implant failure at the last follow-up. No neural or vascular complications related to this technique were observed. CONCLUSIONS Posterior atlantoaxial fixation using C1 titanium cables and C2 pedicle screw-rod construct appears to be an effective and safe technique for treatment of atlantoaxial instability, which could be an alternative method for cases unsuitable for C1 screw placement when using C1-C2 screw fixation.
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Affiliation(s)
- Jie-Hong Zhang
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Zhi-Jing Zhang
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Ya Zhu
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Jian-Dong Shi
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Bin Li
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Yi-Sheng Lu
- Spine Center, the Department of Orthopedics, the 117th Hospital of PLA, Hangzhou, Zhejiang, China.
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Impact of Perioperative Neurologic Deficits on Clinical Outcomes After Posterior Cervical Fusion. World Neurosurg 2018; 119:e250-e261. [PMID: 30053561 DOI: 10.1016/j.wneu.2018.07.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the United States, the number of posterior cervical fusions has increased substantially. Perioperative neurologic complications associated with this procedure, such as spinal cord and peripheral nerve injuries, can have significant effects on patient health. We examined the impact of perioperative neurologic deficits on mortality in patients undergoing posterior cervical fusion. The secondary aim was to understand the risk factors for perioperative neurologic complications. METHODS Data were collected from the National Inpatient Sample (NIS) Health Cost Utilization Project (HCUP) between 1999 and 2011. Patients younger than 18 years and older than 80 years were excluded, as were patients who underwent posterior cervical fusion caused by trauma. Patient demographics and comorbidities were compiled as well as variables that have been associated with increased risk of perioperative neurologic deficits. We used the van Walraven score, a weighted numeric surrogate for the Elixhauser comorbidity index, as a covariate to assess comorbidities that have been associated with in-hospital mortality and morbidity after posterior cervical fusion. In addition, we performed univariate comparisons between covariates and surgical outcomes. We conducted a multivariable logistic regression, adjusting for many of the covariates, as well as trend analyses. RESULTS An analysis of 33,644 patients yielded an overall rate of perioperative neurologic deficits, morbidity, and mortality of 1.08%, 40.44%, and 1.00%, respectively. Perioperative neurologic deficits were independent risk factors predictors of in-hospital mortality (odds ratio, 5.270; P < 0.0001) and morbidity (odds ratio, 2.579; P < 0.0001). Other statistically significant predictors of mortality included increasing van Walraven score, myocardial infarction, metastatic cancer, and weight loss. These were also independent predictors of morbidity along with but not limited to age, device complications, congestive heart failure, paralysis, diabetes with chronic complications, deficiency anemias, device complications, and intraspinal abscess. CONCLUSIONS Perioperative neurologic deficits are serious complications of posterior cervical fusion and can independently predict in-hospital mortality and morbidity. As this procedure continues to be used increasingly, attention should be directed toward preventing these complications and intervening earlier in patients who have a neurologic deficit. Future efforts should be geared toward screening for at-risk patients with the initiation of surgical prehabilitation.
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Herzog JP, Zarkadis NJ, Prabhakar G, Kusnezov NA. Biomechanical comparison of a novel C1 posterior U-construct with four other techniques in a C1-C2 fixation model. J Orthop 2018; 15:741-745. [PMID: 29881231 DOI: 10.1016/j.jor.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background Compare the biomechanical stability of a novel "U" posterior cervical fixation construct to four other posterior cervical atlantoaxial fixation constructs. Methods Eight fresh frozen human cadaver spines were tested after a simulated odontoid fracture, and following stabilization with each construct. Results All constructs significantly decreased flexion-extension and axial rotation compared to the destabilized spine. The U construct provided significantly more axial stability than the Brooks wire technique. Conclusion The novel U construct demonstrated comparable biomechanical stability to the existing constructs in all three planes of motion with the exception of axial rotation, in which it was inferior to TAS.
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Affiliation(s)
- Joshua P Herzog
- Orthopaedic Spine Center, Massachusetts General Hospital, Boston, MA, United States
| | - Nicholas J Zarkadis
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, United States
| | - Gautham Prabhakar
- Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX, United States
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Amelot A, Terrier LM, Lot G. Predictive factors of neurological recovery after chronic craniovertebral brainstem compression. Acta Neurochir (Wien) 2018; 160:1243-1250. [PMID: 29582153 DOI: 10.1007/s00701-018-3523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurologic manifestations of craniovertebral junction (CVJ) disease may generate dramatic brainstem damage, which could evolve to paralysis. In most cases, patients are referred with advanced neurological symptoms such as tetraplegia/paresis. The aim of this study was to identify predictive factors of favorable neurological evolution after non-traumatic brainstem compression. METHODS A prospective study evaluated 143 consecutive patients who had undergone CVJ anterior brainstem decompression. The mean age was 45.1 ± 19.1 years. The study analyzed clinical, surgical, and imagery characters to determine predictive factors of neurological improvement. RESULTS The mean follow-up of our series was 10.2 years (range 0.5-23.9). Seventy-one (49.6%) presented initial tetrapalsies resulting from spinal cord compression. Multivariable analysis revealed that Frankel score [odds ratio (OR) 5.7, CI 95% 1.01-31.8; p < 0.04] and preoperative symptoms < 6 months [OR 0.33, CI 95% 0.125-0.9; p < 0.025] were independently associated with partial neurological improvement, while the only independent factor associated with total neurologic recovery was the preoperative symptom evolution <6 months [odd ratio (OR) 4.3, CI 95% 1.6-11.4; p < 0.003]. None of the following were identified as predictive factors: demographic characteristics, medical history, the etiology of compression, or initial spinal cord MRI. CONCLUSION The earlier the decompression is performed, the better the neurological improvement. Whatever the initial Frankel score, if neurological palsy or disorders evolved for less than 6 months, complete recovery is possible.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Fondation Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
- Department of Neurosurgery, Centre Hospitalier Universitaire de Tours, Tours, France.
| | - Louis-Marie Terrier
- Department of Neurosurgery, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France
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Larsen AMG, Grannan BL, Koffie RM, Coumans JV. Atlantoaxial Fusion Using C1 Sublaminar Cables and C2 Translaminar Screws. Oper Neurosurg (Hagerstown) 2018; 14:647-653. [PMID: 28962019 DOI: 10.1093/ons/opx164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atlantoaxial instability, which can arise in the setting of trauma, degenerative diseases, and neoplasm, is often managed surgically with C1-C2 arthrodesis. Classical C1-C2 fusion techniques require placement of instrumentation in close proximity to the vertebral artery and C2 nerve root. OBJECTIVE To report a novel C1-C2 fusion technique that utilizes C2 translaminar screws and C1 sublaminar cables to decrease the risk of injury to the vertebral artery and C2 nerve root. METHODS To facilitate fixation to the atlas, while minimizing the risk of injury to the vertebral artery and to the C2 nerve root, we sought to determine the feasibility of using a soft cable around the C1 arch and affixing it to a rod connected to C2 laminar screws. We reviewed our experience in 3 patients. RESULTS We used this technique in patients in whom we anticipated difficult C1 screw placement. Three patients were identified through a review of the senior author's cases. Atlantoaxial instability was associated with trauma in 2 patients and chronic degenerative changes in 1 patient. Common symptoms on presentation included pain and limited range of motion. All patients underwent C1-C2 fusion with C2 translaminar screws with sublaminar cable harnessing of the posterior arch of C1. There were no reports of postoperative complications or hardware failure. CONCLUSION We demonstrate a novel, technically straightforward approach for C1-C2 fusion that minimizes risk to the vertebral artery and to the C2 nerve root, while still allowing for semirigid fixation in instances of both traumatic and chronic degenerative atlantoaxial instability.
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Affiliation(s)
- Alexandra M Giantini Larsen
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L Grannan
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
| | - Robert M Koffie
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
| | - Jean-Valéry Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
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Nourbakhsh A, Wiegers NW, Shen FH. Posterior identification and exposure of the V3 segment of the vertebral artery. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:44-49. [PMID: 29755236 PMCID: PMC5934964 DOI: 10.4103/jcvjs.jcvjs_125_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: The purpose of this study was to define the anatomy of the V3 segment of the vertebral artery (VA) from the posterior approach. Methods: Ten formalin-fixed cadavers were carefully dissected bilaterally using landmark features to identify and safely expose the VA from the posterior. Measurements regarding morphometric characteristics of landmark features and feasible resection quantifications were obtained and analyzed. The C2 pars was resected completely in all cadavers, averaging 15.03 ± 1.06 mm in thickness. Results: The average diameter of the VA at the midline of C2 on the right side was 4.66 ± 0.51 mm compared to the left 5.2 ± 0.49 mm (P = 0.002). The distance of the VA from the midline increased from caudal to rostral. The distance between the VA to the lateral edge of the dura in the middle of the window of approach was 9.67 ± 0.81 mm. The rostral-caudal length of the window of approach was 21.94 ± 1.60 mm. The percentage of C2 body removal was 28.04% ± 6.09% through each side (249.55 ± 55.5/898.2 ± 146.17 mm2). While carefully exposing the VA, a posterior approach can be feasible in cases of injury during C1–C2 instrumentation or during resection of tumors of the C2 pars with or without extension into the C2 body. Discussion: The posterior approach for a C2 partial corpectomy can also be used as an adjunct to anterior approaches when necessary to widen the extent of bone resection. Conclusion: Exposure of the V3 segment of the vertebral artery was defined as well as the extent of C2 corpectomy through the posterior approach.
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Affiliation(s)
- Ali Nourbakhsh
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas W Wiegers
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Francis H Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Yuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, Liu X. The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study. J Orthop Surg Res 2018; 13:3. [PMID: 29310670 PMCID: PMC5759802 DOI: 10.1186/s13018-017-0702-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/26/2017] [Indexed: 11/23/2022] Open
Abstract
Background Recently, the excellent outcomes of temporary fixation of C1-2 without fusion in the treatment of odontoid fracture had been reported. It is still unclear if this technique could achieve the equivalent outcomes as the golden standard technique of anterior screw fixation. The objective of this study is to compare the clinical outcome of two treatments of fresh type II odontoid fracture: anterior cannulated screws fixation (ACSF) versus posterior instrumentation of C1-2 without fusion (PIWF). Methods This is a retrospective study. This series included 28 males and 8 females, and the mean age was 41.5 years (range, 22 to 70 years). Eleven patients were treated with ACSF, and 25 patients with PIWF. For PIWF, the implants were removed after fracture union was confirmed at 0.75~1.5 years later. All patients underwent preoperative and serial postoperative clinical examinations at approximately 3 months, 6 months, and annually thereafter. The neck disability index (NDI) was used to assess the neck discomfort caused by the operation. The range of rotary motion was evaluated at each visit. All fractures were reassessed postoperatively with serial X-films and CT scans of the cervical spine at each follow-up visit, to evaluate screw position, fracture alignment, and fusion status. Results All patients achieved immediate spinal stabilization after surgery, and none experienced neurologic deterioration. The follow-up periods ranged from 24 to 60 months. The average range of neck rotation was dramatically lost in PIWF after fixation (46° and 89° respectively in ACSF and PIWF), and recovered to 83° after the implant was removed. The NDI in PIWF was statistically higher than that in ACSF (5 and 13% respectively in ACSF and PIWF) after the first operation and decreased to 8% 1 year after the secondary operation. The fusion rates were 90.9 and 96% respectively in ACSF and PIWF. Both groups had a case of fracture non-union. Conclusions For fresh type II odontoid fractures, high rate of fracture union can be achieved by both ACSF and PIWF. For most fresh type II odontoid fractures, anterior screw fixation was the best option for its simplicity and preservation of normal atlanto-axial rotary function. Posterior instrumentation without fusion could preserve most of the atlanto-axial rotary function and lead to moderate neck discomfort and is also a good alternative if anterior screw fixation is contraindicated.
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Affiliation(s)
- Suomao Yuan
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China
| | - Bin Wei
- Reproductive Medicine Centre, Maternal and Child Health Care Hospital of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, 250014, People's Republic of China
| | - Yonghao Tian
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China
| | - Jun Yan
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China
| | - Wanlong Xu
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China
| | - Lianlei Wang
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China
| | - Xinyu Liu
- Spine Center, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, People's Republic of China.
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Abstract
STUDY DESIGN Evidence-based systematic review. OBJECTIVES To define the optimal treatment of fractures involving the C2 body, including those with concomitant injuries, based upon a systematic review of the literature. SUMMARY OF BACKGROUND DATA Axis body fractures have customarily been treated nonoperatively, but there are some injuries that may require operative intervention. High-quality literature is sparse and there are few class I or class II studies to guide treatment decisions. MATERIALS AND METHODS A literature search was conducted using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus (EMBASE, MEDLINE, COMPENDEX). The quality of literature was rated according to a grading tool developed by the Center for Evidence-based Medicine. Operative and nonoperative treatment of axis body fractures were compared using fracture bony union as the primary outcome measure. As risk factors for nonunion were not consistently reported, cases were analyzed individually. RESULTS The literature search identified 62 studies, of which 10 were case reports which were excluded from the analysis. A total of 920 patients from 52 studies were included. The overall bony union rate for all axis body fractures was 91%. Although the majority of fractures were treated nonoperatively, there has been an increasing trend toward operative intervention for Benzel type III (transverse) axis body fractures. Nearly 76% of axis body fractures were classified as type III fractures, of which 88% united successfully. Nearly all Benzel type I and type II axis body fractures were successfully treated nonoperatively. The risk factors for nonunion included: a higher degree of subluxation, fracture displacement, comminution, concurrent injuries, delay in treatment, and older age. CONCLUSIONS High rates for fracture union are reported in the literature for axis body fractures with nonoperative treatment. High-quality prospective studies are required to develop consensus as to which C2 body fractures require operative fixation.
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Ghostine SS, Kaloostian PE, Ordookhanian C, Kaloostian S, Zarrini P, Kim T, Scibelli S, Clark-Schoeb SJ, Samudrala S, Lauryssen C, Gill AS, Johnson PJ. Improving C1-C2 Complex Fusion Rates: An Alternate Approach. Cureus 2017; 9:e1887. [PMID: 29392099 PMCID: PMC5788400 DOI: 10.7759/cureus.1887] [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] [Indexed: 11/05/2022] Open
Abstract
The surgical repair of atlantoaxial instabilities (AAI) presents complex and unique challenges, originating from abnormalities and/or trauma within the junction regions of the C1-C2 atlas-axis, to surgeons. When this region is destabilized, surgical fusion becomes of key importance in order to prevent spinal cord injury. Several techniques can be utilized to provide for the adequate fusion of the atlantoaxial construct. Nevertheless, many individuals have less than ideal rates of fusion, below 35%-40%, which also involves the C2 nerve root being sacrificed. This suboptimal and unavoidable iatrogenic complication results in the elevated probability of complications typically composed of vertebral artery injury. This review is a retrospective analysis of 87 patients from Cedars Sinai Medical Center in Los Angeles, California, who had the C1-C2 surgical fusion procedure performed within the time frame from 2001 to 2008, with a mean follow-up period of three years. These patients had presented with typical AAI symptoms of fatigability, limited mobility, and clumsiness. Diagnosis of C1-C2 instability was documented via radiographic studies, typically utilizing computed tomography (CT) scans or x-rays. All patients had bilateral C1 lateral masses and C2 pedicle screws. In addition, the C1-C2 joint was accessed by retracting the C2 nerve root superiorly and exposing the joint by utilizing a high-speed burr. The cavity that is developed within the joint is packed with local autologous bone from the cephalad resection of the C2 laminae. Fusion of the C1-C2 joint was achieved in all patients and a final follow-up was conducted approximately three years postoperative. Of the 87 patients, two presented with occipital headaches resulting from the C1 screws impinging on the C2 nerve root. The issue was rectified by removing instrumentation in both patients after documenting complete fusion via radiographic studies, with complete resolution of symptoms. No vertebral artery or spinal cord injuries were reported as a result of the minor complication. Overall, we aim to describe a safe and reliable alternative technique to fuse C1-C2 instability by focusing on intra-articular arthrodesis complementing instrumentation fixation. This methodology is advantageous from a biomechanical standpoint secondary to axial loading, as well as the large surface area available for arthrodesis. Additionally, this technique does not involve the resection of the C2 nerve root, resulting in low risk for vertebral artery or spinal cord injury.
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Affiliation(s)
- Samer S Ghostine
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Paul E Kaloostian
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Christ Ordookhanian
- Neurological Surgery, University of California, Riverside School of Medicine
| | - Sean Kaloostian
- Neurological Surgery, University of California, Irvine School of Medicine
| | | | | | | | | | | | - Carl Lauryssen
- Neurological Surgery, St. David's Round Rock Medical Center
| | - Amandip S Gill
- Neurological Surgery, University of California, Riverside School of Medicine
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Thirumala P, Zhou J, Natarajan P, Balzer J, Dixon E, Okonkwo D, Hamilton DK. Perioperative neurologic complications during spinal fusion surgery: incidence and trends. Spine J 2017; 17:1611-1624. [PMID: 28527755 DOI: 10.1016/j.spinee.2017.05.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/16/2017] [Accepted: 05/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Perioperative neurologic complications after spine surgery may increase morbidity and health-care costs related to the procedure. PURPOSE We estimate the national incidence of perioperative neurologic complications following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion, and thoracolumbar fusion procedures using the Nationwide Inpatient Sample (NIS) data from 1999 to 2011. Additionally, we identify risk factors for developing perioperative neurologic complications and the effects of these injuries on quantifiable patient outcomes. STUDY DESIGN A cross-sectional study was carried out. PATIENT SAMPLE All patients included in the NIS databases from 1999 to 2011 comprised the sample. OUTCOME MEASURES The primary outcome evaluated was the incidence of new neurologic deficits following elective spine surgery. Secondary outcomes evaluated include length of hospital stay, total hospital charges, hospital mortality rate, and discharge disposition. METHODS A retrospective analysis of the NIS databases from the years 1999 to 2011 was conducted to identify the proportion of patients who underwent ACDFs, posterior cervical fusions, and thoracolumbar fusions who also developed perioperative neurologic complications. Statistical analyses were also conducted to identify statistically significant differences in demographics and outcomes between patients who did and did not develop perioperative neurologic complications. RESULTS From 1999 to 2011, the total national incidence of perioperative neurologic deficits following elective ACDFs, posterior cervical fusions, and thoracolumbar fusions was 0.82%, which equates to a total of 15,066 patients who experienced these complications. The annual incidence rate of perioperative neurologic deficits has increased 54.41%, from 0.68% in the year 1999 to 1.05% in the year 2011. Additionally, the total number of procedures performed increased from 82,167 in 1999 to 186,353 in the year 2011. Perioperative neurologic deficits were associated with longer lengths of stay (9.68 days vs. 2.59 days; p<.001), higher total charges ($110,326.23 vs. $48,695.93; p<.001), and higher in-hospital mortality (2.84% vs. 0.13%; p<.001). CONCLUSIONS The incidence rate of perioperative neurologic deficits associated with elective spine surgery documented in the NIS has increased over the time period from 1999 to 2011. The number of elective spine procedures performed has also increased over the same time period. Finally, outcomes data indicate that occurrence of perioperative neurologic complications is associated with increased rates of morbidity and mortality, as well as increased health-care use and cost. These trends indicate that the perioperative neurologic complications following spine surgery represent a growing problem in today's health-care system; further study is warranted to prevent and treat these complications to improve patient care and reduce health-care use and cost.
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Affiliation(s)
- Parthasarathy Thirumala
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA.
| | - James Zhou
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
| | - Piruthiviraj Natarajan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
| | - Jeffrey Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
| | - Edward Dixon
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
| | - D K Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, Pittsburgh, PA 15213-2582, USA
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Wu AM, Jin HM, Lin ZK, Chi YL, Wang XY. Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture. J Orthop Surg Res 2017; 12:141. [PMID: 28962628 PMCID: PMC5622415 DOI: 10.1186/s13018-017-0640-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. METHODS Fifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 transarticular screw fixation technique in treatment of these patients. The visual analogue score (VAS) of neck pain and Neck Disability Index (NDI) of all patients were scored at pre-operation, 3 months after operation, and final follow-up. Additional, technique-related complications were recorded and collected. RESULTS Percutaneous C1/2 transarticular screw fixation was performed successfully in all 15 patients whose odontoid screw fixation failed. No technique-related complications (such as nerve injury, spinal cord injury, and esophageal injury) occurred. The VAS of neck pain and NDI score improved significantly (P = 0.000) after operation, and no significant differences were found when compared to 93 non-salvage patients who successfully performed the percutaneous anterior odontoid screw fixation. No screw loose or breakage occurred, all of the odontoid fractures achieve radiographic fusion, bony fusion bridge could be observed at the C1/2 lateral articular facet on 9/15 patients. CONCLUSIONS We suggest that percutaneous anterior C1/2 transarticular screw fixation is a good alternative salvage technique if percutaneous odontoid screw fixation failed, and it is a minimally invasive, feasible, and safe technique.
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Affiliation(s)
- Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Hai-Ming Jin
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Zhong-Ke Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Yong-Long Chi
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Center, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, Zhejiang 325027 China
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Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To evaluate the outcomes of myelopathy caused by atlantoaxial dislocation (AAD). SUMMARY OF BACKGROUND DATA No reports to date have accurately evaluated the results of surgery for delayed myelopathy for patients with chronic AAD. Thus, the appropriate surgical time and methods of decompression and fusion remain a hot debate. MATERIALS AND METHODS In our study, 18 patients underwent decompression, fixation, and fusion. Demographic data, operation time, blood loss, and complications were evaluated. The Japanese Orthopedic Association Scale, severity of disability and visual analogue scale were evaluated. The fusion rate, space available for the cord, instability index, cord compression index, and cord decompression rate were also assessed. RESULTS The average time of operation was 248±50 minutes, and blood loss was 350±200 mL. Five patients in grade I maintained their neurological status, and the others had improved neurological status. With average follow-up time of 15.3±9.6 months, the Japanese Orthopedic Association score improved, the visual analogue scale score decreased, the space available for the cord improved, and the instability index and cord compression index decreased. Cord decompression rate was 65.9%. Fusion rate reached 83%. CONCLUSIONS There is a high risk of delayed myelopathy for patients with AAD who do not undergo timely surgical treatment. There is no need for complete reduction for treatment of chronic AAD. Whether it can be reduced or not, sufficient decompression and solid fusion for AAD are required. Both C1-C2 fusion for reducible dislocation and occipital-cervical fusion for irreducible dislocation have satisfactory outcomes.
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Outcome of Bilateral C1 Laminar Hooks Combined With C2 Pedicle Screw Fixation for the Treatment of C1-C2 Instability: A Report of 18 Cases From a Single Chinese Center. Clin Spine Surg 2017; 30:E567-E572. [PMID: 28525479 DOI: 10.1097/bsd.0000000000000250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective technical report. OBJECTIVE To assess the effect of bilateral C1 laminar hooks combined with C2 pedicle screw fixation for the treatment of C1-C2 instability. SUMMARY OF BACKGROUND DATA Various posterior atlantoaxial fixations for C1-C2 instability have been developed. However, due to anatomic anomalies of the vertebral artery, the smallness of the pedicle, trajectories of broken screws, or a lack of surgical experience, a simple atlantoaxial fixation technique with good safety and effectiveness is urgently needed. MATERIALS AND METHODS From January 2007 to September 2012, 18 patients with C1-C2 instability who underwent posterior bilateral C1 laminar hooks combined with C2 pedicle screw fixation were evaluated. Six patients had acute odontoid fractures (Anderson IIc type), 8 patients had odontoid pseudarthrosis, 3 had os odontoideum, and 1 had a traumatic rupture of the transverse ligament. The mean age at the time of surgery was 34.1 years. The clinical and radiographic analyses were performed before and after the operation and at follow-up. RESULTS The follow-up period was 12-78 months (with an average follow-up period of 25.6 mo). All patients were relieved of pain and their neurological symptoms were substantially improved. The postoperative JOA score improved significantly (t=-7.234, P<0.001). No neurological or vascular complications occurred in these cases. The device was placed well and had not loosened or broken and plain radiographs revealed bony fusion in 17 patients. One patient had C1 posterior arch fracture 3 weeks postoperatively and she was followed up for 18 months without revision surgery. CONCLUSIONS When appropriate patients were selected, bilateral C1 laminar hooks combined with C2 pedicle screw fixation can be an alternative method to treat C1-C2 instability effectively with a relatively simple procedure. Preoperative planning and evaluation were crucial for the solid atlantoaxial fusion.
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Rusconi A, Freitas-Olim E, Coloma P, Messerer R, Barrey C. Bicortical facet screws as a new option for posterior C2 fixation: anatomical study and clinical experience. 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 2017; 26:1082-1089. [PMID: 28204927 DOI: 10.1007/s00586-017-4997-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE C2 fixation is a demanding procedure, particularly in patients with variants of C1-C2 anatomy. The inferior articular process (IAP) of the axis can be an alternative for screw placement. We report the results of a CT study of C2 IAP anatomy and we present the clinical experience of 28 patients operated with this technique. METHODS Anatomical study: 50 CT angiographies of the vertebral arteries (VA) were used for this study and, therefore, 100 IAPs were considered. We measured on the axial and sagittal planes the length, height and width of the facet, the distance between the anterior cortex and the VA and the distance between the screw entry point and the VA. We also measured the angle between the sagittal plane and the external tangent line of the VA. CLINICAL REPORT 28 patients were treated with C2 IAP screws at the Spine Surgery Department of the University Hospital in Lyon, France, from January 2014 to January 2016. RESULTS Anatomical study: the mean length of C2 IAP was 12 ± 2 mm, the mean distance between the anterior cortical layer and the VA was 5.2 ± 1.4 mm, and the mean angle we found was 0.2° ± 5.3°. CLINICAL REPORT 16 of the 28 patients presented post-traumatic C1-C2 instability, 8 patients presented degenerative disease, 1 patient was treated for pseudoarthrosis, 1 for tumour, 1 for OPLL and 1 for rheumatoid arthritis. All the screws were correctly positioned and there was no VA injury. CONCLUSION IAP screws can represent a safe alternative option for C2 fixation.
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Affiliation(s)
- Angelo Rusconi
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France.
| | - E Freitas-Olim
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - P Coloma
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - R Messerer
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - C Barrey
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
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Du S, Ni B, Lu X, Xie N, Guo X, Guo Q, Yang J, Chen F. Application of Unilateral C2 Translaminar Screw in the Treatment for Atlantoaxial Instability as an Alternative or Salvage of Pedicle Screw Fixation. World Neurosurg 2017; 97:86-92. [PMID: 27717777 DOI: 10.1016/j.wneu.2016.09.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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Alan N, Cohen JA, Zhou J, Pease M, Kanter AS, Okonkwo DO, Hamilton DK. Top 50 most-cited articles on craniovertebral junction surgery. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:22-32. [PMID: 28250633 PMCID: PMC5324355 DOI: 10.4103/0974-8237.199883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Craniovertebral junction is a complex anatomical location posing unique challenges to the surgical management of its pathologies. We aimed to identify the fifty most-cited articles that are dedicated to this field. Methods: A keyword search using the Thomson Reuters Web of Knowledge was conducted to identify articles relevant to the field of craniovertebral junction surgery. The articles were reviewed based on title, abstract, and methods, if necessary, and then ranked based on the total number of citations to identify the fifty most-cited articles. Characteristics of the articles were determined and analyzed. Results: The earliest top-cited article was published in 1948. When stratified by decade, 1990s was the most productive with 16 articles. The most-cited article was by Anderson and Dalonzo on a classification of odontoid fractures. By citation rate, the most-cited article was by Herms and Melcher who described Goel's technique of atlantoaxial fixation using C1 lateral mass screws and C2 pedicle screws with rod fixation. Atlantoaxial fixation was the most common topic. The United States, Barrow Neurological Institute, and VH Sonntag were the most represented country, institute, and author, respectively. The significant majority of articles were designed as case series providing level IV evidence. Conclusion: Using citation analysis, we have provided a list of the most-cited articles representing important contributions of various authors from many institutions across the world to the field of craniovertebral junction surgery.
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Affiliation(s)
- Nima Alan
- Department of Neursurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Jonathan Andrew Cohen
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - James Zhou
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Matthew Pease
- Department of Neursurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Adam S Kanter
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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Comparison of outcomes after atlantoaxial fusion with C1 lateral mass–C2 pedicle screws and C1–C2 transarticular screws. 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 2016; 26:1064-1072. [DOI: 10.1007/s00586-016-4829-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/09/2016] [Accepted: 10/16/2016] [Indexed: 11/25/2022]
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Zheng Y, Hao D, Wang B, He B, Hu H, Zhang H. Clinical outcome of posterior C1–C2 pedicle screw fixation and fusion for atlantoaxial instability: A retrospective study of 86 patients. J Clin Neurosci 2016; 32:47-50. [DOI: 10.1016/j.jocn.2015.12.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 11/16/2022]
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Akinduro OO, Baum GR, Howard BM, Pradilla G, Grossberg JA, Rodts GE, Ahmad FU. Neurological outcomes following iatrogenic vascular injury during posterior atlanto-axial instrumentation. Clin Neurol Neurosurg 2016; 150:110-116. [PMID: 27618782 DOI: 10.1016/j.clineuro.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Iatrogenic vascular injury is a feared complication of posterior atlanto-axial instrumentation. A better understanding of clinical outcome and management options following this injury will allow surgeons to better care for these patients. The object of the study was to systematically review the neurologic outcomes after iatrogenic vascular injury during atlanto-axial posterior instrumentation. METHODS We performed a systematic review of the Medline database following PRISMA guidelines. In our analysis, we included any retrospective cohort studies, prospective cohort studies, case reports, cases series, or systematic reviews with patients who had undergone posterior atlanto-axial fusion via screw rod constructs (SRC) or transarticular screws (TAS) that reported a patient with an injury to an arterial vessel directly attributable to the surgical procedure. RESULTS Sixty cases of vascular injury were reported in 2078 (2.9%) patients over 27 publications. The average age for this patient population was 55.7+/-17.9. Vascular injury following posterior C1/2 instrumentation resulted in ipsilateral stroke in 10.0% (n=6/60) and non-persistent neurologic deficit in 6.7% (n=4/60) of cases with the deficit being permanent (not including death) in 1.7% (n=1/60) of cases. Four patients (6.7%) died. Arteriovenous fistula or pseudoaneurysm occurred in 8.3% (n=5/60) and 3.3% (n=2/60) of cases, respectively. Eight patients (13.3%) underwent endovascular repair of the injury with no permanent deficit. CONCLUSION Neurological morbidity after iatrogenic vascular injury during posterior C1/2 fixation is higher than previously reported in literature. Some patients may benefit from endovascular treatment. Surgeons should be aware of normal and anomalous vertebral artery anatomy to avoid this potentially catastrophic complication.
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Affiliation(s)
- Oluwaseun O Akinduro
- Department of Neurological Surgery, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Griffin R Baum
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 2200, Atlanta, GA 30322, USA
| | - Brian M Howard
- Department of Neurological Surgery, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 2200, Atlanta, GA 30322, USA
| | - Gustavo Pradilla
- Department of Neurological Surgery, Emory University School of Medicine, Grady Memorial Hospital, 49 Jesse Hill Drive SE, Room 341, Atlanta GA 30303, USA
| | - Jonathan A Grossberg
- Department of Neurological Surgery, Emory University School of Medicine, Grady Memorial Hospital, 49 Jesse Hill Drive SE, Room 341, Atlanta GA 30303, USA
| | - Gerald E Rodts
- Emory Orthopedics and Spine Center, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA, 30329 USA
| | - Faiz U Ahmad
- Department of Neurological Surgery, Emory University School of Medicine, Grady Memorial Hospital, 49 Jesse Hill Drive SE, Room 341, Atlanta GA 30303, USA.
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Yan L, He B, Liu T, Yang L, Hao D. A prospective, double-blind, randomized controlled trial of treatment of atlantoaxial instability with C1 posterior arches >4 mm by comparing C1 pedicle with lateral mass screws fixation. BMC Musculoskelet Disord 2016; 17:164. [PMID: 27075577 PMCID: PMC4831184 DOI: 10.1186/s12891-016-1017-8] [Citation(s) in RCA: 8] [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] [Received: 07/22/2015] [Accepted: 04/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background C1 posterior arch screw placement is one of the most effective treatments for atlantoaxial instability (AAI), which can be performed by either pedicle or lateral mass screw fixation. This study attempted to compare the feasibility and clinical outcomes of C1 pedicle with lateral mass screw fixations for treatment of AAI with C1 posterior arches >4 mm. Methods A total of 140 patients with AAI (C1 posterior arches measuring >4 mm) was enrolled in this single-center, randomized, double-blind trial. The subjects were randomly assigned into two treatments: C1 pedicle (group A) or lateral mass (group B) screw fixation. The patients, independent evaluating physicians and radiologists were blinded throughout the entire study. Patients were assessed before operation and in a series of follow-ups at 6 weeks, 6 months, 1 year, and 3 years post-surgery. The operation time, volume of blood loss, intraoperative complications, bone fusion rates, Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores were monitored. Results All 140 patients showed overall improvements in clinical symptoms after surgery. The mean follow-up time was 24.5 ± 13.0 months. In both groups, the mean JOA scores improved significantly at the time of final follow-up as compared to prior surgery (group A: 7.1 ± 1.4 vs 13.7 ± 1.9; group B:7.3 ± 1.8 vs 13.1 ± 1.4; improvement rates: 87.2 % (group A) and 86.5 % (group B)). The VAS scores also decreased significantly in both groups at the time of final follow-up as compared to prior surgery (group A: 6.0 ± 1.3 vs 1.7 ± 0.8, and group B: 5.7 ± 1.1 vs 2.1 ± 1.2). Bone fusion was achieved within 12 months postoperatively in the patients from both groups. The operation time was significantly shorter and volume of blood loss was significantly less in the patients from group A as compared to group B (p < 0.01). Furthermore, thirteen patients had burst bleeding from the C1-2 venous plexus and nine patients had immediate pain and numbness in the occipitocervical region due to C2 nerve roots irritation during lateral mass screw replacement, which were not observed in the patients with C1 pedicle screw insertion. No complications such as screw loosening, shifting, breakage, or AAI were observed in both groups. Conclusions C1 pedicle screw fixation is less invasive and simpler, and has fewer complications. It renders better clinical outcomes than lateral mass screw fixation for treatment of AAI. Trial registration Current Controlled Trials ChiCTR-IOR-15006748.
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Affiliation(s)
- Liang Yan
- Department of Spinal Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Shaanxi, 710054, China
| | - Baorong He
- Department of Spinal Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Shaanxi, 710054, China
| | - Tuanjiang Liu
- Department of Spinal Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Shaanxi, 710054, China
| | - Lixue Yang
- Department of Orthopaedics, First Affiliated Hospital, Shaanxi University of Chinese Medicine, 2 Weiyang West Road, Shaanxi, 712000, China
| | - Dingjun Hao
- Department of Spinal Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Shaanxi, 710054, China.
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Tok S, Neidert MC, Bloemberg G, Sürücü O. Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation. Neurol Neurochir Pol 2016; 50:63-8. [PMID: 26851694 DOI: 10.1016/j.pjnns.2015.11.005] [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: 06/02/2015] [Revised: 10/22/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Central nervous system (CNS) infections after cervical spine surgery are a rare but serious complication and may be caused by uncommon pathogens. We report the case of a 57-year-old male who developed slowly progressive mental confusion with headaches, increased daytime sleepiness and mild gait disturbance within the last 3 weeks. Six weeks prior to admission to our department, he underwent an atlantoaxial fusion by C1-C2 transarticular screw fixation for rheumatoid arthritis related C1-C2 multidirectional instability. METHODS We analyzed clinical and neuroradiological findings. RESULTS The findings were consistent with communicating hydrocephalus secondary to ventriculitis and the left C1-C2 screw was found to be misplaced with perforation of the dura. The situation was interpreted as implant related surgical site infection of the cerebrospinal fluid followed by ventriculitis and hydrocephalus. Bacterial broad range 16S rRNA gene PCR from the cerebrospinal fluid (CSF) followed by sequencing identified Aggregatibacter aphrophilus as the causative agent, while conventional cultures remained negative due to its fastidious growth. The patient was successfully treated with a lumbar drain and intravenous ceftriaxone. CONCLUSIONS To our knowledge, this is the first report of Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation.
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Affiliation(s)
- Sina Tok
- University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1).
| | - Marian Christoph Neidert
- University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1).
| | - Guido Bloemberg
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland(2).
| | - Oguzkan Sürücü
- University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1).
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Skovrlj B, Steinberger J, Guzman JZ, Overley SC, Qureshi SA, Caridi JM, Cho SK. The 100 Most Influential Articles in Cervical Spine Surgery. Global Spine J 2016; 6:69-79. [PMID: 26835204 PMCID: PMC4733372 DOI: 10.1055/s-0035-1551652] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/10/2015] [Indexed: 01/28/2023] Open
Abstract
Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith's 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand's 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.
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Affiliation(s)
- Branko Skovrlj
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jeremy Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Javier Z. Guzman
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Samuel C. Overley
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - John M. Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States,Address for correspondence Samuel K. Cho, MD Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai5 East 98th Street, Box 1188, New York, NY 10029United States
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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.
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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
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Paik SC, Chun HJ, Bak KH, Ryu J, Choi KS. Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients: Comparison with the Bilateral Method. J Korean Neurosurg Soc 2015; 57:460-4. [PMID: 26180616 PMCID: PMC4502245 DOI: 10.3340/jkns.2015.57.6.460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. METHODS Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. RESULTS Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. CONCLUSION Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.
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Affiliation(s)
- Seung-Chull Paik
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Koang Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Jeil Ryu
- Department of Neurosurgery, Guri Hanyang Hospital, Guri, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Guri Hanyang Hospital, Guri, Korea
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Oh CH, Ji GY, Yoon SH, Hyun D, Kim EY, Park H, Jang AR. Delayed Vertebral Artery Dissection after Posterior Cervical Fusion with Traumatic Cervical Instability: A Case Report. KOREAN JOURNAL OF SPINE 2015. [PMID: 26217387 PMCID: PMC4513173 DOI: 10.14245/kjs.2015.12.2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vascular injury presented immediately after the penetration, but delayed onset of vascular symptom caused by an embolism or vessel dissection after cervical fusion or traumatic event is extremely rare. We present a case of a 56-year-old woman who underwent an operation for cervical fusion for type II Odontoid process fracture. She presented symptoms of seizure with hemiparesis in 6 days after the operation. Multifocal acute infarction due to an embolism from the left VA (V3 segment) dissection was observed without a definite screw breach the transverse foramen. We hereby reported the instructive case report of delayed onset of vertebral artery dissection after posterior cervical fusion with type II odontoid process fracture patient. When a cervical operation performed in the cervical trauma patient, even if no apparent VA injury occurs before and during the operation, the surgeon must take caution not to risk cerebral infarction because of the delayed VA dissection.
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Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Research Institute, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Guro Teun Teun Research Institute, Seoul, Korea. ; Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Dongkeun Hyun
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Hyeonseon Park
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - A Reum Jang
- Department of Neurosurgery, Guro Teun Teun Research Institute, Seoul, Korea
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