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Leng A, Li J, Meng L, Wang Q. Combined replantation of the posterior arch of the atlas and bilateral axial lamina in the treatment of intradural schwannoma: a case report. Front Surg 2024; 11:1374208. [PMID: 38912398 PMCID: PMC11190363 DOI: 10.3389/fsurg.2024.1374208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Laminotomy and laminar replantation have emerged as novel treatment modalities for intraspinal tumors, aiming to minimize postoperative complications and retain spinal mobility. However, existing research predominantly emphasizes their application in the thoracolumbar spine. The unique anatomy of the atlantoaxial segments necessitates surgical techniques that differ from those used in other spinal regions, and the clinical effect of such procedure remains unknown. Case presentation A 61-year-old male patient with intradural schwannoma at the atlantoaxial level was operated on. The patient underwent posterior laminectomy, as well as a combined replantation of the posterior arch of the atlas and bilateral axial laminae. Postoperatively, the patient experienced significant neurological improvement, with no deformities or instability on the radiological assessments during the follow-up. Conclusion Laminotomy with combined replantation of the posterior arch of the atlas and bilateral axial lamina emerges as an effective approach for managing intraspinal tumors at the atlantoaxial level. This technique not only offers ample operating space but also restores the stability of the spinal canal. Moreover, it preserves the mobility of the atlantoaxial segment, minimizes impact on adjacent segments, and mitigates the formation of postoperative fibrosis.
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Affiliation(s)
| | | | | | - Qi Wang
- Department of Orthopaedics, General Hospital of Northern Theater Command, Shenyang, China
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Martins RS, Pereira CS, Lemos C, Rodrigues-Pinto R. Posterior Atlantoaxial Screw Placement in a Portuguese Population: A Morphometric Analysis Based on Computed Tomography Scan Measurements. Rev Bras Ortop 2023; 58:48-57. [PMID: 36969775 PMCID: PMC10038719 DOI: 10.1055/s-0042-1744502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/20/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The present study aims to evaluate the screw length and trajectory angles for posterior atlantoaxial fixation in a Portuguese population, through the study of cervical computed tomography (CT) scans. Methods Cervical CT scans of 50 adults were measured according to predefined screw trajectories of C1-C2 transarticular (C1C2TA), C1 lateral mass (C1LM), C2 pedicle (C2P), C2 pars and C2 laminar (C2L) screws. For each of these trajectories, screw length and angles were measured and compared between males and females. Results For the C1C2TA screw trajectory, the mean length, medial, and cranial angles were 34.12 ± 3.19 mm, 6.24° ± 3.06, and 59.25° ± 5.68, respectively, and for the C1LM screw trajectory, they were 27.12 ± 2.15 mm, 15.82° ± 5.07, and 13.53° ± 4.80, respectively. The mean length, medial, and cranial angles for the C2P screw trajectory were 23.44 ± 2.49 mm, 27.40° ± 4.88, and 30.41° ± 7.27, respectively; and for the C2 pars screw trajectory, they were 16.84 ± 2.08 mm, 20.09° ± 6.83, and 47.53° ± 6,97. The mean length, lateral, and cranial angles for the C2L screw trajectory were 29.10 ± 2.48 mm, 49.80° ± 4.71, and 21.56° ± 7.76, respectively. There were no gender differences except for the lengths of the C1C2TA ( p = 0,020) and C2L ( p = 0,001) screws, which were greater in males than in females. Conclusion The present study provides anatomical references for the posterior atlantoaxial fixation in a Portuguese population. These detailed data are essential to aid spine surgeons to achieve safe and effective screw placement.
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Affiliation(s)
- Rita Santos Martins
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Carolina Lemos
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- Unidade Vertebro-Medular, Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Liu HT, Song J, Zhou FC, Liang ZH, Zhang QQ, Zhang YH, Shao J. Cervical spine involvement in pediatric mucopolysaccharidosis patients: Clinical features, early diagnosis, and surgical management. Front Surg 2023; 9:1059567. [PMID: 36684186 PMCID: PMC9852728 DOI: 10.3389/fsurg.2022.1059567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/22/2022] [Indexed: 01/08/2023] Open
Abstract
Mucopolysaccharidosis (MPS) is a progressive genetic disease that causes a deficiency in lysosomal enzymes, which play an important role in the degradation pathway of glycosaminoglycans. As a result of enzyme defects, mucopolysaccharides cannot be metabolized and thus accumulate. The cervical spine is one of the most commonly involved sites; thus, prompt surgical management before the onset of severe neurological deterioration is critical. However, because of the rarity of the disease, there is no standard treatment. In this review, we characterize the cervical spinal involvement in pediatric patients with MPS, describe the useful imaging technologies for diagnosis, and provide screening procedure for children with MPS. Surgical managements, including indications, surgical methods, possible difficulties, and solutions, are reviewed in detail.
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Affiliation(s)
| | | | | | | | | | | | - Jiang Shao
- Correspondence: Yue-Hui Zhang Jiang Shao
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Accuracy of atlantoaxial screw placement using computed tomography-based navigation system-assisted surgery: The single-level vertebral registration. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Zou X, Yang H, Deng C, Fu S, Chen J, Ma R, Ma X, Xia H. The use of a novel reduction plate in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. Front Surg 2023; 10:1072894. [PMID: 37206357 PMCID: PMC10188962 DOI: 10.3389/fsurg.2023.1072894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background Transoral anterior C1-ring osteosynthesis has been reported as an effective treatment for unstable atlas fracture, which aims to preserve important C1-C2 motion. However, previous studies have shown that the anterior fixation plates used in this technique were not suitable for the anterior anatomy of the atlas and lacked an intraoperative reduction mechanism. Objective This study aims to evaluate the clinical effects of a novel reduction plate used in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. Methods 30 patients with unstable atlas fractures treated by this technique from June 2011 to June 2016 were included in this study. The patients' clinical data and radiographs were reviewed, and the reduction of the fracture, internal fixation placement, and bone fusion were assessed using pre- and postoperative images. The patients' neurological function, rotatory range of motion, and pain levels were evaluated clinically during follow-up. Results All 30 surgeries were successfully performed, and the average follow-up duration was 23.5 ± 9.5 months (range 9-48 months). One patient suffered atlantoaxial instability during the follow-up and was treated with posterior atlantoaxial fusion. The remaining 29 patients had satisfactory clinical outcomes, with ideal fracture reduction, good screw and plate placement, well-preserved range of motion, neck pain alleviation and solid bone fusion. There were no vascular or neurological complications during the operation or follow-up. Conclusions The use of this novel reduction plate in transoral anterior C1-ring osteosynthesis is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique offers an immediate intraoperative reduction mechanism, which provides satisfactory fracture reduction, bone fusion, and preservation of C1-C2 motion.
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Affiliation(s)
| | | | | | | | | | | | | | - Hong Xia
- Correspondence: Xiangyang Ma Hong Xia
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Ma Z, Zhang YN, Ma X, Chen C, Feng HY. Comparison of the clinical efficacy of unilateral and bilateral pedicle screw short-segment fixation and fusion in the treatment of atlantoaxial fracture-dislocation. Technol Health Care 2023; 31:1619-1629. [PMID: 36970926 PMCID: PMC10578255 DOI: 10.3233/thc-220721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Few studies have compared the clinical efficacy of unilateral and bilateral pedicle screw fixation and fusion in treating atlantoaxial fracture-dislocation. OBJECTIVE To compare the efficacy of unilateral and bilateral fixation and fusion for atlantoaxial fracture-dislocation and to explore the feasibility of the unilateral surgical procedure. METHODS Twenty-eight consecutive patients with atlantoaxial fracture-dislocation were included in the study from June 2013 to May 2018. They were divided into a unilateral fixation group and a bilateral fixation group (14 patients in each group with an average age of 43.6 ± 16.3 years and 51.8 ± 15.4 years, respectively). The unilateral group had a unilateral anatomical variation of the pedicle or vertebral artery, or traumatic pedicle destruction. All patients underwent atlantoaxial unilateral or bilateral pedicle screw fixation and fusion. Intraoperative blood loss and operation time were recorded. The visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scoring systems were used to evaluate pre- and postoperative occipital-neck pain and neurological function. X-ray and computerized tomography (CT) were used to assess atlantoaxial stability, the implants' position, and bone graft fusion. RESULTS All patients were followed up for 39-71 months postoperatively. Intraoperatively, no spinal cord or vertebral artery injury was observed. At the last follow-up, occipital-neck pain and neurological function in the two groups were significantly improved (P< 0.05). The X-ray films and CT showed satisfactory atlantoaxial stability, implant position, and osseous fusion in all the patients at 6 months postoperatively. CONCLUSION Unilateral and bilateral pedicle screw fixation and fusion can restore atlantoaxial stability and improve occipital-neck pain and neurological function in patients with atlantoaxial fracture-dislocation. The unilateral surgical procedure can be a supplementary option for patients with unilateral abnormal atlantoaxial lesions.
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Affiliation(s)
- Zhuo Ma
- Department of Orthopedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yan-Nan Zhang
- Department of Orthopedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xun Ma
- Department of Orthopedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chen Chen
- Department of Orthopedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hao-Yu Feng
- Department of Orthopedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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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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Chen H, Zhu C, Yi H, Sun H, Ma X, Wang J, Zhang K, Ai F, Wu Z, Yin Q, Tu Q, Xia H. Incidence and management of surgical site infection in the cervical spine following a transoral approach. INTERNATIONAL ORTHOPAEDICS 2022; 46:2329-2337. [PMID: 35773531 DOI: 10.1007/s00264-022-05492-0] [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: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Transoral approach can accomplish ventral decompression directly. However, surgical site infection (SSI) cannot be ignored. This paper aims to review the prevalence of infection and conduct advice for the treatment of SSI in the cervical spine following the transoral approach. METHODS A retrospective analysis of patients with SSI after transoral atlantoaxial reduction plate (TARP) surgery was performed. SSI was classified into three kinds according to the modified American CDC criteria. RESULTS 2.9% (17/581) patients who underwent TARP surgery, experienced SSI, of which five had superficial SSI (SI), eight had deep SSI (DI), and four had organ/space SSI (O/SI). The patients with SI underwent intravenous antibiotic treatment and were ultimately cured. Among the remaining 12 patients with DI and O/SI, 11 underwent reoperation for TARP system removal and subsequently one-stage posterior occipitocervical fixation, and one patient experienced infection two months post-operatively and died without receiving treatment. Among patients who underwent revision surgery, three experienced intracranial infection due to intra-operative dural tears, and continuous lumbar cerebrospinal fluid drainage and intrathecal injection of antibiotics were used as effective and appropriate treatments, with outcomes of one recovery and two deaths. All patients with SSI were begun on intravenous antibiotics with conversion to oral antibiotics. CONCLUSIONS The incidence of SSI was 2.9% (17/581). Adequate peri-operative preparation, early diagnosis, and appropriate treatment of SSI require further research.
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Affiliation(s)
- Hu Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Changrong Zhu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Honglei Yi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Hao Sun
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Xiangyang Ma
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Jianhua Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Kai Zhang
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Fuzhi Ai
- Department of Orthopedic, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zenghui Wu
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Qingshui Yin
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Qiang Tu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China.
| | - Hong Xia
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China.
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Ellatif M, Sharif B, Baxter D, Saifuddin A. Update on imaging of the cervical spine in rheumatoid arthritis. Skeletal Radiol 2022; 51:1535-1551. [PMID: 35146552 DOI: 10.1007/s00256-022-04012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.
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Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK.
| | - Ban Sharif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
| | - David Baxter
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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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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[The effect of axis pedicle and intra-axial vertebral artery on C 2 pedicle screw placement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:866-872. [PMID: 35848184 PMCID: PMC9288901 DOI: 10.7507/1002-1892.202202008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the influence of axis pedicle and intra-axial vertebral artery (IAVA) alignment on C 2 pedicle screw placement by measuring the data of head and neck CT angiography. METHODS The axis pedicle diameter (D), isthmus height (H), isthmus thickness (T), and IAVA alignment types were measured in 116 patients (232 sides) who underwent head and neck CT angiography examinations between January 2020 and June 2020. Defined the IAVA offset direction by referencing the vertical line through the center of C 3 transverse foramen on the coronal scan, it was divided into lateral (L), neutral (N), and medial (M). Defined the IAVA high-riding degree by referencing the horizontal line through the outlet of the C 2 transverse foramen, it was divided into below (B), within (W), and above (A). The rate of pedicle stenosis, high-riding vertebral artery, and different IAVA types were calculated, and their relationships were analysed. Simulative C 2 pedicle screws were implanted by Mimics 19.0 software, and the interrelation among the rates of pedicle stenosis, high-riding vertebral artery, IAVA types, and vertebral artery injury were analyzed. RESULTS The rate of C 2 pedicle stenosis was 33.6% (78/232), and the rate of high-riding vertebral artery was 35.3% (82/232). According to the offset direction and the degree of riding, IAVA was divided into 9 types, among which the N-W type (29.3%) was the most, followed by the L-W type (19.0%) and the L-B type (12.9%), accounting for 60.9%. The vertebral artery injury rate of simulative implanted C 2 pedicle screws was 35.3% (82/232). The vertebral artery injury rate in patients with pedicle stenosis and high-riding vertebral artery was significantly higher than that who were not ( P<0.001). The rate of pedicle stenosis, high-riding vertebral artery, and vertebral artery injury were significantly different among IAVA types ( P<0.001), and M-A type was the most common. CONCLUSION Vertebral artery injury is more common in pedicle stenosis and/or high-riding vertebral artery and/or IAVA M-A type. Preoperative head and neck CT angiography examination has clinical guiding significance.
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Janjua MB, Passias PG, Ray WZ. Critical appraisal of bibliometric study on most influential publications of upper cervical spine instability. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:190-192. [PMID: 35875620 PMCID: PMC9263730 DOI: 10.21037/jss-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M. Burhan Janjua
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Yang J, Wang J, Zhai D, Zhou X, Yan J, Liu R, Zhang B, Fan G, Cai W. Low-dose three-dimensional CT angiography for the evaluation of posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: a quantitative anatomical comparison study of the rotational and neutral positions. Clin Radiol 2022; 77:384-389. [PMID: 35177230 DOI: 10.1016/j.crad.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
AIM To investigate the changes in relevant anatomical parameters of posterolateral protrusion of the vertebral artery (VA) between head-neck rotational and neutral positions using low-dose three-dimensional computed tomography angiography (3D-CTA). MATERIALS AND METHODS Low-dose 3D-CTA images obtained for various craniocervical diseases in 36 non-dominant VA side patients with neutral, left and right head-neck rotational positions were evaluated. The relevant parameters from superior and inferior views, including external diameter (ED), internal diameter (ID), transverse diameter (TD), heights and diameters of posterolateral protrusion of the VA over the posterior arch of the atlas in the neutral and rotational positions, were recorded and compared. RESULTS There was no significant differences in the rotational angle (left/right: 31.23 ± 6.60/29.94 ± 6.09°, p>0.05). There were no significant differences in heights and diameters of bilateral VA between rotational and neutral positions (all p>0.05). The contralateral ID, ED, and TD of the rotational positions were significantly shorter than those of the neutral position (all p<0.05), while there were no significant differences in the three ipsilateral diameters (all p>0.05). CONCLUSIONS Posterolateral protrusion of the VA is not uncommon in the population, and surgeons should be aware of its presence, especially the increased possibility of injury to the VA caused by head-neck rotation, during the operation; thus, preoperative evaluation by low-dose 3D-CTA should be considered.
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Affiliation(s)
- J Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - J Wang
- Department of Radiology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, 314000, China
| | - D Zhai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - X Zhou
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - J Yan
- Department of Spinal Surgery, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - R Liu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - B Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - G Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - W Cai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Jiangsu, 215123, China.
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14
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Dahdaleh N, Cho S, Shlobin N. Os odontoideum: A comprehensive review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:256-264. [PMID: 36263339 PMCID: PMC9574117 DOI: 10.4103/jcvjs.jcvjs_71_22] [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: 05/18/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients. A literature review was conducted using the PubMed, EMBASE, and Scopus databases. A search using the query “os odontoideum” yielded 4319 results, of which 112 articles were chosen and analyzed for insights on factors such as etiology, clinical presentation, and management of OO. The presentation of OO varies widely from asymptomatic cases to severe neurological deficits. Asymptomatic patients can be managed either conservatively or surgically, while symptomatic patients should undergo operative stabilization. Although multiple studies show different techniques for surgical management involving posterior fusion, the diversity of such cases illustrates how treatment must be tailored to the individual patient to prevent complications. Conflicting studies and the paucity of current literature on OO highlight poor comprehension of the condition. Further understanding of the natural history of OO is critical to form evidence-based guidelines for the management of OO patients. More large-center studies are thus needed to promote accurate management of OO patients with optimal outcomes.
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15
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Heiler U, Schray D, Pitzen T. [Early intraoperative and postoperative complications of C1-C2 fixation using the Goel-Harms technique : How often? Which? Why?]. Unfallchirurg 2021; 125:792-800. [PMID: 34713344 DOI: 10.1007/s00113-021-01080-w] [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: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Fractures of the axis are among the most frequent spinal injuries. Posterior C1-C2 fixation according to Goel-Harms is an accepted alternative to the more traditional procedures: initial stability has been shown and there is a wide range of indications but there is a paucity of data on possible complications. Such knowledge, however, is essential in order to improve outcomes.Thus, the aim of the study was:1. to describe the frequency, type and severity of early postoperative complications following C1-C2 fixation according to Goel-Harms,2. to investigate whether there is a correlation between frequency and severity of complications,3. to detect risk factors for complications.Patients included in this study were treated surgically using the C1-C2 fixation according to Goel-Harms between March 2011 and July 2018. Data were taken from our hospital database and checked via OPS 10 code "S12.1". We analyzed age, sex, ASA score, blood loss, operating time and complications. These data were extracted from clinical data sheets.A total of 134 patients were detected, 54% female, mean age 75 years and mean ASA score 3. There were 122 complications. All these complications were observed in 50% of the patients. These were mainly minor complications (32%), and 18% severe complications. Mortality was 2%. We found that patients with more severe complications also had significantly more complications when compared to patients with minor complications (Fisher's exact test, p = 0.001). Preoperative ASA score was the only risk factor to significantly influence the number (p = 0.001) and severity (p = 0.002) of postoperative complications. Each increase of the preoperative ASA score increased the risk to get one more complication by a factor of 2.55 (odds ratio 2.55) and increased the risk to get a severe complication by a factor of 2.43 (odds ratio 2.43). Intraoperative blood loss, patient age and duration of surgery, however, were not identified as risk factors for complications.
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Affiliation(s)
- Ute Heiler
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland.
| | - D Schray
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland
| | - T Pitzen
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland
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16
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Dibble CF, Javeed S, Zhang JK, Pennicooke B, Ray WZ, Molina C. Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21414. [PMID: 35855058 PMCID: PMC9265201 DOI: 10.3171/case21414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact. Serial cervical traction was placed with minimal radiographic reduction. Ultimately, she underwent intraoperative reduction, instrumentation, and fusion. Freehand C1 lateral mass reduction screws were placed, then C2 translaminar screws, and finally lateral mass screws at C3 and C4. The C2–4 instrumentation was used as bilateral rod anchors to reduce the C1 lateral mass reduction screws engaged onto the subluxated atlantodental complex. As a final step, cortical allograft spacers were inserted at C1–2 under compression to facilitate long-term stability and fusion. LESSONS This is the first description of a technique using extended tulip cervical reduction screws to correct traction-irreducible atlantoaxial subluxation. This case is a demonstration of using intraoperative tools available for the spine surgeon managing complex cervical injuries requiring intraoperative reduction that is resistant to traction reduction.
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Affiliation(s)
| | - Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Camilo Molina
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
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17
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Karthigeyan M, Salunke P. Neck Tilt in a Child. J Pediatr 2021; 237:308-309. [PMID: 34126120 DOI: 10.1016/j.jpeds.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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18
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Kim KT, Song MG, Park YJ, Lee DY, Kim DH. Cortical Trajectory Screw Fixation in Lumbar Spine Surgery: A Review of the Existing Literature. Asian Spine J 2021; 16:127-140. [PMID: 33915615 PMCID: PMC8873998 DOI: 10.31616/asj.2020.0575] [Citation(s) in RCA: 3] [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: 11/11/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Posterior lumbar fusion is a safe and effective surgical method for diseases, such as lumbar stenosis, spondylolisthesis, lumbar instability, spinal deformity, and tumor. Pedicle screw (PS) fixation was first introduced by Bouche and has been adopted as the gold standard for posterior lumbar fusion. Santoni and colleagues introduced a new methodological screw insertion technique that uses a cortical bone trajectory (CBT), described as that from a medial to lateral path in the transverse axial plane and caudal to the cephalad path in the sagittal plane through the pedicle for maximum contact of the screw with the cortical bone. Owing to the lower invasiveness, superior cortical bone contact, and reduced neurovascular injury incidence, the CBT technique has been widely used in posterior lumbar fusion; however, these advantages have not been proven in clinical/radiological and biomechanical studies. We designed the present study to review the existing evidence and evaluate the merit of CBT screw fixation. Six electronic databases were searched for relevant articles published in August 2020 using the search terms "cortical bone trajectory," "CBT spine," "CBT fixation," "cortical pedicle screws," and "cortical screws." Studies were analyzed and divided into the following groups: "biomechanics investigation," "surgical technique," and "clinical/radiological studies." Most studies compared CBT and PS fixation, and the CBT screw fixation method showed better or similar outcomes.
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Affiliation(s)
- Kun-Tae Kim
- Regional Trauma Center, Gyeongsang National University Hospital, Jinju, Korea.,Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Myung-Geun Song
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young-Jin Park
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Dong-Yeong Lee
- Department of Orthopaedic Surgery and Joint Center, Barun Hospital, Jinju, Korea
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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Patil T, Mahajan N, Chandanwale A, Sonawane D. Management of C1-C2 instability with distorted cranio-vertebral anatomy by using 3D CT angiography model: A rare case report. JOURNAL OF ORTHOPAEDICS AND SPINE 2021. [DOI: 10.4103/joasp.joasp_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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