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Lin Y, Rao S, Liu B, Sun Y, Zhao S, Su G, Chen S, Li Y, Chen B. Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:720. [PMID: 35845524 PMCID: PMC9279768 DOI: 10.21037/atm-22-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses. Case Description The patient in Case 1 presented with neck pain and numbness and weakness in the limbs. The patient in Case 2 presented with numbness in the extremities and the patient in Case 3 presented with bilateral hand numbness and left lower limb weakness. They were all diagnosed with DASM and underwent PFEC1L treatment to maintain the enlargement and decompression of the atlantal canal, which achieved favorable outcomes without complications during the postoperative follow-up visit. Conclusions DASM is rare but potentially dangerous. Its diagnosis is made based on clinical manifestations combined with radiological imaging examinations, especially computed tomography (CT) scan and magnetic resonance imaging (MRI). While C1L is the most common surgical method, PFEC1L is a new feasible and safe therapeutic option with comparable good outcomes and the advantage of being minimally-invasive. To our knowledge this is the first report that PFEC1L was applied for DASM treatment.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Rao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingxin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai Zhao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyi Su
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shudong Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongjin Li
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
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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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Zhang H, Chai W, Wang S, Wang Y, Li H. Persistent first intersegmental artery (PFIA) visualized by three-dimensional computed tomography angiography in Chinese population. Int J Surg 2018; 52:233-236. [DOI: 10.1016/j.ijsu.2018.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
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Nagoshi N, Suda K, Morita T, Matsumoto S, Iimoto S, Yasui K, Komatsu M, Kobayashi Y, Minami A, Toyama Y, Matsumoto M, Nakamura M. C1 posterior arch screw as an auxiliary anchor in posterior reconstruction for atlantoaxial dislocation associated with type II odontoid fracture: a case report and review of the literature. SPRINGERPLUS 2014; 3:672. [PMID: 25485206 PMCID: PMC4234742 DOI: 10.1186/2193-1801-3-672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 11/07/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although pedicle or lateral mass screws are usually chosen to fix atlantoaxial (C1-C2) instability, there is an increased risk for vertebral artery (VA) injury when used in patients with bone or arterial anomalies or osteoporotic bone. Here we report the C1 posterior arch screw as a new technique for upper cervical fixation. CASE DESCRIPTION A 90-year-old man complained of upper cervical pain after falling in his house. The initial computed tomography (CT) scan showed C1-C2 posterior dislocation with a type II odontoid fracture. The patient underwent C2 fracture reduction and posterior C1-C2 fixation. On the right side of C1, because lateral mass screw placement could cause injury to the dominant VA considering a risk in oldest-old osteoporotic patients, a posterior arch screw was chosen instead as an auxiliary anchor. An intralaminar screw was placed on the right side of C2 because a high-riding VA was observed. A lateral mass screw and a pars interarticularis screw were placed on the left side of C1 and C2, respectively. Ten months later, the odontoid fracture had healed, with normal anatomical alignment. Although the patient experienced slight weakness when spreading his bilateral fingers, his overall condition was good. DISCUSSION AND EVALUATION We have presented a novel technique using C1 posterior arch screws for the fixation of a C1-C2 dislocation. Such a screw is an alternative to the C1 lateral mass screw in patients who are at risk for a VA injury because of anomalous bone and arterial structures or poor bone quality. CONCLUSIONS Although there have been few comparable studies, and the long-term outcome is unknown, fixation with a posterior arch screw could be a beneficial choice for surgeries involving the upper cervical region.
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Affiliation(s)
- Narihito Nagoshi
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan ; Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Kota Suda
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Tomonori Morita
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Satoko Matsumoto
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Seiji Iimoto
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Keigo Yasui
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Miki Komatsu
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Yosuke Kobayashi
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Akio Minami
- Department of Orthopedic Surgery, Spinal Cord Injury Center, Hokkaido Chuo Rosai Hospital, 3-1, Higashi-yonjo Minami-icchome, Bibai, 072-0015 Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, 160-8582 Shinjuku-ku Japan
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Jang HJ, Oh SY, Shim YS, Yoon SH. Endovascular treatment of symptomatic high-flow vertebral arteriovenous fistula as a complication after c1 screw insertion. J Korean Neurosurg Soc 2014; 56:348-52. [PMID: 25371787 PMCID: PMC4219195 DOI: 10.3340/jkns.2014.56.4.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 12/05/2022] Open
Abstract
High-flow vertebral arteriovenous fistulas (VAVF) are rare complications of cervical spine surgery and characterized by iatrogenic direct-communication of the extracranial vertebral artery (VA) to the surrounding venous plexuses. The authors describe two patients with VAVF presenting with ischemic presentation after C1 pedicle screw insertion for a treatment of C2 fracture and nontraumatic atlatoaxial subluxation. The first patient presented with drowsy consciousness with blurred vision. The diffusion MRI showed an acute infarction on bilateral cerebellum and occipital lobes. The second patient presented with pulsatile tinnitus, dysarthria and a subjective weakness and numbness of extremities. In both cases, digital subtraction angiography demonstrated high-flow direct VAVFs adjacent to C1 screws. The VAVF of the second case occurred near the left posterior inferior cerebellar artery originated from the persistent first intersegmental artery of the left VA. Both cases were successfully treated by complete occlusion of the fistulous portion and the involved segment of the left VA using endovascular coil embolization. The authors reviewed the VAVFs after the upper-cervical spine surgery including C1 screw insertion and the feasibility with the attention notes of its endovascular treatment.
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Affiliation(s)
- Hyun Jun Jang
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Se-Yang Oh
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Korea
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