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Gu J, Zhao M, Wu Y, Li Z, Feng Z, Jiang Y, Hu H, Zhong M, Luan Z, Xie Z, Qi S, Lu Y. Finite element modelling of posterior occiput-axis fixation and biomechanical analysis of C2 intralaminar screw fixation with offset connectors. Br J Neurosurg 2024; 38:104-110. [PMID: 34612789 DOI: 10.1080/02688697.2021.1988056] [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: 05/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The occiput-axis crossing translaminar screw (C2LAM) fixation technique can help avoid vertebral injury, while the inclusion of offset connectors can facilitate implantation. This three-dimensional finite element (FE) study compared the stability of C2LAM using offset connectors (C2LAM + OF) with other methods. MATERIALS AND METHODS Occipital and cervical spine computed tomography images of a healthy 30-year-old man were selected to build the FE model. Four internal fixation instruments including occiput plate-C2 pedicle (C2P) and pars (C2Pars) screws, as well as C2LAM and C2LAM + OF were applied consecutively to the model respectively to establish four new models, which were subjected to all states of motion and physiological loads to simulate normal movement, including the four kinds of basic activities of human such as flexion, extension, lateral bending, and axial rotation. Physiological measures and comparison included the range of motion (ROM) and stress distribution in the model. RESULTS ROM between the fixation techniques was comparable, and the stability of the C2LAM + OF fixation technique was similar to that of C2P. Screw entry points, offset connectors and rods were the main stress distribution regions in the C2LAM + OF system. The mean von Mises stress of the inner wall was significantly smaller than that of the outer wall in flexion, extension, and rotation (p < 0.05); however, lateral bending was comparable, indicating a relatively small risk of damage to the inner wall. CONCLUSIONS The results of this study indicate that the C2LAM + OF fusion technique can provide sufficient stability and can be used as an alternative to C2P under special circumstances.
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Affiliation(s)
- Jiyong Gu
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Minchan Zhao
- Network Information Management Center, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Yi Wu
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Zhibin Li
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Zize Feng
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Yalan Jiang
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Huixian Hu
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Minggu Zhong
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Zhongqin Luan
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Zhengyuan Xie
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, PR China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Yuntao Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
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Tang C, Liao YH, Wang Q, Tang Q, Ma F, Cai CH, Xu SC, Leng YB, Chu TW, Zhong DJ. The association between unilateral high-riding vertebral artery and atlantoaxial joint morphology: a multi-slice spiral computed tomography study of 396 patients and a finite element analysis. Spine J 2023; 23:1054-1067. [PMID: 36868381 DOI: 10.1016/j.spinee.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND CONTEXT A high-riding vertebral artery (HRVA) can deviate too medially, too posteriorly, or too superiorly to allow the safe insertion of screws. However, it is unknown whether the presence of a HRVA is associated with morphological changes of the atlantoaxial joint. PURPOSE To investigate the association between HRVA and atlantoaxial joint morphology in patients with and without HRVA. STUDY DESIGN A retrospective case-control study and finite element (FE) analysis. PATIENT SAMPLE A total of 396 patients with cervical spondylosis underwent multi-slice spiral computed tomography (MSCT) of cervical spine at our institutions from 2020 to 2022. OUTCOME MEASURES A series of atlantoaxial joint morphological parameters, including C2 lateral mass settlement (C2 LMS), C1-2 sagittal joint inclination (C1-2 SI), C1-2 coronal joint inclination (C1-2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval (LADI), and C1-2 relative rotation angle (C1-2 RRA) were measured, and lateral atlantoaxial joints osteoarthritis (LAJs-OA) was recorded. The stress distribution on the C2 facet surface under different torques of flexion-extension, lateral bending, and axial rotation was analyzed by FE models. A 2-Nm moment was applied to all models to determine the range of motion (ROM). METHODS A total of 132 consecutive cervical spondylosis patients with unilateral HRVA were enrolled in the HRVA group, and 264 patients without HRVA matched for age and sex were enrolled in the normal (NL) group. Atlantoaxial joint morphological parameters were compared between two sides of C2 lateral mass within HRVA or NL group, and between HRVA and NL groups. A 48-year-old woman with cervical spondylosis without HRVA was selected for cervical MSCT. A three-dimensional (3D) FE intact model of the normal upper cervical spine (C0-C2) was created. We established the HRVA model by simulating atlantoaxial morphological changes of unilateral HRVA with FE method. RESULTS The C2 LMS was significantly smaller on the HRVA side than that on the non-HRVA side in the HRVA group, but C1-2 SI, C1-2 CI, and LADI on HRVA side were significantly larger than those on non-HRVA side. There was no significant difference between left and right sides in the NL group. The difference in C2 LMS (d-C2 LMS) between HRVA side and non-HRVA side in the HRVA group was larger than that in the NL group (P < 0.05). Meanwhile, the differences in C1-2 SI (d-C1/2 SI), C1-2 CI (d-C1/2 CI), and LADI (d-LADI) in the HRVA group were significantly larger than those in the NL group. The C1-2 RRA in the HRVA group was significantly larger than that in the NL group. Pearson correlations showed that d-C1/2 SI, d-C1/2 CI, and d-LADI were positively associated with d-C2 LMS (r=0.428, 0.649, 0.498, respectively, p<.05 for all). The incidence of LAJs-OA in the HRVA group (27.3%) was significantly larger than that in the NL group (11.7%). Compared with the normal model, the ROM of C1-2 segment declined in all postures of the HRVA FE model. We found a larger distribution of stress on the C2 lateral mass surface of the HRVA side under different moment conditions. CONCLUSIONS We suggest that HRVA affects the integrity of the C2 lateral mass. This change in patients with unilateral HRVA is associated with the nonuniform settlement of the lateral mass and an increase in the lateral mass inclination, which may further affect the degeneration of the atlantoaxial joint because of the stress concentration on the C2 lateral mass surface.
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Affiliation(s)
- Chao Tang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China; Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Ye Hui Liao
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Qing Wang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Qiang Tang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Fei Ma
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Chen Hui Cai
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China
| | - Shi Cai Xu
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Ye Bo Leng
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Tong Wei Chu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China.
| | - De Jun Zhong
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China.
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Kim D, Jang Y, Whang K, Kim J, Cho S. Emergent Vertebral Artery Embolization during C12 Screw Fixation for Rheumatoid Arthritis. Korean J Neurotrauma 2021; 17:199-203. [PMID: 34760835 PMCID: PMC8558018 DOI: 10.13004/kjnt.2021.17.e30] [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: 09/16/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
The subaxial screw fixation technique is commonly used for fixation in a wide range of cervical diseases, including traumatic, degenerative, and neoplastic diseases, rheumatoid arthritis (RA), and spondyloarthropathy. Although it is regarded as a relatively safe procedure, several complications may be encountered during surgery, such as vertebral artery (VA) and nerve root injuries, facet violation, and mass fracture. We report a case of endovascular embolization after VA injury during a high cervical spinal surgery. A 48-year-old woman was scheduled for C-1-2-3 posterior fixation. Plain radiography of the cervical spine revealed a severely unstable state. During dissection around the C1 lateral mass on the right side, sudden brisk arterial bleeding was observed. On vertebral angiography, flow voiding was noted above the right V3 portion. After checking patent collateral flow from the contralateral VA, routine coil embolization was performed to pack the V3 segment. Iatrogenic vascular injuries due to spinal surgery are rare but serious complications. For patients with RA, we recommend careful preoperative evaluation before a high cervical surgical procedure to avoid iatrogenic VA injury and endovascular interventions that are safe and effective in the diagnosis and treatment of such vascular injuries.
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Affiliation(s)
- Donghee Kim
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Younkyu Jang
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Kum Whang
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jongyeon Kim
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sungmin Cho
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
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Shimizu T, Koda M, Abe T, Shibao Y, Kono M, Eto F, Miura K, Mataki K, Noguchi H, Takahashi H, Funayama T, Yamazaki M. Correlation between osteoarthritis of the atlantoaxial facet joint and a high-riding vertebral artery. BMC Musculoskelet Disord 2021; 22:406. [PMID: 33941142 PMCID: PMC8091766 DOI: 10.1186/s12891-021-04275-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high-riding vertebral artery (HRVA) is an intraosseous anomaly that narrows the trajectory for C2 pedicle screws. The prevalence of a HRVA is high in patients who need surgery at the craniovertebral junction, but reports about HRVAs in subaxial cervical spine disorders are limited. We sought to determine the prevalence of HRVAs among patients with subaxial cervical spine disorders to elucidate the potential risk for VA injury in subaxial cervical spine surgery. METHODS We included 215 patients, 94 were with a main lesion from C3 to C7 (subaxial group) and 121 were with a main lesion from T1 to L5 (thoracolumbar group). A HRVA was defined as a maximum C2 pedicle diameter of < 3.5 mm on axial CT. The sex, age of patients, body mass index (BMI), osteoarthritis of the atlantoaxial (C1-2) facet joints, and prevalence of a HRVA in the 2 groups were compared and logistic regression was used to identify the factors correlated with a HRVA. RESULTS The patients in the subaxial group were younger than those in the thoracolumbar group, but their sex and BMI did not differ significantly between the 2 groups. The mean osteoarthritis grade of the C1-2 facet joints of patients in the subaxial group was significantly higher than that in those in the thoracolumbar group. A HRVA was found in 26 patients of 94 (27.7 %) in the subaxial group and in 19 of 121 (15.7 %) in the thoracolumbar group. The prevalence of a HRVA in the subaxial group was significantly higher and osteoarthritis of C1-2 facet joints correlated significantly with a HRVA. CONCLUSIONS The prevalence of a HRVA in patients with subaxial cervical spine disorders is higher than in those without and osteoarthritis of the C1-2 facet joints is correlated with a HRVA.
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Affiliation(s)
- Tomoaki Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Mamoru Kono
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Fumihiko Eto
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Kentaro Mataki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
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Obo T, Fujishiro T, Mizutani M, Yano T, Hayama S, Nakaya Y, Nakano A, Neo M. Biologic Agents Preserve the C-2 Pedicle in Patients with Rheumatoid Arthritis: A Comparative Imaging Study Using Three-Dimensional Computed Tomography. World Neurosurg 2021; 149:e42-e50. [PMID: 33647486 DOI: 10.1016/j.wneu.2021.02.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether biologic agents (BAs) reduce a narrow C-2 pedicle screw trajectory, which is often a key stabilizer in surgical treatment, in patients with rheumatoid arthritis (RA). METHODS A total of 100 patients with RA treated with and without BAs (BA [+] group [n = 50] and BA [-] group [n = 50]), respectively, were included in the present study. Computed tomography (CT) images of their cervical spine, including C-2, were analyzed. The maximum screw diameter at C-2 that could be inserted without breaching the cortex, measured on 3-dimensional images using a CT-based navigation system, was compared between the groups with and without BA administration. Furthermore, the destruction of the atlantoaxial joint was examined using CT images. The risk factors for a narrow C-2 pedicle were elucidated among the patients treated with BAs. RESULTS The pedicle in the BA (+) group had a significantly larger C-2 maximum screw diameter than the BA (-) group (6.00 mm vs. 5.13 mm, P < 0.001), with less destruction of the atlantoaxial joint. Among the BA (+) group, a longer period until the initial administration of BAs and RA disease duration were associated with a narrow C-2 pedicle. CONCLUSIONS This study suggests that BAs can maintain the trajectory for C-2 pedicle screws, which acts as a key stabilizer in surgical management for the rheumatoid cervical spine, by halting the destruction of the atlantoaxial joint. Early introduction of BAs can be especially important to prevent the narrowing of the C-2 pedicle.
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Affiliation(s)
- Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Toma Yano
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Fujioka T, Nakata K, Nishida H, Sugawara T, Konno N, Maeda S, Kamishina H. A novel patient‐specific drill guide template for stabilization of thoracolumbar vertebrae of dogs: cadaveric study and clinical cases. Vet Surg 2018; 48:336-342. [DOI: 10.1111/vsu.13140] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Toru Fujioka
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- Ivy Animal Clinic Okayama Japan
| | - Kohei Nakata
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Hidetaka Nishida
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Taku Sugawara
- Department of Spinal SurgeryResearch Institute for Brain and Blood Vessels‐Akita Akita Japan
| | | | - Sadatoshi Maeda
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
| | - Hiroaki Kamishina
- The United Graduate School of Veterinary Sciences, Gifu University Gifu Japan
- The Animal Medical Center of Gifu University, Gifu University Gifu Japan
- Center for Highly Advanced Integration of Nano and Life SciencesGifu University Gifu Japan
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Gu J, Lei W, Xin Z, Wu Y, Peng L, Li Z, Feng Z, Zhao M, Qi S, Lu Y. Occiput-axis crossing translaminar screw fixation technique using offset connectors: An in vitro biomechanical study. Clin Neurol Neurosurg 2018; 169:49-54. [PMID: 29627641 DOI: 10.1016/j.clineuro.2018.04.005] [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: 02/08/2018] [Revised: 03/28/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Fixation with the axis vertebra (C2) using pedicle screws is commonly used to treat an unstable occipitocervical junction; however, it is accompanied by a risk of vertebral artery injury. The occiput-C2 (OC2) crossing translaminar screw fixation technique may avoid this risk, but rod implantation is difficult. Offset connectors can help facilitate this construct. This study aimed to evaluate the stability of a technique for OC2 crossing translaminar screw fixation using offset connectors (C2LAM + OF) in comparison with other methods. PATIENTS AND METHODS Six fresh-frozen human cadaveric occipital-cervical spines were tested intact under flexion, extension, lateral bending, and axial rotation. These were then made into a type II odontoid fracture model, instrumented with an occipital plate, and tested in the following modes: C2 bilateral pedicle screws (C2P), a single C2 pedicle screw and bilateral C3 lateral mass screws (C2P + C3M), C2 crossing translaminar screws (C2LAM), and C2LAM + OF. The OC2 range of motion (ROM) for each construct was obtained and compared using a repeated-measures analysis. RESULTS The ROM of the C2LAM + OF construct was found not to be significantly different from that of the C2P and C2P + C3M fixations in every direction (p > 0.05). However, the C2LAM + OF construct was superior to the C2LAM construct in axial rotation (p < 0.05). CONCLUSIONS OC2 crossing translaminar screw fixation using offset connectors offers similar stability to C2 pedicle screw fixation and is an effective alternative method for treating an unstable occipitocervical junction.
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Affiliation(s)
- Jiyong Gu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China; Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China
| | - Weiwei Lei
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China
| | - Zong Xin
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China
| | - Yi Wu
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China
| | - Lin Peng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China
| | - Zhibin Li
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China
| | - Zize Feng
- Department of Neurosurgery, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China
| | - Minchan Zhao
- Network Information Management Center, Jiangmen Central Hospital, Jiangmen City, Guangdong Province, PR China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China.
| | - Yuntao Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China.
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Darwazeh R, Liu Q, Deng L, Xia J, Elzain MA, Darwazeh M, Sharma P, Zhang B, Yan Y. Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C 2 Pedicle. World Neurosurg 2017; 103:647-654. [PMID: 28457924 DOI: 10.1016/j.wneu.2017.04.124] [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: 03/07/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results. METHODS From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C2 pedicle at our department. All patients underwent "posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C2 and lateral mass of C3 on the narrowed C2 pedicle side-for non-narrowed C2 pedicle side, the screw was only inserted into C2 pedicle without extending the fixation to C3 vertebrae-using a titanium screw-rod (plate) fixation system." The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy. RESULTS A total of 134 screws were inserted into the C2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C2, and lateral mass of C3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions (P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion. CONCLUSION This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C2 pedicle.
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Affiliation(s)
- Rami Darwazeh
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Deng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiajie Xia
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Mazhar Darwazeh
- Department of Neurosurgery, Specialized Arab Hospital, Nablus, Palestine
| | - Piyush Sharma
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Bo Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Yan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Shih YT, Kao TH, Pan HC, Chen HT, Tsou HK. The Surgical Treatment Principles of Atlantoaxial Instability Focusing on Rheumatoid Arthritis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:518164. [PMID: 26273625 PMCID: PMC4529935 DOI: 10.1155/2015/518164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/29/2015] [Accepted: 05/14/2015] [Indexed: 01/27/2023]
Abstract
OBJECT This retrospective review was conducted to determine the surgical treatment principle for rheumatoid arthritis (RA) patients with atlantoaxial instability (AAI). METHODS Thirteen patients with AAI, including 5 RA patients, received preoperative computed tomography- (CT-) based image-guided navigation system (IGS) in C1 lateral mass-C2 pedicle screw-rod system fixation (LC1-PC2 fixation). These 13 patients were analyzed for 52 screws inserted into C1 and C2. We defined these patients as non-RA group (8 patients, 32 screws) and RA group (5 patients, 20 screws). The neurological status for RA group was evaluated using the Ranawat classification. The causes of AAI, surgical indications, complications, surgical method revolution, and CT-based navigation application are discussed. RESULTS None of the 13 patients expressed neurological function deterioration. The non-RA group screw accuracy was 100%. In the RA group, 1 RA patient developed left C2 screw loosening at 1(+) months after operation due to screw malposition. The screw accuracy for this group was 95%. CONCLUSIONS Higher intraoperative surgical complication rate was described in RA patients. Preoperative CT-based IGS in LC1-PC2 fixation can provide good neurological function and screw accuracy results. However, for higher screw accuracy in RA patients, intraoperative CT-based IGS application may be considered.
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Affiliation(s)
- Yu-Tung Shih
- Department of Neurosurgery, Jen-Ai Hospital, No. 483 Dong Rong Road, Dali, Taichung 41265, Taiwan
| | - Ting-Hsien Kao
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, No. 161, Section 6, Minquan E. Road, Neihu District, Taipei 11490, Taiwan
- Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, No. 79-9, Sha-Luen-Hu, Xi Zhou Li, Hou-Loung Town, Miaoli County 35664, Taiwan
| | - Hung-Chuan Pan
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11266, Taiwan
| | - Hsien-Te Chen
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
- Department of Orthopaedic Surgery, China Medical University Hospital, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, No. 79-9, Sha-Luen-Hu, Xi Zhou Li, Hou-Loung Town, Miaoli County 35664, Taiwan
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10
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Ohya J, Chikuda H, Kato S, Horiguchi H, Takeshita K, Tanaka S, Yasunaga H. Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database. World Neurosurg 2015; 83:603-7. [DOI: 10.1016/j.wneu.2014.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/06/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022]
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11
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A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 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 2014; 23:2166-74. [DOI: 10.1007/s00586-014-3470-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 06/25/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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12
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Nagahama K, Sudo H, Abumi K, Ito M, Takahata M, Hiratsuka S, Kuroki K, Iwasaki N. Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine. Bone Joint J 2014; 96-B:535-40. [PMID: 24692624 DOI: 10.1302/0301-620x.96b4.33210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the incidence of anomalies in the vertebral arteries and Circle of Willis with three-dimensional CT angiography in 55 consecutive patients who had undergone an instrumented posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications. The frequency of congenital anomalies was 30.9%, abnormal vertebral artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in 41.8% of patients and bilaterally in 38.2%. Variations in the vertebral arteries and Circle of Willis were not significantly related to the presence or absence of posterior communicating arteries. Importantly, 18.2% of patients showed characteristic variations in the Circle of Willis with unilateral vertebral artery stenosis or a dominant vertebral artery, indicating that injury may cause lethal complications. One patient had post-operative cerebellar symptoms due to intra-operative injury of the vertebral artery, and one underwent a different surgical procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle of Willis is essential if a posterior spinal fusion with instrumentation is to be carried out safely.
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Affiliation(s)
- K Nagahama
- Hokkaido University Hospital, Department of Orthopaedic Surgery, North-15, West-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
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13
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Neo M, Yoshitomi H, Takemoto M, Izeki M. The reinforcement of a C2 laminar screw by a C2 laminar hook as an anchor of occipito-C2 fusion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:635-9. [DOI: 10.1007/s00590-013-1349-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
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14
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Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J 2013; 13:775-85. [PMID: 23684237 DOI: 10.1016/j.spinee.2013.04.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 02/10/2013] [Accepted: 04/03/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral artery and/or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. PURPOSE To compare the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral artery and a narrow pedicle using computed tomography (CT) scan images and three-dimensional (3D) screw trajectory software. STUDY DESIGN Radiographic analysis using CT scans. PATIENT SAMPLE Computed tomography scans of 269 consecutive patients, for a total of 538 potential screw insertion sites for each type of screw. OUTCOME MEASURES Cortical perforation into the vertebral artery groove of C2 by a screw. METHODS We simulated the placement of 4.0 mm transarticular and pedicle screws using 1-mm-sliced CT scans and 3D screw trajectory software. We then compared the frequency of C2 vertebral artery groove violation by the two different fixation methods. This was done in the overall patient population, in the subset of those with a high-riding vertebral artery (defined as an isthmus height ≤ 5 mm or internal height ≤ 2 mm on sagittal images) and with a narrow pedicle (defined as a pedicle width ≤ 4 mm on axial images). RESULTS There were 78 high-riding vertebral arteries (14.5%) and 51 narrow pedicles (9.5%). Most (82%) of the narrow pedicles had a concurrent high-riding vertebral artery, whereas only 54% of the high-riding vertebral arteries had a concurrent narrow pedicle. Overall, 9.5% of transarticular and 8.0% of pedicle screws violated the C2 vertebral artery groove without a significant difference between the two types of screws (p=.17). Among those with a high-riding vertebral artery, vertebral artery groove violation was significantly lower (p=.02) with pedicle (49%) than with transarticular (63%) screws. Among those with a narrow pedicle, vertebral artery groove violation was high in both groups (71% with transarticular and 76% with pedicle screws) but without a significant difference between the two groups (p=.55). CONCLUSIONS Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent high-riding vertebral artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral artery injury.
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Affiliation(s)
- Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-ku, Sungnam 463-707, Republic of Korea
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15
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Scheufler KM, Franke J, Eckardt A, Dohmen H. Accuracy of Image-Guided Pedicle Screw Placement Using Intraoperative Computed Tomography-Based Navigation With Automated Referencing, Part I: Cervicothoracic Spine. Neurosurgery 2011; 69:782-95; discussion 795. [DOI: 10.1227/neu.0b013e318222ae16] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
BACKGROUND:
Image-guided spinal instrumentation reduces the incidence of implant misplacement.
OBJECTIVE:
To assess the accuracy of intraoperative computed tomography (iCT)-based neuronavigation (iCT-N).
METHODS:
In 35 patients (age range, 18-87 years), a total of 248 pedicle screws were placed in the cervical (C1-C7) and upper and midthoracic (T1-T8) spine. An automated iCT registration sequence was used for multisegmental instrumentation, with the reference frame fixed to either a Mayfield head clamp and/or the most distal spinous process within the instrumentation. Pediculation was performed with navigated drill guides or Jamshidi cannulas. The angular deviation between navigated tool trajectory and final implant positions (evaluated on postinstrumentation iCT or postoperative CT scans) was calculated to assess the accuracy of iCT-N. Final screw positions were also graded according to established classification systems. Mean follow-up was 16.7 months.
RESULTS:
Clinically significant screw misplacement or iCT-N failure mandating conversion to conventional technique did not occur. A total of 71.4% of patients self-rated their outcome as excellent or good at 12 months; 99.3% of cervical screws were compliant with Neo classification grades 0 and 1 (grade 2, 0.7%), and neurovascular injury did not occur. In addition, 97.8% of thoracic pedicle screws were assigned grades I to III of the Heary classification, with 2.2% grade IV placement. Accuracy of iCT-N progressively deteriorated with increasing distance from the spinal reference clamp but allowed safe instrumentation of up to 10 segments.
CONCLUSION:
Image-guided spinal instrumentation using iCT-N with automated referencing allows safe, highly accurate multilevel instrumentation of the cervical and upper and midthoracic spine. In addition, iCT-N significantly reduces the need for reregistration in multilevel surgery.
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Affiliation(s)
| | - Joerg Franke
- Department of Orthopedic Surgery, University Hospital, Magdeburg, Germany
| | - Anke Eckardt
- Department of Orthopedic Surgery, Hirslanden Klinik Birshof, Bale, Switzerland
| | - Hildegard Dohmen
- Department of Neuropathology, University Hospital, Zürich, Switzerland
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16
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Zenmyo M, Ijiri K, Sasaki H, Sakakima H, Taketomi E, Nagayoshi R, Yamamoto T, Komiya S. Magnetic Resonance Angiography for Vertebral Artery Evaluation in Rheumatoid Arthritis Patients. Neurosurgery 2010; 66:1174-80; discussion 1180. [DOI: 10.1227/01.neu.0000369192.96801.0b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michihisa Zenmyo
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Kosei Ijiri
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Hiromi Sasaki
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Harutoshi Sakakima
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Eiji Taketomi
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Ryusaku Nagayoshi
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Science, Kagoshima Japan
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17
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Kabir SMR, Casey ATH. Modification of Wright's technique for C2 translaminar screw fixation: technical note. Acta Neurochir (Wien) 2009; 151:1543-7. [PMID: 19657582 DOI: 10.1007/s00701-009-0459-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe a modification of Wright's technique for C2 translaminar screw fixation. METHODS Bilateral crossing C2 laminar screws have recently become popular as an alternative technique for C2 fixation. This technique is particularly useful in patients with anomalous anatomy, as a salvage technique where other modes of fixation have failed or as a primary procedure. However, reported disadvantages of this technique include breach of the dorsal lamina and spinal canal, early hardware failure and difficulty in bone graft placement due to the position of the polyaxial screw heads. To address some of these issues, a modified technique was used in six patients. In this technique, the upper part of the spinous process of C2 was removed and the entry point of the screw was in the base of this removed spinous process. RESULTS The screw position was satisfactory in all patients. There were no intraoperative or early postoperative complications. CONCLUSIONS Our modification enables placement of a bone graft on the C2 lamina and is also less likely to cause inadvertent cortical breach. Because of these advantages, it is especially suitable for patients with advanced rheumatoid arthritis with destruction of the lateral masses of C2 or as part of a hybrid construct in patients with a unilateral high-riding vertebral artery. This technique is not suitable for bilateral translaminar screw placement.
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