C1-C3 Lateral Mass Screw-Rod Fixation and Fusion for C2 Pathologies and Hangman's Fractures

Atlantoaxial instability and cervical noninfectious spondylodiscitis in a patient with Wegener’s granulomatosis: A case report

A 61‐year‐old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.

Management of Neglected Upper Cervical Spine Injuries

BACKGROUND

Injuries involving upper cervical spine are serious and fatal injuries which are associated with alteration of normal occipital-cervical anatomy. These injuries may result in permanent neurologic deficits or neck deformity if not treated in a timely and appropriate manner.

OBJECTIVE

To evaluate the outcomes of neglected upper cervical spine injuries treated by various methods.

STUDY DESIGN

Retrospective study.

MATERIALS AND METHODS

Twelve patients attending ER or OPD with a history of neck trauma and who were diagnosed with fractures and fracture dislocations C1 and C2 were included in the study. Fresh injuries sustained within a week were excluded from study. The outcomes were measured in terms of improvement in VAS, ODI Scores and correction of the neck deformity. Surgical parameters like duration of surgery and blood loss were also observed.

RESULTS

Eleven males and one female. The mean age was 40.9 ± 16.9 (07-67 years). Eleven patients underwent posterior instrumentation, while one patient was treated anteriorly. The mean delay in presentation was 28 ± 8.67 days (15-42 days). The mean duration of surgery was 188.3 ± 34.35 min (120-240 min), average blood loss was 350 ± 111.8 ml (150-600 ml). The mean VAS improved from 8.45 ± 0.89 to 3.9 ± 0.51 (p < 0.05). The mean ODI Pre-operatively was 88.45 ± 5.89 which improved to 31.9 ± 4.01 (p < 0.05). The neck deformity/torticollis was corrected in all the patients.

CONCLUSIONS

Neglected upper cervical spine injuries are difficult to treat and a posterior approach is helpful in reducing the subluxations indirectly and to obtain a posterior fusion.

Lateral mass screw fixation in cervical spine injury

Objective:

To determine clinical outcome in patients with cervical injury after lateral mass screws fixation in a tertiary care hospital.

Methods:

This study included 88 patients, with cervical injury confirmed radiologically. Patients <12 or >70 years, with traumatic discs, cord compression without subluxation and previously operated on cervical spine were excluded from this study. All patients underwent fixation with lateral mass screws through posterior approach under fluoroscopic guidance. Frankel grading was used to assess the clinical status of these patients pre-operatively & post-operatively.

Results:

There were 60(68.18%) males and 28(31.8%) females. The ages varied from 18 to 55 years with a mean of 32 yrs ± 8 yrs. The most common level of injury was C5-C6 in 46(52%) patients. According to Frankel grading system, 35 (39.8%) patients were placed in Grade A, 15(17.05%) in Grade B, 22(25%) in Grade C, 12 (13.6%) in Grade D, four (4.5%) in Grade E on admission. Postoperatively, 16 (18.2%) patients were placed in Grade A, 23 (26.1%) in Grade B, eight (9.1%) in Grade C, nine (10.2%) in Grade D and 26(29.6%) patients in Grade E with an overall improvement in neurological function in 51(58%) and power in 37(42%) patients. The major complications encountered were respiratory infections in 10(11.36%) and wound infection in four (4.5%) while eight (9.1%) patients expired.

Conclusion:

Lateral mass screws technique is a safe and effective method for cervical fixation after proper reduction.

Transpedicular direct osteosynthesis of hangman's fracture from a mini-open exposure as a less invasive procedure: A technical note

This surgical technical case report presents initial clinical experience and preliminary results with a less invasive surgical solution for selected hangman's fracture. A well-known stabilization technique (i.e. direct transpedicular osteosynthesis) was applied through a minimally invasive small incision transmuscular posterior approach guided by a standard C-arm fluoroscopy. This mini-open approach to C2 vertebra allows similar dissection, visualization of the bony landmarks, visual control of the transpedicular screw path drilling, tapping and screw insertion to the standard posterior cervical spine approach. At the same time it has the benefits of less invasive procedures.

Operative strategy and clinical outcomes of ROI-C(TM) fusion device in the treatment of Hangman's fracture

OBJECTIVE

to compare the clinical outcomes of anterior fusion with ROI-C(TM) and titanium plate in the treatment of Hangman's fractures.

METHODS

From Dec 2005 to Jan 2015, a total of 21 patients with Hangman's fracture, who underwent anterior internal fixation with titanium plate or ROI-C(TM), were retrospectively reviewed. All patients underwent anteroposterior, lateral, and flexion-extension radiography and computed tomography of cervical spine preoperatively and postoperatively at 3 days and 3 months. Cervical visual analog scale (VAS) score, Bazaz dysphagia score, angular displacement (AD), horizontal displacement (HD), fusion rate, and blood loss were measured.

RESULTS

The VAS and Bazaz dysphagia score at postoperative 3 days were significantly lower in ROI-C(TM) group, as compared to titanium plate group (P<0.05). AD and HD were significantly decreased in both groups after operation (P<0.05). The postoperative rate of complete reduction of spondylolisthesis was significantly higher in ROI-C(TM) group than that in titanium plate group (P<0.05). The operative time and blood loss was significantly decreased in ROI-C(TM) group, as compared to titanium plate group (P<0.05).

CONCLUSION

ROI-C(TM) device showed superiority to titanium plate in the treatment of Hangman's fractures, suggesting that anterior operation with ROI-C(TM) device may be a better choice for treating Hangman's fractures.

The efficacy of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation

OBJECTIVE

To explore the effect of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation.

PATIENTS AND METHOD

From June 2003 to February 2009, 14 cases of atlas dislocation with upper cervical cord compression were enrolled and anterior transoral soft tissue release combined with posterior reduction and pedicle screw fixation were performed. CT, MRI and radiograph were used preoperatively, and screw placement and bone graft were administered in all cases intraoperatively. Cervical collars were used for 3 months.

RESULTS

Screws were successfully placed in atlas in all cases. The average follow-up period was 18 months. Bone fusion was observed in all cases without the following complications: neurologic symptoms, internal fixation failure and redislocation. Neurological recovery was observed in all 14 cases.

CONCLUSIONS

Pedicle screw instrument has the following advantages in atlas and axis injury treatment: direct screw placement, short-segment fusion, intraoperative reduction and high fusion rate, which should be a better surgical method for the treatment of atlantoaxial dislocation.