1
|
Xu Z, Wu J, Chen F, Ding Y, Ni B, Xu P, Guo Q. Atlantoaxial intra-articular cage fusion by posterior intermuscular approach for treating reducible atlantoaxial dislocation: a technique note with case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08318-2. [PMID: 38816537 DOI: 10.1007/s00586-024-08318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). METHODS An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. RESULTS The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. CONCLUSIONS AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach.
Collapse
Affiliation(s)
- Zhenji Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Yiyang Ding
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China
| | - Peng Xu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
| | - Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
| |
Collapse
|
2
|
Huang CC, Fitts J, Huie D, Bhowmick DA, Abd-El-Barr MM. Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions-A Narrative Review. J Clin Med 2024; 13:2122. [PMID: 38610887 PMCID: PMC11012719 DOI: 10.3390/jcm13072122] [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: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
Collapse
Affiliation(s)
- Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jamal Fitts
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| |
Collapse
|
3
|
Mathkour M, Iwanaga J, Loukas M, Bui CJ, Dumont AS, Tubbs RS. Muscle Sparing C1-C2 Laminoplasty: Cadaveric Feasibility Study. World Neurosurg 2020; 147:e234-e238. [PMID: 33316488 DOI: 10.1016/j.wneu.2020.12.028] [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: 10/22/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Posterior cervical approaches for atlantoaxial and craniovertebral junction pathologies with or without instrumentation are often associated with excessive soft tissue dissection and bleeding consequent with disruption of the venous plexus. A few minimally invasive approaches to this region have been reported from clinical and cadaveric studies in an effort to minimize blood loss, reduce soft tissue dissection, and decrease postoperative pain; however, unilateral minimally invasive approaches have not been described. Here, we describe a minimally invasive atlantoaxial and craniovertebral approach. METHODS Using fresh cadavers, we performed a novel, right-sided, muscle-sparing minimally invasive C1-C2 laminotomy with laminoplasty for access to the atlantoaxial level and craniovertebral junction and used the traditional approach on left sides. RESULTS Using this approach, the atlantoaxial space and craniovertebral junction with wide and generous exposure via unilateral soft tissue dissection and muscle splitting was achieved. After exposure, the musculoosseous unit was easily repositioned, thus allowing for C1-C2 laminoplasty. Grossly, no damage to the vertebral artery or regional nerves was noted. CONCLUSIONS We present a novel, unilateral minimally invasive approach to reach the atlantoaxial and craniovertebral junction. This could allow for faster postoperative recovery, less pain and opioid requirement, and increased maintenance of atlantoaxial stability. Such a technique, after being confirmed in patients, could optimize this surgical technique.
Collapse
Affiliation(s)
- Mansour Mathkour
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Neurosurgery Section, Surgery Department, Jazan University School of Medicine, Jazan, Kingdom of Saudi Arabia
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| |
Collapse
|
4
|
Klimov V, Kosimshoev M, Evsyukov A, Stepanenko V, Rzaev J. Surgical treatment of neglected C2 odontoid process fracture with anterior atlantoaxial dislocation. Br J Neurosurg 2020; 35:275-279. [PMID: 32619122 DOI: 10.1080/02688697.2020.1787340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a case of the atlantoaxial (C1-2) deformity secondary to a neglected C2 odontoid fracture that was successfully treated with 3-stage operation performed in one session.
Collapse
Affiliation(s)
- Vladimir Klimov
- Federal Center of Neurosurgery, The Ministry of Health, Novosibirsk, Russia.,Novosibirsk State Medical University, The Ministry of Health, Novosibirsk, Russia
| | | | - Aleksey Evsyukov
- Federal Center of Neurosurgery, The Ministry of Health, Novosibirsk, Russia
| | - Vitaly Stepanenko
- Municipal Multi-Field Hospital №2, Russian Federation, Saint-Petersburg, Russia
| | - Jamil Rzaev
- Federal Center of Neurosurgery, The Ministry of Health, Novosibirsk, Russia
| |
Collapse
|
5
|
Minimally Invasive Percutaneous C1-C2 Fixation Using an Intraoperative Three-Dimensional Imaging–Based Navigation System for Management of Odontoid Fractures. World Neurosurg 2020; 137:266-271. [DOI: 10.1016/j.wneu.2019.12.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022]
|
6
|
Camacho JE, Usmani MF, Strickland AR, Banagan KE, Ludwig SC. The use of minimally invasive surgery in spine trauma: a review of concepts. JOURNAL OF SPINE SURGERY 2019; 5:S91-S100. [PMID: 31380497 DOI: 10.21037/jss.2019.04.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting post-traumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.
Collapse
Affiliation(s)
- Jael E Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashely R Strickland
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
7
|
Splitting of the semispinalis capitis muscle as a less invasive approach for atlantoaxial fusion – A technical note. J Clin Neurosci 2019; 62:260-263. [DOI: 10.1016/j.jocn.2018.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/11/2018] [Indexed: 11/17/2022]
|
8
|
Dandekar MP, Fenoy AJ, Carvalho AF, Soares JC, Quevedo J. Deep brain stimulation for treatment-resistant depression: an integrative review of preclinical and clinical findings and translational implications. Mol Psychiatry 2018; 23:1094-1112. [PMID: 29483673 DOI: 10.1038/mp.2018.2] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
Collapse
Affiliation(s)
- M P Dandekar
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - J C Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, Brazil
| |
Collapse
|
9
|
Lasswell TL, Cronin DS, Medley JB, Rasoulinejad P. Incorporating ligament laxity in a finite element model for the upper cervical spine. Spine J 2017; 17:1755-1764. [PMID: 28673824 DOI: 10.1016/j.spinee.2017.06.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/30/2017] [Accepted: 06/27/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Predicting physiological range of motion (ROM) using a finite element (FE) model of the upper cervical spine requires the incorporation of ligament laxity. The effect of ligament laxity can be observed only on a macro level of joint motion and is lost once ligaments have been dissected and preconditioned for experimental testing. As a result, although ligament laxity values are recognized to exist, specific values are not directly available in the literature for use in FE models. PURPOSE The purpose of the current study is to propose an optimization process that can be used to determine a set of ligament laxity values for upper cervical spine FE models. Furthermore, an FE model that includes ligament laxity is applied, and the resulting ROM values are compared with experimental data for physiological ROM, as well as experimental data for the increase in ROM when a Type II odontoid fracture is introduced. DESIGN/SETTING The upper cervical spine FE model was adapted from a 50th percentile male full-body model developed with the Global Human Body Models Consortium (GHBMC). FE modeling was performed in LS-DYNA and LS-OPT (Livermore Software Technology Group) was used for ligament laxity optimization. METHODS Ordinate-based curve matching was used to minimize the mean squared error (MSE) between computed load-rotation curves and experimental load-rotation curves under flexion, extension, and axial rotation with pure moment loads from 0 to 3.5 Nm. Lateral bending was excluded from the optimization because the upper cervical spine was considered to be primarily responsible for flexion, extension, and axial rotation. Based on recommendations from the literature, four varying inputs representing laxity in select ligaments were optimized to minimize the MSE. Funding was provided by the Natural Sciences and Engineering Research Council of Canada as well as GHMBC. The present study was funded by the Natural Sciences and Engineering Research Council of Canada to support the work of one graduate student. There are no conflicts of interest to be reported. RESULTS The MSE was reduced to 0.28 in the FE model with optimized ligament laxity compared with an MSE 0f 4.16 in the FE model without laxity. In all load cases, incorporating ligament laxity improved the agreement between the ROM of the FE model and the ROM of the experimental data. The ROM for axial rotation and extension was within one standard deviation of the experimental data. The ROM for flexion and lateral bending was outside one standard deviation of the experimental data, but a compromise was required to use one set of ligament laxity values to achieve a best fit to all load cases. Atlanto-occipital motion was compared as a ratio to overall ROM, and only in extension did the inclusion of ligament laxity not improve the agreement. After a Type II odontoid fracture was incorporated into the model, the increase in ROM was consistent with experimental data from the literature. CONCLUSIONS The optimization approach used in this study provided values for ligament laxities that, when incorporated into the FE model, generally improved the ROM response when compared with experimental data. Successfully modeling a Type II odontoid fracture showcased the robustness of the FE model, which can now be used in future biomechanics studies.
Collapse
Affiliation(s)
- Timothy L Lasswell
- Department of MME, University of Waterloo, 200 University Ave West, Waterloo, Ontario, Canada N2L 3G1
| | - Duane S Cronin
- Department of MME, University of Waterloo, 200 University Ave West, Waterloo, Ontario, Canada N2L 3G1.
| | - John B Medley
- Department of MME, University of Waterloo, 200 University Ave West, Waterloo, Ontario, Canada N2L 3G1
| | - Parham Rasoulinejad
- Victoria Hospital, London Health Sciences Center, 800 Commisioners Rd East, London, Ontario, Canada
| |
Collapse
|
10
|
Xu Y, Xiong W, Han SII, Fang Z, Li F. Posterior Bilateral Intermuscular Approach for Upper Cervical Spine Injuries. World Neurosurg 2017; 104:869-875. [PMID: 28546119 DOI: 10.1016/j.wneu.2017.05.051] [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: 03/19/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate a novel intermuscular surgical approach for posterior upper cervical spine fixation. METHODS Twenty-three healthy volunteers underwent magnetic resonance imaging. By using the magnetic resonance imaging scans in transverse view at the level of lower edge of atlas, the distances from the posterior midline to lateral margin of trapezius, to the medial margin of splenius capitis, and to middle line of semispinalis capitis were recorded. The angle between posterior middle line and the line crossing the lateral margin of trapezius and middle point of ipsilateral pedicles. From October 2009 to May 2013, 12 patients with upper cervical spine injuries were operated via the bilateral intermuscular approach. The time required for surgery, blood loss, and pre- and postoperative visual analogue scale scores were analyzed. RESULTS The average distance of 0-T was 39.2 ± 7.5 mm, the angle between the approach and posterior middle line was 33.2 ± 8.4°. The surgical time was 78.3 ± 22.5 minutes (45-140 minutes), and the mean intraoperative blood loss was 87.5 ± 44.2 mL (30-200 mL). Preoperative and postoperative visual analogue scale scores were 6.4 ± 0.8 and 1.8 ± 0.7, respectively. The average follow-up time was 19.7 ± 11.5 months (9-48 months). CONCLUSIONS The posterior bilateral intermuscular approach for upper cervical spine injuries is a valid alternative for Hangmans' fractures type I, type II, and type Ia according to Levine and Edwards classification as well as atlantoaxial subluxation caused by upper cervical spine trauma.
Collapse
Affiliation(s)
- Yong Xu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Wei Xiong
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
| | - Sung I I Han
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhong Fang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Feng Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| |
Collapse
|
11
|
Srikantha U, Khanapure KS, Jagannatha AT, Joshi KC, Varma RG, Hegde AS. Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases. J Neurosurg Spine 2016; 25:675-680. [DOI: 10.3171/2016.5.spine151459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion.
MATERIALS
Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail.
RESULTS
Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1–2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case.
CONCLUSIONS
Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.
Collapse
|
12
|
Disorganization of white matter architecture in major depressive disorder: a meta-analysis of diffusion tensor imaging with tract-based spatial statistics. Sci Rep 2016; 6:21825. [PMID: 26906716 PMCID: PMC4764827 DOI: 10.1038/srep21825] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/01/2016] [Indexed: 02/05/2023] Open
Abstract
White matter (WM) abnormalities have long been suspected in major depressive disorder (MDD). Tract-based spatial statistics (TBSS) studies have detected abnormalities in fractional anisotropy (FA) in MDD, but the available evidence has been inconsistent. We performed a quantitative meta-analysis of TBSS studies contrasting MDD patients with healthy control subjects (HCS). A total of 17 studies with 18 datasets that included 641 MDD patients and 581 HCS were identified. Anisotropic effect size-signed differential mapping (AES-SDM) meta-analysis was performed to assess FA alterations in MDD patients compared to HCS. FA reductions were identified in the genu of the corpus callosum (CC) extending to the body of the CC and left anterior limb of the internal capsule (ALIC) in MDD patients relative to HCS. Descriptive analysis of quartiles, sensitivity analysis and subgroup analysis further confirmed these findings. Meta-regression analysis revealed that individuals with more severe MDD were significantly more likely to have FA reductions in the genu of the CC. This study provides a thorough profile of WM abnormalities in MDD and evidence that interhemispheric connections and frontal-striatal-thalamic pathways are the most convergent circuits affected in MDD.
Collapse
|
13
|
Minimally invasive instrumentation of uncomplicated cervical fractures. 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 2015; 25:127-133. [PMID: 26272375 DOI: 10.1007/s00586-015-4194-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/09/2015] [Accepted: 08/09/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Many authors favor conservative treatment options in oligo-symptomatic non-dislocated cervical fractures. This is mainly because of adverse events, anesthesia times and blood loss associated with surgical treatment of these injuries. We, therefore, sought to minimize the invasiveness of the surgical treatment of simple cervical fractures using image-guidance and a percutaneous approach. METHODS Iso-C3D-based image guidance was used to place unilateral lag screws and conventional screws in pedicles, isthmi and lateral masses C1-C6. The navigation reference marker array was attached to the Mayfield clamp avoiding any additional skin incisions. Drilling of the screws trajectories was performed using a high speed drill with diamond tip, minimizing the risk of dislocations of cervical vertebrae and/or bone fragments relative to the iso-C3D scan to which the navigation system was registered. RESULTS Image-guided percutaneous placement of cervical pedicle, isthmic and lateral mass screws resulted in correct screw placement in all six cases (three hangman fractures, three odontoid fracture Anderson 2 in elderly patients and one C6 posttraumatic pedicular pseudoarthrosis). Average blood loss was 194 ml, total average operating time 106 min and average X-ray time 3.8 min (395 cGy/cm(2)) including iso-C3D imaging. CONCLUSION The technique presented here was found to be a feasible minimally invasive treatment option for uncomplicated cervical fractures. Besides to our best knowledge, we here present the first percutaneous implantation of lateral mass screws.
Collapse
|