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Ryu S, Ha BJ, Yoon S, Lee CK, Shin DA, Kim KN, Yi S. Feasibility and safety report on robotic assistance for cervical pedicle screw fixation: a cadaveric study. Sci Rep 2024; 14:10881. [PMID: 38740762 DOI: 10.1038/s41598-024-60435-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
This cadaveric study aimed to evaluate the safety and usability of a novel robotic system for posterior cervical pedicle screw fixation. Three human cadaveric specimens and C2-T3 were included. Freshly frozen human cadaver specimens were prepared and subjected to robot-assisted posterior cervical pedicle screw fixation using the robotic system. The accuracy of screw placement, breach rate, and critical structure violations were evaluated. The results were statistically compared with those of previous studies that used different robotic systems for cervical pedicle screw fixation. The robotic system demonstrated a high accuracy rate in screw placement. A significant number of screws were placed within predetermined safe zones. The total entry offset was 1.08 ± 0.83 mm, the target offset was 1.86 ± 0.50 mm, and the angle offset was 2.14 ± 0.77°. Accuracy rates comparable with those of previous studies using different robotic systems were achieved. The system was also feasible, allowing precise navigation and real-time feedback during the procedure. This cadaveric study validated the safety and usability of the novel robotic system for posterior cervical pedicle screw fixation. The system exhibited high precision in screw placement, and the results support the extension of the indications for robot-assisted pedicle screw fixation from the lumbar spine to the cervical spine.
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Affiliation(s)
- Seungjun Ryu
- Department of Neurosurgery, Daejeon Eulji University Hospital, School of Medicine, Eulji University, Daejeon, South Korea
- IBS Center for Cognition and Sociality, Expo-ro, Doryong-dong, Yuseong-gu, Daejeon, South Korea
| | - Byeong-Jin Ha
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 11923, Republic of Korea
| | - Sunjin Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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Kang KC, Lee JH, Lee KY, Jang TS. Surgical Outcomes of Extensive Dome-Like Laminoplasty Using En Bloc Resection of C2 Inner Lamina for Patients With Severe Cord Compression Behind C2 Body. Clin Spine Surg 2024; 37:115-123. [PMID: 38637931 DOI: 10.1097/bsd.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN A retrospective, single-center study. OBJECTIVE The aim of this study is to evaluate the efficacy and safety of a newly developed extensive dome-like laminoplasty using en bloc resection of the C2 inner lamina in patients with severe cord compression behind the C2 body. SUMMARY OF BACKGROUND DATA A surgery for severe cord compression behind C2 body is challenging for spinal surgeons. To date, there has been no established solution for severe cord compression behind the C2 body. MATERIALS AND METHODS Patients with severe cord compression behind the C2 body who underwent posterior surgery consecutively were enrolled. Extensive dome-like laminoplasty that was newly developed was performed to remove en bloc removal of the C2 inner lamina were performed. Preoperative and postoperative canal diameters behind the C2 and mean removed area of the C2 inner lamina were measured using MRI and CT scan. Clinical and radiographic parameters were assessed preoperative and postoperative periods. In addition, perioperative complications were analyzed. RESULTS A total of 36 patients underwent extensive dome-like laminoplasty and their diagnoses were ossification of the posterior longitudinal ligament (OPLL, 66.7%) and congenital stenosis with spondylosis (33.3%). The mean canal diameter behind the C2 increased from 9.85 (2.28) mm preoperatively to 19.91 (3.93) mm at the last follow-up ( P <0.001). Clinically, neck and arm visual analog scale, Japanese Orthopaedic Association score, and neck disability index significantly improved at postoperative 1 month ( P <0.05), and the scores were maintained until the last follow-up. No meaningful radiographic changes occurred after the surgeries. During the procedures, there were no particular complications, but one patient showed deteriorated myelopathic symptoms and underwent additional C1-C2 decompressive surgery. CONCLUSIONS After extensive dome-like laminoplasty, surgical outcomes are satisfactory, and complications are rare. This technique may be a viable option for patients with severe cord compression behind the C2 body. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Godil J, Smith S, Wright C, Yoo JU. Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study. Global Spine J 2024; 14:889-893. [PMID: 36052427 DOI: 10.1177/21925682221125127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE To determine the incidence of vertebral artery injury (VAI), risk factors, intervention, associated complications, and mortality in patients undergoing anterior cervical corpectomy. METHODS We performed a retrospective review of the incidence of VAI during anterior cervical corpectomy using the PearlDiver database from 2010-2017. The CPT code 63 081 to identify corpectomy patients. Patient data extracted included, incidence of VAI, demographic factors, intervention, and future complications of death and stroke. The risk were calculated compared with those patients who did not have VAI. RESULTS 26 126 patients were identified to have undergone cervical corpectomy. Multivariate analysis of risk factors showed that younger age and male sex were associate with higher rate of injury (t = -11.5; P < .0001 and t = 3.8; P = .0001, respectively). Vertebral artery injuries occurred in 78 patients at an incidence of .3%. 11 (14%) VAI patients had a cerebral infarction compared with 1705 (7%) for non-VAI patients (OR = 2.13; 95% CI = [1.18 - 3.85; P = .0179]) during the follow up period. 1-year mortality rates were higher in patients who suffered a VAI (14%) compared to those who did not suffer a VAI (4%; OR = 3.85; CI = [2.04 - 7.14]; P < .0001). CONCLUSION Consequence of VAI may not be known for months following the injury. Although the same admission mortality is rare with this injury, there is a significant increase in post-discharge complications. This study suggests that further investigations into long term health risk of VAI is needed.
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Affiliation(s)
- Jamila Godil
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Christina Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jung U Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Miao XZ, Xu Z, Zhu FK, Hu H, Liu Y, Yang JS, Yan ZJ, Deng ZL, Chu L, Shi L. Unilateral Biplanar Screw-Rod Fixation Technique for the Treatment of Odontoid Fractures in Patients with Atlantoaxial Bone or Vascular Abnormalities. World Neurosurg 2024:S1878-8750(24)00486-8. [PMID: 38537785 DOI: 10.1016/j.wneu.2024.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
OBJETIVE This study aims to introduce the unilateral biplanar screw-rod fixation (UBSF) technique (a hybrid fixation technique: 2 sets of atlantoaxial screws were placed on the same side), which serves as a salvage method for traditional posterior atlantoaxial fixation. To summarize the indications of this technique and to assess its safety, feasibility, and clinical effectiveness in the treatment of odontoid fractures. METHODS Patients with odontoid fractures were enrolled according to special criteria. Surgical duration and intraoperative blood loss were documented. Patients were followed up for a minimum of 12 months. X-ray and computerized tomography scans were conducted and reviewed at 1 day, and patients were asked to return for computerized tomography reviews at 3, 6, 9, and 12 months after surgery until fracture union. Recorded and compared the Neck Visual Analog Scale and Neck Disability Index presurgery and at 1 week and 12 months postsurgery. RESULTS Between January 2016 and December 2022, our study enrolled 7 patients who were diagnosed with odontoid fractures accompanied by atlantoaxial bone or vascular abnormalities. All 7 patients underwent successful UBSF surgery, and no neurovascular injuries were recorded during surgery. Fracture union was observed in all patients, and the Neck Visual Analog Scale and Neck Disability Index scores improved significantly at 1 week and 12 months postoperative (P < 0.01). CONCLUSIONS The UBSF technique has been demonstrated to be safe, feasible, and effective in treating odontoid fractures. In cases where the atlantoaxial bone or vascular structure exhibits abnormalities, it can function as a supplementary or alternative approach to the conventional posterior C1-2 fixation.
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Affiliation(s)
- Xi-Zi Miao
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Orthopaedics, The Ninth People's hospital of Chongqing, Chongqing, China
| | - Fu-Kuan Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Hu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Liu
- Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Jun-Song Yang
- Department of Orthopaedics, Hong Hui Hospital of Xi'an, Xi'an, China
| | - Zheng-Jian Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Chu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Shi
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China.
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Ball JR, Shelby T, Mertz K, Mills ES, Ton A, Alluri RK, Hah RJ. The Incidence of Vertebral Artery Injury in Cervical Spine Surgery. World Neurosurg 2024; 181:e841-e847. [PMID: 37931877 DOI: 10.1016/j.wneu.2023.10.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Previously reported estimates of vertebral artery injuries (VAIs) during cervical spine surgery relied on self-reported survey studies and retrospective cohorts, which may not be reflective of national averages. The largest study to date reports an incidence of 0.07%; however, significant variation exists between different cervical spine procedures. This study aimed to identify the incidence of VAIs in patients undergoing cervical spine procedures for degenerative pathologies. METHODS In this retrospective cohort study, a national insurance database was used to access data from the period 2010-2020 of patients who underwent anterior cervical discectomy and fusion, anterior corpectomy, posterior cervical fusion (C3-C7), or C1-C2 posterior fusion for degenerative pathologies. Patients who experienced a VAI were identified, and frequencies for the different procedures were compared. RESULTS This study included 224,326 patients, and overall incidence of VAIs across all procedures was 0.03%. The highest incidence of VAIs was estimated in C1-C2 posterior fusion (0.12%-1.10%). The number of patients with VAIs after anterior corpectomy, anterior cervical discectomy and fusion, and posterior fusion was 14 (0.06%), 43 (0.02%), and 26 (0.01%), respectively. CONCLUSIONS This is the largest study to date to our knowledge that provides frequencies of VAIs in patients undergoing cervical spine surgery in the United States. The overall incidence of 0.03% is lower than previously reported estimates, but significant variability exists between procedures, which is an important consideration when counseling patients about risks of surgery.
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Affiliation(s)
- Jacob R Ball
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Tara Shelby
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kevin Mertz
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Emily S Mills
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Andy Ton
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ram K Alluri
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raymond J Hah
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Omotoso BR, Harrichandparsad R, Lazarus L. Prevalence of anatomical variations at the suboccipital (V3) segment of the vertebral artery: a systematic review. Neuroradiology 2023; 65:1677-1684. [PMID: 37878031 PMCID: PMC10654174 DOI: 10.1007/s00234-023-03223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND OBJECTIVE A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore, this review is designed to investigate the incidence of variations in the suboccipital component of the vertebral artery in different population groups according to the available literature. METHODS This systematic review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review is based on a comprehensive and extensive search of PubMed, Google Scholar, and ResearchGate. The following search terms were used: "vertebral artery" AND "suboccipital segment" AND "anomalies/anatomical variations of the V3 segment." Reference lists of all extracted articles were also extensively searched for references to any further relevant publications. RESULTS A total of 17 papers met the inclusion criteria. The 17 studies corresponded to a total of 10,820 patients. A persistent first intersegmental artery was registered in 1.8% (197 out of 10,820) of the patients. Extradural PICA origin was observed in 1.6% (175 out of 10,820) of the patients. Fenestration was detected in 0.7% (72 out of 10,820) of the patients. CONCLUSION The authors summarize the incidence of vascular variation at the suboccipital segment of the VA in different population groups across the Asian, European, American, and African continents. Awareness of the extent of possible anatomical variation will help interpret radiographs, which will enhance the identification of vascular pathologies and reduce the risk of iatrogenic injury.
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Affiliation(s)
- Bukola R Omotoso
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Rohen Harrichandparsad
- Department of Neurosurgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lelika Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
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Meynard A, Salle H, Caire F, Barrey CY. Harms Technique: Alternative Perspectives for C2 Screws. World Neurosurg 2023; 180:238-240. [PMID: 37914570 DOI: 10.1016/j.wneu.2023.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Alexandre Meynard
- Neurosurgery Department, University Hospital Center Dupuytren, Limoges, France
| | - Henri Salle
- Neurosurgery Department, University Hospital Center Dupuytren, Limoges, France
| | - François Caire
- Neurosurgery Department, University Hospital Center Dupuytren, Limoges, France
| | - Cédric Y Barrey
- Department of Spine and Spinal Cord Neurosurgery, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
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Meynard A, Fréchède B, Pommier B, Mitton D, Barrey C. Biomechanical Comparison of Facet Versus Laminar C2 Screws. Neurosurgery 2023; 93:910-917. [PMID: 37057918 DOI: 10.1227/neu.0000000000002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/14/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Transpedicular or transisthmic screws for C2 instrumentation represent the gold standard; however, the anatomy is not always compatible (hypoplastic pedicles, procidentia of the vertebral artery). Laminar screws (LS) have been proposed as a rescue technique and recently, bicortical facet screws (FS). To date, the biomechanical property of FS remains unknown. OBJECTIVE To compare the pull-out resistance of bicortical facet (FS) vs laminar (LS) C2 screws. METHODS Thirty-two human cadaveric C2 vertebrae were screened by CT scan imaging and dual x-ray absorptiometry before receiving both techniques and were randomized according to side and sequence (FS or LS first). Screw positioning was validated using 2-dimensional x-rays. Sixty-four mechanical tests were performed using pure tensile loading along the axis of the screws until pull-out. Mean pull-out strengths were compared using paired tests, multivariate and survival analysis (Kaplan-Meier curves). RESULTS The morphometric data were consistent with previous studies. Over 64 tests, the mean pull-out strength of LS (707 ± 467 N) was significantly higher than that of FS (390 ± 230 N) ( P = .0004). Bone mineral density was weakly correlated with pull-out strength (r = 0.42 for FS and r = 0.3 for LS). Both techniques were mechanically equivalent for vertebrae in which intralaminar cortical grip was not achievable for LS. The mean pull-out strength for LS with laminar cortical grip (1071 ± 395 N) was significantly higher than that of LS without (423 ± 291 N) ( P < .0001). CONCLUSION Our results suggest that bicortical FS of C2 offer less mechanical resistance than LS.
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Affiliation(s)
- Alexandre Meynard
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Bertrand Fréchède
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Benjamin Pommier
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
| | - David Mitton
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Cédric Barrey
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris , France
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Lee SH, Park JH, Lee JB, Lee HJ, Kim IS, Hur JW, Hong JT. Safety and Efficacy of Intraoperative Doppler Sonography-Assisted Cervical Pedicle Screw Fixation-A Retrospective Comparison with Conventional Pedicle Screw Implantation. Global Spine J 2023; 13:1592-1601. [PMID: 35193407 PMCID: PMC10448084 DOI: 10.1177/21925682211041965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A Retrospective Cohort Study. OBJECTIVE To introduce a new Doppler sonography-assisted pedicle screw fixation technique that enables vertebral artery (VA) monitoring during surgery and compares the accuracies of Doppler sonography-assisted cervical pedicle screw fixation and the conventional technique. METHODS This retrospective study was performed on 164 consecutive patients that underwent pedicle-based screw fixation from C2 to C6 between January 2013 and August 2020. Surgery was performed without intraoperative Doppler sonography in 84 cases (the Control group) or with intraoperative Doppler sonography in 80 cases (the Doppler group). Proper positioning of pedicle screws was graded, and the incidences of VA injury and screw breach in the Control and Doppler groups were compared. RESULTS Three hundred and ninety-nine screws were placed in the 164 patients (Doppler, 186 screws; Control, 213 screws). The percentages of well-positioned screws in the two groups were significantly different (Doppler, 97.8%; Control, 85.0%). There were two cases of VA injury in the Control group, an incidence of 2.4%, but no case in the Doppler group. CONCLUSION Doppler sonography can be used intraoperatively to help guide the trajectory of the cervical pedicle screw insertion. It can detect the VA inside the screw trajectory and may reduce the risk of VA injury during cervical pedicle screw fixation.
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Affiliation(s)
- Sang Hyo Lee
- Department of Neurosurgery, The Catholic University of Korea Eunpyeong St Mary’s Hospital, Eunpyeong-gu, Korea
| | - Jong-Hyeok Park
- Department of Neurosurgery, The Catholic University of Korea Incheon St Mary’s Hospital, Incheon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University, Cheongju, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, The Catholic University of Korea St Vincent’s Hospital, Suwon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, The Catholic University of Korea St Vincent’s Hospital, Suwon, Korea
| | - Jeong Woo Hur
- Department of Neurosurgery, The Catholic University of Korea Eunpyeong St Mary’s Hospital, Eunpyeong-gu, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, The Catholic University of Korea Eunpyeong St Mary’s Hospital, Eunpyeong-gu, Korea
- Department of Neurosurgery, The Catholic University of Korea St Vincent’s Hospital, Suwon, Korea
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Karthigeyan M, Kataria M, Salunke P, Puneeth S. Posterior circulation infarct without apparent vertebral artery injury following realignment of atlantoaxial dislocation. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Hong JT. Evaluation of Cervicomedullary Compression Around the Craniovertebral Junction: Commentary on "Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy". Neurospine 2022; 19:896-898. [PMID: 36597626 PMCID: PMC9816595 DOI: 10.14245/ns.2245048.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea,Corresponding Author Jae Taek Hong Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
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Serikyaku H, Yara T, Higa S. Bilateral persistent intersegmental artery in a patient with posterior atlantoaxial subluxation after subaxial cervical laminoplasty. Int J Surg Case Rep 2023; 102:107796. [PMID: 36481588 DOI: 10.1016/j.ijscr.2022.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE To summarize the clinical manifestations and treatment of bilateral persistent first intersegmental artery (PFIA) in a patient with posterior subluxation of atlantoaxial joint. CASE PRESENTATION A-85-year-old woman with a two-months history of aggravating of gait disturbance and finger clumsiness was referred to our hospital. Magnetic resonance imaging revealed posterior subluxation of the atlantoaxial joint and spinal cord compression at C1 level. Three-dimensional computed tomography angiography (CTA) of cervical spine showed bilateral PFIA and left side high-riding VA. Because of the high risk of vertebral artery injury with posterior arch resection and lateral mass screw insertion due to the presence of PFIA, as well as the bony fragility of the cervical spine and the fact that the posterior atlantoaxial subluxation was reduced in the flexed position, the posterior occipito-thoracic fixation without posterior arch resection in the mildly flexed cervical position was underwent. The postoperative course was uneventful and her neurological symptoms improved gradually after surgery. CLINICAL DISCUSSION PFIA is a very rare condition representing between 0.01 % and 1.8 %. Most patients with this condition have a unilateral persistent segmental artery, but in a small minority of cases it occurs bilaterally. It may be more difficult to resect of posterior arch or insert the C1 lateral mass screw in cases of PFIA. CONCLUSION The best way to avoid IVAI may be careful examining the abnormal running of VA preoperatively especially on 3D-CT of cervical spine with arteriography and not to choose a technique with a high risk of VA injury.
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Yongjun T, Yaming X, Biao C, Yonghong Y, Xinhua Z. Delayed Hemorrhage Followed by Vertebral Artery Injury during Cervical Anterior Controllable Antedisplacement and Fusion Surgery: Case Report and Literature Review. Orthop Surg 2022; 14:2788-2795. [PMID: 35929645 PMCID: PMC9531085 DOI: 10.1111/os.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/26/2022] [Accepted: 06/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background Vertebral artery injury (VAI) during cervical spine surgery is rare. Anterior controllable ante‐displacement and fusion (ACAF) surgery is a novel technique for treating degenerative cervical spine disorders, especially ossification of the posterior longitudinal ligament. To date, there have been no reports of VAI during cervical ACAF surgery. Here, we report a rare case of perioperative complication of VAI during ACAF surgery. The available English literature that provides treatment instructions were reviewed. Case Presentation A patient diagnosed with mixed ossification of the posterior longitudinal ligament (OPLL) underwent ACAF surgery from C2–C6. Two level transverse foramina were ruptured, and severe bleeding was encountered during ACAF osteotomy. Hemostatic tamponade was performed using bone waxes. The patient had delayed hemorrhage on postoperative day 6. Emergence angiography revealed two vertebral artery pseudoaneurysms in the ruptured transverse foramina. A balloon‐expandable covered stent was deployed to treat the pseudoaneurysm. The patient recovered without complications. Conclusion ACAF surgery is a good choice for multiple‐level OPLL disease, but special attention should be paid to VAI in the perioperative period. Intraoperative tamponade with bone wax and postoperative digital subtraction angiography (DSA) are effective in preventing disaster‐related hemorrhage.
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Affiliation(s)
- Tong Yongjun
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
| | - Xie Yaming
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
| | - Chen Biao
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
| | - Yang Yonghong
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
| | - Zhao Xinhua
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
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14
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Roth SG, Khan I, Chotai S, Chanbour H, Stephens B, Abtahi A, Devin CJ, Zuckerman SL. Is it Better to Stop at C2 or C3/4 in Elective Posterior Cervical Decompression and Fusion? Spine (Phila Pa 1976) 2022; 47:565-73. [PMID: 34738985 DOI: 10.1097/BRS.0000000000004273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE (a) Compare operative variables, complications, and patient-reported outcomes (PROs) in patients with an upper instrumented vertebrae (UIV) of C2 versus C3/4, and (b) assess outcomes based on C2 screw type. SUMMARY OF BACKGROUND DATA When performing elective posterior cervical laminectomy and fusion (PCLF), spine surgeons must choose the upper instrumented vertebrae (UIV) at the subaxial cervical spine (C3/4) versus C2. Differences in long-term complications and PROs remain unknown. METHODS A single-institution, retrospective cohort study from a prospective registry was conducted. All patients undergoing elective, degenerative PCLF from December 2010 to June 2018 were included. Patients were divided into a UIV of C2 versus C3/4. Groups were 2:1 propensity matched for fusion extending to the thoracic spine. Demographics, operative, perioperative, complications, and 1-year PRO data were collected. RESULTS One hundred seventeen patients underwent elective PCLF and were successfully propensity matched (39 C2 vs. 78 C3/4). Groups were similar in fusion extending to the thoracic spine (P = 0.588). Expectedly, the C2 group had more levels fused (5.63 ± 1.89) compared with the C3/4 group (4.50 ± 0.91) (P = 0.001). The C2 group had significantly longer operative time (P < 0.001), yet no differences were seen in estimated blood loss (EBL) (P = 0.494) or length of stay (LOS) (P = 0.424). Both groups significantly improved all PROs at 1-year (EQ-5D; NRS-NP/AP; NDI). Both groups had the same percentage of surgical adverse events at 6.8% (P = 1.00). Between C2 screw type, no differences were seen in operative time, EBL, LOS, complications, or PROs. CONCLUSION In patients undergoing elective PCLF, those instrumented to C2 had only longer operative times compared with those stopping at C3/4. No differences were seen in EBL, LOS, 1-year PROs, and complications. Type of C2 screw had no impact on outcomes. Besides increased operative time, instrumenting to C2 had no detectable difference on surgical outcomes or adverse event rates.Level of Evidence: 3.
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15
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Yang J, Li T, Wang Q, Wang G, Wang S, Xu S, Zhang S, Li Q. Morphological characteristics of subaxial cervical pedicles and surrounding critical structures in patients with vertebral artery dominance - an anatomical study based on computed tomographic imaging. BMC Musculoskelet Disord 2022; 23:306. [PMID: 35354402 PMCID: PMC8969319 DOI: 10.1186/s12891-022-05264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background No study has assessed the feasibility and safety of cervical pedicle screw implantation in patients with vertebral artery dominance (VAD), a common vertebral artery (VA) variation which can increase VA injury (VAI) risk. This study was to assess morphological characteristics of the subaxial cervical pedicles and surrounding critical structures, and identify their correlations in patients with VAD. Methods Computed tomography arteriography scans of 152 patients were used for retrospectively measuring parameters including pedicle outer width (POW), the distance from the lateral pedicle border to the closest part of VA (DPVA), diameter of VA (DVA), area of VA (AVA), area of transverse foramen (ATF) and occupational ratio of transverse foramen (TF). Moreover, correlations among some critical parameters were assessed. Results One hundred eight males and 44 females, with a mean age of 55.9 years were included. POW was smaller on the dominant side than on the non-dominant side, whereas DPVA, DVA, AVA, ATF, and TF were larger on the dominant side than those on the non-dominant side. On both sides, POW < 4 mm and POW + DPVA < 5 mm were observed most frequently at C3 and C4. On both sides, POW was correlated to ATF, and ATF was correlated to DVA and AVA. DPVA was correlated to ATF on the dominant side. Conclusion Patients with VAD exhibited smaller POW on the dominant side, most frequently at C3 and C4. Dominant VA may indirectly affect POW. TF may be a key determinant of DPVA and POW.
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Affiliation(s)
- Jin Yang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Tao Li
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China.,Department of Orthopedics, Zigong Fourth People's Hospital, 19 Tan Mulin Street, Zigong, 643000, Sichuan, China
| | - Qing Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China.
| | - Gaoju Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Song Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Shuang Xu
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Shuai Zhang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Qiuhan Li
- Department of Clinical skills center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
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16
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Nagatani S, Ohya J, Yasukawa T, Yoshida Y, Onishi Y, Kunogi J, Kawamura N. Occipital Erosion as a Late Complication Following Atlantoaxial Fixation: A Case Report. Spine Surg Relat Res 2022; 6:181-184. [PMID: 35478986 PMCID: PMC8995112 DOI: 10.22603/ssrr.2020-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/23/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Satoshi Nagatani
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Junichi Ohya
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Taiki Yasukawa
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Yuichi Yoshida
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Yuki Onishi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Junichi Kunogi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center
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17
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Arnold MCA, Zhao S, Doyle RJ, Jeffers JRT, Boughton OR. Power-Tool Use in Orthopaedic Surgery: Iatrogenic Injury, Its Detection, and Technological Advances: A Systematic Review. JB JS Open Access 2021; 6:JBJSOA-D-21-00013. [PMID: 34841185 PMCID: PMC8613350 DOI: 10.2106/jbjs.oa.21.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Power tools are an integral part of orthopaedic surgery but have the capacity to cause iatrogenic injury. With this systematic review, we aimed to investigate the prevalence of iatrogenic injury due to the use of power tools in orthopaedic surgery and to discuss the current methods that can be used to reduce injury.
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Affiliation(s)
| | - Sarah Zhao
- The MSk Lab, Imperial College London, London, United Kingdom
| | - Ruben J Doyle
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Wadhwa H, Malacon K, Medress ZA, Leung C, Sklar M, Zygourakis CC. First reported use of real-time intraoperative computed tomography angiography image registration using the Machine-vision Image Guided Surgery system: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2125. [PMID: 35855470 PMCID: PMC9245760 DOI: 10.3171/case2125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vertebral artery injury is a devastating potential complication of C1–2 posterior fusion. Intraoperative navigation can reduce the risk of neurovascular complications and improve screw placement accuracy. However, the use of intraoperative computed tomography (CT) increases radiation exposure and operative time, and it is unable to image vascular structures. The Machine-vision Image Guided Surgery (MvIGS) system uses optical topographic imaging and machine vision software to rapidly register using preoperative imaging. The authors presented the first report of intraoperative navigation with MvIGS registered using a preoperative CT angiogram (CTA) during C1–2 posterior fusion. OBSERVATIONS MvIGS can register in seconds, minimizing operative time with no additional radiation exposure. Furthermore, surgeons can better adjust for abnormal vertebral artery anatomy and increase procedure safety. LESSONS CTA-guided navigation generated a three-dimensional reconstruction of cervical spine anatomy that assisted surgeons during the procedure. Although further study is needed, the use of intraoperative MvIGS may reduce the risk of vertebral artery injury during C1–2 posterior fusion.
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20
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Ohnishi T, Suda K, Komatsu M, Harmon SM, Watanabe T, Asukai M, Kadoya K, Takahata M, Iwasaki N, Minami A. Morphologic Changes in the Vertebral Artery Subsequent to Cervical Spine Degeneration and Aging: Analyses by Computed Tomography Angiography Using Multiplanar and 3-Dimensional Reconstructions. World Neurosurg 2021; 150:e686-e695. [PMID: 33771746 DOI: 10.1016/j.wneu.2021.03.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify the morphologic changes in the vertebral artery (VA) subsequent to cervical spine degeneration and aging and to investigate the risk factors for iatrogenic VA injury or occlusion. METHODS Eighty-eight consecutive patients (176 bilateral VAs) were retrospectively analyzed using radiographs, computed tomography, and computed tomography angiography images. The Kellgren and Lawrence (KL) score and its modified subscores were used to grade the severity of degenerative changes in the cervical spine. VA tortuosity widths and diameters were measured between the C2 and C6 transverse foramens. The outcome measures were statistically analyzed for difference, correlation, and explanatory variable. The level with a high prevalence of VA stenosis was also evaluated. RESULTS There were significant positive correlations between the KL score and VA tortuosity width, and between age and VA tortuosity width. Osteophyte formation in the facet joint was the predominant explanatory variable for medial deviation of the VA. Significant positive correlations were evident between the dominant VA diameter and KL score or age. VA stenosis occurred at C3/C4 (24.5%) with the highest prevalence and it was caused by uncovertebral joint osteophytes (52.0%) with the highest incidence. CONCLUSIONS The present study provides important evidence for decisions of surgical strategy and for avoiding catastrophic VA injury or occlusion in cervical spine surgeries.
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Affiliation(s)
- Takashi Ohnishi
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan; Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Kota Suda
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Miki Komatsu
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Satoko Matsumoto Harmon
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Takamasa Watanabe
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan; Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mitsuru Asukai
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Ken Kadoya
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akio Minami
- Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
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21
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Holland MT, Mansfield K, Mitchell A, Burchiel KJ. Hidden Error in Optical Stereotactic Navigation Systems and Strategy to Maximize Accuracy. Stereotact Funct Neurosurg 2021; 99:369-376. [PMID: 33744897 DOI: 10.1159/000514053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optical neuronavigation has been established as a reliable and effective adjunct to many neurosurgical procedures. Operations such as asleep deep brain stimulation (aDBS) benefit from the potential increase in accuracy that these systems offer. Built into these technologies is a degree of tolerated error that may exceed the presumed accuracy resulting in suboptimal outcomes. OBJECTIVE The objective of this study was to identify an underlying source of error in neuronavigation and determine strategies to maximize accuracy. METHODS A Medtronic Stealth system (Stealth Station 7 hardware, S8 software, version 3.1.1) was used to simulate an aDBS procedure with the Medtronic Nexframe system. Multiple configurations and orientations of the Nexframe-Nexprobe system components were examined to determine potential sources of, and to quantify navigational error, in the optical navigation system. Virtual entry point and target variations were recorded and analyzed. Finally, off-plan error was recorded with the AxiEM system and visual observation on a phantom head. RESULTS The most significant source of error was found to be the orientation of the reference marker plate configurations to the camera system, with the presentation of the markers perpendicular to the camera line of site being the most accurate position. Entry point errors ranged between 0.134 ± 0.048 and 1.271 ± 0.0986 mm in a complex, reproducible pattern dependent on the orientation of the Nexprobe reference plate. Target errors ranged between 0.311 ± 0.094 and 2.159 ± 0.190 mm with a similarly complex, repeatable pattern. Representative configurations were tested for physical error at target with errors ranging from 1.2 mm to 1.4 mm. Throughout data acquisition, no orientation was indicated as outside the acceptable tolerance by the Stealth software. CONCLUSIONS Use of optical neuronavigation is expected to increase in frequency and variety of indications. Successful implementation of this technology depends on understanding the tolerances built into the system. In situations that depend on extremely high precision, surgeons should familiarize themselves with potential sources of error so that systems may be optimized beyond the manufacturer's built-in tolerances. We recommend that surgeons align the navigation reference plate and any optical instrument's reference plate spheres in the plane perpendicular to the line of site of the camera to maximize accuracy.
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Affiliation(s)
- Marshall T Holland
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ann Mitchell
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA,
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22
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Farah K, Meyer M, Reyre A, Cot K, Fuentes S. PICA injury secondary to anterior odontoid screw fixation: Case report of an exceptional complication. Neurochirurgie 2021; 67:310-314. [PMID: 33753130 DOI: 10.1016/j.neuchi.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Odontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation. CASE DESCRIPTION We report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders. CONCLUSION To the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.
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Affiliation(s)
- K Farah
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
| | - M Meyer
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - A Reyre
- Endovascular neuroradiology department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - K Cot
- Anesthesiology-intensive care department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - S Fuentes
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
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23
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OTSUKA T, IZUMI T, NISHIHORI M, TSUKADA T, ARAKI Y, YOKOYAMA K, UDA K, GOTO S, IKEZAWA M, KATO N, NAKANO M, SAITO R. Management of Asymptomatic Vertebral Artery Injury Caused by a Cervical Pedicle Screw Malposition: Two Case Reports. NMC Case Rep J 2021; 8:713-717. [PMID: 35079538 PMCID: PMC8769478 DOI: 10.2176/nmccrj.cr.2021-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022] Open
Abstract
Iatrogenic vertebral artery (VA) injury in cervical fusion is an extremely rare complication but can lead to serious sequelae. We present two successful cases of internal trapping for preventing delayed-onset ischemic stroke after iatrogenic VA stenosis caused by a cervical pedicle screw. A 34-year-old female underwent posterior cervical fusion for C4/C5 dislocation fracture. No neurological deficits were observed after the operation. However, the postoperative images revealed that the left C5 pedicle screw perforated the transverse foramen, and the left VA was suspected to be occluded at the screw insertion site. Before revision surgery, we tried to embolize the injured VA with coils. A microcatheter could be navigated from the ipsilateral VA to the distal of the screw, and internal trapping was performed with coils. Another case is that of a 50-year-old male with cervical spondylosis, who underwent posterior decompression and cervical fusion. The neurological symptoms did not deteriorate after the operation. However, the postoperative computed tomography images revealed the perforation of the right C3 transverse foramen by the pedicle screw. In right vertebral angiography, about 70% stenosis was observed at the screw insertion site. Although revision surgery was not planned due to good stability, we embolized the right VA after balloon occlusion test, to prevent the delayed-onset thromboembolic complications. Both the patients recovered without any neurological deficits. Iatrogenic VA injuries, even if asymptomatic immediately after surgery, can lead to serious sequelae in case of delayed-onset ischemic stroke. Therefore, careful attention should be paid when the screw perforates the transverse foramen.
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Affiliation(s)
- Takafumi OTSUKA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi IZUMI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro NISHIHORI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tetsuya TSUKADA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio ARAKI
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kinya YOKOYAMA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji UDA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsaku GOTO
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mizuka IKEZAWA
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki KATO
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mizuki NAKANO
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta SAITO
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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24
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Hong JT, Koller H, Abumi K, Yuan W, Falavigna A, Lee HJ, Lee JB, Le Huec JC, Park JH, Kim IS. SOF System; A New Nomenclature System for the Surgical Techniques of Cervical Spine Deformity. Neurospine 2020; 17:505-512. [PMID: 33022155 PMCID: PMC7538365 DOI: 10.14245/ns.2040472.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 12/05/2022] Open
Abstract
Although cervical spinal deformity (CSD) can have a profoundly negative impact on an individual’s quality of life and there have been many advances in surgical treatment of CSD in recent years, there exists no comprehensive classification system of surgical treatment that categorizes anterior and posterior surgery separately according to the grade of surgery. The objective of this study is to introduce the new classification system of various surgical treatments for CSD. We developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. This new classification system can provide a consistent description of the various osteotomies performed in CSD surgery. Especially, regarding research, there has been a clear benefit to this classification. Having a standardized classification that allows for common frame for cervical deformity correction surgery, communication between surgeons and the evaluation of the CSD surgeries make it possible to conduct global comparative research about surgical outcome.
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Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Kuniyoshi Abumi
- Department of Orthopedic Surgery, Sapporo Orthopedic Hospital, Sapporo, Japan
| | - Wen Yuan
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, RS, Brazil
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Jong Hyuk Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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25
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Wei F, Li Z, Liu Z, Liu X, Jiang L, Yu M, Xu N, Wu F, Dang L, Zhou H, Li Z, Cai H. Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. Ann Transl Med 2020; 8:332. [PMID: 32355776 PMCID: PMC7186708 DOI: 10.21037/atm.2020.03.32] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Reconstruction following resection of the primary tumors of the upper cervical spine is challenging, and conventional internal implants develop complications in this region. 3D printing, also known as additive manufacturing, can produce patient-specific porous implants in a particular shape for bone defect reconstruction. This study aimed to describe the clinical outcomes of upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. Methods Patients with primary tumors involving C2 who were treated in our institution between July 2014 and November 2018 were enrolled. A two-stage intralesional spondylectomy was performed using the posterior-anterior approach. Anterior reconstruction was accomplished using a customized 3D-printed vertebral body, which was fabricated by successive layering of melted titanium alloy powder using electron beam melting. No bone graft was used. Results Nine patients (2 males and 7 females) were included in the study with a mean age of 31.4 years (12 to 59 years). Seven patients demonstrated tumors located in C2 and 2 showed involvement of C2 and C3. During a mean follow-up of 28.6 months (range, 12–42 months), 1 patient died of systemic metastasis and 1 had local tumor recurrence, the other 7 patients were alive and functional in their daily living until the last follow-up without evidence of disease. The 3D-printed vertebral bodies were all stable with no sign of displacement or subsidence, evidence of implant osseointegration was observed on the imaging studies. For the posterior instrumentation systems, no screw loosening or rod breakage was found. Conclusions Spinal reconstruction in the upper cervical region using customized 3D-printed vertebral body is reliable. The tailored shape matching with the contact surfaces and the porous structure conductive to osseointegration provide both short- and long-term stability to the implant.
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Affiliation(s)
- Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhehuang Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Lei Dang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hua Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zihe Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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26
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Won D, Lee JM, Park IS, Lee CH, Lee K, Kim JY, Lee YS. Posterior Inferior Cerebellar Artery Infarction Originating at C1-2 after C1-2 Fusion. Korean J Neurotrauma 2019; 15:192-198. [PMID: 31720276 PMCID: PMC6826101 DOI: 10.13004/kjnt.2019.15.e27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/15/2022] Open
Abstract
Vertebral artery injuries associated with C1 lateral mass screw insertion rarely occur during C1-2 fusion. The posterior inferior cerebellar artery (PICA) is uncommonly located at the C1 lateral mass insertion position. A 71-year-old woman with atlanto-axial subluxation and cord compression underwent C1-2 fusion. Sixth nerve palsy and diplopia were detected postoperatively, and decreased consciousness occurred on postoperative day 4. Brain magnetic resonance image (MRI) and computed tomography (CT) revealed PICA infarction. In the preoperative CT angiography, the PICA originated between the C1 and C2 level. In the postoperative CT scan, the PICA was not visible. The patient was treated conservatively for two weeks and recovered. PICA originating between the C1 and C2 level comprises 1.1–1.3% of cases. Therefore, vertebral artery anomalies should be evaluated prior to C1-2 fusion to prevent vessel injuries.
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Affiliation(s)
- Donghyun Won
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwangho Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-yoon Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
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