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Cine HS, Avci I, Uysal E, Unsal UU, Gunaydin ME, Paksoy K, Senturk S, Yaman O. The New Alternative Technique Outcomes: Atlas Lateral Mass Screw and C2-3 Transfacet Screw Fixation for Complex Atlantoaxial Instability in Patients with Thin C2 Pedicle or High-Riding Vertebral Artery. World Neurosurg 2024:S1878-8750(24)01469-4. [PMID: 39197703 DOI: 10.1016/j.wneu.2024.08.100] [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: 06/11/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE The study aimed to evaluate the safety, feasibility, effect on fusion, and clinical efficacy of atlas lateral mass and C2-3 transfacet screw fixation technique, serves as an alternative method to traditional posterior atlantoaxial fixation. METHODS Patients with atlantoaxial instability who underwent atlas lateral mass and C2-3 transfacet fixation surgery were included. The duration of the surgery and the quantity of blood lost during the operation were recorded. Patients were monitored via X-ray and computed tomography scans to evaluate the degree of fusion at the 1-month and 12-month follow-up. The Neck Visual Analog Scale and Neck Disability Index were evaluated preoperatively, in the postoperative first week, and at the 12-month follow-up for clinical follow-up. RESULTS A total of 8 patients with atlantoaxial instability due to odontoid fracture or Arnold- Chiari malformation accompanied by bony or vascular abnormalities were included in the study between 2017 and 2024. All 8 patients underwent successful atlas lateral mass and C2-3 transfacet screw fixation, with no neurovascular injury noted during surgery. All patients with fracture exhibited fusion at the 12-month mark, and both the Neck Visual Analog Scale and Neck Disability Index scores demonstrated significant improvement at both the 1-week and 12-month postoperative periods (P < 0.05). CONCLUSIONS The atlas lateral mass and C2-3 transfacet screw fixation technique, an alternative to conventional posterior fixation, has been demonstrated to be an efficacious method for providing adequate stabilization and fusion in patients with atlantoaxial instability, even in the cases of thin C2 pedicle, high-riding vertebral artery, previous failed surgeries, or reoperation.
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Affiliation(s)
- Hidayet Safak Cine
- Department of Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Idris Avci
- Department of Neurosurgery, Uskudar University, Istanbul, Turkey
| | - Ece Uysal
- Department of Neurosurgery, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ulkun Unlu Unsal
- Department of Neurosurgery, Manisa City Hospital, Manisa, Turkey
| | - Mehmet Emre Gunaydin
- Department of Neurosurgery, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Kemal Paksoy
- Department of Neurosurgery, Memorial Bahcelievler Hospital, Spine Center, Istanbul, Turkey
| | - Salim Senturk
- Department of Neurosurgery, Memorial Bahcelievler Hospital, Spine Center, Istanbul, Turkey
| | - Onur Yaman
- Department of Neurosurgery, Memorial Bahcelievler Hospital, Spine Center, Istanbul, Turkey
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Zhou LP, Zhang RJ, Zhang HQ, Jiang ZF, Shang J, Shen CL. Effect of High-Riding Vertebral Artery on the Accuracy and Safety of C2 Pedicle Screw Placement in Basilar Invagination and Related Risk Factors. Global Spine J 2024; 14:458-469. [PMID: 35719094 PMCID: PMC10802529 DOI: 10.1177/21925682221110180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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 investigate the effect of HRVA on the intrapedicular accuracy of C2PS placement through the freehand method in patients with BI and analyse the possible risk factors for C2PS malpositioning. METHOD A total of 91 consecutive patients with BI who received 174 unilateral C2PS placements through the freehand method were retrospectively included. The unilateral pedicles were assigned to the HRVA and non-HRVA groups. The primary outcome was the intrapedicular accuracy of C2PS placement in accordance with the Gertzbein-Robbins scale. Moreover, the risk factors that possibly affected intrapedicular accuracy were assessed. RESULTS The rate of intrapedicular accuracy in C2PS placement in patients with BI was 23.6%. Results showed that the non-HRVA group had remarkably higher rates of optimal and clinically acceptable C2PS placement than the HRVA group. Nevertheless, the HRVA group exhibited similar results for grade B classification as the non-HRVA group. Moreover, in the HRVA and non-HRVA groups, the most common direction of screw deviations was the lateral direction. Furthermore, the multivariate analyses showed that the obliquity of the lateral atlantoaxial joint in the sagittal plane ≥15°, and that in the coronal plane ≥ 20°, isthmus height < 4.3 mm, and distance from the skin to the spinous process ≥ 2.8 cm independently contributed to a high rate of screw malpositioning in BI patients. CONCLUSION The presence of HRVA in BI patients contributed to the high rate of malpositioning in C2PS placement via the freehand method. However, the rates of intrapedicular accuracy in patients with BI with and without HRVA were considerably low.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ren-Jie Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua-Qing Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Cai-Liang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Lu Q, Tang J, Xie W, Mei X, Kang H, Liu X, Xu F, Cai X. Anterior atlantoaxial motion preservation fixation technique for axis complex fractures (odontoid process with Hangman's fractures) and technique notes. Sci Rep 2024; 14:687. [PMID: 38182723 PMCID: PMC10770067 DOI: 10.1038/s41598-024-51367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
This study aims to investigate the feasibility and efficacy of anterior atlantoaxial motion preservation fixation (AMPF) in treating axis complex fractures involving the odontoid process fracture and Hangman's fractures with C2/3 instability. A retrospective study was conducted on eight patients who underwent AMPF for axis complex fractures at the General Hospital of Central Theater Command from February 2004 to October 2021. The types of axis injuries, reasons for injuries, surgery time, intraoperative blood loss, spinal cord injury classification (American Spinal Injury Association, ASIA), as well as complications and technical notes, were documented. This study included eight cases of type II Hangman's fracture, five cases of type II and three cases of type III odontoid process fracture. Five patients experienced traffic accidents, while three patients experienced falling injuries. All patients underwent AMPF surgery with an average intraoperative blood loss of 288.75 mL and a duration of 174.5 min. Two patients experienced dysphagia 1 month after surgery. The patients were followed up for an average of 15.63 months. One case improved from C to E in terms of neurological condition, three cases improved from D to E, and four cases remained at E. Bony fusion and Atlantoaxial Motion Preservation were successfully achieved for all eight patients. AMPF is a feasible and effective way for simultaneous odontoid process fracture and Hangman's fractures with C2/3 instability, while preserving atlantoaxial movement.
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Affiliation(s)
- Qilin Lu
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Jin Tang
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Wei Xie
- Department of Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan, Hubei, People's Republic of China
| | - Xianzhong Mei
- Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Hui Kang
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Ximing Liu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, South China Hospital of Shenzhen University, No. 1 Fuxin Road, Longgang District, Shenzhen, 518111, Guangdong, People's Republic of China.
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Li J, Cao S, Guo D, Lu T, Zang Q. Biomechanical properties of different anterior and posterior techniques for atlantoaxial fixation: a finite element analysis. J Orthop Surg Res 2023; 18:456. [PMID: 37365580 DOI: 10.1186/s13018-023-03905-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Many techniques for atlantoaxial fixation have been developed. However, the biomechanical differences among various atlantoaxial fixation methods remain unclear. This study aimed to evaluate the biomechanical influence of anterior and posterior atlantoaxial fixation techniques on fixed and nonfixed segments. METHODS An occiput-C7 cervical finite element model was used to construct 6 surgical models including a Harms plate, a transoral atlantoaxial reduction plate (TARP), an anterior transarticular screw (ATS), a Magerl screw, a posterior screw-plate, and a screw-rod system. Range of motion (ROM), facet joint force (FJF), disc stress, screw stress, and bone-screw interface stress were calculated. RESULTS The C1/2 ROMs were relatively small in the ATS and Magerl screw models under all loading directions except for extension (0.1°-1.0°). The posterior screw-plate system and screw-rod system generated greater stresses on the screws (77.6-1018.1 MPa) and bone-screw interfaces (58.3-499.0 MPa). The Harms plate and TARP models had relatively small ROMs (3.2°-17.6°), disc stress (1.3-7.6 MPa), and FJF (3.3-106.8 N) at the nonfixed segments. Changes in disc stress and FJF of the cervical segments were not consistent with changes in ROM. CONCLUSIONS ATS and Magerl screws may provide good atlantoaxial stability. The posterior screw-rod system and screw-plate system may have higher risks of screw loosening and breakage. The Harms plate and TARP model may more effectively relieve nonfixed segment degeneration than other techniques. The C0/1 or C2/3 segment may not be more susceptible to degeneration than other nonfixed segments after C1/2 fixation.
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Affiliation(s)
- Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Shuai Cao
- Department of Orthopedics, Civil Aviation General Hospital, No. 1, Gaojing Stress, Chaoyang District, Beijing, 100123, China
| | - Dong Guo
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Teng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
| | - Quanjin Zang
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
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Zhou LP, Zhang RJ, Zhang WK, Kang L, Li KX, Zhang HQ, Jia CY, Zhang YS, Shen CL. Clinical application of spinal robot in cervical spine surgery: safety and accuracy of posterior pedicle screw placement in comparison with conventional freehand methods. Neurosurg Rev 2023; 46:118. [PMID: 37166553 DOI: 10.1007/s10143-023-02027-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
The novel robot-assisted (RA) technique has been utilized increasingly to improve the accuracy of cervical pedicle screw placement. Although the clinical application of the RA technique has been investigated in several case series and comparative studies, the superiority and safety of RA over conventional freehand (FH) methods remain controversial. Meanwhile, the intra-pedicular accuracy of the two methods has not been compared for patients with cervical traumatic conditions. This study aimed to compare the rate and risk factors of intra-pedicular accuracy of RA versus the conventional FH approach for posterior pedicle screw placement in cervical traumatic diseases. A total of 52 patients with cervical traumatic diseases who received cervical screw placement using RA (26 patients) and FH (26 patients) techniques were retrospectively included. The primary outcome was the intra-pedicular accuracy of cervical pedicle screw placement according to the Gertzbin-Robbins scale. Secondary outcome parameters included surgical time, intraoperative blood loss, postoperative drainage, postoperative hospital stay, and complications. Moreover, the risk factors that possibly affected intra-pedicular accuracy were assessed using univariate analyses. Out of 52 screws inserted using the RA method, 43 screws (82.7%) were classified as grade A, with the remaining 7 (13.5%) and 2 (3.8%) screws classified as grades B and C. In the FH cohort, 60.8% of the 79 screws were graded A, with the remaining screws graded B (21, 26.6%), C (8, 10.1%), and D (2, 2.5%). The RA technique showed a significantly higher rate of optimal intra-pedicular accuracy than the FH method (P = 0.008), but there was no significant difference between the two groups in terms of clinically acceptable accuracy (P = 0.161). Besides, the RA technique showed remarkably longer surgery time, less postoperative drainage, shorter postoperative hospital stay, and equivalent intraoperative blood loss and complications than the FH technique. Furthermore, the univariate analyses showed that severe obliquity of the lateral atlantoaxial joint in the coronal plane (P = 0.003) and shorter width of the lateral mass at the inferior margin of the posterior arch (P = 0.014) were risk factors related to the inaccuracy of C1 screw placement. The diagnosis of HRVA (P < 0.001), severe obliquity of the lateral atlantoaxial joint in the coronal plane (P < 0.001), short pedicle width (P < 0.001), and short pedicle height (P < 0.001) were risk factors related to the inaccuracy of C2 screw placement. RA cervical pedicle screw placement was associated with a higher rate of optimal intra-pedicular accuracy to the FH technique for patients with cervical traumatic conditions. The severe obliquity of the lateral atlantoaxial joint in the coronal plane independently contributed to high rates of the inaccuracy of C1 and C2 screw placements. RA pedicle screw placement is safe and useful for cervical traumatic surgery.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Wen-Kui Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Kai-Xuan Li
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Hua-Qing Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chong-Yu Jia
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yin-Shun Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Cai-Liang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Zhou LP, Shang J, Zhang ZG, Jiang ZF, Zhang HQ, Jia CY, Zhang RJ, Shen CL. Characteristics and Comparisons of Morphometric Measurements and Computed Tomography Hounsfield Unit Values of C2 Laminae for Translaminar Screw Placement Between Patients With and Without Basilar Invagination. Neurospine 2022; 19:899-911. [PMID: 36597627 PMCID: PMC9816593 DOI: 10.14245/ns.2244730.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Patients with basilar invagination (BI) had high incidences of vertebral variations and high-riding vertebral artery (HRVA) that might restrict the use of pedicle or pars screw and increase the use of translaminar screw on axis. Here, we conducted a radiographic study to investigate the feasibility of translaminar screws and the bone quality of C2 laminae in patients with BI, which were compared with those without BI as control to provide guidelines for safe placement. METHODS In this study, a total of 410 patients (205 consecutive patients with BI and 205 matched patients without BI) and 820 unilateral laminae of the axis were included at a 1:1 ratio. Comparisons with regard to insertion parameters (laminar length, thickness, angle, and height) for C2 translaminar screw placement and Hounsfield unit (HU) values for the assessment of the appropriate bone mineral density of C2 laminae between BI and control groups were performed. Besides, the subgroup analyses based on the Goel A and B classification of BI, HRVA, atlas occipitalization, and C2/3 assimilation were also carried out. Furthermore, the factors that might affect the insertion parameters and HU values were explored through multiple linear regression analyses. RESULTS The BI group showed a significantly smaller laminar length, thickness, height, and HU value than the control group, whereas no significant difference was observed regarding the laminar angle. By contrast, the control group showed significantly higher rates of acceptability for unilateral and bilateral translaminar screw fixations than the BI group. Subgroup analyses showed that the classification of Goel A and B, HRVA, atlas occipitalization, and C2/3 assimilation affected the insertion parameters except the HU values. Multiple linear regression indicated that the laminar length was significantly associated with the male gender (B = 0.190, p < 0.001), diagnoses of HRVA (B = -0.109, p < 0.001), Goel A (B = -0.167, p < 0.001), and C2/3 assimilation (B = -0.079, p = 0.029); the laminar thickness was significantly associated with the male gender (B = 0.353, p < 0.001), diagnoses of HRVA (B = -0.430, p < 0.001), Goel B (B = -0.249, p = 0.026), and distance from the top of odontoid to the Chamberlain line (B = -0.025, p = 0.003); laminar HU values were significantly associated with age (B = -2.517, p < 0.001), Goel A (B = -44.205, p < 0.001), Goel B (B = -25.704, p = 0.014), and laminar thickness (B = -11.706, p = 0.001). CONCLUSION Patients with BI had narrower and smaller laminae with lower HU values and lower unilateral and bilateral acceptability for translaminar screws than patients without BI. Preoperative 3-dimensional computed tomography (CT) and CT angiography were needed for BI patients.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin Shang
- Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Zhi-Gang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Hua-Qing Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chong-Yu Jia
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ren-Jie Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Co-corresponding Author Ren-Jie Zhang Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Cai-Liang Shen
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Corresponding Author Cai-Liang Shen Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
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Hou Z, Jian Q, Fan W, Zhao X, Wang Y, Fan T. Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery. J Orthop Surg Res 2022; 17:495. [PMCID: PMC9670565 DOI: 10.1186/s13018-022-03391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Objective
This study aims to investigate the clinical application and feasibility of C2 subfacetal screws in patients with Klippel-Feil syndrome (KFS), narrow C2 pedicles, and high-riding vertebral arteries (HRVAs).
Methods
The clinical data of seven patients with KFS, atlantoaxial dislocation, narrow C2 pedicles, and HRVAs treated with C2 subfacetal screws were analyzed in this retrospective study. The internal height, isthmus height, and pedicle width of C2 vertebra were measured using preoperative computed tomography (CT). Subfacetal screws were inserted for 7 patients (12 sides). The position and length of the screws were observed using postoperative CT. Intraoperative dura mater and vertebral artery (VA) injuries were recorded. Bone fusion was observed using follow-up CT.
Results
The internal height was 10.5 ± 3.2 mm, the isthmus height was 3.7 ± 1.8 mm, the pedicle width was 3.0 ± 1.4 mm, and the screw length was 19.7 ± 1.5 mm. All patients had HRVAs and narrow pedicles. No injury to the dura mater and vertebral artery (VA) occurred in this group of patients. Bone fusion was achieved in all patients during follow-up.
Conclusions
In patients with KFS, HRVA, and a narrow C2 pedicle, there is sufficient space below the C2 articular surface for screw insertion. When the pedicle is narrow and the C2 pedicle screw is not suitable for placement due to possible injury to the VA, subfacetal screws are a feasible alternative.
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Cho S, Shlobin NA, Dahdaleh NS. Os odontoideum: A comprehensive review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:256-264. [PMID: 36263339 PMCID: PMC9574117 DOI: 10.4103/jcvjs.jcvjs_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients. A literature review was conducted using the PubMed, EMBASE, and Scopus databases. A search using the query "os odontoideum" yielded 4319 results, of which 112 articles were chosen and analyzed for insights on factors such as etiology, clinical presentation, and management of OO. The presentation of OO varies widely from asymptomatic cases to severe neurological deficits. Asymptomatic patients can be managed either conservatively or surgically, while symptomatic patients should undergo operative stabilization. Although multiple studies show different techniques for surgical management involving posterior fusion, the diversity of such cases illustrates how treatment must be tailored to the individual patient to prevent complications. Conflicting studies and the paucity of current literature on OO highlight poor comprehension of the condition. Further understanding of the natural history of OO is critical to form evidence-based guidelines for the management of OO patients. More large-center studies are thus needed to promote accurate management of OO patients with optimal outcomes.
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Affiliation(s)
- Sia Cho
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Du YQ, Yin YH, Li T, Qiao GY, Yu XG. Can C1 lateral mass and C3 pedicle screw fixation be used as an option for atlantoaxial reduction and stabilization in Klippel-Feil patients? A study of its morphological feasibility, technical nuances, and clinical efficiency. Neurosurg Rev 2022; 45:2183-2192. [PMID: 35022938 DOI: 10.1007/s10143-021-01729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/04/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
In Klippel-Feil patients with atlantoaxial dislocation, narrow C2 pedicles are often encountered preventing pedicle screw placement. Alternative techniques, including translaminar screws, pars screws, and inferior process screws could not achieve 3-column rigid fixation, and have shown inferior biomechanical stability. The present study aimed to evaluate the feasibility, safety, and efficacy of C3 pedicle screws (C3PSs) as an option for atlantoaxial stabilization in Klippel-Feil patients, and to introduce a freehand technique, the "medial sliding technique," for safe and accurate C3PS insertion. Thirty-seven Klippel-Feil patients with congenital C2-3 fusion who have received atlantoaxial fixation were reviewed. Preoperative CT and CT angiography were acquired to evaluate the feasibility of C3PS placement. C1 lateral mass and C3PS constructs were used for atlantoaxial stabilization. The "medial sliding technique" was introduced to facilitate C3PS insertion. Clinical outcomes and complications were evaluated, and screw accuracy was graded on postoperative CT scans. Morphological measurements showed that more than 80% C3 pedicles could accommodate a 3.5-mm screw. Fifty-eight C3PSs were placed in 33/37 patients using the medial sliding technique. Overall, 96.7% screws were considered safe and there was no related neurovascular complications; 27/33 patients exhibited neurological improvement and 30/33 patients had a solid bone fusion at an average 19.3-month follow-up. Therefore, the C3PS was a feasible option for atlantoaxial fixation in Klippel-Feil patients. The clinically efficiency of C3PS was satisfied with high fusion rates and low complications. The medial sliding technique we used could facilitate safe and accurate placement of C3PSs in Klippel-Feil patients with fused C2-3 vertebra.
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Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yi-Heng Yin
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
| | - Teng Li
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China.
| | - Xin-Guang Yu
- Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Haidian District, 28 Fuxing Road, Beijing, 100853, China
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Xiong R, Zhang S, Gan Z, Qi Z, Liu M, Xu X, Wang Q, Zhang J, Li F, Chen X. A novel 3D-vision-based collaborative robot as a scope holding system for port surgery: a technical feasibility study. Neurosurg Focus 2022; 52:E13. [PMID: 34973666 DOI: 10.3171/2021.10.focus21484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A clear, stable, suitably located vision field is essential for port surgery. A scope is usually held by hand or a fixing device. The former yields fatigue and requires lengthy training, while the latter increases inconvenience because of needing to adjust the scope. Thus, the authors innovated a novel robotic system that can recognize the port and automatically place the scope in an optimized position. In this study, the authors executed a preliminary experiment to test this system's technical feasibility and accuracy in vitro. METHODS A collaborative robotic (CoBot) system consisting of a mechatronic arm and a 3D camera was developed. With the 3D camera and programmed machine vision, CoBot can search a marker attached to the opening of the surgical port, followed by automatic alignment of the scope's axis with the port's longitudinal axis so that optimal illumination and visual observation can be achieved. Three tests were conducted. In test 1, the robot positioned a laser range finder attached to the robot's arm to align the sheath's center axis. The laser successfully passing through two holes in the port sheath's central axis defined successful positioning. Researchers recorded the finder's readings, demonstrating the actual distance between the finder and the sheath. In test 2, the robot held a high-definition exoscope and relocated it to the setting position. Test 3 was similar to test 2, but a metal holder substituted the robot. Trained neurosurgeons manually adjusted the holder. The manipulation time was recorded. Additionally, a grading system was designed to score each image captured by the exoscope at the setting position, and the scores in the two tests were compared using the rank-sum test. RESULTS The CoBot system positioned the finder successfully in all rounds in test 1; the mean height errors ± SD were 1.14 mm ± 0.38 mm (downward) and 1.60 mm ± 0.89 mm (upward). The grading scores of images in tests 2 and 3 were significantly different. Regarding the total score and four subgroups, test 2 showed a more precise, better-positioned, and more stable vision field. The total manipulation time in test 2 was 20 minutes, and for test 3 it was 52 minutes. CONCLUSIONS The CoBot system successfully acted as a robust scope holding system to provide a stable and optimized surgical view during simulated port surgery, providing further evidence for the substitution of human hands, and leading to a more efficient, user-friendly, and precise operation.
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Affiliation(s)
- Ruochu Xiong
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Shiyu Zhang
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Zhichao Gan
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and.,3Medical School, Nankai University, Tianjin, China
| | - Ziyu Qi
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and.,3Medical School, Nankai University, Tianjin, China
| | - Minghang Liu
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Xinghua Xu
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Qun Wang
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Jiashu Zhang
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Fangye Li
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Xiaolei Chen
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
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Traynelis VC, Fontes RBV, Abode-Iyamah KO, Cox EM, Greenlee JD. Posterior fusion for fragility type 2 odontoid fractures. J Neurosurg Spine 2021; 35:644-650. [PMID: 34388709 DOI: 10.3171/2021.2.spine201645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the outcomes of elderly patients with type 2 odontoid fractures treated with an instrumented posterior fusion. METHODS Ninety-three consecutive patients older than 65 years of age in whom a type 2 odontoid fracture had been treated with a variety of C1-2 posterior screw fixation techniques were retrospectively reviewed. RESULTS The average age was 78 years (range 65-95 years). Thirty-seven patients had an additional fracture, 30 of which involved C1. Three patients had cervical spinal cord dysfunction due to their injury. All patients had comorbidities. The average total hospitalization was 9.6 days (range 2-37 days). There were 3 deaths and 19 major complications, the most common of which was pneumonia. No patient suffered a vertebral artery injury. Imaging studies were obtained in 64 patients at least 12 months postsurgery (mean 19 months). Fusion was assessed by dynamic radiographs in all cases and with a CT scan in 80% of the cases. Four of the 64 patients did not achieve fusion (6.25% overall). All patients in whom fusion failed had undergone C1 lateral mass fixation and C2 pars (1/29, 3.4%) or laminar (3/9, 33.3%) fixation. CONCLUSIONS Instrumented posterior cervical fusions may be performed in elderly patients with acceptable morbidity and mortality. The fusion rate is excellent except when bilateral C2 translaminar screws are used for axis fixation.
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Affiliation(s)
- Vincent C Traynelis
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ricardo B V Fontes
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | | | - Efrem M Cox
- 3Department of Neurosurgery, UNLV School of Medicine, Las Vegas, Nevada; and
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A novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability: technical details, accuracy assessment and perioperative complications. 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 2021; 30:1585-1595. [PMID: 33704580 DOI: 10.1007/s00586-021-06780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To introduce a novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability, and to categorize the screw accuracy and perioperative complications regarding this technique in a large case series. METHODS Between January 2015 and January 2020, patients who had atlas assimilation, basilar invagination and atlantoaxial instability, and underwent atlantoaxial fixation using C1 lateral mass screws were reviewed. C1 lateral mass screws were placed with a novel surgical protocol following a series key steps, including posterior para-odontoid ligament release, panoramic exposure of the invaginated lateral mass, and diligent protection of the abnormal VA. Screw accuracy and related complications were specifically evaluated. RESULTS A total of 434 C1 lateral mass screws were placed. Fifteen screws (3.5%) were classified as unacceptable, 54 screws (12.4%) were classified as acceptable, and 365 screws (84.1%) were classified as ideal. Overall, 96.5% of screws were deemed safe. There were no cases of vascular injury or permanent neurological defects. One patient with an unacceptable screw presented with hypoglossal nerve paralysis and recovered after an immediate revision surgery. Thirty-seven patients complained about occipital neuralgia and were successfully managed with medication. CONCLUSION Placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability following this surgical protocol is safe and accurate. Thorough para-odontoid ligamental release, wide exposure of the invaginated lateral mass, and diligent protection of the vertebral artery are critical to maximize the chances of successful screw placement.
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