Efficacy of the Lateral Mass Fusion Device Combined with a Three-dimensional Printed Model in the Treatment of Craniovertebral Junction Abnormalities

2021 ◽  
Author(s):  
Landa Shi ◽  
Deng Xue ◽  
Yuqiang Wang ◽  
Dean Chou ◽  
Yao Zhao ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Lateral Mass ◽  
Fusion Device

scholarly journals Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy

2017 ◽  
Vol 08 (01) ◽  
pp. 014-019
Author(s):  
Arun Srivastava ◽  
Jayesh Sardhara ◽  
Sanjay Behari ◽  
Sindgikar Pavaman ◽  
Jeena Joseph ◽  
...  
Keyword(s):  
Facet Joint ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Craniovertebral Junction ◽  
Technical Note ◽  
Adult Patients ◽  
Lateral Mass ◽  
Joint Orientation ◽  
Dimensional Reconstruction ◽  
Clinical Accuracy

ABSTRACT Context: Existence of complex variable bony and vertebral artery (VA) anomalies at craniovertebral junction (CVJ) in subset of complex CVJ anomalies demands individualized instrumentation policy and placing screws in each bone requires strategic preoperative planning and intraoperative skills. Aim: To evaluate the clinical accuracy of knock and drill (K and D) technique for the screw placement in complex CVJ anomalies. Settings and Design: Prospective study and operative technical note. Materials and Methods: Totally 36 consecutive patients (16 - pediatrics, 20 - adult patients) of complex CVJ: Complete/partial occipitalized C1 vertebra; at least one hypoplastic (C1/C2) articular mass, rotational component, and variations in the third part of VA were included in this study. Preoperative detail computed tomography (CT) CT CVJ with three-dimensional reconstruction was done for the assessment of CVJ anatomy and facet joint orientation. The accuracy of novel technique was assessed with postoperative CT to evaluate cortical breach in between 5th and 7th postoperative day in all the patients. All patients were underwent clinico-radiological evaluation at 6-month follow-up. Results: Totally 144 screws were placed using K and D technique (pediatric group - 64 screws, adult patients - 80 screws). Total of 12 screws were placed in C1 lateral mass in both age group without any bony cortical breach and complication. Sixteen C2 pedicle screws and 12 C2 pars screw in pediatrics and 18 C2 pedicle screws in adult patients were placed without any bony breach or VA injury. Out of thirty subaxial lateral mass screws in pediatric group, the bony breach was encountered with one screw (3.3%). Total of 38 C2 pars screws was placed in adult group in which bony breach along with VA injury was encounter with 1screw (2.6%). Conclusion: A simple technique of K and D for placing a screw increases the accuracy and spectrum of bony purchase and has the potential to reduce the complication in patients with complex CVJ anomalies.

Three-Dimensional Anatomic Landmarks of the Foramen Magnum for the Craniovertebral Junction

2011 ◽  
Vol 22 (3) ◽  
pp. 1073-1076 ◽  
Author(s):  
Figen Govsa ◽  
Mehmet Asim Ozer ◽  
Servet Celik ◽  
Nezih Metin Ozmutaf
Keyword(s):  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Anatomic Landmarks

Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

2008 ◽  
Vol 9 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Atul Goel ◽  
Nitin Dange
Keyword(s):  
Bone Graft ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Postoperative Phase ◽  
Complete Disappearance ◽  
Lateral Mass ◽  
Rheumatoid Disease ◽  
Mass Reconstruction

The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

scholarly journals Cartilaginous development of the human craniovertebral junction as visualised by a new three-dimensional computer reconstruction technique

1998 ◽  
Vol 192 (2) ◽  
pp. 269-277 ◽  
Author(s):  
KAROLY M. DAVID ◽  
JOHN C. McLACHLAN ◽  
JAMES F. AITON ◽  
SUSAN C. WHITEN ◽  
STEVE D. SMART ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Reconstruction Technique ◽  
Computer Reconstruction

scholarly journals Occipitoatlantoaxial Malformation in a Dog Treated with a Custom-Made Implant

VCOT Open ◽  
2020 ◽  
Vol 03 (02) ◽  
pp. e170-e176
Author(s):  
Carina Rotter ◽  
Clare Rusbridge ◽  
Noel Fitzpatrick
Keyword(s):  
Locking Plate ◽  
Treatment Options ◽  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Complete Fusion ◽  
Atlantoaxial Joint ◽  
New Bone Formation ◽  
Implant Positioning ◽  
Custom Made ◽  
Congenital Condition

Abstract Background Occipitoatlantoaxial malformation (OAAM) is reported rarely in dogs and few treatment options are described. The congenital condition is thought to be associated with a proatlas re-segmentation failure resulting in malformation and malalignment of the craniovertebral junction which can result in C1 to 5 myelopathic signs. Methods Customized three-dimensional printed locking plate with trajectory screw implantation points for the stabilization of the atlantoaxial joint in a dog with OAAM. The dog was evaluated at time points 0, 2, 6 and 9 months to determine clinical outcome, degree of fusion, implant positioning and subsidence. Results New bone formation was noted 9 months after surgery, but complete fusion remained absent, although no implant failure occurred. Clinically, the dog made a good recovery and was able to exercise normally 9 months after surgery. The only residual deficit was a subtle left-sided cervical torticollis. Clinical Significance This report illustrates a management option and outcome of a dog treated with OAAM. Collaboration between clinicians and engineers provides a new dimension of care for patients with vertebral malformations.

Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone

2014 ◽  
Vol 20 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Pravin Salunke ◽  
Sameer Futane ◽  
Sushant K. Sahoo ◽  
Mandeep S. Ghuman ◽  
Niranjan Khandelwal
Keyword(s):  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Lateral Mass ◽  
3D Ct ◽  
Ct Angiogram ◽  
Pars Interarticularis

Object Stabilization of the craniovertebral junction (CVJ) by using lateral masses requires extensive dissection. The vertebral artery (VA) is commonly anomalous in patients with congenital CVJ anomaly. Such a vessel is likely to be injured during dissection or screw placement. In this study the authors discuss the importance of preoperative evaluation and certain intraoperative steps that reduce the chances of injury to such vessels. Methods A 3D CT angiogram was obtained in 15 consecutive patients undergoing surgery for congenital atlantoaxial dislocation. The course of the VA and its relationship to the C1–2 facets was studied in these patients. The anomalous VA was exposed intraoperatively, facet surfaces were drilled in all, and the screws were placed according to the disposition of the vessel. Results A skeletal anomaly was found in all 10 patients who had an anomalous VA. Four types of variations were noted: 1) the first intersegmental artery in 5 patients (bilateral in 1); 2) fenestration of VA in 1 patient; 3) anomalous posterior inferior cerebellar artery crossing the C1–2 joint in 1 patient; and 4) medial loop of VA in 5 patients. The anomalous vessel was dissected and the facet surfaces were drilled in all. The C-1 lateral mass screw was placed under vision, taking care not to compromise the anomalous vessel, although occipital screws or sublaminar wires were used in the initial cases. A medial loop of the VA necessitated placement of transpedicular or C-2 lateral mass screws instead of pars interarticularis screws. The anomalous vessel was injured in none. Conclusions Preoperative 3D CT angiography is a highly useful method of imaging the artery in patients with CVJ anomaly. It helps in identifying the anomalous VA or its branch and its relationship to the C1–2 facets. The normal side should be surgically treated and distracted first because this helps in opening the abnormal side, aiding in dissection. In the posterior approach the C-2 nerve root is always encountered before the anomalous vessel. The defined vascular anatomy helps in choosing the type of screw. The vessel should be mobilized so as to aid the drilling of facets and the placement of screws and spacers under vision, avoiding its injury (direct or indirect) or compression. With these steps, C1–2 (short segment) rigid fusion can be achieved despite the presence of anomalous VA.

Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique

2003 ◽  
Vol 98 (2) ◽  
pp. 202-209 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Neil R. Crawford ◽  
Robert H. Chamberlain ◽  
Luis E. Perez Garza ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Biomechanical Analysis ◽  
Lateral Bending ◽  
Content Type ◽  
Additional Stability ◽  
A New Technique ◽  
Flexion And Extension ◽  
Fine Print

Object. The authors compared the biomechanical stability resulting from the use of a new technique for occipitoatlantal motion segment fixation with an established method and assessed the additional stability provided by combining the two techniques. Methods. Specimens were loaded using nonconstraining pure moments while recording the three-dimensional angular movement at occiput (Oc)—C1 and C1–2. Specimens were tested intact and after destabilization and fixation as follows: 1) Oc—C1 transarticular screws plus C1–2 transarticular screws; 2) occipitocervical transarticular (OCTA) plate in which C1–2 transarticular screws attach to a loop from Oc to C-2; and (3) OCTA plate plus Oc—C1 transarticular screws. Occipitoatlantal transarticular screws reduced motion to well within the normal range. The OCTA loop and transarticular screws allowed a very small neutral zone, elastic zone, and range of motion during lateral bending and axial rotation. The transarticular screws, however, were less effective than the OCTA loop in resisting flexion and extension. Conclusions. Biomechanically, Oc—C1 transarticular screws performed well enough to be considered as an alternative for Oc—C1 fixation, especially when instability at C1–2 is minimal. Techniques for augmenting these screws posteriorly by using a wired bone graft buttress, as is currently undertaken with C1–2 transarticular screws, may be needed for optimal performance.

Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography

2008 ◽  
Vol 50 (6) ◽  
pp. 485-490 ◽  
Author(s):  
Masashi Yamazaki ◽  
Akihiko Okawa ◽  
Mitsuhiro Hashimoto ◽  
Atsuomi Aiba ◽  
Yukio Someya ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Vertebral Artery ◽  
Ct Angiography ◽  
Three Dimensional ◽  
Craniovertebral Junction

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

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