Clinical Outcome of Dorsal Cervical C1–C2 Fusion Using C1 Lateral Mass Screws, C2 Lamina Screws, and Interarcual Bone Graft Technique

2019 ◽  
Vol 81 (03) ◽  
pp. 200-206
Author(s):  
Dominik Baschera ◽  
Lazar Tosic ◽  
Joachim Oberle ◽  
Jagos Golubovic ◽  
Alex Alfieri
Keyword(s):  
Neck Pain ◽  
Bone Graft ◽  
Clinical Results ◽  
Fusion Rate ◽  
Implant Failure ◽  
Bony Union ◽  
Lateral Mass ◽  
Root Injury ◽  
Lateral Mass Screws

Aims To evaluate the clinical and radiologic results of patients treated with dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft. Methods We retrospectively analyzed the clinical and radiologic results of eight patients treated from 2011 to 2016. Neck pain, neurologic deficits, use of analgesics, vertebral artery injury, C2 root injury, radiologic fusion rate, malposition of screws, and implant failure were examined on day 3 and at 3 and 12 months postoperatively. Results One patient required revision surgery for a right-sided medial cutout of a lamina screw. None of the patients had vascular or neurologic complications. All patients were pain free and had ceased all analgesic therapy at the first follow-up examination. At the 1-year follow-up there were no complaints of neck pain, no radiologic signs of implant failure were found, and a bony union between C1 and C2 was present in all patients. Conclusion Dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft are less common techniques, although they can be used safely and demonstrated excellent clinical results with regard to pain relief and a high fusion rate. The technique is an ideal alternative when other techniques are not safe for anatomical reasons.

C1 Lateral Mass Fixation

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A153-A160 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Daniel C. Lu ◽  
Sanjay S. Dhall ◽  
Valli P. Mummaneni ◽  
Dean Chou
Keyword(s):  
Neck Pain ◽  
Visual Analog Scale ◽  
Complication Rate ◽  
Pedicle Screws ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Analog Scale ◽  
Flexion Extension ◽  
Lateral Mass Screws

Abstract OBJECTIVE We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1–C2 constructs, and C1 to mid/low cervical constructs. METHODS We performed a retrospective chart review of 42 consecutive patients who underwent C1 lateral mass fixation by 2 of the authors (PVM and DC). The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1–C2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent OC fusions incorporating C1 screws (2 of which were OC-thoracic constructs). All constructs were combined either with a C2 pars screw (38 patients), C2 translaminar screw (1 patient), or C3 lateral mass screw (3 patients). No C2 pedicle screws were used. Fusion was assessed using flexion-extension x-rays in all patients and computed tomographic scans in selected cases. Clinical outcomes were assessed with preoperative and postoperative visual analog scale neck pain scores and Nurick grading. The nuances of the surgical technique are reviewed, and a surgical video is included. RESULTS Two patients (5%) were lost to follow-up. The mean follow-up for the remaining patients was 2 years. During the follow-up period, there were 4 deaths (none of which were related to the surgery). For patients with follow-up, the visual analog scale neck pain score improved a mean of 3 points after surgery (P < .001). For patients with myelopathy, the Nurick score improved by a mean of 1 grade after surgery (P < .001). The postoperative complication rate was 12%. The complication rate was 38% in OC constructs, 17% in C1 to mid/low cervical constructs, and 0% for C1–C2 construct cases. Patients with OC constructs had the statistically highest rate of complications (P < .001). Patients with C1 to mid/low cervical constructs had more complications than those with C1–C2 constructs (P < .001). Of the 42 cases, there were 3 pseudoarthroses (1 in an OC case, 1 in a C1 to midcervical construct, and 1 in a C1–C2 construct). OC constructs had the highest risk of pseudoarthrosis (13%) (P < .001). CONCLUSION Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.

Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

2017 ◽  
Vol 78 (06) ◽  
pp. 556-560 ◽  
Author(s):  
Christof Wrangel ◽  
Ali Karakoyun ◽  
Kaye-Marie Buchholz ◽  
Olaf Süss ◽  
Theodoros Kombos ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Implant Failure ◽  
Adjacent Segment ◽  
Adjacent Level ◽  
Lumbar Instability ◽  
Titanium Cages

Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning. Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease. Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively. Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.

scholarly journals Navigation-Assisted Posterior Open Reduction and Internal Fixation in a C-CLAMP Fashion for an Isolated C1 Fracture

2020 ◽  
Author(s):  
Daniele Starnoni ◽  
Timo Ecker ◽  
Juan Barges-Coll
Keyword(s):  
Neck Pain ◽  
Internal Fixation ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Lateral Displacement ◽  
Lateral Mass ◽  
Transverse Ligament ◽  
Alar Ligament ◽  
The Right

AbstractC1 fractures with an intact transverse ligament are usually treated conservatively. Patients who present with a progressive diastasis of bone fragments and a progressive articular subluxation mainly attributed to progressive lengthening of the transverse ligament (TAL) fibers can be treated with a C1 “C-clamp” fusion.A 75-year-old male who sustained a motor vehicle accident was neurologically intact. A computed tomography (CT) imaging demonstrated a Jefferson's type-C1 fracture with a slight lateral displacement of the C1 left lateral mass (LM) and a rotatory subluxation on the right. MRI showed an intact TAL and demonstrated an isolated rupture of the left alar ligament. Conservative treatment was chosen. Radiographic follow-up showed, at 3 months, progressive lateral mass displacement, most likely due to elongation of the TAL fibers; this was also associated with a persistent mechanical neck pain. For this reason, we performed a posterior reduction and internal fixation in a C-clamp fashion by placement of C1 lateral mass screws and posterior compression sparing the C1–2 joint. Using navigation, a 3.5-mm screw was inserted into the LM bilaterally. The screw heads were then connected with a rod and compression was applied before tightening. Postoperative CT scan demonstrated a satisfying reduction and further imaging will be made during the follow-up. The patient had a considerable relief of neck pain. Simple lateral mass fixation with C-clamp technique is a reasonable option in case of isolated C1 fractures in patients who have failed conservative management while preserving the range of motion (ROM) at the atlanto–axial joint.The link to the video can be found at: https://youtu.be/x8bsVwzCt_M.

scholarly journals The Fate of Bone Graft for Periprosthetic Osteolysis in Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Yoo Jung Park ◽  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcome ◽  
Bone Graft ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Implant Failure ◽  
Periprosthetic Osteolysis ◽  
Aofas Score ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our experience of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: Between May 2004 and Oct. 2013, 238 primary TAA were performed on 219 patients. We excluded 37 ankles with follow-up less than 24 months; thus, 201 ankles in 185 patients with mean follow-up of 61.9 (range, 24-130) months were included in the study. Nineteen patients were treated with a total of 21 bone graft procedures for periprosthetic osteolysis after TAA. Of these patients, 12 (57.1%) were males with mean follow-up length after bone graft 35.0 months. Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed total of 62 osteolysis lesions in 19 patients; 35 (56.5%) distal tibial lesions, 23 (37.0%) talar lesions. Autogenous iliac bone graft was used in 18 procedures (85.7%). The mean scores (and standard deviation) improved for the VAS from 4.8 ± 1.23 points before bone graft to 3.0 ± 0.94 points at the last follow-up (p<0.05); and for the AOFAS score from 76.8 ± 5.9 before bone graft to 84.3 ± 4.5 at the last follow-up (p<0.05). After 21 bone graft procedures, 6 demonstrated detection of newly developed osteolysis. One patient needed a repeat bone graft procedure with cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

Atlantoaxial stabilization using multiaxial C-1 posterior arch screws

2008 ◽  
Vol 9 (6) ◽  
pp. 522-527 ◽  
Author(s):  
Michael B. Donnellan ◽  
Ioannis G. Sergides ◽  
William R. Sears
Keyword(s):  
Clinical Results ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Normal Anatomy ◽  
Novel Technique ◽  
Vertebral Arteries ◽  
Fixation Techniques ◽  
Atlantoaxial Fixation ◽  
Atlantoaxial Stabilization ◽  
Lateral Mass Screws

The authors present a novel technique of atlantoaxial fixation using multiaxial C-1 posterior arch screws. The technique involves the insertion of bilateral multiaxial C-1 posterior arch screws, which are connected by crosslinked rods to bilateral multiaxial C-2 pars screws. The clinical results are presented in 3 patients in whom anomalies of the vertebral arteries, C-1 lateral masses, and/or posterior arch of C-1 presented difficulty using existing fixation techniques with transarticular screws, C-1 lateral mass screws, or posterior wiring. The C-1 posterior arch screws achieved solid fixation and their insertion appeared to be technically less demanding than that of transarticular or C-1 lateral mass screws. This technique may reduce the risk of complications compared with existing techniques, especially in patients with anatomical variants of the vertebral artery, C-1 lateral masses, or C-1 posterior arch. This technique may prove to be an attractive fixation option in patients with normal anatomy.

scholarly journals Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases

2016 ◽  
Vol 25 (6) ◽  
pp. 675-680 ◽  
Author(s):  
Umesh Srikantha ◽  
Kiran S. Khanapure ◽  
Aniruddha T. Jagannatha ◽  
Krishna C. Joshi ◽  
Ravi G. Varma ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Conventional Approach ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Correct Position ◽  
Vertebral Canal ◽  
Atlantoaxial Fusion ◽  
Lateral Mass Screws ◽  
Clinical Cases

OBJECTIVE Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion. MATERIALS Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail. RESULTS Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1–2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case. CONCLUSIONS Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.

Use of HA–PLLA Composite Screws to Fix Acetabular Bone Graft in Cemented THA: Absorption Pattern of Screws in Six Patients

2011 ◽  
Vol 493-494 ◽  
pp. 422-425 ◽  
Author(s):  
Koji Goto ◽  
Haruhiko Akiyama ◽  
Keiichi Kawanabe ◽  
Kazutaka So ◽  
Takashi Nakamura
Keyword(s):  
Clinical Trial ◽  
Total Hip Arthroplasty ◽  
Bone Graft ◽  
Clinical Results ◽  
Acetabular Bone ◽  
Safety And Efficacy ◽  
Absorption Pattern ◽  
Negative Effect

We used a composite of uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-l-lactide (PLLA) to fix the acetabular bone graft in total hip arthroplasty (THA) in a clinical trial in six patients, and followed them for over 10 years. The patients were evaluated clinically and radiologically to assess the safety and efficacy of the screws and the characteristics of their absorption. No patient in this series experienced revision or radiographic loosening during the follow-up period. The configurations of the HA–PLLA composite screws were confirmed on early post-operative radiographs in every case, whereas they appeared obscure on radiographs within 5 years after surgery, and only osteosclerotic traces remained in the screw positions at the final follow-up. Some screw heads were covered with bone within 3 months of surgery, and some screw heads migrated laterally with breakage, but were absorbed in situ within 5 years. The screws seemed to have no negative effect on the mid-term clinical results of the THAs.

scholarly journals Is open bone graft always necessary when treating aseptic subtrochanteric nonunion with a reamed intramedullary nail?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Won Chul Shin ◽  
Jae Hoon Jang ◽  
Nam Hoon Moon ◽  
Se Bin Jun
Keyword(s):  
Bone Graft ◽  
Pathologic Fracture ◽  
Bony Union ◽  
Open Procedure ◽  
Radiological Results ◽  
Intramedullary Reaming ◽  
Closed Procedure ◽  
Without Bone Graft ◽  
Large Bone

Abstract Background This study aimed to compare the radiological results between closed nailing without bone graft (BG) and open nailing with BG for aseptic subtrochanteric nonunion and to determine when an open procedure with BG should be considered. Methods In this retrospective study, we investigated patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. Patients with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up of less than 1 year were excluded. We compared the demographic details and radiological results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated. Results Thirty-seven patients met the criteria and were divided into the following two groups: the BG group (n=19) who underwent open nailing with BG and the non-BG group (n=18) who underwent closed reamed nailing without BG. The mean degrees of correction of varus and flexion deformity were significantly different (p=0.001, respectively), 6.2° and 2.9° in the BG group and 4.1° and 0.6° in the non-BG group, respectively. Bony union was observed in 17 cases (89.5%) in an average of 7.4 months in the BG group and in 16 cases (88.9%) in 7.6 months in the non-BG group, with no significant differences. The factors that were significantly associated with failure of revision were atypical fracture, two or more previous surgeries, and varus and sagittal anterior angulation. Conclusions The radiological results of closed reamed nailing without BG for subtrochanteric nonunion were satisfactory. In the effort of percutaneous realignment, gap reduction, and intramedullary reaming, the radiological results of closed nailing without BG were not different from those of open nailing with BG; therefore, closed procedure without BG may be an acceptable option in appropriately selected patients.

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