scholarly journals Comparison of two techniques for the treatment for atlantoaxial instability injury: C1–C2 transarticular screws and C1 lateral mass–C2 pedicle screws

2020 ◽  
Author(s):  
Hoang Gia Du ◽  
Dao Xuan Thanh ◽  
Vu Xuan Phuoc ◽  
Nguyen Duc Hoang ◽  
Le Dang Tan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Operation Time ◽  
Hospital Length ◽  
Pedicle Screw Fixation ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Fixation Techniques ◽  
Group 2

Abstract Background: The aim was to evaluate the effectiveness and safety of transarticular C1–C2 screw fixation (C1C2-TAS) and C1 lateral mass–C2 pedicle screw fixation (C1LM-C2PS) in patients with C1–C2 instability injuries.Methods: This study was a prospective, self-controlled, single-institute study on two fixation techniques for the treatment of atlantoaxial instability caused by injury. From 06/2006 to 02/2017, 118 patients were allocated into two groups: group 1 (C1C2-TAS group) with 52 patients and group 2 (C1LM-C2PS group) with 66 patients. The investigated variables were noted before, during and after surgery. All patients were closely followed up through physical examination and radiological imaging at 3 months postoperatively.Results: There were significant differences in operation time, blood loss, and hospital length-stay between the two groups (p <0.001). Compared with those in the C1LM-C2PS group, the mean operation time was shorter (78.94 vs. 110.91 min; p = 0.0003), blood loss during surgery was lower (122.31 vs. 258.33 ml; p <0.0001) and hospital length-stay was shorter (5.31 vs. 8.34 days; p = 0.0003) in the C1C2–TAS group. The complication of surgery was low with no injury of vertebral artery. After surgery, clinical presentations were significantly reduced and were statistically significant in both groups. The remaining patients showed satisfactory internal fixation in the postoperative radiographs and CT examination.Conclusion: C1C2-TAS and C1LM-C2PS demonstrated effectiveness and safety in the treatment of patients with atlantoaxial instability injury. Notably, C1C2-TAS resulted in shorter surgical time, lower blood loss during surgery and shorter in-hospital stay than C1LM-C2PS.

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

scholarly journals Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques

2018 ◽  
Vol 8 (7) ◽  
pp. 751-760 ◽  
Author(s):  
Andrei Fernandes Joaquim ◽  
Marcelo Luis Mudo ◽  
Lee A. Tan ◽  
K. Daniel Riew
Keyword(s):  
Cervical Spine ◽  
Literature Review ◽  
Screw Fixation ◽  
Surgical Techniques ◽  
Pedicle Screw Fixation ◽  
Lateral Mass ◽  
Modified Technique ◽  
Screw Insertion ◽  
Subaxial Cervical Spine ◽  
Fixation Techniques

Study Design: A narrative literature review. Objectives: To review the surgical techniques of posterior screw fixation in the subaxial cervical spine. Methods: A broad literature review on the most common screw fixation techniques including lateral mass, pedicle, intralaminar and transfacet screws was performed on PubMed. The techniques and surgical nuances are summarized. Results: The following techniques were described in detail and presented with illustrative figures, including (1) lateral mass screw insertion: by Roy-Camille, Louis, Magerl, Anderson, An, Riew techniques and also a modified technique for C7 lateral mass fixation; (2) pedicle screw fixation technique as described by Abumi and also a freehand technique description; (3) intralaminar screw fixation; and finally, (4) transfacet screw fixation, as described by Takayasu, DalCanto, Klekamp, and Miyanji. Conclusions: Many different techniques of subaxial screw fixation were described and are available. To know the nuances of each one allows surgeons to choose the best option for each patient, improving the success of the fixation and decrease complications.

scholarly journals Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Wenshuai Fan ◽  
Tianyao Zhou ◽  
Jinghuan Li ◽  
Yunfan Sun ◽  
Yutong Gu
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Tumor Resection ◽  
Pedicle Screw Fixation ◽  
Incision Length ◽  
Group 2 ◽  
Duration Of Operation ◽  
Minimally Invasive Decompression ◽  
Group 1

Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety.Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups.Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P &lt; 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups.Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.

Versatile Usage of the Modified Lateral Mass Screw as an Alternative to Cervical Pedicle Screw Fixation

2021 ◽  
Author(s):  
Moon-Kyu Kim ◽  
Jung-Jae Lee ◽  
Su-Hee Cho ◽  
Dai-Soon Kwak
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Clinical Results ◽  
Pedicle Screw Fixation ◽  
Complete Fusion ◽  
Lateral Mass ◽  
Screw Misplacement ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws ◽  
Lateral Mass Screws

Abstract Objective Posterior subaxial cervical screw fixation is commonly performed using the cervical pedicle screws (CPS) and lateral mass screws (LMS); however, their compatibility is low. Modified lateral mass screws (mLMS, also called paravertebral foramen screw) fixation was introduced as a salvage technique for LMS fixation and has features of both LMS and CPS techniques. In the present study, the use of mLMS as an alternative to CPS was analyzed based on clinical results. Methods Seventy-eight screws (38 CPSs and 40 mLMSs) were inserted into 12 patients. The misplacement of the screws was evaluated by computed tomography (CT). The failure of instrumentation and instability were evaluated using plain radiographs. Results The total number of CPS misplacements was 3 (10.5%); however, neurologic complications were not observed. mLMSs were used in the middle segments of the fusion in 10 patients and 2 patients had mLMS fixation for single-level fusion. An additional bridging implant was not required for connecting both CPSs and mLMSs. Instability was not observed during the observation period (4–51 months). Complete fusion was seen in 10 patients. Conclusions The alternative mLMS fixation can decrease the risk of screw misplacement compared with CPS fixation alone and achieves adequate stability leading to fusion.

Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques

2008 ◽  
Vol 8 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Henry E. Aryan ◽  
C. Benjamin Newman ◽  
Eric W. Nottmeier ◽  
Frank L. Acosta ◽  
Vincent Y. Wang ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Case Series ◽  
Pedicle Screws ◽  
Joint Space ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
X Ray ◽  
Harms Technique ◽  
Flexion And Extension

Object Stabilization of the atlantoaxial complex has proven to be very challenging. Because of the high mobility of the C1–2 motion segment, fusion rates at this level have been substantially lower than those at the subaxial spine. The set of potential surgical interventions is limited by the anatomy of this region. In 2001 Jürgen Harms described a novel technique for individual fixation of the C-1 lateral mass and the C-2 pedicle by using polyaxial screws and rods. This method has been shown to confer excellent stability in biomechanical studies. Cadaveric and radiographic analyses have indicated that it is safe with respect to osseous and vascular anatomy. Clinical outcome studies and fusion rates have been limited to small case series thus far. The authors reviewed the multicenter experience with 102 patients undergoing C1–2 fusion via the polyaxial screw/rod technique. They also describe a modification to the Harms technique. Methods One hundred two patients (60 female and 42 male) with an average age of 62 years were included in this analysis. The average follow-up was 16.4 months. Indications for surgery were instability at the C1–2 level, and a chronic Type II odontoid fracture was the most frequent underlying cause. All patients had evidence of instability on flexion and extension studies. All underwent posterior C-1 lateral mass to C-2 pedicle or pars screw fixation, according to the method of Harms. Thirty-nine patients also underwent distraction and placement of an allograft spacer into the C1–2 joint, the authors' modification of the Harms technique. None of the patients had supplemental sublaminar wiring. Results All but 2 patients with at least a 12-month follow-up had radiographic evidence of fusion or lack of motion on flexion and extension films. All patients with an allograft spacer demonstrated bridging bone across the joint space on plain x-ray films and computed tomography. The C-2 root was sacrificed bilaterally in all patients. A postoperative wound infection developed in 4 patients and was treated conservatively with antibiotics and local wound care. One patient required surgical debridement of the wound. No patient suffered a neurological injury. Unfavorable anatomy precluded the use of C-2 pedicle screws in 23 patients, and thus, they underwent placement of pars screws instead. Conclusions Fusion of C1–2 according to the Harms technique is a safe and effective treatment modality. It is suitable for a wide variety of fracture patterns, congenital abnormalities, or other causes of atlantoaxial instability. Modification of the Harms technique with distraction and placement of an allograft spacer in the joint space may restore C1–2 height and enhance radiographic detection of fusion by demonstrating a graft–bone interface on plain x-ray films, which is easier to visualize than the C1–2 joint.

scholarly journals Personalized Rapid Prototyping Template for Direct C1 Pedicle Screw Fixation of Unstable C1 Semi-Ring Fractures

2020 ◽  
Author(s):  
Wei-xin Dong ◽  
Yong Hu ◽  
William Ryan Spiker ◽  
Zhen-shan Yuan ◽  
Jian-bin Zhong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Rapid Prototyping ◽  
Vertebral Artery ◽  
Pedicle Screw ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Intraoperative Blood Loss

Abstract Background: Placement of C1 pedicle screws carries an inherent risk of injury to the spinal cord and vertebral artery. Use of a personalized rapid prototyping template may be able to improve the safety of C1 pedicle fixation. To evaluate the clinical and radiographic outcomes of direct posterior C1 pedicle screw fixation using a personalized rapid prototyping template for unstable C1 semi-ring fractures.Methods: From May of 2010 to September of 2015, 38 patients with unstable C1 semi-ring fractures were treated with direct posterior C1 pedicle screw fixation. A standard open technique was utilized in 20 patients (Free-hand group) and 18 patients underwent C1 pedicle screw fixation with the aid of a personalized rapid prototyping template (RP group). The operative time, intraoperative blood loss, preoperative ADI, LMD and VAS were recorded. The postoperative ADI, LMD and VAS score were recorded at 180 days postoperatively.Results: No spinal cord or vertebral artery injuries were encountered in either group. Similarly, no post-operative instrumentation failures or cases of postoperative C1-2 instability were reported in either group. There was no statistically significant difference in intraoperative blood loss and operative time between RP and Free-hand group. In both groups, all patients obtained radiographic fusion at 6 months, reported no residual neck pain and were found to have a full range of motion at final follow up.Conclusion: Use of a personalized rapid prototyping template for the placement of direct posterior C1 pedicle screws is safe and effective in the treatment of unstable C1 semi-ring fractures with similar radiographic and clinical outcomes to more traditional techniques.

Thoracic transfacet pedicle screw fixation: a new instrumentation technique

2005 ◽  
Vol 3 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Atilla Akbay ◽  
Serkan İnceoğlu ◽  
Ryan Milks ◽  
Richard Schlenk ◽  
Selcuk Palaoglu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Pedicle Screw Fixation ◽  
Content Type ◽  
Thoracic Surgical Procedures ◽  
Flexion Extension ◽  
Fixation Techniques ◽  
Fine Print

Object. Pedicle screw instrumentation of the thoracic spine remains technically challenging. Transverse process and costotransverse screw fixation techniques have been described as alternatives to pedicle screw fixation (PSF). In this study, the authors introduce thoracic transfacet PSF and compare its experimental biomechanical results with those of standard PSF in short-term cyclic loading in cadaveric thoracic specimens. Methods. Specimens were tested intact for six cycles at compressive loads of 250 N offset by 1 cm along appropriate axes to induce flexion, extension, and left and right lateral bending. The specimens were then fixed with either a pedicle screw/rod construct or transfacet pedicle screws and retested in the same fashion. After this sequence, specimens were loaded until failure in flexion mode at a rate of 5 mm/minute was observed. Both fixation constructs provided significantly greater stiffnesses than that demonstrated when the specimen was intact (p < 0.05, two-way analysis of variance). Additionally, the two constructs were statistically equivalent in terms of stiffness and load-to-failure values (p < 0.05, two-tailed nonpaired t-test). The only difference observed was that the low midthoracic region (T7–9) was biomechanically weaker than the upper midthoracic and lower thoracic areas in flexion after the destabilization and instrumentation-augmented stabilization procedures. Conclusions. In selected thoracic surgical procedures, transfacet PSF may, after analysis of long-term biomechanical data, potentially become a reasonable alternative to conventional PSF.

scholarly journals Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta-analysis

2020 ◽  
Vol 29 (10) ◽  
pp. 2491-2504
Author(s):  
Carolijn Kapoen ◽  
Yang Liu ◽  
Frank W. Bloemers ◽  
Jaap Deunk
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fractures ◽  
Short Segment ◽  
Fracture Level

Abstract Objective Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. Methods A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence. Results Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better short-term and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low. Conclusion In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss.

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