Feasibility of lateral mass screw insertion in patients with the risky triad of C1: evaluation of the over-the-arch technique

2021 ◽  
pp. 1-8
Author(s):  
Hyung Rae Lee ◽  
Dong-Ho Lee ◽  
Jae Hwan Cho ◽  
Eui Seung Hwang ◽  
Sang Yun Seok ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Lateral Wall ◽  
Bony Union ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Screw Insertion ◽  
Scale Scores ◽  
Neck Disability

OBJECTIVE The objective of this study was to evaluate the feasibility and complications of the over-the-arch (OTA) technique for screw insertion into the C1 lateral mass in patients in whom conventional techniques (i.e., posterior arch [PA] and inferior lateral mass [ILM]) are not feasible due to 1) PA with a very small height (< 3.5 mm), 2) a caudally tilted PA blocking the inferior part of the C1 lateral mass, or 3) loss of height at the ILM (< 3.5 mm). METHODS The authors reviewed the medical records of 60 patients who underwent C1 screw fixation with the OTA technique (13 screws) and the PA/ILM technique (107 screws) between 2011 and 2019. Vertebral artery (VA) injuries, screw malposition, and bony union were radiologically assessed. Clinical outcome measures, including Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and occipital neuralgia, were recorded. RESULTS Thirteen OTA screws were successfully inserted without any major complications. NDI and JOA scale scores did not show significant differences between the two groups at final follow-up. No VA injuries were recognized during screw insertion. There was no evidence of ischemic damage to the VA or bony erosion in the occiput or atlas. Medial wall violation was observed in 1 screw (7.7%); however, no C0–1, C1–2, or lateral wall violations were observed. No patients developed new-onset neuralgia postoperatively after C1 fixation with the OTA technique. CONCLUSIONS The OTA technique was safe and useful for C1 screw fixation in patients in whom conventional techniques could not be employed.

scholarly journals Anterior Controllable Antedisplacement and Fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS): a retrospective study of 45 cases

2019 ◽  
Author(s):  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
Shunmin Wang ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Significant Difference ◽  
Csf Leakage ◽  
One Year ◽  
Neck Disability ◽  
Multilevel Cervical Spondylotic Myelopathy

Abstract Background To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), and compare ACAF with hybrid decompression fixation (HDF). Methods A retrospective analysis of 85 cases with MCSMSS was carried out. 45 patients were treated with ACAF, while 40 patients were treated with HDF. The operation time, intraoperative bleeding volume, postoperative complications, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, Computed Tomography (CT) transverse measurement, cervical curvature and Kang's grade were compared between two groups. Results The patients were followed up for 12 to 17 months. Compared with HDF, ACAF group achieved better decompression according to CT measurement and Kang’s grade (P < 0.05), and recovered to a greater cervical Cobb’s angle (P < 0.05). However, JOA score and NDI index showed no significant difference one year after surgery (P＞0.05). Additionally, ACAF presented longer operation time and greater intraoperative blood loss (P < 0.05). As to complications, ACAF developed less incidences of cerebrospinal fluid examination (CSF) leakage, neurologic deterioration, epidural hematoma and C5 palsy by comparing with HDF. Conclusions ACAF is an effective method for the treatment of MCSMSS. Compared with HDF, ACAF has the advantages of significant decompression, increasing cervical curvature, and reducing the incidences of complications.

C2 Nerve Root Transection During C1 Lateral Mass Screw Fixation

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 475-481 ◽  
Author(s):  
Michael C. Dewan ◽  
Saniya S. Godil ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
Matthew J. McGirt
Keyword(s):  
Nerve Root ◽  
Screw Fixation ◽  
Neck Disability Index ◽  
Occipital Neuralgia ◽  
Lateral Mass ◽  
Negative Consequences ◽  
Lateral Mass Screw ◽  
Patient Reported ◽  
C2 Nerve Root ◽  
C1 Lateral Mass Screw

Abstract BACKGROUND: Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE: To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS: All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS: A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION: C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization.

Does Obesity Correlate With Worse Patient-Reported Outcomes Following Elective Anterior Cervical Discectomy and Fusion?

Neurosurgery ◽  
2016 ◽  
Vol 79 (1) ◽  
pp. 69-74 ◽  
Author(s):  
John A. Sielatycki ◽  
Chotai Silky ◽  
Kay Harrison ◽  
David Stonko ◽  
Matthew McGirt ◽  
...  
Keyword(s):  
Scale Score ◽  
Patient Reported Outcomes ◽  
Minimal Clinically Important Difference ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Japanese Orthopaedic Association Score ◽  
Association Score ◽  
Clinically Important Difference ◽  
Patient Reported ◽  
Neck Disability

Abstract BACKGROUND Studies have investigated the impact of obesity in thoracolumbar surgery; however, the effect of obesity on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF) is unknown. OBJECTIVE To examine the relationship between obesity and PROs following elective ACDF. METHODS Consecutive patients undergoing ACDF for degenerative conditions were evaluated. Patients were divided into groups with a body mass index ≥35. The EuroQol-5D, Short-Form 12 (SF-12), modified Japanese Orthopaedic Association score, and Neck Disability Index were used. Correlations between PROs and obesity were calculated at baseline and 1 year. RESULTS A total of 299 patients were included, with 80 obese (27%) and 219 nonobese (73%). patients At baseline, obesity was associated with worse myelopathy (modified Japanese Orthopaedic Association score: 10.7 vs 12.2, P = .01), general physical health (SF-12 physical component scale score: 28.7 vs 31.8, P = .02), and general mental health (SF-12 mental component scale score: 38.9 vs 42.3, P = .04). All PROs improved significantly following surgery in both groups. There was no difference in absolute scores and change scores for any PRO at 12 months following surgery. Furthermore, there was no difference in the percentage of patients achieving a minimal clinically important difference for the Neck Disability Index (52% vs 56%, P = .51) and no difference in patient satisfaction (85% vs 85%, P = .85) between groups. CONCLUSION Obesity was not associated with less improvement in PROs following ACDF. There was no difference in the proportion of patients satisfied with surgery and those achieving a minimal clinically important difference across all PROs. Obese patients may therefore achieve meaningful improvement following elective ACDF.

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.

Feasibility of Atlas Pedicle Screw Fixation Perpendicular to the Coronal Plane—A 3D Anatomic Analysis

2021 ◽  
pp. 219256822098071
Author(s):  
Chao Wu ◽  
Jiayan Deng ◽  
Qing Wang ◽  
Jian Pan ◽  
Haigang Hu ◽  
...  
Keyword(s):  
3D Reconstruction ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Lateral Wall ◽  
Pedicle Screw Fixation ◽  
Coronal Plane ◽  
Posterior Arch ◽  
Short Axis ◽  
Advanced Technique ◽  
Average Width

Study Design: An anatomic analysis. Objective: To investigate the feasibility of the ideal atlas pedicle screw trajectory perpendicular to the coronal plane via atlas digital 3D reconstruction. Methods: One hundred adult atlases were evaluated in this study. The projection of the corridor for atlas pedicle screw fixation perpendicular to the coronal plane was quickly obtained using the perspective model of 3D reconstruction, and the area, long axis, short axis and width of the pedicle corridor were measured. The inner trajectory was near the lateral wall of the pedicle, and the center of the corridor was point A. The lateral trajectory was near the lateral wall of the transverse foramen, and the center of the trajectory was point C. The midpoint of A and C was B. The length of the inner, middle and lateral trajectorys were measured. The distances from points A, B and C to the posterior tubercle of the atlas and safety swing angle were measured. Results: From the dorsal view, the pedicle corridor was fitted into an ellipse with an average long axis of 13.6 mm, an average short axis of 5.2 mm, and an average area of 56.3 mm2. From the axial view, the pedicle corridor had an average width of 9.4 mm. The average lengths of the inner trajectory, middle trajectory and lateral trajectory were 31.7 mm, 28.7 mm and 25.1 mm, respectively; The average distances from the posterior tubercle to points A, B and C were 17.1 mm, 20.8 mm and 24.5 mm, respectively. The average swing angles from points A, B and C were 16.1°, 25.5°, and 28.1°, respectively. Conclusion: Atlas pedicle screw fixation perpendicular to the coronal plane is feasible for almost all the volunteers. Pedicle screws close to the pedicle lateral wall of the atlas posterior arch perpendicular to the coronal plane is an advanced technique that is easy to master.

scholarly journals Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity

2020 ◽  
Vol 33 (4) ◽  
pp. 441-445
Author(s):  
Alex Soroceanu ◽  
Justin S. Smith ◽  
Darryl Lau ◽  
Michael P. Kelly ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Deformity Correction ◽  
Minimum Clinically Important Difference ◽  
Cervical Deformity ◽  
Clinically Important Difference ◽  
Significant Difference ◽  
The Mean ◽  
Neck Disability

OBJECTIVEIt is being increasingly recognized that adult cervical deformity (ACD) is correlated with significant pain, myelopathy, and disability, and that patients who undergo deformity correction gain significant benefit. However, there are no defined thresholds of minimum clinically important difference (MCID) in Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scores.METHODSPatients of interest were consecutive patients with ACD who underwent cervical deformity correction. ACD was defined as C2–7 sagittal Cobb angle ≥ 10° (kyphosis), C2–7 coronal Cobb angle ≥ 10° (cervical scoliosis), C2–7 sagittal vertical axis ≥ 4 cm, and/or chin-brow vertical angle ≥ 25°. Data were obtained from a consecutive cohort of patients from a multiinstitutional prospective database maintained across 13 sites. Distribution-based MCID, anchor-based MCID, and minimally detectable measurement difference (MDMD) were calculated.RESULTSA total of 73 patients met inclusion criteria and had sufficient 1-year follow-up. In the cohort, 42 patients (57.5%) were female. The mean age at the time of surgery was 62.23 years, and average body mass index was 29.28. The mean preoperative NDI was 46.49 and mJOA was 13.17. There was significant improvement in NDI at 1 year (46.49 vs 37.04; p = 0.0001). There was no significant difference in preoperative and 1-year mJOA (13.17 vs 13.7; p = 0.12). Using multiple techniques to yield MCID thresholds specific to the ACD population, the authors obtained values of 5.42 to 7.48 for the NDI, and 1.00 to 1.39 for the mJOA. The MDMD was 6.4 for the NDI, and 1.8 for the mJOA. Therefore, based on their results, the authors recommend using an MCID threshold of 1.8 for the mJOA, and 7.0 for the NDI in patients with ACD.CONCLUSIONSThe ACD-specific MCID thresholds for NDI and mJOA are similar to the reported MCID following surgery for degenerative cervical disease. Additional studies are needed to verify these findings. Nonetheless, the findings here will be useful for future studies evaluating the success of surgery for patients with ACD undergoing deformity correction.

Risk factors for intraoperative lateral mass fracture of lateral mass screw fixation in the subaxial cervical spine

2014 ◽  
Vol 20 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Shinichi Inoue ◽  
Tokuhide Moriyama ◽  
Toshiya Tachibana ◽  
Fumiaki Okada ◽  
Keishi Maruo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Screw Insertion ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Lateral Mass Fracture ◽  
Destructive Spondyloarthropathy

ObjectAlthough lateral mass screw fixation for the cervical spine is a safe technique, lateral mass fracture during screw fixation is occasionally encountered intraoperatively. This event is regarded as a minor complication; however, it poses difficulties in management that may affect fixation stability and clinical outcome. The purpose of this study is to determine the incidence and etiology of lateral mass fractures during cervical lateral mass screw fixation.MethodsA retrospective clinical review of patient records was performed in 117 consecutive patients (mean age 57 years, range 15–86 years) who underwent lateral mass screw fixation using a modified Magerl method from 1997 to 2010 at a single institution. A total of 555 lateral masses were included in this study. The outer diameters of the screws were 3.5 or 4.0 mm. In the retrospective clinical analysis, the incidence of intraoperative lateral mass fractures was reviewed. Potential risk factors for this complication were assessed using multivariate analysis.ResultsThe incidence of lateral mass fractures during cervical lateral mass screw fixation was 4.7% (26 lateral masses) among all cases. Among the disorders, the incidence was highest in patients with destructive spondyloarthropathy (DSA) (18.8%, 12 lateral masses). There was no significant difference with respect to lateral mass fracture between the use of 4.0-mm screws (5.6%) and 3.5-mm screws (3.6%). Independent risk factors identified by logistic regression were DSA (OR 7.89, p < 0.001) and screw insertion in the C-6 lateral masses (OR 2.80, p = 0.018).ConclusionsThe overall incidence of lateral mass fracture during cervical lateral mass screw fixation was 4.7%. Destructive spondyloarthropathy as an underlying cause of morbidity and screw placement in the C-6 lateral mass were identified as independent risk factors. Use of a 4.0-mm screw in patients with DSA may be a principal risk factor for this complication.

scholarly journals Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

2020 ◽  
Author(s):  
Yan Liang ◽  
Shuai Xu ◽  
Guanjie Yu ◽  
Zhenqi Zhu ◽  
Haiying Liu
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Cervical Discectomy ◽  
Cervical Alignment ◽  
Neck Disability

Abstract Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P<0.05) but UAL and LAL were of no significance. NDI and JOA got improvement in both groups at IPO and FFU while ASD was in no difference between SSC and ACP. A total of 40 patients (18 vs 22) acquired CL improvement with a larger population in ACP group. There were no differences on the rate if ASD, NDI, JOA and their change between IM and NIM subgroup and the change of CL were not correlated with NDI, JOA and their change.Conclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

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