Atlantoaxial Mobility After Screw Fixation of the Odontoid

Jeanneret, B.; Vernet, Olivier; Frei, S.; Magerl, F.

doi:10.1097/00002517-199106000-00011

Cited by 69 publications

(44 citation statements)

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“…Literature [20,26,31,35,39,40,52,66] and our current results demonstrate that the C1-2 facet joints can be a meaningful source of pain. Thirty-one percent of our patients had at least one lateral C1-2 joint displaying advanced AAOA, more than half had signs of C2-nerve root conferred radiculopathy and motion induced suboccipital pain.…”

Section: Clinical Outcomesupporting

confidence: 62%

“…Jeanneret [39] measured left and right ROT C1-2 25°and 24°after AOSF using functional CT-scans. Likely due to sample size and fracture analysis, the study did not find any correlation between residual ROT C1-2 and fracture pattern, quality of reduction or osteosynthesis.…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

“…Therefore, any rotation of the head is conferred to the C1-2 facets and in the current sample with an overall reduced total ROT C1-2 of 40°the articulating surfaces of C1 and C2 must, at some point, have encountered a restraint. As Jeanneret [39], Pang [58], Ruf [65], Kim [42] and others pointed out, soft or bony interlock can have its source in malunited vertebral bodies, odontoid or lateral mass fractures, intraarticular scarring and pieces of cartilage wedged into the joint spaces, or can be a sequelae of capsular and periarticular ligamentous scarring like arthrofibrosis. We demonstrated that an altered joint anatomy of C1-2 caused reduced ROT C1-2 and %ROT C1-2 , sometimes deformation being striking and the restraint of axial rotation obvious (Fig.…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

“…Jeanneret noted three patients with restricted ROT C1-2 and explained the decreased motion with intraarticular comminution of the C1-2 joints that was supposed to produce painful posttraumatic AAOA [39]. AAOA can disrupt the smooth, gliding joint motions [60] and a clinical hallmark of AAOA is known to be the significantly reduced ROT C1-2 [20,31,35,66].…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

“…Any C2-fracture affects at least theoretically the ability of the C1-2 complex to take the major part in total neck rotation. Using functional CT-scans in 14 patients, Jeanneret [39] showed that the range of motion (ROM) for the rotation C1-2 (Rot C1-2 ) was significantly reduced even after anatomical reduction of odontoid fractures with AOSF. Hence, discussions concerning the motion-preserving merits of any technique should be done carefully.…”

Section: Introductionmentioning

confidence: 99%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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Section: Clinical Outcomesupporting

confidence: 62%

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique

Haberland

Ebmeier

Grunewald

et al. 2000

Comput. Aided Surg.

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Objective: We report on the first successful incorporation of intraoperative computerized tomography in spinal navigation procedures.Materials and Methods: All operations were performed with the aid of a Tomoscan M mobile CT system (Philips Medical Systems, Eindhoven, The Netherlands). The system comprises a mobile gantry, a mobile patient examination table, and a mobile workstation. Three different navigation systems were used: the EasyGuide (Philips Medical Systems, Eindhoven, The Netherlands), the Surgical Tool Navigator (Zeiss, Oberkochen, Germany), and a prototype of an ultrasound navigation system developed by ourselves (IVS GbR, Chemnitz, Germany). All surgical operations were performed with the patient positioned on the mobile table of the CT system. Following dorsal preparation of the vertebral region, the surgeon implanted small titanium screws in the vertebrae to serve as fiducial markers. Image data acquisition and image-to-patient registration were performed after implantation of the marker screws. The pedicle screws were inserted using the navigation system, and the position of each implant was confirmed by intraoperative CT scans.Results: To date, 35 patients with various spine disorders have been operated upon using the technique described, and 161 pedicle screws have been inserted. There were no misplacements of pedicle screws. In three (1.9 %) cases we observed lateral perforation (maximum 2 mm) of the lateral pedicle wall. We achieved a registration error of 0.85 mm (RMSE) ؎ 0.42 mm (SD).Conclusions: The combination of intraoperative computerized tomography and spinal navigation allows easy navigation with a high application accuracy of 0.8 mm ؎ 0.4 mm (SD) at the target point (measured in experiments with a plastic spine model). The possibility of performing an intraoperative quality check on demand markedly improves the safety of these procedures.

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Spätinstabilitäten der Wirbelsäule und ihre operative Behandlung

Noack

Kirgis

1992

Fortschritte in Der Unfallchirurgie

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Atlantoaxial Mobility After Screw Fixation of the Odontoid

Cited by 69 publications

References 0 publications

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique

Spätinstabilitäten der Wirbelsäule und ihre operative Behandlung

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