Biomechanical evaluation of two alternative techniques to the Goel-Harms technique for atlantoaxial fixation: C1 lateral mass–C2 bicortical translaminar screw fixation and C1 lateral mass–C2/3 transarticular screw fixation

Du, Yue-Qi; Li, Teng; Ma, Chao; Qiao, Guangyu; Yin, Yong; Yu, Xinguang

doi:10.3171/2019.11.spine191178

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…The industrial robot has already been introduced in other fields such as radiosurgery, spine surgery, and otosurgery. [33][34][35][36][37] Although a previous study argued the possible but complicated application of industrial robots in surgery, 38 we believe that an appropriate and thoroughly designed translational research of industrial robots can excavate even more potential uses for surgical robots and simplify surgical procedures.…”

Section: Discussionmentioning

confidence: 92%

A novel 3D-vision–based collaborative robot as a scope holding system for port surgery: a technical feasibility study

Xiong

Zhang

Gan

et al. 2022

Neurosurgical Focus

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OBJECTIVE A clear, stable, suitably located vision field is essential for port surgery. A scope is usually held by hand or a fixing device. The former yields fatigue and requires lengthy training, while the latter increases inconvenience because of needing to adjust the scope. Thus, the authors innovated a novel robotic system that can recognize the port and automatically place the scope in an optimized position. In this study, the authors executed a preliminary experiment to test this system’s technical feasibility and accuracy in vitro. METHODS A collaborative robotic (CoBot) system consisting of a mechatronic arm and a 3D camera was developed. With the 3D camera and programmed machine vision, CoBot can search a marker attached to the opening of the surgical port, followed by automatic alignment of the scope’s axis with the port’s longitudinal axis so that optimal illumination and visual observation can be achieved. Three tests were conducted. In test 1, the robot positioned a laser range finder attached to the robot’s arm to align the sheath’s center axis. The laser successfully passing through two holes in the port sheath’s central axis defined successful positioning. Researchers recorded the finder’s readings, demonstrating the actual distance between the finder and the sheath. In test 2, the robot held a high-definition exoscope and relocated it to the setting position. Test 3 was similar to test 2, but a metal holder substituted the robot. Trained neurosurgeons manually adjusted the holder. The manipulation time was recorded. Additionally, a grading system was designed to score each image captured by the exoscope at the setting position, and the scores in the two tests were compared using the rank-sum test. RESULTS The CoBot system positioned the finder successfully in all rounds in test 1; the mean height errors ± SD were 1.14 mm ± 0.38 mm (downward) and 1.60 mm ± 0.89 mm (upward). The grading scores of images in tests 2 and 3 were significantly different. Regarding the total score and four subgroups, test 2 showed a more precise, better-positioned, and more stable vision field. The total manipulation time in test 2 was 20 minutes, and for test 3 it was 52 minutes. CONCLUSIONS The CoBot system successfully acted as a robust scope holding system to provide a stable and optimized surgical view during simulated port surgery, providing further evidence for the substitution of human hands, and leading to a more efficient, user-friendly, and precise operation.

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Section: Discussionmentioning

confidence: 92%

A novel 3D-vision–based collaborative robot as a scope holding system for port surgery: a technical feasibility study

Xiong

Zhang

Gan

et al. 2022

Neurosurgical Focus

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“…Atlanto-axial instability has been treated by variety of method such as wiring techniques 3 , posterior trans-articular screw fixation with bone graft 6 , Goel-Harm's technique 7 . In 2003, Reindl et al 10 conducted a study on cadavers using the classic Smith-Robinson retropharyngeal approach 8 to perform anterior trans-articular C1-C2 fixation in traumatic aetiology.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study to Assess the Efficacy of Anterior Transarticular C1-C2 Screw Fixation for Stabilization of AtlantoAxial Instability

Varun kumar Agarwal,

Naveen Mahaur,

Praveen Garg

et al. 2021

MLU

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Introduction: The upper cervical spine includes the atlas (C1) and Axis (C2). The anatomy of upper two vertebrae is unique from each other. Atlanto-axial articulation is the most unique, mobile segment of spine, which largely depends on ligamentous supports based on integrity of odontoid for its stability. Historically, atlanto-axial subluxation was treated by reduction and fusion of C1-C2 joint. However, High riding vertebral artery precludes the placement of posterior trans-articular screw, which is liable to injury during screw placement. Socomputed tomography scans can be used to evaluate the risk of "high riding" vertebral artery during the management of atlanto-axial subluxation. Hence, anterior trans-articular screw fixation technique avoids the course of high riding vertebral artery. Material and Method: Nine patients underwent NCCT cervical spine with 3-D reconstruction and clinical evaluation of pain was done by recording the VAS score done pre operatively and after surgery. Results: All surgical cohorts underwent anterior C1-C2 fixation with an average follow up for 24 months. All patients were assessed as per fixed protocol of our local hospital guidelines of orthopaedics department. Pain score was clinically evaluated by VAS score before and after surgery yielding 90% excellent result. Conclusion: Anterior Trans-articular C1-C2 screw fixation isa minimally invasive technique with less blood loss, shorter skins car and faster post-operative recovery. It is an appropriate technique for stabilization of Atlanto-Axial instabilities.

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“…[ 6 , 94 , 98 ] Another technique that can be employed for atlantoaxial stabilization is C1-C2 fusion with polyaxial screw-rod fixation, also known as the Goel-Harms technique. [ 17 , 99 ] Independent placement of the C1 and C2 lateral mass and pars allows for intraoperative reduction and decreases the risk of vertebral artery injury, rendering the procedure safer than TASF or sublaminar wiring. [ 11 , 100 ] While this technique can be combined with TASF, it has superior fusion rates and versatility due to the possibility of joint manipulation.…”

Section: Surgical Managementmentioning

confidence: 99%

“…[ 11 , 100 ] While this technique can be combined with TASF, it has superior fusion rates and versatility due to the possibility of joint manipulation. [ 6 , 11 , 99 ] Disadvantages of C1-C2 fusion include the loss of normal neck rotation by up to 50% but are outweighed by the high proportion of OO patients for whom neurological compromise is prevented. [ 2 , 26 ] Both TASF and the polyaxial screw-rod fixation techniques obviate the need for rigid external postoperative immobilization unless additional stability is desired.…”

Section: Surgical Managementmentioning

confidence: 99%

Os odontoideum

Dahdaleh

Cho

Shlobin

2022

Journal of Craniovertebral Junction and Spine

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Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients. A literature review was conducted using the PubMed, EMBASE, and Scopus databases. A search using the query “os odontoideum” yielded 4319 results, of which 112 articles were chosen and analyzed for insights on factors such as etiology, clinical presentation, and management of OO. The presentation of OO varies widely from asymptomatic cases to severe neurological deficits. Asymptomatic patients can be managed either conservatively or surgically, while symptomatic patients should undergo operative stabilization. Although multiple studies show different techniques for surgical management involving posterior fusion, the diversity of such cases illustrates how treatment must be tailored to the individual patient to prevent complications. Conflicting studies and the paucity of current literature on OO highlight poor comprehension of the condition. Further understanding of the natural history of OO is critical to form evidence-based guidelines for the management of OO patients. More large-center studies are thus needed to promote accurate management of OO patients with optimal outcomes.

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Biomechanical evaluation of two alternative techniques to the Goel-Harms technique for atlantoaxial fixation: C1 lateral mass–C2 bicortical translaminar screw fixation and C1 lateral mass–C2/3 transarticular screw fixation

Cited by 15 publications

References 25 publications

A novel 3D-vision–based collaborative robot as a scope holding system for port surgery: a technical feasibility study

A novel 3D-vision–based collaborative robot as a scope holding system for port surgery: a technical feasibility study

A Clinical Study to Assess the Efficacy of Anterior Transarticular C1-C2 Screw Fixation for Stabilization of AtlantoAxial Instability

Os odontoideum

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