“Direct vision” operation of posterior atlantoaxial transpedicular screw fixation for unstable atlantoaxial fractures

Cao, Lu; Yang, En-Hui; Xu, Jian-Guang; Lian, Xiaojuan; Cai, Bin; Liu, Xiaokang; Zhang, Guowang

doi:10.1097/md.0000000000007054

Cited by 8 publications

(6 citation statements)

References 44 publications

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“…Grade 0 is considered the accuracy of in C2 screw placement [ 28 ]. [ 17 , 28 , 29 , 50 , 52 , 56 , 59 , 63 , 67 , 68 , 75 , 82 , 84 , 87 ] Laine et al [ 89 ] 2000 Based on CT images, in this classification, screw position was staged as screw inside the pedicle or perforation of the pedicle cortex by up to 2 mm, from 2 to 4 mm, from 4 to 6 mm, or by more than 6 mm. Type I and type II were categorized as acceptable placement.…”

Section: Resultsmentioning

confidence: 99%

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

et al. 2020

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Study design: Systematic review and meta-analysis. Aim: The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods: Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results: From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion: Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.

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Section: Resultsmentioning

confidence: 99%

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

et al. 2020

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“…However, because of the obvious biomechanical advantage of C1 pedicle screw compared with lateral mass screw [ 24 ], all cases in this study received pedicle screw fixation, and long screws should be selected to reach the anterior cortex as much as possible. For patients with posterior arch dysplasia (height <3.5 mm) who cannot complete the complete pedicle screw placement, semi embedded pedicle screw placement was performed to maximize the mechanical stability [ 25 , 26 ]. In cases which C2 pedicle screws cannot be applied due to severe high-riding vertebral artery, theoretically, laminar screws or isthmus screws can be used instead.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases

Shen¹,

Xia²,

Xu³

2020

Med Sci Monit

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Background Surgical procedures on atlantoaxial dislocation combined with osteoporosis remain controversial. This study was established to assess the mid-term clinical outcomes of atlantoaxial dislocation combined with osteoporosis using posterior atlantoaxial rod, screw fixation and posterior interfacet fusion. Material/Methods From January 2017 to January 2020, 21 patients (4 males and 17 females) with coexisting atlantoaxial dislocation and osteoporosis who underwent posterior atlantoaxial rod and screw fixation were included in our study with an average age of 64±8.1 years (range, 57–74 years). The subjective and objective symptoms, together with the neurological function of the patients were measured. Radiography and magnetic resonance imaging (MRI) were performed, Japanese Orthopaedic Association (JOA) score for spinal cord function and VAS score for pain recovery was assessed. Results JOA and visual analog scale (VAS) score were significantly improved at 14±5.9 month follow-up compared with pretreatment values. Complete or almost complete anatomical reduction was observed in all 21 patients. All patients had good bony fusion at the final follow-up. No screw-loosening or atlantoaxial redislocation occurred in 21 cases. The only complication was mild numbness in the C2 innervation area of the posterior occipital region in 6 cases, which had no effect on life. Conclusions The results suggested that posterior atlantoaxial rod, screw fixation system, and posterior interfacet fusion could achieve satisfactory initial results for the treatment of atlantoaxial dislocation combined with osteoporosis.

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“…Posterior surgery is prone to damage of the vertebral artery and nerves [25], resulting in severe consequences such as massive haemorrhage of the vertebral artery, cerebral infarction and hemiplegia caused by vertebral artery embolism, and dyspnoea resulting from central nervous system damage; in severe cases, the life of the patient may be in danger [26,27]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [28][29][30] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [31,32], and the atlantoaxial complex can be more safely fused through the anterior approach.…”

Section: Discussionmentioning

confidence: 99%

Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis

Zhang

et al. 2020

J Orthop Surg Res

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Purpose: To design a new type of screw for minimally invasive atlantoaxial anterior transarticular screw (AATS) fixation with a diameter that is significantly thicker than that of traditional screws, threaded structures at both ends, and a porous metal structure in the middle. The use of a porous metal structure can effectively promote bone fusion and compensate for the disadvantages of traditional AATSs in terms of insufficient fixation strength and difficulty of bone fusion. The biomechanical stability of this screw was verified through finite element analysis. This instrument may provide a new surgical option for the treatment of atlantoaxial disorders. Methods: According to the surgical procedure, the new type of AATS was placed in a three-dimensional atlantoaxial model to determine the setting of relevant parameters such as the diameter, length, and thread to porous metal ratio of the structure. According to the results of measurement, the feasibility and safety of the new AATS were verified, and a representative finite element model of the upper cervical vertebrae was chosen to establish, and the validity of the model was verified. Then, finite element-based biomechanical analysis was performed using three models, i.e., atlantoaxial posterior pedicle screw fixation, traditional atlantoaxial AATS fixation, and atlantoaxial AATS fixation with the new type of screw, and the biomechanical effectiveness of the novel AATS was verified.

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“Direct vision” operation of posterior atlantoaxial transpedicular screw fixation for unstable atlantoaxial fractures

Abstract: Supplemental Digital Content is available in the text

Cited by 8 publications

References 44 publications

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases

Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis

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