Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Costa, Francesco; Ortolina, Alessandro; Attuati, Luca; Cardia, Andrea; Tomei, Massimo; Riva, Marco; Balzarini, Luca; Fornari, Maurizio

doi:10.3171/2014.10.spine14122

Cited by 31 publications

(23 citation statements)

References 28 publications

(25 reference statements)

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“…Depending on the case, plain radiography, intraoperative fluoroscopy, CT imaging, or 3D navigation may aid in the proper placement of instrumentation [25]. Currently, the choice of surgical approach and instrumentation is determined largely by the presence of associated injuries to the cervical spine.…”

Section: Operative Techniquesmentioning

confidence: 99%

“…Furthermore, the misplacement or migration of instrumentation may result in vertebral arterial injury [34]. Intraoperative imaging such as fluoroscopy is useful in order to avoid misplacement of screws and avoid damage to the vertebral artery [25,30]. Reduced bone density and osteoporosis are also potential sources of hardware failure in the upper cervical spine.…”

Section: Complicationsmentioning

confidence: 99%

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C1 fractures: a review of diagnoses, management options, and outcomes

Mead

Millhouse

Krystal

et al. 2016

Curr Rev Musculoskelet Med

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The atlas is subject to fracture under axial load, often due to traumatic injuries such as shallow dives and automobile accidents. These fractures account for 2-13 % of injuries to the cervical spine [Marcon RM et al. Clinics (Sao Paulo) 68(11):1455-61, 2013]. Fractures of the C1 vertebra are often difficult to diagnose, as there is often no neurological deficit or easily identifiable findings on radiographs. However, injuries to the atlas can be associated with vertebral artery injury and atlantoaxial or atlanto-occipital instability, making prompt and accurate diagnosis imperative. A detailed understanding of the anatomy, inherent stability, and common injury patterns is essential for any surgeon treating spinal trauma. This chapter explores the diagnosis and management of C1 fractures, as well as outcomes after treatment.

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Section: Operative Techniquesmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

C1 fractures: a review of diagnoses, management options, and outcomes

Mead

Millhouse

Krystal

et al. 2016

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

show abstract

“…There have been several studies on surgery of the atlantoaxial junction using imaging guided techniques. However, except for case reports, the study by Costa et al 2) was the first to report on 17 patients with C1-2 traumatic fractures who underwent surgery using 3D navigation system. Jacob et al 9) also presented similar results with O-arm navigation and analyzed the accuracy of screw placement.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have described the usefulness of screw fixation using the intraoperative CT based navigation in the surgical field of atlantoaxial junction 2,7,8,13) . These studies focused on the accuracy of the placement of pedicle screws and surgical complications and most have shown satisfactory results.…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Surgical Outcomes of C1–2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation

Lee

Son

Lee

et al. 2020

J Korean Neurosurg Soc

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Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

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“…War bisher die Navigation im Bereich der HWS dorsalen Zugängen vorbehalten, so finden sich immer mehr Berichte, auch bei ventral anzugehenden Pathologien zu navigierensei es durch Anbringen der Referenzklemme am OP-Tisch [22] oder an der medialen Klavikula über eine kleine Inzision bei der Versorgung von Densfrakturen von ventral [23].…”

Section: Pr a Xistippunclassified

Stellenwert der Navigation

Jarvers¹,

Spiegl²,

Glasmacher³

et al. 2017

Die Wirbelsäule

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Importance of Navigation Navigation and intraoperative imaging have undergone an enormous development in recent years. By using intraoperative navigation, the precision of pedicle screw implantation can be increased in the sense of patient safety. Especially in the case of complex defects or tumor diseases, navigation is a decisive aid. As a result of the constantly improved technology, the requirements for reduced radiation exposure and intraoperative control can also be met. The high costs of the devices can be amortized, for example by a reduced number of revisions. This overview presents the principles of navigation in spinal surgery and the advantages and disadvantages of the different navigation procedures.

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Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Cited by 31 publications

References 28 publications

C1 fractures: a review of diagnoses, management options, and outcomes

C1 fractures: a review of diagnoses, management options, and outcomes

Comparative Analysis of Surgical Outcomes of C1–2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation

Stellenwert der Navigation

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