Navigated odontoid screw placement using the O-arm: technical note and case series

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>As odontoid process fractures become increasingly common in the aging population, a technical understanding of treatment approaches is critical. 3D image guidance can improve the safety of posterior cervical hardware placement, but few studies have explored its utility in anterior approaches. The authors present in a stepwise fashion the technique of odontoid screw placement using the Medtronic O-arm navigation system and describe their initial institutional experience with this surgical approach.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors retrospectively reviewed all cases of anterior odontoid screw fixation for Type II fractures at an academic medical center between 2006 and 2015. Patients were identified from a prospectively collected institutional database of patients who had suffered spine trauma. A standardized protocol for navigated odontoid screw placement was generated from the collective experience at the authors' institution. Secondarily, the authors compared collected variables, including presenting symptoms, injury mechanism, surgical complications, blood loss, operative time, radiographically demonstrated nonunion rate, and clinical outcome at most recent follow-up, between navigated and nonnavigated cases.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Ten patients (three female; mean age 61) underwent odontoid screw placement. Most patients presented with neck pain without a neurological deficit after a fall. O-arm navigation was used in 8 patients. An acute neck hematoma and screw retraction, each requiring surgery, occurred in 2 patients in whom navigation was used. Partial vocal cord paralysis occurred after surgery in one patient in whom no navigation was used. There was no difference in blood loss or operative time with or without navigation. One patient from each group had radiographic nonunion. No patient reported a worsening of symptoms at follow-up (mean duration 9 months).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors provide a detailed step-by-step guide to the navigated placement of an odontoid screw. Their surgical experience suggests that O-arm–assisted odontoid screw fixation is a viable approach. Future studies will be needed to rigorously compare the accuracy and efficiency of navigated versus nonnavigated odontoid screw placement.</jats:p></jats:sec>

Comparison of clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures

“…For the modified Gallie wiring technique involving a cable passed the posterior arch of C1 and looped around a notched inferior C2 spinous process, tightening the cable is required to make the interface between graft-bone and grafting bed closer, thereafter increasing the regional lordosis in atlantoaxial complex and decreasing the lower cervical lordosis as compensation. [ 25 , 26 ] For the posterior cervical screw technique, rod-screw fixation in situ is enough to provide stabilization, without the need to provide extra compression.…”

Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report

“…Pisapia et al recently compared outcomes for anterior odontoid screw fixation between navigated and non-navigated cases using the O-arm system. No malpositioned screws or neurovascular injury were reported although one patient in the navigated group had screw loosening and required posterior occipitocervical fusion [ 15 ]. Keskin et al previously reported outcomes in 31 patients undergoing navigated anterior odontoid screw fixation using the Iso-C system.…”

Min-invasive surgical treatment for multiple axis fractures: A case report

“…This may reduce the need for blood transfusion and the risk of infection. The operating time can be shortened to within 2 h. Placement of the screws using intraoperative navigation and neurophysiological monitoring is safe and reliable[8,15-18]. In addition, the fracture site on the axis is stable enough for early motion.…”

“…The traditional surgery, such as posterior C1-2 internal fixation with a C1 lateral mass and a C2 pedicle screw and rod, which may be feasible for this type of complex upper cervical fracture[4,5]. With the development of technology, 3D navigation and mobile intraoperative computed tomography (CT) can provide a min-invasive and safe surgical opportunity for the management of this type of injury[6-8].…”