Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion

Iure, Federico De; Donthineni, Rakesh; Boriani, Stefano

doi:10.1007/s00586-009-0981-1

Cited by 45 publications

(32 citation statements)

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“…7,18,21,35,38 The 97% fusion rate in the present study compares very favorably with these prior reports, especially considering that the present study population is confined to elderly patients, including a substantial number with rheumatoid disease.…”

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confidence: 87%

“…Several prior reports document experience with C1-2 segmental instrumented arthrodesis without C-2 neurectomy. 7,18,21,23,30,33,35,38 Among these reports, the mean surgical duration varies considerably, from 83 minutes 35 to 169 minutes, 21 with overall ranges in time from 35 minutes 35 to 240 minutes. 29 The mean operative time in the present study (129 minutes) is comparable to these prior reports.…”

Section: Discussionmentioning

confidence: 99%

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C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

Hamilton

Smith

Sansur

et al. 2011

SPI

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Object The originally described technique of atlantoaxial stabilization using C-1 lateral mass and C-2 pars screws includes a C-2 neurectomy to provide adequate hemostasis and visualization for screw placement, enable adequate joint decortication and arthrodesis, and prevent new-onset postoperative C-2 neuralgia. However, inclusion of a C-2 neurectomy for this procedure remains controversial, likely due in part to a lack of studies that have specifically addressed whether it affects patient outcome. The authors' objective was to assess the surgical and clinical impact of routine C-2 neurectomy performed with C1–2 segmental instrumented arthrodesis in a consecutive series of elderly patients with C1–2 instability. Methods Forty-four consecutive patients (mean age 71 years) underwent C1–2 instrumented fusion, including C-1 lateral mass screw insertion. Bilateral C-2 neurectomies were performed. Standardized clinical assessments were performed both pre- and postoperatively. Numbness or discomfort in a C-2 distribution was documented at follow-up. Fusion was assessed using the Lenke fusion grade. Results Among all 44 patients, mean blood loss was 200 ml (range 100–350 ml) and mean operative time was 129 minutes (range 87–240 minutes). There were no intraoperative complications, and no patients reported new postoperative onset or worsening of C-2 neuralgia postoperatively. Outcomes for the 30 patients with a minimum 13-month follow-up (range 13–72 months) were assessed. At a mean follow-up of 36 months, Nurick grade and pain numeric rating scale scores improved from 3.7 to 1.0 (p < 0.001) and 9.4 to 0.6 (p < 0.001), respectively. The mean postoperative Neck Disability Index score was 7.3%. The fusion rate was 97%, and the patient satisfaction rate was 93%. All 24 patients with preoperative occipital neuralgia reported relief. Seventeen patients noticed C-2 distribution numbness only during examination in the clinic, and 2 patients reported C-2 numbness, but it did not affect their daily function. Conclusions In this series of C1–2 instrumented arthrodesis in elderly patients, excellent fusion rates were achieved, and patient satisfaction was not negatively affected by C-2 neurectomy. In the authors' experience, C-2 neurectomy enhanced surgical exposure of the C1–2 joint, thereby facilitating hemostasis, placement of instrumentation, and decortication of the joint space for arthrodesis. Importantly, with C-2 neurectomy in the present series, no cases of new onset postoperative C-2 neuralgia occurred, in contrast to a growing number of reports in the literature documenting new-onset C-2 neuralgia without C-2 neurectomy. On the contrary, 80% of patients in the present series had preoperative occipital neuralgia and in all of these patients this neuralgia was relieved following C1–2 instrumented arthrodesis with C-2 neurectomy.

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confidence: 87%

Section: Discussionmentioning

confidence: 99%

C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

Hamilton

Smith

Sansur

et al. 2011

SPI

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“…The mechanism of type II odontoid fracture is variable, including hyperflexion, hyperextension, lateral flexion and a combination (10). As this type of fracture has a relatively high risk of nonunion, the appropriate treatment of type II odontoid fractures has been the subject of many investigations but still remains a matter of debate (16,17,19).…”

Section: Discussionmentioning

confidence: 99%

Clinical results of surgical management in type ii odontoid fracture: a preliminary report

Mashhadinezhad¹,

Samini²,

Mashhadinezhad³

et al. 2011

Turkish Neurosurgery

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AIm: This study was conducted to evaluate the therapeutic effectiveness of surgical approaches in type II odontoid fracture. mATeRIAL and meTHods:In a retrospective study in Mashhad university, 15 patients with anterior screw fixation technique (ASF) and 31 patients with posterior approaches (PA) were reviewed. Patient demographics, clinical presentation, length of hospital stay, operation time, injury severity score (ISS), Preinjury Charlson comorbidity index, fusion rate and surgical complications were analyzed in these two groups.ResuLTs: Neck pain was the most common clinical presentation in these two groups (89.7%). There were no significant differences in ISS and mean length of hospital stay and Comorbidity index between the two groups. The operation time was different between these two groups (65 minutes in ASF versus118 minutes in PA, P < 0.05). Bone union was documented in 13 patients (87%) with ASF and 28 patients (90%) with PA. CoNCLusIoN:The outcome of surgery with anterior or posterior approach in the patients are potential candidates for surgery is good. In our patients, the operation time is different in the two groups but differences in fusion rate, length of hospital stay, comorbidity index and postsurgical complications are not considerable. KeywoRds:Type II odontoid fracture, Surgical management, Anterior approach, Posterior approach ÖZ AmAÇ: Bu çalışma tip II odontoid kırıklarda cerrahi yaklaşımın terapötik etkinliğini değerlendirmek için yapıldı. yÖNTem ve GeReÇLeR: Mashhad Üniversitesinde yapılan retrospektif bir çalışmada anterior vida fiksasyon tekniği (ASF) kullanılan 15 hasta ve posterior yaklaşımlar (PA) kullanılan 31 hasta gözden geçirildi. Bu iki grupta hasta demografik bilgileri, klinik sunum, hastanede kalma süresi, operasyon süresi, yaralanma şiddeti skoru (ISS), yaralanma öncesi Charlson Komorbidite İndeksi, füzyon oranı ve cerrahi komplikasyonlar analiz edildi.BuLGuLAR: Bu iki grupta en sık görülen klinik sunum boyun ağrısıydı (%89,7). İki grup arasında ISS ve ortalama hastanede kalma süresi ile komorbidite indeksi arasında önemli fark yoktu. Operasyon süresi bu iki grup arasında farklıydı (ASF grubunda 65 dakika ve PA grubunda 118 dakika, P < 0,05). Kemik birleşmesi ASF'li 13 hastada (%87) ve PA'lı 28 hastada (%90) görüldü. soNuÇ: Cerrahi için uygun olan hastalarda anterior veya posterior yaklaşımla cerrahi sonuçları iyidir. Hastalarımızda operasyon süresi iki grupta farklıydı ama füzyon oranı, hastanede kalma süresi, komorbidite indeksi ve cerrahi sonrası komplikasyonlar açısından önemli fark yoktu.

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“…Nevertheless, C1 lateral mass and C2 pedicle X. Meng (&) Á J. Xu Department of Spine, Hebei Medical University Third Hospital, No. 139, Zi-qiang Street, Shijiazhuang 050051, Hebei, China e-mail: mengxianzhong3@gmail.com screws fixation have been successfully used for the treatment of atlantoaxial instability in a few studies [6,11,14,15,21,31,35]. More recently, the anatomic suitability and guidelines for transarticular, C1 and C2 pedicle screw placement in the general adult population was established by Resnick et al [27].…”

Section: Introductionmentioning

confidence: 99%

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Meng

2011

Eur Spine J

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Introduction Patients with os odontoideum always present instability in atlantoaxial joint and need atlantoaxial fixation. C2 pedicle or laminar screws fixation has proven to be efficient and reliable for atlantoaxial instability. However, os odontoideum is a congenital or developmental disease, featured with anomalous bony anatomies. The anatomic measurements and guidelines for C2 pedicle screw placement in general population tends to differ with those of os odontoideum patients, for whom C2 pedicle screws are often needed. The option and techniques of C2 fixation are still challenging and yet to be fully explored. Material and methods We recruited 29 adult patients with os odontoideum and measured the dimension of C2 pedicle and lamina for each patient to examine how well do they match with the screws anatomically. In order to access the intra-observer reliability and inter-observer repeatability of the measurements, the intraclass correlation coefficient (ICC) was also calculated. Results The results for reliability of the CT measurements showed excellent intraobserver (ICC = 0.95 and 0.96) and interobserver correlation coefficient (ICC = 0.93). The diameter and length of C2 pedicle were found to be 6.06 ± 1.37 and 24.05 ± 2.54 mm, while the corresponding figures of C2 laminar were 6.95 ± 0.82 and 25.60 ± 2.18 mm, respectively. In the measurements, all 29 cases had suitable diameter (larger than 5.5 mm) for C2 laminar screw (the laminar diameters ranged from 5.52 to 8.82 mm). In C2 pedicle measurements, the diameters of the 29 cases were from 3.50 to 9.86 mm, while 20 pedicles (34.5%) in 14 cases were less than 5.5 mm in diameter. Six had bilateral small pedicles where the diameter was less than 5.5 mm. Conclusion Anatomically, we found laminar screw is a better match in comparison with pedicle screw for C2 fixation in os odontoideum. The options for C2 fixation should be made based on careful preoperative imaging and thorough consideration. Preoperative reconstructive CT scan can offer great assistance for the choice of fixation in os odontoideum by revealing the anatomy of the C2 pedicles in detail.

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Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion

Cited by 45 publications

References 10 publications

C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

Clinical results of surgical management in type ii odontoid fracture: a preliminary report

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

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