Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery

Wu, Ai-Min; Wang, Xiangyang; Zhou, Feng; Zhang, Xiaolei; Xu, Huazi; Chi, Yong-Long

doi:10.1179/2045772314y.0000000298

“…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

¹

,

Li

²

,

Li

³

et al. 2020

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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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“…resulting from central nervous system damage; in severe cases, the life of the patient may be in danger [24,25]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [26][27][28] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [29,30], 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

¹

,

Li

²

,

Li

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

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 was 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.Results: By measuring the atlantoaxial parameters, the atlantoaxial CT data of the representative 30-year-old normal adult male were selected to create a personalized 3D printing AATS screw. In this case，the design parameters of the new screw were determined as follows: diameter, 6mm; length of the head thread structure, 10 mm; length of the middle porous metal structure, 8 mm (a middle porous structure containing an annular cylinder );length of the tail thread structure, 8 mm; and total length,26 mm. Apply the same load conditions to the atlantoaxial complex along different directions in the established finite element models of the three types of atlantoaxial fusion modes, the immediate stability of the new AATS is similar with Atlantoaxial posterior pedicle screw fixation.They are both superior to traditional atlantoaxial anterior screw fixation.The maximum local stress on the screw head in the atlantoaxial anterior surgery were less than those of traditional atlantoaxial anterior surgery.Conclusions: By measuring relevant atlantoaxial data, we found that screws with a larger diameter can be used in AATS surgery, and the new AATS can make full use of the atlantoaxial lateral mass space and increase the stability of fixation. The finite element analysis and verification revealed that the biomechanical stability of the new AATS was superior to the AATS used in traditional atlantoaxial AATS fixation. The porous metal structure of the new AATS may promote fusion between atlantoaxial joints and allow more effective bone fusion in the minimally invasive anterior approach surgery.

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“…Posterior surgery is prone to damage of the vertebral artery and nerves [23], 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 [24,25]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [26][27][28] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [29,30], 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

¹

,

Li

²

,

Li

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

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 was 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.Results: By measuring the atlantoaxial parameters, the atlantoaxial CT data of the representative 30-year-old normal adult male were selected to create a personalized 3D printing AATS screw. In this case，the design parameters of the new screw were determined as follows: diameter, 6mm; length of the head thread structure, 10 mm; length of the middle porous metal structure, 8 mm (a middle porous structure containing an annular cylinder );length of the tail thread structure, 8 mm; and total length,26 mm. Apply the same load conditions to the atlantoaxial complex along different directions in the established finite element models of the three types of atlantoaxial fusion modes, the immediate stability of the new AATS is similar with Atlantoaxial posterior pedicle screw fixation.They are both superior to traditional atlantoaxial anterior screw fixation.The maximum local stress on the screw head in the atlantoaxial anterior surgery were less than those of traditional atlantoaxial anterior surgery.Conclusions: By measuring relevant atlantoaxial data, we found that screws with a larger diameter can be used in AATS surgery, and the new AATS can make full use of the atlantoaxial lateral mass space and increase the stability of fixation. The finite element analysis and verification revealed that the biomechanical stability of the new AATS was superior to the AATS used in traditional atlantoaxial AATS fixation. The porous metal structure of the new AATS may promote fusion between atlantoaxial joints and allow more effective bone fusion in the minimally invasive anterior approach surgery.

show abstract

Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery

Abstract: Our small case series results suggested that percutaneous anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion is a technically minimally invasive, safe, feasible, and useful method to treat patients with a high-riding vertebral artery.

Cited by 7 publications

References 28 publications

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

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

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

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

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