Posterior atlanto-axial fusion: A new compression clamp for laminar osteosynthesis

Roosen, K.; Trauschel, A.; Grote, W

doi:10.1007/bf00381539

Cited by 27 publications

(4 citation statements)

References 17 publications

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“…Transoral odontoid resection is an effective and safe surgical procedure. Several authors have described good results obtained with this procedure [7,8,16,17,30,39,44,45,[60][61][62], but very few studies have been published about the transoral approach including odontoid resection for irreducible AAK [22,24,35,53,59].…”

Section: Discussionmentioning

confidence: 99%

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Kandziora

Mittlmeier

Kerschbaumer

1999

European Spine Journal

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Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre-and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 ± 19.3 months (range 21-96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P < 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3°± 7.8°for rotation; 7.8°± 5.6°for bending; average gain of motion in group II: 21.5°± 14.0°f or rotation; 17.2°± 5.5°for bending), while it decreased significantly in group III (10.7°± 18.1°for rotation; 6.7°± 18.5°for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.Key words Atlanto-axial instability · Transoral approach · Decompression · Rheumatoid arthritis · C1/C2 fusion ORIGINAL ARTICLE Eur Spine J (1999) 8 : 371-381

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Section: Discussionmentioning

confidence: 99%

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Kandziora

Mittlmeier

Kerschbaumer

1999

European Spine Journal

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“…In the L-region, we should focus on the presence of high-riding VA and VA loop during C2 pedicle screw (C2PS) insertion. The risk of injury to VA caused by C2PS insertion due to highriding VA has been reported, 15 but the risk of VA loop in upper cervical spine during surgery have not been reported before. Park et al 16 reported the incidence of VA loop as 0.6% in patients with vertebral bone erosion or widened transverse foramen.…”

Section: Special Surgical Strategies For the Variationsmentioning

confidence: 99%

Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients

Yan

Chen

et al. 2021

Neurospine

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Objective: To summarize the vertebral artery (VA) pattern of 96 “sandwich” atlantoaxial dislocation (AAD) patients and to describe the strategies of reducing the injury of VA during surgery.Methods: From 2009 to 2020, we retrospectively reviewed the 3-dimensional computed tomography angiography data of 96 AAD patients combined with atlas occipitalization and C2–3 fusion, which were diagnosed as “sandwich” AAD and 96 patients as control group patients who were without atlas occipitalization, C2–3 fusion and any other cervical bone deformity at our institution. The variations of each side of VA were described in 3 different parts (C0–1, C1–2, and C2–3) according to the characteristics of the 3-part pathological structures in “sandwich” subgroup.Results: One hundred ninety-two sides of VAs in every group of patients were analyzed and every VA was described separately at 3 different level regions. There were different variations in these 3 different regions: 4 variations in the upper fusion region, 5 variations in the sandwiched region, and 6 variations in the lower fusion region in sandwich AAD patients. And the rate of VA deformity in sandwich AAD patients was much higher and more types of VA variations existed.Conclusion: In “sandwich” AAD patients, deformities of vertebral arteries in craniovertebral junction are more common, and the same VA may have deformities at different levels that severely affect surgical procedures. Therefore, preoperative imaging examination of VA for “sandwich” AAD patients is vital of guiding surgeons to avoid injury of VA during surgery.

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“…Kürzlich wurden neue winkelstabile anteriore atlantoaxiale Spondylodeseplatten vorgestellt, die im Vergleich zu bisherigen Systemen eine signifikant höhere Primärstabilität aufweisen [33,36]. Diese Plattensysteme könnten das dorso-ventral kombinierte Stabilisierungsverfahren Reponible Form der rotatorischen atlantoaxialen Instabilität Die dorsale Drahtzerklage Technik nach Brooks [5] oder die Fixation mittels Halifax-Klammern [56] sollte bei rotatorischer Instabilität nur in Ausnahmefällen angewendet werden [51]. Operatives Therapieverfahren der Wahl bei der rheumatischen rotatorischen Instabilität ist die atlantoaxiale Stabilisierung nach Magerl [13].…”

Section: Irreponible Form Der Atlantoaxialen Kyphoseunclassified

Operative Therapie der Halswirbelsäuleninstabilität bei Rheumatoider Arthritis

Kerschbaumer¹,

Rittmeister²,

Kandziora³

2003

Akt Rheumatol

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EpidemiologieDie Rheumatoide Arthritis betrifft häufig die Halswirbelsäule. In Abhängigkeit von den Untersuchungsmethoden finden sich Halswirbelsäulenaffektionen bei 19 % bis 88 % der Patienten mit Rheumatoider Arthritis [28,29,41,44,48,53,54]. Dabei dominiert zahlenmäßig die Affektion der oberen Halswirbelsäule (C0 -C2) [7,62]. Darüber hinaus ist die rheumatoide Arthritis eine der häufigsten Ursachen für eine atlantoaxiale Instabilität [28n30, 37]. ZusammenfassungInstabilitäten der Halswirbelsäule bei Rheumatoider Arthritis sind häufig. Unter pathomorphologischen und pathobiomechanischen Gesichtspunkten kann zwischen einer translatorischen, rotatorischen und vertikalen Instabilität der Halswirbelsäule unterschieden werden. Die bildgebende Diagnostik hat für die Differenzierung unterschiedlicher Instabilitätsformen sowie für die Indikationsstellung und Operationsplanung eine entscheidende Bedeutung. Eine Operationsindikation bei rheumatischer Instabilität der Halswirbelsäule besteht bei therapieresistenten Schmerzen und klinisch manifesten neurologischen Ausfällen. Darüber hinaus haben radiologische Messparameter und neurophysiologische Untersuchungsmethoden prognostische Relevanz und sind demzufolge als Entscheidungshilfen zur Erstellung einer Operationsindikation geeignet. Speziell für die Wahl des Operationsverfahrens ist eine Differenzierung zwischen geschlossen reponiblen und irreponiblen Instabilitätsformen notwendig. Um ein ideales Operationsergebnis zu erzielen, ist neben einer stadienbezogenen operativen Therapie vor allem eine rechtzeitige Indikationsstellung zur Operation entscheidend. AbstractThe cervical spine is a frequent source of instability in rheumatoid arthritis. Due to pathomorphologic and pathobiomechanical mechanisms we differentiate between a translatory, rotatory, and vertical instability of the cervical spine. Radiographic evaluation allows differentiation of types of instability and is important in preoperative planning. Indications for surgery are pain and/or a neurological deficit. Radiographic and neurophysiological parameters have shown prognostic relevance and assist in decision-making for surgery. Surgical treatment modalities of cervical spine instability in rheumatoid arthritis depend on the ability to reduce the deformity. A stage-related surgical therapy and well-timed indication for spinal surgery are essential for good clinical results.

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Posterior atlanto-axial fusion: A new compression clamp for laminar osteosynthesis

Cited by 27 publications

References 17 publications

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients

Operative Therapie der Halswirbelsäuleninstabilität bei Rheumatoider Arthritis

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