Posterior atlantoaxial fusion: a comprehensive review of surgical  techniques and relevant vascular anomalies

Chen, Qi; Brahimaj, Bledi; Khanna, Raman; Kerolus, Mena G.; Tan, Lee A.; David, Brian T.; Fessler, Richard G.

doi:10.21037/jss.2020.03.05

Cited by 22 publications

(28 citation statements)

References 104 publications

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“…A fixação com parafuso transarticular, introduzida por Magerl, oferece alta estabilidade e taxas de fusão entre 92% e 100%. 5 No entanto, esta técnica requer redução do complexo C1-C2 antes da colocação do parafuso e está associada ao risco de lesão da artéria vertebral, principalmente em indivíduos com AV de trajeto elevado. 13…”

Section: Discussionunclassified

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Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada

Martins

Pereira

Lemos

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo O presente estudo tem como objetivo avaliar o comprimento e os ângulos de trajetória do parafuso para fixação atlantoaxial posterior em uma população portuguesa por meio do estudo de tomografia computadorizada (TC) cervical. Métodos Tomografias computadorizadas cervicais de 50 adultos foram analisadas quanto às trajetórias pré-definidas dos parafusos transarticulares C1-C2 (C1C2TA), na massa lateral de C1 (C1LM), no pedículo de C2 (C2P) e na pars de C2 e C2 laminar (C2L). O comprimento e os ângulos dos parafusos em cada uma destas trajetórias foram medidos e comparados entre homens e mulheres. Resultados O comprimento médio e ângulos medial e cranial da trajetória do parafuso C1C2TA foram de 34,12 ± 3,19 mm, 6,24° ± 3,06 e 59,25° ± 5,68, respectivamente; as medidas da trajetória do parafuso C1LM foram 27,12 ± 2,15 mm, 15,82° ± 5,07 e 13,53° ± 4,80. O comprimento médio e os ângulos medial e cranial da trajetória do parafuso C2P foram de 23,44 ± 2,49 mm, 27,40° ± 4,88 e 30,41° ± 7,27, respectivamente; as medidas da trajetória do parafuso da pars de C2 foram 16,84 ± 2,08 mm, 20,09° ± 6,83 e 47,53° ± 6,97. O comprimento médio e ângulos lateral e cranial da trajetória do parafuso C2L foram de 29,10 ± 2,48 mm, 49,80° ± 4,71 e 21,56° ± 7,76, respectivamente. Não houve diferenças entre os gêneros, à exceção do comprimento dos parafusos C1C2TA (p = 0,020) e C2L (p = 0,001), que foi maior no sexo masculino do que no feminino. Conclusão O presente estudo fornece referências anatômicas para a fixação atlantoaxial posterior em uma população portuguesa. Estes dados detalhados são essenciais para ajudar os cirurgiões de coluna a colocar os parafusos de maneira segura e eficaz.

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Section: Discussionunclassified

“…12 Due to the variable anatomy of the C1-C2 complex, a preoperative cervical CT scan or magnetic resonance imaging (MRI) is highly recommended to determine the anatomic feasibility and safe screw trajectory to avoid complications related to the placement of the screw. 5…”

Section: Discussionmentioning

confidence: 99%

Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada

Martins

Pereira

Lemos

et al. 2022

Rev Bras Ortop (Sao Paulo)

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“…Posterior lumbar fusion is a safe and effective surgical method for diseases, such as lumbar stenosis, spondylolisthesis, lumbar instability, spinal deformity, and tumor [1][2][3]. Pedicle screw (PS) fixation was first introduced by Boucher [4] and has been adopted as the gold standard in posterior lumbar fusion [4].…”

Section: Introductionmentioning

confidence: 99%

Cortical Trajectory Screw Fixation in Lumbar Spine Surgery: A Review of the Existing Literature

et al. 2022

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Posterior lumbar fusion is a safe and effective surgical method for diseases, such as lumbar stenosis, spondylolisthesis, lumbar instability, spinal deformity, and tumor. Pedicle screw (PS) fixation was first introduced by Bouche and has been adopted as the gold standard for posterior lumbar fusion. Santoni and colleagues introduced a new methodological screw insertion technique that uses a cortical bone trajectory (CBT), described as that from a medial to lateral path in the transverse axial plane and caudal to the cephalad path in the sagittal plane through the pedicle for maximum contact of the screw with the cortical bone. Owing to the lower invasiveness, superior cortical bone contact, and reduced neurovascular injury incidence, the CBT technique has been widely used in posterior lumbar fusion; however, these advantages have not been proven in clinical/radiological and biomechanical studies. We designed the present study to review the existing evidence and evaluate the merit of CBT screw fixation. Six electronic databases were searched for relevant articles published in August 2020 using the search terms "cortical bone trajectory," "CBT spine," "CBT fixation," "cortical pedicle screws," and "cortical screws." Studies were analyzed and divided into the following groups: "biomechanics investigation," "surgical technique," and "clinical/radiological studies." Most studies compared CBT and PS fixation, and the CBT screw fixation method showed better or similar outcomes.

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“…[2][3][4][5][6][7][8][9] These injuries can be complex, involving bony, ligamentous, and vascular structures, as well as spinal cord injury. 10 Nondisplaced type III odontoid fractures are generally treated nonoperatively but can progress to nonunion and AA instability. [11][12][13] Niemeier et al reviewed 125 patients with type III odontoid fracture and found that conservative management, with cervical collar or halo orthosis, had a 21% failure rate, and most patients in whom the treatment failed displayed progressive anterolisthesis and angulation.…”

mentioning

confidence: 99%

“… 2–9 These injuries can be complex, involving bony, ligamentous, and vascular structures, as well as spinal cord injury. 10 …”

mentioning

confidence: 99%

Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

Dibble

Javeed

Zhang

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact. Serial cervical traction was placed with minimal radiographic reduction. Ultimately, she underwent intraoperative reduction, instrumentation, and fusion. Freehand C1 lateral mass reduction screws were placed, then C2 translaminar screws, and finally lateral mass screws at C3 and C4. The C2–4 instrumentation was used as bilateral rod anchors to reduce the C1 lateral mass reduction screws engaged onto the subluxated atlantodental complex. As a final step, cortical allograft spacers were inserted at C1–2 under compression to facilitate long-term stability and fusion. LESSONS This is the first description of a technique using extended tulip cervical reduction screws to correct traction-irreducible atlantoaxial subluxation. This case is a demonstration of using intraoperative tools available for the spine surgeon managing complex cervical injuries requiring intraoperative reduction that is resistant to traction reduction.

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Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies

Cited by 22 publications

References 104 publications

Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada

Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada

Cortical Trajectory Screw Fixation in Lumbar Spine Surgery: A Review of the Existing Literature

Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

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