Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws

Kiran, Narayanam Anantha Sai; Sivaraju, Laxminadh; Vidyasagar, Kanneganti; Aryan, Sarita; Raj, Vivek; Rajagopal, Niranjana; Mohan, Dilip; Thakar, Sumit; Rao, Arun S; Hegde, Alangar S.

doi:10.1016/j.wneu.2018.06.184

Cited by 16 publications

(18 citation statements)

References 55 publications

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“…Overall, types I, IIa, and IIb were categorized as acceptable placement and types IIc and III as unacceptable placement. [ 33 , 77 , 79 ] Sciubba et al [ 19 ] 2009 It is described by location (lateral, medial, inferior, and superior) and percentage of screw diameter over cortical edge (0 = none; grade I = < 25% of screw diameter; grade II = 26–50%; grade III = 51–75%; and grade IV = 76–100%). Type 0 was categorized as acceptable placement.…”

Section: Resultsmentioning

confidence: 99%

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

et al. 2020

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Study design: Systematic review and meta-analysis. Aim: The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods: Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results: From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion: Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.

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Section: Resultsmentioning

confidence: 99%

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

et al. 2020

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“…Sai Kiran et al 24 avaliaram a segurança e a precisão da colocação guiada por fluoroscopia anatômica e lateral de parafusos na pars de C2. Estes autores determinaram que a colocação de um parafuso com 16 mm de comprimento e angulação medial e cranial de 23° e 30°, respectivamente, era segura.…”

Section: Discussionunclassified

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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“…15,16 However, the C1 lateral mass screw can be safely placed with careful attention to the anatomy and using lateral fluoroscopic guidance. 17 One of the most challenging steps of C1 lateral mass screw insertion is avoiding and minimizing the bleeding from the large venous sinus overlying the C1-2 joint during dissection. 1,10…”

Section: Discussionmentioning

confidence: 99%

The Intersection Between Lateral Mass and Inferomedial Edge of the C1 Posterior Arch: A Reference Point for C1 Lateral Mass Screw Insertion

et al. 2021

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Objective: To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using the intersection between the lateral mass and inferomedial edge of the posterior arch as an easily identifiable and reproducible medial reference point. Selection of an ideal entry point and trajectory of C1 lateral mass screw insertion can help to minimize neurovascular injuries. While various techniques for screw insertion have been proposed in the past, they all require extensive dissection of the C1 lateral mass, which can cause profuse bleeding. Methods: Ninety-three 3-dimensional computed tomography reconstructed images of C1 lateral masses in adult patients were utilized to simulate the placement of C1 lateral mass screws via 4 entry points and 2 trajectory angles referencing off of a medial reference point using Vero's VISI 17 software. The safety during screw insertion simulation, as well as the screw length, were evaluated. Results: We found that C1 lateral mass screws could be safely placed bilaterally at 3 mm lateral to the reference point in both 0° and 15° medial screw angulation without violation of the cortex. The 15° medial angulation allowed for longer (18 mm) screws than the 0° angulation. Conclusion:We recommend starting C1 lateral mass screws 3 mm lateral to the intersection between the lateral mass and inferomedial edge of the posterior arch at a 15° medial angulation.

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Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws

Cited by 16 publications

References 55 publications

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis

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

The Intersection Between Lateral Mass and Inferomedial Edge of the C1 Posterior Arch: A Reference Point for C1 Lateral Mass Screw Insertion

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