Freehand C1 lateral mass screw fixation technique: our experience

被引:28
作者
Simsek, Serkan [1 ]
Yigitkanli, Kazim [1 ]
Seckin, Hakan [1 ]
Akyol, Cetin [1 ]
Belen, Deniz [1 ]
Bavbek, Murad [1 ]
机构
[1] Diskapi Educ & Res Hosp, Minist Hlth, Dept Neurosurg, TR-06110 Ankara, Turkey
来源
SURGICAL NEUROLOGY | 2009年 / 72卷 / 06期
关键词
C1 lateral mass; C1 pedicle screw; Atlas; Freehand fixation; Lateral mass screw; Occipitocervical fixation; INTERNAL CAROTID-ARTERY; MORPHOMETRIC EVALUATION; QUANTITATIVE ANATOMY; POLYAXIAL SCREW; PLACEMENT; ATLAS; VERTEBRA; PLATE;
D O I
10.1016/j.surneu.2009.06.015
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Although C1 lateral mass fixation technique is frequently performed in upper cervical instabilities, it requires the guidance of fluoroscopic imaging. The fluoroscopy guidance is time-consuming and has the risks of accumulative radiation. Biplane fluoroscopy is also difficult in upper cervical pathologic conditions because of the use of cranial fixations. This study aimed to demonstrate that unicortical C1 lateral mass screws could be placed safely and rapidly without fluoroscopy guidance. Methods: Between 2002 and 2008, 32 C1 lateral mass screws were inserted in 17 consecutive patients with various pathologic conditions involving either atlantoaxial or occipitocervical instability. Results: C1 screw lengths ranged from 18 to 32 mm. The atlantoaxial fixation was performed in 13 patients, and C1 lateral mass screws were added to the occipitocervical construct in 3 patients, to the posterior cervical construct in 2 patients, and to the cervicothoracic construct in 1 patient. In 2 patients, because C1 lateral mass screws could not be inserted unilaterally, C1 pedicle screw analogs were inserted. There were no screw malpositions or neurovascular complications related to screw insertion. Operation time and intraoperative bleeding of the isolated atlantoaxial fixations were retrospectively evaluated. The mean follow-up was w32.3 months (range, 7-59 months). No screw loosening or construct failure was observed within this period. Postoperatively, 4 patients complained of hypoesthesia, whereas one patient had superficial wound infection. Conclusion: C1 lateral mass screws may be used safely and rapidly in upper cervical instabilities without intraoperative fluoroscopy guidance and the use of the spinal navigation systems. Preoperative planning and determining the ideal screw insertion point, the ideal trajections, and the lengths of the screws are the most important points. (C) 2009 Elsevier Inc. All rights reserved.
引用
收藏
页码:676 / 681
页数:6
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