Modified Posterior C1 Lateral Mass Screw Insertion for Sort II Odontoid Course of Fractures Utilizing Intraoperative Computed Tomography-Primarily based Spinal Navigation to Decrease Postoperative Occipital Neuralgia.
World Neurosurg. 2017 Nov;107:194-201
Authors: Ishak B, Schneider T, Tubbs RS, Gimmy V, Younsi A, Unterberg AW, Kiening KL
BACKGROUND: Numerous surgical strategies have been described for treating odontoid instability and reaching efficient stabilization. The earliest approach to be described proposed a C1 lateral mass entry level together with neurectomy of the C2 nerve roots to make sure hemostasis. As a result of C2 neurectomy stays controversial, preservation of the C2 nerve root as described in Goel-Harms approach can result in intractable occipital neuralgia and important blood loss. The intention of this examine was to change the Goel-Harms approach with a excessive C1 lateral mass screw entry level to reinforce general intraoperative security.
METHODS: Sixty-three sufferers (common age, 70 ± 16 years) with acute traumatic odontoid fracture sort II underwent posterior stabilization with a modified posterior C1 lateral mass entry level utilizing intraoperative computed tomography (CT)-guided spinal navigation. Problems had been recorded, particularly bleeding from the epidural venous plexus and growth of occipital neuralgia. All sufferers had been adopted up for no less than 6 months.
RESULTS: Not one of the sufferers developed occipital neuralgia or numbness. Blood transfusion was obligatory in 1 affected person due to a coagulation dysfunction. There was no bleeding from the epidural venous plexus. All screws had been appropriately positioned. Two sufferers wanted surgical revision (wound an infection, dural tear). Two developed cardiopulmonary issues. Stable bony fusion was achieved in all sufferers.
CONCLUSIONS: This examine confirms that altering the C1 entry level to the junction of the posterior arch and superior-posterior a part of the C1 lateral mass by utilizing intraoperative CT navigation yields a secure and efficient process with few issues. The general complication price was 6%.
PMID: 28826707 [PubMed – indexed for MEDLINE]