Experience and Results of Posterior Cervical Instrumentation Applied in Upper Cervical Injuries

Abstract

Aim Surgical treatment options for upper cervical trauma are few and have a very high risk. We aimed to present our experiences on the cases in which we performed surgery by eliminating the flexion restriction in the postoperative period by not including the occipital region in surgery. Materials and Method 16 cases who underwent atlantoaxial fixation with C1 mass-C2 pedicle screwing due to atlantoaxial instability after the year 2008 were retrospectively examined. Results 16 patients were included in the study. While the median surgical procedure time of the patients was calculated as 107.5 (range, 60-150) minutes; Intraoperative blood loss was measured as median 350 (range, 200-550) mL. Postoperative complications were observed in 2 patients (12.5%). 1 (6.3%) of the complications was screw revision and 1 (6.3%) was superficial infection. It was observed that the VAS scores of the patients decreased significantly in the postoperative period. Conclusion In cases where surgery is planned due to atlantoaxial instability, internal fixation with C1 lateral mass C2 pedicular screws and rod system from the posterior is recommended as an appropriate surgical method due to early and high solid fusion and no restriction in neck flexion movements.

Keywords

• Atlantoaxial instability
• C1 fracture
• C2 fracture
• Odontoid fracture

Üst Servikal Yaralanmalarda Uygulanan Posterior Servikal Enstrümantasyon Deneyimi ve Sonuçları

Abstract

Amaç Üst servikal travmalarda cerrahi tedavi seçenekleri az ve yüksek risklidir. Oksipital bölgeyi cerrahiye dahil etmeyerek postoperatif dönemde fleksiyon kısıtlamasını ortadan kaldırarak yaptığımız olgular üzerindeki deneyimlerimizi sunmayı amaçladık. Yöntem ve Gereçler 2008 sonrası atlantoaxial instabilite nedeniyle C1 mass-C2 pedikül vidalama ile atalantoaxial fiksasyon yapılan 16 olgu retrospesifik olarak incelendi. Bulgular Araştırmaya 16 hasta dahil edildi. Hastaların cerrahi işlem süresi median 107.5 (range, 60-150) dk olarak hesaplanırken; intraoperatif kan kaybı median 350 (range, 200-550) mL olarak ölçüldü. Postoperatif 2 hastada (12.5%) komplikasyon görüldü. Komplikasyonların 1’i (6.3%) vida revizyonu, 1’i (6.3%) de yüzeysel enfeksiyon şeklindeydi. Hastaların postoperatif dönemde anlamlı olarak VAS skorlarının azaldığı izlendi. Sonuç Atlantoaksiyal instabilite nedeniyle cerrahi planlanan olgularda posteriordan C1 lateral mass C2 pediküler vidalama ve rod sistemiyle internal fiksasyon yapılması erken ve yüksek oranda solid füzyon gerçekleşmesi, boyun fleksiyon hareketlerinde kısıtlama olmaması nedeniyle uygun cerrahi yöntem olarak önerilmektedir.

Keywords

• Atlantoaxial instabilite
• C1 fraktürü
• C2 fraktürü
• Odontoid fraktürü

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