Üst Servikal Yaralanmalarda Uygulanan Posterior Servikal Enstrümantasyon Deneyimi ve Sonuçları

Year 2024, Volume: 14 Issue: 2, 172 - 179, 30.06.2024

Mustafa Kaya Hikmet Turan Süslü

https://doi.org/10.31832/smj.1444941

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

Ethical Statement

Girişimsel olmayan etik kurul başvuru dosyası, Sayı: E-71522473-050.04-340192-45

Supporting Institution

Sakarya Üniversitesi Rektörlüğü Tıp Fakültesi Dekanlığı Fakülte Girişimsel Olmayan Etik Kurulu

Thanks

Bu çalışmamızda bize destek olan ve onay veren etik kurulu üyelerimize şükranlarımızı sunuyoruz

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

References

• 1. M. Çiftdemir. Cervical Spine Injuries. J Turk Spinal Surg 2007;18(4):43-50. 2007;18(4):43-50.
• 2. S. Çağlı. Spinal Cord and Spine Anatomy. Basic Neurosurgery. 2010;81-90.
• 3. Panjabi M, Dvorak J, Crisco J, 3rd, Oda T, Hilibrand A, Grob D. Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord. 1991;4(2):157-67. doi:10.1097/00002517-199106000-00005
• 4. Pryputniewicz DM, Hadley MN. Axis fractures. Neurosurgery. 2010;66(3 Suppl):68-82. doi:10.1227/01.NEU.0000366118.21964.A8
• 5. da Corte FC, Neves N. Cervical spine instability in rheumatoid arthritis. Eur J Orthop Surg Traumatol. 2014;24 Suppl 1:S83-91. doi:10.1007/s00590-013-1258-2
• 6. Huang DG, Hao DJ, He BR, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271-81. doi:10.1016/j.spinee.2015.07.008
• 7. Kalaycı M KK. Surgical Approaches and Fixation Methods to the Upper Cervical Spine. Basic Neurosurgery. Turkish Neurosurgery Association Publications; 2010;1373-90.
• 8. Joaquim AF, Ghizoni E, Rubino PA, et al. Lateral mass screw fixation of the atlas: surgical technique and anatomy. World Neurosurg. 2010;74(2-3):359-62. doi:10.1016/j.wneu.2010.05.010
• 9. Harms J MR. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine. 2001;Nov 15;26(22):2467-71. doi:10.1097/00007632-200111150-00014.
• 10. Yoshida M, Neo M, Fujibayashi S, Nakamura T. Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976). 2006;31(15):E513-7. doi:10.1097/01.brs.0000224516.29747.52
• 11. Morishima N, Ohota K, Miura Y. The influences of Halo-vest fixation and cervical hyperextension on swallowing in healthy volunteers. Spine (Phila Pa 1976). 2005;30(7):E179-82. doi:10.1097/01.brs.0000157475.47514.75
• 12. Jain VK, Behari S. Management of congenital atlanto-axial dislocation: some lessons learnt. Neurol India. 2002;50(4):386-97.
• 13. Yuan B, Zhou S, Chen X, Wang Z, Liu W, Jia L. Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients. J Orthop Surg Res. 2017;12(1):105. doi:10.1186/s13018-017-0607-y
• 14. Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992;5(4):464-75. doi:10.1097/00002517-199212000-00012
• 15. Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg. 1998;88(4):634-40. doi:10.3171/jns.1998.88.4.0634
• 16. Lee SH, Kim ES, Sung JK, Park YM, Eoh W. Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1-C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation. J Clin Neurosci. 2010;17(7):886-92. doi:10.1016/j.jocn.2009.10.008
• 17. Bourdillon P, Perrin G, Lucas F, Debarge R, Barrey C. C1-C2 stabilization by Harms arthrodesis: indications, technique, complications and outcomes in a prospective 26-case series. Orthop Traumatol Surg Res. 2014;100(2):221-7. doi:10.1016/j.otsr.2013.09.019
• 18. Jeon SW, Jeong JH, Choi GH, Moon SM, Hwang HS, Choi SK. Clinical outcome of posterior fixation of the C1 lateral mass and C2 pedicle by polyaxial screw and rod. Clin Neurol Neurosurg. 2012;114(6):539-44. doi:10.1016/j.clineuro.2011.11.001
• 19. Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976). 2002;27(22):2435-40. doi:10.1097/00007632-200211150-00004
• 20. Buchmann N, Schweizer C, Kirschke JS, et al. C1-C2 posterior screw fixation in atlantoaxial fractures revisited: technical update based on 127 cases. Eur Spine J. 2020;29(5):1036-1042. doi:10.1007/s00586-019-06244-2
• 21. Yanni DS, Perin NI. Fixation of the axis. Neurosurgery. 2010;66(3 Suppl):147-52. doi:10.1227/01.NEU.0000365743.16893.EA
• 22. Bransford RJ, Freeborn MA, Russo AJ, et al. Accuracy and complications associated with posterior C1 screw fixation techniques: a radiographic and clinical assessment. Spine J. 2012;12(3):231-8. doi:10.1016/j.spinee.2012.02.011
• 23. Ghaith AK, Yolcu YU, Alvi MA, et al. Rate and Characteristics of Vertebral Artery Injury Following C1-C2 Posterior Cervical Fusion: A Systematic Review and Meta-Analysis. World Neurosurg. 2021;148:118-126. doi:10.1016/j.wneu.2020.12.165
• 24. Klepinowski T, Limanowka B, Sagan L. Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports. Neurosurg Rev. 2021;44(3):1391-1400. doi:10.1007/s10143-020-01366-4
• 25. Patel AA, Lindsey R, Bessey JT, Chapman J, Rampersaud R, Spine Trauma Study G. Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals. Spine (Phila Pa 1976). 2010;35(21 Suppl):S209-18. doi:10.1097/BRS.0b013e3181f32ca5
• 26. Hitti FL, Hudgins ED, Chen HI, Malhotra NR, Zager EL, Schuster JM. Intraoperative Navigation Is Associated with Reduced Blood Loss During C1-C2 Posterior Cervical Fixation. World Neurosurg. 2017;107:574-578. doi:10.1016/j.wneu.2017.08.051
• 27. Elliott RE, Tanweer O, Smith ML, Frempong-Boadu A. Impact of Starting Point and Bicortical Purchase of C1 Lateral Mass Screws on Atlantoaxial Fusion: Meta-Analysis and Review of the Literature. J Spinal Disord Tech. 2015;28(7):242-53. doi:10.1097/BSD.0b013e31828ffc97
• 28. Xie Y, Li Z, Tang H, Li M, Guan Z. Posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial instability. J Clin Neurosci. 2009;16(12):1592-4. doi:10.1016/j.jocn.2009.03.026