Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability
BACKGROUND: The C1 lateral mass and C2 isthmic stabilization, as introduced by Goel and Laheri and by Harms and Melcher, is a well-known fixation technique. We present the clinical and radiographic results with freehand fluoroscopy guided C1 lateral mass and C2 isthmic fixation in a consecutive series of 28 patients, evaluating the accuracy of screw placement.
METHODS: Twenty-eight consecutive patients suffering from post-traumatic and other C1-C2 instability were operated on between 2001 and 2010. Indications for surgery were: trauma (n = 21 cases), os odontoideum (n = 1), cranio-verterbal malformation (n = 1), and arthritis (n = 3) and idiopathic instability (n = 2). C1 lateral mass and C2 isthmic screws were placed according to the usual anatomical landmarks with lateral fluoroscopy guidance. All patients underwent a postoperative CT scan. The extent of cortical lateral or medial breach was determined and classified as follows: no breach (grade A), 0-2 mm (grade B), 2-4 mm (grade C), 4-6 mm (grade D), more than 6 mm (grade E). Grade A and B screws were considered well positioned.
RESULTS: A total of 56 C1 lateral mass and 55 C2 isthmic screws were placed. Accuracy of screw placement was as follows: 107 grade A (96.4%), four grade B (3.6%), and no grade C, D or E. Clinical and radiological follow-up showed improvement in symptoms (mainly pain) and stability of the implants at the end of the follow-up.
CONCLUSIONS: Freehand fluoroscopy-guided insertion of C1 lateral mass and C2 isthmic screws can be safely and effectively performed.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2011 |
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| Erschienen: |
2011 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:153 |
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| Enthalten in: |
Acta neurochirurgica - 153(2011), 7 vom: 07. Juli, Seite 1417-25; discussion 1425 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tessitore, Enrico [VerfasserIn] |
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| Anmerkungen: |
Date Completed 07.05.2012 Date Revised 10.12.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00701-011-1039-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM208538275 |
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| 100 | 1 | |a Tessitore, Enrico |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability |
| 264 | 1 | |c 2011 | |
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| 500 | |a Date Completed 07.05.2012 | ||
| 500 | |a Date Revised 10.12.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The C1 lateral mass and C2 isthmic stabilization, as introduced by Goel and Laheri and by Harms and Melcher, is a well-known fixation technique. We present the clinical and radiographic results with freehand fluoroscopy guided C1 lateral mass and C2 isthmic fixation in a consecutive series of 28 patients, evaluating the accuracy of screw placement | ||
| 520 | |a METHODS: Twenty-eight consecutive patients suffering from post-traumatic and other C1-C2 instability were operated on between 2001 and 2010. Indications for surgery were: trauma (n = 21 cases), os odontoideum (n = 1), cranio-verterbal malformation (n = 1), and arthritis (n = 3) and idiopathic instability (n = 2). C1 lateral mass and C2 isthmic screws were placed according to the usual anatomical landmarks with lateral fluoroscopy guidance. All patients underwent a postoperative CT scan. The extent of cortical lateral or medial breach was determined and classified as follows: no breach (grade A), 0-2 mm (grade B), 2-4 mm (grade C), 4-6 mm (grade D), more than 6 mm (grade E). Grade A and B screws were considered well positioned | ||
| 520 | |a RESULTS: A total of 56 C1 lateral mass and 55 C2 isthmic screws were placed. Accuracy of screw placement was as follows: 107 grade A (96.4%), four grade B (3.6%), and no grade C, D or E. Clinical and radiological follow-up showed improvement in symptoms (mainly pain) and stability of the implants at the end of the follow-up | ||
| 520 | |a CONCLUSIONS: Freehand fluoroscopy-guided insertion of C1 lateral mass and C2 isthmic screws can be safely and effectively performed | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Validation Study | |
| 700 | 1 | |a Bartoli, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Schaller, Karl |e verfasserin |4 aut | |
| 700 | 1 | |a Payer, Michael |e verfasserin |4 aut | |
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