Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis

Purpose Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentation and C1-2 trans-articular stabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated. We provide an anatomic description of anterior occipital condyle (AOC) screw endonasal placement as proof-of-concept for endonasal craniocervical stabilization. Methods Eight adult, injected cadaveric heads were studied for placing 16 AOC screws endonasally. Thin-cut CT was used for registration. After turning a standard inferior U-shaped nasopharyngeal flap endonasally, 4 mm × 22 mm AOC screws were placed with a 0° driver using neuronavigation. Post-placement CT scans were obtained to determine: site-of-entry, measured from the endonasal projection of the medial O-C1 joint; screw angulation in sagittal and axial planes, proximity to critical structures. Results Average site-of-entry was 6.88 mm lateral and 9.74 mm rostral to the medial O-C1 joint. Average angulation in the sagittal plane was 0.16° inferior to the palatal line. Average angulation in the axial plane was 23.97° lateral to midline. Average minimum screw distances from the jugular bulb and hypoglossal canal were 4.80 mm and 1.55 mm. Conclusion Endonasal placement of AOC screws is feasible using a 0° driver. Our measurements provide useful parameters to guide optimal placement. Given proximity of hypoglossal canal and jugular bulb, neuronavigation is recommended. Biomechanical studies will ultimately be necessary to evaluate the strength of AOC screws with plate-screw constructs utilizing endonasal C1 lateral mass or C1-2 trans-articular screws as inferior fixation points..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:32

Enthalten in:

European spine journal - 32(2023), 2 vom: 03. Jan., Seite 682-688

Sprache:

Englisch

Beteiligte Personen:

Forbes, Jonathan A. [VerfasserIn]
Kumar, Chitra [VerfasserIn]
McGough, Dan [VerfasserIn]
Palmisciano, Paolo [VerfasserIn]
Hussein, Ahmed E. [VerfasserIn]
Zhebrykov, Dmytro [VerfasserIn]
Gibson, Justin [VerfasserIn]
Andaluz, Norberto [VerfasserIn]
Sedaghat, Ahmad R. [VerfasserIn]
Prestigiacomo, Charles J. [VerfasserIn]
Mendez-Rosito, Diego [VerfasserIn]
Virojanapa, Justin [VerfasserIn]
Phillips, Katie M. [VerfasserIn]
Schwartz, Theodore H. [VerfasserIn]
Cheng, Joseph S. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Endonasal
Endoscopic surgery
Occipitocervical fusion
Odontoidectomy

RVK:

RVK Klassifikation

Anmerkungen:

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s00586-022-07520-4

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2133912304

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