Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Enrico Tessitore & Andrea Bartoli & Karl Schaller & Michael Payer
- چاپ و سال / کشور: 2011
Description
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), cranioverterbal 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.
Acta Neurochir (2011) 153:1417–1425 Received: 23 March 2011 / Accepted: 19 April 2011 / Published online: 21 May 2011
