Publication year: 2012
Source: World Neurosurgery, Available online 30 January 2012
Alexander Taghva, Frank Attenello, Gabriel Zada, Alexander Khalessi, Patrick C. Hsieh
ObjectiveMinimally invasive surgical(MIS) techniques show several potential advantages over open techniques, including decreased blood loss, post-operative pain, and recovery time. Our study aimed to demonstrate atlantoaxial fusion using MIS techniques, shown previously in only two reports. Smaller operating corridor with MIS may increase difficulty of instrumentation placement and risk of instrumentation-related complications.MethodsFive cadaveric specimens were studied pre-surgically with CT determining bony anatomy, vertebral artery course, and trajectory for C1/C2 screw placement. Four specimens had adequate C2 pedicle sizes to accommodate screw placement. Specimens were used to perform C1-2 instrumentation through minimal access tubular retractors. Following procedures, specimens were re-examined with CT to assess accuracy of MIS C1-2 screw placement.ResultsThrough minimal access expandable tubular retractors, C1-lateral mass and C2 pedicle screws were placed in all four specimens. Post-instrumentation CT analysis demonstrated no violation of the foramen transversarium in all cases. There was one grade 1 medial breach from C1 lateral mass screw placement. Two patients with type-2 odontoid fracture were treated with MIS C1-2 fusion with follow-up 4-24 months. Average operating time was 3.5 hours, and average surgical blood loss was 125 milliliters. Both cases were examined with CT scan post-surgically and there were no bony breaches with screw placement. Both patients remained neurologically intact postoperatively with significant improvement in pain scores. Followup imaging at two years demonstrates union of odontoid fracture.ConclusionsMinimally invasive atlantoaxial fixation is feasible and safe. Preoperative CT is paramount for preoperative evaluation of the vertebral artery anatomy in relation to C1/2 vertebra.
Source: World Neurosurgery, Available online 30 January 2012
Alexander Taghva, Frank Attenello, Gabriel Zada, Alexander Khalessi, Patrick C. Hsieh
ObjectiveMinimally invasive surgical(MIS) techniques show several potential advantages over open techniques, including decreased blood loss, post-operative pain, and recovery time. Our study aimed to demonstrate atlantoaxial fusion using MIS techniques, shown previously in only two reports. Smaller operating corridor with MIS may increase difficulty of instrumentation placement and risk of instrumentation-related complications.MethodsFive cadaveric specimens were studied pre-surgically with CT determining bony anatomy, vertebral artery course, and trajectory for C1/C2 screw placement. Four specimens had adequate C2 pedicle sizes to accommodate screw placement. Specimens were used to perform C1-2 instrumentation through minimal access tubular retractors. Following procedures, specimens were re-examined with CT to assess accuracy of MIS C1-2 screw placement.ResultsThrough minimal access expandable tubular retractors, C1-lateral mass and C2 pedicle screws were placed in all four specimens. Post-instrumentation CT analysis demonstrated no violation of the foramen transversarium in all cases. There was one grade 1 medial breach from C1 lateral mass screw placement. Two patients with type-2 odontoid fracture were treated with MIS C1-2 fusion with follow-up 4-24 months. Average operating time was 3.5 hours, and average surgical blood loss was 125 milliliters. Both cases were examined with CT scan post-surgically and there were no bony breaches with screw placement. Both patients remained neurologically intact postoperatively with significant improvement in pain scores. Followup imaging at two years demonstrates union of odontoid fracture.ConclusionsMinimally invasive atlantoaxial fixation is feasible and safe. Preoperative CT is paramount for preoperative evaluation of the vertebral artery anatomy in relation to C1/2 vertebra.
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