Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note
<i>Study design</i>: Technical note. <i>Objectives</i>: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. <i>Background and Objectives</i>: Atlantoaxial subluxation (AAS) is a relatively common sequelae in pa...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/1/11 |
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| author | Masato Tanaka Naveen Sake Dae-Geun Kim Shinya Arataki Dhvanit Desai Yoshihiro Fujiwara Taro Yamauchi |
| author_facet | Masato Tanaka Naveen Sake Dae-Geun Kim Shinya Arataki Dhvanit Desai Yoshihiro Fujiwara Taro Yamauchi |
| author_sort | Masato Tanaka |
| collection | DOAJ |
| description | <i>Study design</i>: Technical note. <i>Objectives</i>: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. <i>Background and Objectives</i>: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) and upper cervical trauma. If they present with severe symptoms, surgical intervention such as posterior fusion is indicated. The established treatment for AAS is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique) to achieve bony fusion. However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation, we present here a novel C-arm-free C1 lateral mass screw insertion technique for AAS. <i>Materials and Methods</i>: A 67-year-old man was referred to our hospital with neck pain, quadriparesis, and clumsiness and numbness of both upper and lower limbs. He had undergone C3–6 posterior fusion previously in another hospital. In physical examination, he had severe muscle weakness of bilateral upper limbs and hypoesthesia of all four limbs. He had hyper-reflexia of bilateral lower limbs and pollakiuria. His Japanese orthopedic score was 8 points out of 17. Preoperative radiograms showed AAS with an atlantodental interval (ADI) of 7 mm. MRI indicated retro-odontoid pseudotumor and severe spinal cord compression at the C1–2 level. The patient underwent posterior atlantoaxial fixation under navigation guidance. To prevent epidural bleeding during the insertion and placement of a C1 lateral mass screw, we have here defined a novel screw insertion technique. <i>Results</i>: The surgical time was clocked as 127 min and blood loss was 100 mL. There were no complications per-operatively or in the postoperative period. The patient showed almost full recovery (JOA 16/17) at two months follow-up and a solid bony fusion was noticed in the radiograms at one year follow-up. <i>Conclusions</i>: This novel surgical procedure and C1 lateral mas screw placement technique is a practical and safe method in recent advances of AAS treatment. Procedurally, the technique helps prevent epidural bleeding from the screw entry point and also allows for proper C1 screw insertion under navigation guidance without exposing surgeons and staff to the risk of fluoroscopic radiation. |
| first_indexed | 2024-03-09T11:45:34Z |
| format | Article |
| id | doaj.art-817ea82887df495eb2de9335f8764148 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T11:45:34Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-817ea82887df495eb2de9335f87641482023-11-30T23:23:07ZengMDPI AGMedicina1010-660X1648-91442022-12-015911110.3390/medicina59010011Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical NoteMasato Tanaka0Naveen Sake1Dae-Geun Kim2Shinya Arataki3Dhvanit Desai4Yoshihiro Fujiwara5Taro Yamauchi6Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, JapanDepartment of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan<i>Study design</i>: Technical note. <i>Objectives</i>: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. <i>Background and Objectives</i>: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) and upper cervical trauma. If they present with severe symptoms, surgical intervention such as posterior fusion is indicated. The established treatment for AAS is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique) to achieve bony fusion. However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation, we present here a novel C-arm-free C1 lateral mass screw insertion technique for AAS. <i>Materials and Methods</i>: A 67-year-old man was referred to our hospital with neck pain, quadriparesis, and clumsiness and numbness of both upper and lower limbs. He had undergone C3–6 posterior fusion previously in another hospital. In physical examination, he had severe muscle weakness of bilateral upper limbs and hypoesthesia of all four limbs. He had hyper-reflexia of bilateral lower limbs and pollakiuria. His Japanese orthopedic score was 8 points out of 17. Preoperative radiograms showed AAS with an atlantodental interval (ADI) of 7 mm. MRI indicated retro-odontoid pseudotumor and severe spinal cord compression at the C1–2 level. The patient underwent posterior atlantoaxial fixation under navigation guidance. To prevent epidural bleeding during the insertion and placement of a C1 lateral mass screw, we have here defined a novel screw insertion technique. <i>Results</i>: The surgical time was clocked as 127 min and blood loss was 100 mL. There were no complications per-operatively or in the postoperative period. The patient showed almost full recovery (JOA 16/17) at two months follow-up and a solid bony fusion was noticed in the radiograms at one year follow-up. <i>Conclusions</i>: This novel surgical procedure and C1 lateral mas screw placement technique is a practical and safe method in recent advances of AAS treatment. Procedurally, the technique helps prevent epidural bleeding from the screw entry point and also allows for proper C1 screw insertion under navigation guidance without exposing surgeons and staff to the risk of fluoroscopic radiation.https://www.mdpi.com/1648-9144/59/1/11atlantoaxial subluxationGoel techniqueC1 lateral mass screwnavigation |
| spellingShingle | Masato Tanaka Naveen Sake Dae-Geun Kim Shinya Arataki Dhvanit Desai Yoshihiro Fujiwara Taro Yamauchi Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note Medicina atlantoaxial subluxation Goel technique C1 lateral mass screw navigation |
| title | Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note |
| title_full | Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note |
| title_fullStr | Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note |
| title_full_unstemmed | Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note |
| title_short | Innovative C-Arm-Free Navigation Technique for Posterior Spinal Fixation for Atlantoaxial Subluxation: A Technical Note |
| title_sort | innovative c arm free navigation technique for posterior spinal fixation for atlantoaxial subluxation a technical note |
| topic | atlantoaxial subluxation Goel technique C1 lateral mass screw navigation |
| url | https://www.mdpi.com/1648-9144/59/1/11 |
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