Novel Technique for C1-2 Interlaminar Arthrodesis Utilizing a Modified Sonntag Loop-Suture Graft With Posterior C1-2 Fixation.
Novel Technique for C1-2 Interlaminar Arthrodesis Utilizing a Modified Sonntag Loop-Suture Graft With Posterior C1-2 Fixation.
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DOI：
10.14245/ns.1938344.172
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发表时间：
2020-09
期刊：
影响因子：
3.2
通讯作者：
Shin JH
中科院分区：
文献类型：
--
作者：
Koffie RM;Larsen AMG;Grannan BL;Hadzipasic M;Yanamadala V;Beaver LV;Shankar GM;Shin JH
寰枢椎固定和融合的传统技术通常在C1椎板下方穿过线缆或钢丝，以将植骨固定在C1-2后部元件之间，这会导致并发症，如脑脊液（CSF）漏和神经损伤。随着固定硬件的发展，我们提出了一种新的C1-2固定技术，可避免与椎板下线缆和钢丝相关的发病率和并发症。 该技术需要在C1和C2之间楔入和锚定结构性髂嵴移植物进行椎板间关节固定，并在C1侧块和C2关节间部螺钉固定时使用0-Prolene缝线固定。 我们确定了32例患者接受手术寰枢椎与我们的技术。颈部残疾指数显示疼痛相关残疾较术前基线改善60%（p<0.001）。无神经功能缺损。并发症包括2例与外伤相关的脑脊液漏，1例手术部位感染，1例一过性吞咽困难。6个月时影像学寰枢椎融合率为96.8%，无内固定失败、移植物脱位或移植物相关并发症的证据。 我们证明了一种新的C1-2关节融合技术，是一种安全有效的寰枢椎融合术。
Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1–2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1–2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires. This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation. We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p<0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications. We demonstrate a novel technique for C1–2 arthrodesis that is a safe and effective option for atlantoaxial fusion.