C2 partial transpedicular screw technique for atlantoaxial dislocation with high-riding vertebral artery: A technique note with case series
C2 partial transpedicular screw technique for atlantoaxial dislocation with high-riding vertebral artery: A technique note with case series
复制标题
C2 部分经椎弓根螺钉技术治疗椎动脉高位寰枢椎脱位：病例系列技术说明
DOI：
10.1016/j.clineuro.2020.106403
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发表时间：
2021-01-01
影响因子：
1.9
通讯作者：
Ni, Bin
中科院分区：
文献类型：
--
作者：
Guo, Qunfeng;Zhou, Xin;Ni, Bin
目的：尽管C2椎弓根螺钉（C2 PS）是目前C2固定的最具生物力学稳健性的选择，但高位椎动脉（HRVA）妨碍了C2 PS的安全放置。然而，临床上经常发生由于C2 PS放置而导致的无意的部分C2椎弓根穿孔和椎孔侵犯，而没有神经血管并发症。因此，我们尝试在HRVA患者中应用C2部分经椎弓根螺钉（C2 PTS），初步结果令人满意。目的：介绍C2 PTS技术，并报告其应用的初步影像学和临床效果。患者与方法：回顾性分析15例寰枢椎脱位患者行后路钉棒融合术的临床资料。所有患者的单侧或双侧HRVA均排除了安全的C2 PS置入，C2 PTS被用作替代方案。在这项技术中，使用Penfield剥离器适当地从后方移动HRVA，以防止椎动脉损伤，并为C2 PTS放置铺平道路。C2 PTS在峡部的上级边缘下方向同侧寰枢关节行进。结果：所有患者均获得满意的C2 PTS置入和寰枢椎复位。术后无椎动脉损伤和内固定失败，所有患者均获得骨性融合。结论：C2 PTS可实现枢椎三柱固定，是HRVA禁用的C2 PS的有效替代方法; C2 PTS置入时，必须轻轻松动HRVA，以防止椎动脉损伤。
Objective: Although the C2 pedicle screw (C2PS) is currently the most biomechanically robust option for C2 fixation, the high-riding vertebral artery (HRVA) precludes safe C2PS placement. However, unintentional partial C2 pedicle perforation and vertebral foramen violation due to C2PS placement without neurovascular complications occurred frequently in clinic. Therefore, we have attempted to apply C2 partial transpedicular screw (C2PTS) in patients with HRVA with satisfactory preliminary outcomes. The aim of the present study is to introduce the C2PTS technique and report the preliminary radiological and clinical outcomes of application of C2PTS.Patients and methods: The data of 15 patients with atlantoaxial dislocation underwent atlantoaxial arthrodesis with posterior screw-rod construct were retrospectively reviewed. All patients had unilateral or bilateral HRVA that precluded safe C2PS placement and C2PTS was used as an alternative. In this technique, a Penfield dissector was used to properly mobilize the HRVA inferiorly to preclude vertebral artery injury and pave the way for C2PTS placement. The C2PTS travelled under the superior border of the isthmus and toward the ipsilateral atlantoaxial articulation. The implant position and atlantoaxial reduction were evaluated using computed tomography (CT) scans and vertebral artery (VA) was assessed using CT angiography postoperatively.Results: Satisfactory C2PTS placement and atlantoaxial reduction were achieved in all patients. Postoperatively, no vertebral artery injury and implant failure were observed, and bone fusion was achieved in all the patients. Additionally, there were no VA occlusion or stenosis due to screws demonstrated on VA CT angiography.Conclusion: C2PTS can achieve three-column fixation of axis and is an efficient alternative to C2PS which is prohibited due to HRVA; also, gently mobilizing the HRVA inferiorly is mandatory to prevent vertebral artery injury during C2PTS placement.