Study Design: Retrospective radiographic/imaging study.
Objective: To evaluate preoperative and sequential postoperative radiographs following C1-C2 arthrodesis for atlantoaxial subluxation in patients with rheumatoid arthritis (RA) to determine risk factors for the development of subaxial subluxations (SAS).
Summary Of Background Data: The development of SAS has often been observed after C1-C2 arthrodesis. However, there have been no previous reports on the correlation between radiographic parameters and the incidence of postoperative SAS.
Methods: The study group comprised of 58 patients with RA who underwent C1-C2 arthrodesis due to atlantoaxial subluxation. There were 5 men and 53 women with a mean age of 55.8 years. The mean follow-up period was 137 months. Nineteen patients with a postoperative SAS after C1-C2 arthrodesis were classified as the SAS+ group. Other 39 patients without a postoperative SAS were included in the SAS- group. Clinical outcomes and plain radiographs were reviewed retrospectively and compared between the 2 groups.
Results: The difference between pre- and postoperative atlantoaxial (AA) angles in the SAS+ group was significantly greater than those in the SAS- group (P = 0.039). The C2-C7 angles changed significantly between pre- and postoperative periods in the SAS+ group (P = 0.039), but not in the SAS- group (P = 0.897). It was suggested that a large AA angle and a small C2-C7 angle observed at the early postoperative period were the risk factors for the development of SAS. We also demonstrated that a high incidence of the C3-C4 SAS resulted from excessive bone fusion at the C2-C3.
Conclusion: Excessive correction of AA angle is likely to cause loss of cervical lordosis, resulting in the development of postoperative SAS. In addition, extensive bony union at C2-C3 following C1-C2 arthrodesis frequently leads to the development of extensive SAS at the C3-C4.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/BRS.0b013e3181af0d85 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Superior biomechanical stability of pedicle screws compared to lateral mass screws: recommendations for bicortical positioning and enhancing bone contact in geriatric C1 vertebrae.
J Orthop Surg Res
January 2025
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg- Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Background: In atlantoaxial instabilities, posterior C1/C2 fusion using lateral mass screws (LMS) or pedicle screws (PS) in a mono- or bicortical position in the atlas is a typical treatment. The bone microstructure and positioning of the screw trajectories appear to be of significant relevance for stability.
Purpose: The aim of this study was a comparative analysis of the mechanical durability of screw fixation concerning microstructural characteristics of the trajectories of LMS and PS in mono- and bicortical position.
Treatment of iatrogenic vertebral artery injury during C1-C2 arthrodesis with a covered stent.
J Neurointerv Surg
January 2025
Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
Iatrogenic vertebral artery injury (VAI) has been described in the context of both anterior and posterior approaches to the cervical spine.1 2 Endovascular treatment of VAI primarily entails vessel sacrifice or vascular reconstruction. The latter option offers the advantage of achieving hemostasis while maintaining parent vessel patency.
View Article and Find Full Text PDFAsymptomatic iatrogenic bilateral occlusion of vertebral artery after atlantoaxial fusion: a case report.
Acta Orthop Traumatol Turc
November 2024
Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
Article Synopsis
- Vertebral arterial injury (VAI) can be a serious complication after C1-C2 posterior screw fixation, as observed in a case of a 34-year-old woman with quadriplegia who suffered bilateral VAI caused by her surgical screws.
- Postoperative imaging revealed that the screws had violated the vertebral arteries but did not result in any neurological deterioration or infarction.
- The case highlights the importance of careful screw placement to prevent VAI during surgery, as well as the potential for variations in blood circulation to impact patient outcomes.
A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing.
Nagoya J Med Sci
August 2024
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
C1-C2 fixation has been developed for the rigid fusion of atlantoaxial instability. C1 lateral mass screw (C1 LMS)-C2 pedicle screw fixation is used more frequently due to its rigid fixation and high bone fusion rate. However, C1 screw placement is relatively unsafe even with recently developed image-based navigation systems.
View Article and Find Full Text PDFBiomechanical differences of three cephalic fixation methods for patients with basilar invagination and atlantoaxial dislocation in the setting of congenital atlas occipitalization: a finite element analysis.
Spine J
February 2025
Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China. Electronic address:
Article Synopsis
- The study examines the biomechanical differences of three cranial fixation methods in patients with basilar invagination-atlantoaxial dislocation (BI-AAD) complicated by atlas occipitalization (AOZ).
- It presents findings from finite element analysis on a specific patient, comparing C1-C2 fixation, occipitocervical fixation, and an occipital plate fixation regarding range of motion and peak stress.
- Results indicate that C1 lateral mass screws offer reduced movement in lateral bending and axial rotation but come with higher stress, while the occipital plate group shows the most movement and lowest stress.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!